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Query: UMLS:C0004623 (bacterial infection)
 15,226 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present the case of a 67 year old woman who was resuscitated due to cardiac tamponade. Examination of the pus fluid showed a bacterial infection with streptococcus milleri. Four days before resuscitation the patient experienced weakness, dyspnoea, increased temperature (39 degrees C), swelling of the neck, and pain on swallowing. Using computed tomography, examination revealed an infection extending from the right tonsil to the mediastinum and into the pericardium. After surgery to remove the retropharyngeal abscess, the patient healed well. Therefore, on presentation of a cardiac tamponade, possible hematogenous or lymphogenous causes or per continuitatem infections should always be considered. In this case the germs in the fluid and the typical patient history indicated an oropharyngeal reason.
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PMID:[A case report: suppurative pericardial effusion]. 1090 Jun 77

Terminally ill patients are very susceptible to infections, which are the result of disease-related processes and/or therapy-induced mechanisms. These patients are already subject to multiple severe symptoms and associated comorbid conditions, with much resultant distress. Infection increases this symptom burden and further reduces quality of life. We have retrospectively investigated the prevalence of infection and clinical course in 102 consecutive patients who died after admission to a tertiary palliative care unit and assessed the site-specific frequency of infection, pathogenic organisms involved, and the pattern of antibiotic agents used. The prevalence of symptoms and comorbid conditions on admission and during the progress phase of care were noted. Median overall survival of the total cohort was 12 days. The median survival of patients with infections was 22 days. Thirty-seven patients (36.3%) were diagnosed with 42 separate infections. The sites of infections were the urinary tract (42.5%), the respiratory tract (22.9%), blood (12.5%), skin and subcutaneous tissues (12.5%), and the eyes (10.0%). There were 20 separate positive cultures isolated from specimens obtained from 13 individual patients. Three isolates were obtained from 1 patient, 2 isolates obtained from 5 patients, and 1 isolate was obtained from each of the 7 remaining patients. Escherichia coli was the most common pathogen isolated. Eleven patients with infections (31.4%) were diagnosed on admission, and antibiotic treatment was commenced within 48 hours of admission in 21 patients (60%). Overall antibiotic response and symptom control of infections was observed to be a minimum of 40%. Psychological distress was common in this group of patients (P = 0.001) as were disabling symptoms on admission, such as pain, immobility, and weakness. Symptoms indicating poor survival, such as severe pain and dyspnea, were not significantly associated with infection. Decreased patient survival in this cohort was not significantly associated with the presence of bacterial infection (P = 0.07), irrespective of whether or not a positive culture isolate was obtained. We conclude that appropriate management of infection resulted in enhanced palliative symptom control.
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PMID:Bacterial infections in terminally ill hospice patients. 1106 54

The benefit of antimicrobial therapy for patients with an acute exacerbation of chronic bronchitis (AECB) remains controversial for two main reasons. First, the distal airways of patients with chronic bronchitis are persistently colonised, even during clinically stable periods, with the same bacteria that have been associated with AECB. Second, bacterial infection is only one of several causes of AECB. These factors have led to conflicting analyses on the role of bacterial agents and the response to antimicrobial therapy of patients with AECB. An episode of AECB is said to be present when a patient with chronic obstructive pulmonary disease (COPD) experiences some combination of increased dyspnoea, increased sputum volume, increased sputum purulence and worsening lung function. While the average COPD patient experiences 2 - 4 episodes of AECB per year, some patients, particularly those with more severe airway obstruction, are more susceptible to these attacks than others. Bacterial agents appear to be particularly associated with AECB in patients with low lung function and those with frequent episodes accompanied by purulent sputum. Non-typeable Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis account for up to 50% of episodes of AECB. Gram-negative bacilli are more likely to occur in patients with more severe lung disease. Antibiotics have been used to ameliorate AECB, to prevent AECB and to prevent the long-term loss of lung function that characterises COPD. Numerous prevention trials have been conducted with fairly consistent results; antibiotics do not lessen the number of episodes of AECB but do reduce the number of days lost from work. Most antibiotic trials have studied the impact of treatment on episodes of AECB and results have been inconsistent, largely due to patient selection and end point definition. In patients with severe airway obstruction, especially in the presence of purulent sputum, antibiotic therapy significantly shortens the duration of symptoms and can be cost-effective. Over the past 50 years, virtually all classes of antimicrobial agents have been studied in AECB. Important considerations include penetration into respiratory secretions, spectrum of activity and antimicrobial resistance. These factors limit the usefulness of drugs such as amoxicillin, erythromycin and trimethoprim-sulfamethoxazole. Extended-spectrum oral cephalosporins, newer macrolides and doxycycline have demonstrated efficacy in clinical trials. Amoxicillin-clavulanate and flouoroquinolones should generally be reserved for patients with more severe disease. A number of investigational agents, including ketolides and newer quinolones, hold promise for treatment of AECB.
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PMID:Antibiotics in the treatment of acute exacerbations of chronic bronchitis. 1208 2

Basidiobolus ranarum is a saprophytic fungus in the environment that also is a part of the endogenous microflora in the gastrointestinal tract of several vertebrates. These organisms may penetrate skin or muscosa of humans and other animals, causing granulomatous inflammation. Two dogs infected with B. ranarum had prolonged or repeated exposure to water or soil in their environment. One dog had progressive subcutaneous infection of all the limbs, and the other dog had recurrent coughing and dyspnea caused by tracheobronchitis. In both dogs, secondary bacterial infection of the lesions was evident. Treatment of the dog with subcutaneous infection involved cutaneous dressings and sequential use of enrofloxacin and itraconazole; however, this resulted in suspected liver damage without clinical improvement. Subsequent treatment with potassium iodide and a lipid formulation of amphotericin B was also unsuccessful, and the dog was euthanatized. The other dog was treated alternately with enrofloxacin and itraconazole. When the clinical signs and infection returned, combination treatment with both drugs was more effective; however, the dog developed liver damage. Subsequent treatment with enrofloxacin on an intermittent basis controlled the dog's coughing during a 3-year period.
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PMID:Infection with Basidiobolus ranarum in two dogs. 1218 3

Two types of pneumonia are well recognized during influenza: primary viral pneumonia and secondary bacterial pneumonia. Primary viral pneumonia occurs after a typical onset of influenza with rapid progression of dyspnea and cough leading to acute respiratory distress syndrome. Treatment consists of respiratory assistance, but mortality is high. Secondary bacterial pneumonia occurs more frequently in the elderly and in patients with chronic pulmonary diseases. Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae are the most frequently isolated bacteria. After an initial phase of clinical improvement, manifestations of bacterial infection with pulmonary consolidation occur. The outcome is favorable with antibiotics but depends on the patient's underlying conditions.
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PMID:[Influenza pneumonia]. 1455 65

Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality. The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation/perfusion mismatching with a relative increase in the physiological dead space leads to hypercapnia and hence acidosis. This is largely the result of a shift to a rapid shallow breathing pattern and a rise in the dead space/tidal volume ratio of each breath. This breathing pattern results from adaptive physiological responses which lessen the risk of respiratory muscle fatigue and minimise breathlessness. Treatment is directed at reducing the mechanical load applied to each breath, correcting specific precipitating factors, e.g. bacterial infection, and maintaining gas exchange. Both bronchodilators and oral corticosteroids can improve spirometric results in exacerbations of COPD and should be routinely offered to patients with respiratory failure. Controlled oxygen is still not always prescribed appropriately and high inspired oxygen concentrations can lead to severe acidosis by either worsening ventilation/perfusion mismatching and/or inducing a degree of hypoventilation. Ventilatory support using noninvasive ventilation has revolutionised the approach to these patients. Acute respiratory failure due to chronic obstructive pulmonary disease remains a common medical emergency that can be effectively managed. More attention should be focused on the prevention of these episodes and identifying the factors which cause early relapse.
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PMID:Respiratory failure in chronic obstructive pulmonary disease. 1462 Nov 14

Two women, aged 50 and 45 years, had a chronic process in the lower abdomen. The first presented with cough and progressive dyspnoea, and her chest X-ray raised the suspicion of a metastasis of a malignancy. The second patient had abdominal pain, frequent urination and irregular vaginal bleeding. She was initially treated for a urinary-tract infection. Diagnostic investigations showed pelvic actinomycosis in both patients. Both had used an intrauterine device (IUD). In the first patient a pelvic abscess was drained. Antimicrobial treatment consisted of penicillin i.v. for several weeks and orally for 6 months. Actinomycosis is a slowly progressive bacterial infection that characteristically expands through anatomic structures and can lead to fistulae and abscesses. The disease is caused by Actinomyces species. Diagnosis is often delayed because other diseases (e.g. malignancy) are considered more probable. Actinomycosis is associated with prolonged use of an IUD, but it is rare and removal of the IUD is not indicated unless symptoms of pelvic inflammatory disease are present. The mainstay of actinomycosis therapy is administration of an effective antibiotic (e.g. penicillin). Except for drainage of abscesses, surgical intervention is rarely necessary. When antimicrobial therapy is continued for 6-9 months, prognosis is favourable, as was the case in both patients.
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PMID:[Two women with a chronic process in the lower abdomen]. 1467 81

The current authors present the case of a 68-yr-old female patient who developed severe respiratory failure after medication with ciprofloxacin for acute urinary tract infection. A chronic subdural haematoma was surgical evacuated. Postoperatively, an acute urinary tract infection was treated with ciprofloxacin. Six days later, C-reactive protein was rising and the patient was suffering from intermittent high fever, dyspnoea and severe hypoxaemia. The high-resolution-computed tomography (HRCT) showed an interstitial lung disease in the anterior upper lobe on the left side as well as in the lingula. Assuming a bacterial infection amoxyl/clavulanic acid was started which did not improve the clinical symptoms. Bronchoalveolar lavage revealed a marked lymphocytosis (87%). Analysis for typical bacterial infections, Tuberculosis, Mycoplasma, Chlamydia and Legionella spp. were all negative. Another HRCT scan was made because of worsening of symptoms and this showed rapidly progressive infiltrates in most lobes. An open lingular biopsy showed an interstitial lymphoplasmocytotic infiltrate with some eosinophilic granulocytes and a few scattered giant cell granulomas, consistent with hypersensitivity pneumonitis. The patient's symptoms rapidly improved with systemic corticosteroid therapy and another HRCT scan revealed complete remission of pulmonary infiltrates. Ciprofloxacin can induce interstitial pneumonitis with acute respiratory failure. This is an important fact considering that ciprofloxacin is a widely used antibiotic agent in treatment of urinary tract infection.
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PMID:Ciprofloxacin-induced acute interstitial pneumonitis. 1473 49

There are several case reports of systemic vasculitis associated with chronic suppurative lung diseases. We describe a 46-year-old female, previously diagnosed as having diffuse panbronchiolitis (DPB), presenting with hemosputum and dyspnea. Her serum titer of MPO-ANCA was positive together with a high titer of BPI-ANCA. Chest X-ray and chest CT scan showed pulmonary hemorrhage, and the renal biopsy specimen revealed necrotizing, crescentic glomerulonephritis. She was diagnosed as having ANCA-associated vasculitis, and more specifically, microscopic polyangiitis accompanied by DPB. She was treated with methylprednisolone pulse therapy, followed by intravenous cyclophosphamide. This case suggested a possible association with chronic bacterial infection, which may play a role in the pathogenesis of ANCA-associated vasculitis.
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PMID:Microscopic polyangiitis associated with diffuse panbronchiolitis. 1516 79

COPD is often accompanied with acute symptoms exacerbations. Patients in Ist stage: slide grade of COPD and IInd stage: middle grade of COPD suffer exacerbations accompanied with increased dyspnoea often together with increased cough and increased production of sputum. Patients in IIIrd stage (serious) and IVth stage (very serious) experience during exacerbations development of respiration insufficiency or its worsening and thus are usually treated in hospital. The most frequent causes of exacerbations are tracheobronchial tree infections and air pollution. The cause of approximately one third of serious exacerbations is not disclosed. Conditions which can resemble acute exacerbation are pneumonia, congestive heart failure, pneumothorax, pleural exudation, pulmonary embolism, and arrhythmia. Exacerbation treatment is symptomatic. Obstruction symptoms are treated with bronchodilatants and corticosteroids administration, hypoxemia with oxygen administration and signs of bacterial infection with antibiotics.
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PMID:[Treatment principle of the chronic obstructive pulmonary disease (COPD) exacerbation]. 1558 Sep 1


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