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T1 Age 2 11 36-yr-old T2 History 12 30 previously healthy T3 Personal_background 31 41 Sri Lankan T4 Sex 42 46 male T5 Occupation 51 72 takes care of a horse T6 Clinical_event 73 82 presented E1 Clinical_event:T6 T7 Nonbiological_location 90 111 medical casualty ward R1 MODIFY Arg1:T7 Arg2:E1 T8 Sign_symptom 117 122 fever E2 Sign_symptom:T8 T9 Sign_symptom 124 134 arthralgia E3 Sign_symptom:T9 T10 Sign_symptom 139 146 myalgia E4 Sign_symptom:T10 T11 Duration 151 158 one day E5 Duration:T11 T12 Sign_symptom 182 189 dysuria E6 Sign_symptom:T12 A1 POLARITY E6 UNCERTAIN T13 Severity 177 181 mild R2 MODIFY Arg1:T13 Arg2:E6 T14 Diagnostic_procedure 205 217 urine output E7 Diagnostic_procedure:T14 T15 Lab_value 198 204 normal R3 MODIFY Arg1:T15 Arg2:E7 T16 Sign_symptom 241 245 pain E8 Sign_symptom:T16 A2 POLARITY E8 NEG T17 Biological_structure 235 240 chest R4 MODIFY Arg1:T17 Arg2:E8 T18 Sign_symptom 249 268 shortness of breath E9 Sign_symptom:T18 A3 POLARITY E9 NEG T19 History 307 369 treated for leptospirosis during a febrile illness in the past #1 AnnotatorNotes T19 history because no time frame is specified T20 Diagnostic_procedure 374 385 examination E10 Diagnostic_procedure:T20 T21 Sign_symptom 399 407 afebrile E11 Sign_symptom:T21 T22 Sign_symptom 409 418 anicteric E12 Sign_symptom:T22 T23 Diagnostic_procedure 424 438 blood pressure E13 Diagnostic_procedure:T23 T24 Lab_value 443 453 90/60 mmHg R5 MODIFY Arg1:T24 Arg2:E13 T25 Diagnostic_procedure 458 468 pulse rate E14 Diagnostic_procedure:T25 T26 Lab_value 469 475 76 bpm R6 MODIFY Arg1:T26 Arg2:E14 T27 Diagnostic_procedure 489 500 examination E15 Diagnostic_procedure:T27 T28 Lab_value 505 517 unremarkable R7 MODIFY Arg1:T28 Arg2:E15 T29 Diagnostic_procedure 527 541 investigations E16 Diagnostic_procedure:T29 T30 Sign_symptom 596 608 leukocytosis E17 Sign_symptom:T30 T31 Biological_structure 585 595 neutrophil R8 MODIFY Arg1:T31 Arg2:E17 T32 Sign_symptom 615 632 thrombocytopaenia E18 Sign_symptom:T32 T33 Severity 610 614 mild R9 MODIFY Arg1:T33 Arg2:E18 T34 Sign_symptom 649 659 haematuria E19 Sign_symptom:T34 T35 Detailed_description 637 648 microscopic R10 MODIFY Arg1:T35 Arg2:E19 T36 Diagnostic_procedure 671 685 Renal function E20 Diagnostic_procedure:T36 T37 Diagnostic_procedure 690 703 liver enzymes E21 Diagnostic_procedure:T37 T38 Lab_value 709 729 within normal limits R11 MODIFY Arg1:T38 Arg2:E21 R12 MODIFY Arg1:T38 Arg2:E20 T39 Diagnostic_procedure 731 745 Urine analysis E22 Diagnostic_procedure:T39 T40 Lab_value 755 777 pus cells 05 – 06 /hpf T41 Lab_value 779 801 red cells 30 – 35 /hpf R13 MODIFY Arg1:T40 Arg2:E22 R14 MODIFY Arg1:T41 Arg2:E22 T42 Diagnostic_procedure 803 806 CRP E23 Diagnostic_procedure:T42 T43 Diagnostic_procedure 808 826 C-reactive protein E24 Diagnostic_procedure:T43 R15 IDENTICAL Arg1:E24 Arg2:E23 T44 Lab_value 832 840 75 mg/dl R16 MODIFY Arg1:T44 Arg2:E23 T45 Disease_disorder 866 879 leptospirosis E25 Disease_disorder:T45 T46 Medication 923 933 penicillin E26 Medication:T46 T47 Administration 911 922 intravenous R17 MODIFY Arg1:T47 Arg2:E26 T48 Therapeutic_procedure 958 967 hydration E27 Therapeutic_procedure:T48 T49 Date 976 986 second day E28 Date:T49 T50 Sign_symptom 1012 1023 hypotension E29 Sign_symptom:T50 T51 Sign_symptom 1029 1040 tachycardia E30 Sign_symptom:T51 T52 Sign_symptom 1045 1053 dyspnoea E31 Sign_symptom:T52 T53 Diagnostic_procedure 1055 1058 ECG E32 Diagnostic_procedure:T53 T54 Sign_symptom 1074 1085 tachycardia E33 Sign_symptom:T54 T55 Detailed_description 1068 1073 sinus R18 MODIFY Arg1:T55 Arg2:E33 T56 Detailed_description 1091 1121 ST depression in leads V4 – V6 R19 MODIFY Arg1:T56 Arg2:E33 T59 Diagnostic_procedure 1138 1141 CXR E35 Diagnostic_procedure:T59 #2 AnnotatorNotes E35 Would normally annotate "chest" separately but there is an acronym used here T57 Diagnostic_procedure 1143 1154 chest x ray E34 Diagnostic_procedure:T57 R20 IDENTICAL Arg1:E34 Arg2:E35 T58 Disease_disorder 1169 1181 cardiomegaly E36 Disease_disorder:T58 T60 Detailed_description 1163 1168 gross R21 MODIFY Arg1:T60 Arg2:E36 T61 Sign_symptom 1206 1213 shadows E37 Sign_symptom:T61 T62 Biological_structure 1196 1205 pulmonary T63 Detailed_description 1186 1195 bilateral R22 MODIFY Arg1:T62 Arg2:E37 R23 MODIFY Arg1:T63 Arg2:E37 T64 Diagnostic_procedure 1231 1254 central venous pressure E38 Diagnostic_procedure:T64 T65 Diagnostic_procedure 1226 1229 CVP E39 Diagnostic_procedure:T65 R24 IDENTICAL Arg1:E38 Arg2:E39 T66 Lab_value 1260 1268 16 cmH2O R25 MODIFY Arg1:T66 Arg2:E39 T67 Diagnostic_procedure 1276 1290 echocardiogram E40 Diagnostic_procedure:T67 T68 Detailed_description 1273 1275 2D R26 MODIFY Arg1:T68 Arg2:E40 T69 Sign_symptom 1300 1310 dilatation E41 Sign_symptom:T69 #3 AnnotatorNotes E41 kind of (sp) T70 Biological_structure 1314 1331 all four chambers R27 MODIFY Arg1:T70 Arg2:E41 T71 Disease_disorder 1347 1358 hypokinesia E42 Disease_disorder:T71 T72 Detailed_description 1340 1346 global R28 MODIFY Arg1:T72 Arg2:E42 T73 Severity 1333 1339 severe R29 MODIFY Arg1:T73 Arg2:E42 T74 Diagnostic_procedure 1363 1380 ejection fraction E43 Diagnostic_procedure:T74 T75 Disease_disorder 1481 1492 myocarditis E44 Disease_disorder:T75 T76 Lab_value 1384 1387 20% R30 MODIFY Arg1:T76 Arg2:E43 T77 Detailed_description 1464 1469 early T78 Severity 1474 1480 severe R31 MODIFY Arg1:T78 Arg2:E44 R32 MODIFY Arg1:T77 Arg2:E44 T79 Clinical_event 1506 1517 transferred E45 Clinical_event:T79 T80 Nonbiological_location 1521 1524 ICU T81 Nonbiological_location 1526 1545 intensive care unit R33 IDENTICAL Arg1:T81 Arg2:T80 R34 MODIFY Arg1:T80 Arg2:E45 T82 Therapeutic_procedure 1560 1577 inotropic support E46 Therapeutic_procedure:T82 T83 Medication 1591 1602 antibiotics E47 Medication:T83 T84 Administration 1579 1590 Intravenous R35 MODIFY Arg1:T84 Arg2:E47 T85 Medication 1613 1623 penicillin E48 Medication:T85 T86 Medication 1625 1634 meropenem E49 Medication:T86 T87 Medication 1639 1651 levofloxacin E50 Medication:T87 R36 SUB_PROCEDURE Arg1:E48 Arg2:E47 R37 SUB_PROCEDURE Arg1:E49 Arg2:E47 R38 SUB_PROCEDURE Arg1:E50 Arg2:E47 T88 Therapeutic_procedure 1691 1701 ventilated E51 Therapeutic_procedure:T88 T89 Date 1709 1716 3rd day E52 Date:T89 T90 Disease_disorder 1742 1762 respiratory distress E53 Disease_disorder:T90 T91 Severity 1735 1741 severe R39 MODIFY Arg1:T91 Arg2:E53 T92 Disease_disorder 1800 1819 atrial fibrillation E54 Disease_disorder:T92 T93 Time 1771 1779 same day E55 Time:T93 T94 Detailed_description 1794 1799 rapid R40 MODIFY Arg1:T94 Arg2:E54 T95 Medication 1847 1854 digoxin E56 Medication:T95 T96 Medication 1871 1881 amiodarone E57 Medication:T96 T97 Administration 1859 1870 intravenous R41 MODIFY Arg1:T97 Arg2:E57 T98 Diagnostic_procedure 1883 1897 Platelet count E58 Diagnostic_procedure:T98 T99 Lab_value 1898 1905 dropped R42 MODIFY Arg1:T99 Arg2:E58 T100 Lab_value 1909 1921 10 × 103 μ/L R43 MODIFY Arg1:T100 Arg2:E58 T101 Therapeutic_procedure 1939 1960 platelet transfusions E59 Therapeutic_procedure:T101 T102 Medication 2015 2033 methylprednisolone E60 Medication:T102 T103 Administration 2003 2014 intravenous R44 MODIFY Arg1:T103 Arg2:E60 T104 Diagnostic_procedure 2157 2167 creatinine E61 Diagnostic_procedure:T104 T105 Biological_structure 2151 2156 serum R45 MODIFY Arg1:T105 Arg2:E61 T106 Lab_value 2168 2177 increased T107 Lab_value 2181 2192 362 μ mol/L R46 MODIFY Arg1:T107 Arg2:E61 R47 MODIFY Arg1:T106 Arg2:E61 T108 Date 2200 2207 5th day E62 Date:T108 T109 Diagnostic_procedure 2223 2226 ALT E63 Diagnostic_procedure:T109 T110 Diagnostic_procedure 2228 2248 alanine transaminase E64 Diagnostic_procedure:T110 R48 IDENTICAL Arg1:E64 Arg2:E63 T111 Diagnostic_procedure 2254 2257 AST E65 Diagnostic_procedure:T111 T112 Diagnostic_procedure 2259 2281 aspartate transaminase E66 Diagnostic_procedure:T112 R49 BEFORE Arg1:E66 Arg2:E65 T113 Lab_value 2297 2305 elevated R50 MODIFY Arg1:T113 Arg2:E65 R51 MODIFY Arg1:T113 Arg2:E63 T114 Lab_value 2312 2320 2726 U/l T115 Lab_value 2325 2333 7438 U/l R52 MODIFY Arg1:T114 Arg2:E63 R53 MODIFY Arg1:T115 Arg2:E65 T116 Disease_disorder 2370 2380 infections E67 Disease_disorder:T116 A4 POLARITY E67 NEG T117 Detailed_description 2359 2369 Mycoplasma T118 Detailed_description 2348 2354 Dengue R54 MODIFY Arg1:T117 Arg2:E67 R55 MODIFY Arg1:T118 Arg2:E67 T119 Diagnostic_procedure 2396 2410 Blood cultures E68 Diagnostic_procedure:T119 T120 Lab_value 2416 2424 negative R56 MODIFY Arg1:T120 Arg2:E68 T121 Diagnostic_procedure 2441 2449 antibody E69 Diagnostic_procedure:T121 T122 Detailed_description 2426 2440 Leptospira IgM R57 MODIFY Arg1:T122 Arg2:E69 T123 Date 2467 2474 5th day E70 Date:T123 T124 Diagnostic_procedure 2500 2503 IgG E71 Diagnostic_procedure:T124 T125 Lab_value 2504 2512 negative R58 MODIFY Arg1:T125 Arg2:E71 T126 Lab_value 2490 2498 positive R59 MODIFY Arg1:T126 Arg2:E69 T127 Disease_disorder 2533 2549 refractory shock E72 Disease_disorder:T127 T128 Clinical_event 2554 2558 died E73 Clinical_event:T128 T129 Sign_symptom 2585 2596 tachycardia E74 Sign_symptom:T129 T130 Biological_structure 2573 2584 ventricular T131 Detailed_description 2562 2572 persistent R60 MODIFY Arg1:T130 Arg2:E74 R61 MODIFY Arg1:T131 Arg2:E74 T132 Therapeutic_procedure 2613 2622 treatment E75 Therapeutic_procedure:T132 T133 Nonbiological_location 2630 2633 ICU R62 MODIFY Arg1:T133 Arg2:E75 T134 Detailed_description 2605 2612 optimal R63 MODIFY Arg1:T134 Arg2:E75 R64 AFTER Arg1:E1 Arg2:E2 * OVERLAP E2 E3 E4 E5 R65 BEFORE Arg1:E5 Arg2:E6 * OVERLAP E6 E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17 E18 E19 E20 E21 E22 E23 E25 E26 E27 R66 BEFORE Arg1:E27 Arg2:E28 * OVERLAP E28 E29 E30 E31 E32 E33 E35 E36 E37 E39 E40 E41 E42 E43 E76 R67 BEFORE Arg1:E44 Arg2:E45 * OVERLAP E45 E46 E47 R68 BEFORE Arg1:E47 Arg2:E51 * OVERLAP E51 E52 E53 R69 BEFORE Arg1:E53 Arg2:E55 * OVERLAP E55 E54 E56 E57 R70 BEFORE Arg1:E57 Arg2:E58 * OVERLAP E58 E59 E60 R71 BEFORE Arg1:E60 Arg2:E61 * OVERLAP E61 E62 E63 E65 E67 E68 E69 E70 E71 R72 BEFORE Arg1:E71 Arg2:E72 * OVERLAP E72 E73 E74 E75 T135 Diagnostic_procedure 1389 1399 Troponin I E76 Diagnostic_procedure:T135 T136 Lab_value 1404 1415 12.77 ng/ml E77 Lab_value:T136 R73 MODIFY Arg1:E77 Arg2:E76 R74 BEFORE Arg1:E76 Arg2:E44