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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection of the urinary tract due to Candida albicans is an uncommon but well-described complication of modern therapeutics. Despite the rarity of this infection, culture of properly collected urine yielding C. albicans requires an explanation. The significance of systemic factors in the defense of the urinary tract against candidal infection is unknown, but secretions from the prostate gland in men and from periurethral glands in women have been reported to be fungistatic. In addition, growth of Candida at sites on mucous membranes may be suppressed by other normal flora. Conditions that predispose to candiduria include diabetes mellitus, antibiotic and corticosteroid therapy, as well as factors such as local physiology and disturbance of urine flow. Lower urinary tract candidiasis is usually the result of a retrograde infection, while renal parenchymal infection most often follows candidemia. In addition to asymptomatic candiduria, recognized clinical forms of candidal urinary tract infections include bladder infection, renal parenchymal infection, and infections associated with fungus ball formation. Unfortunately, clinical criteria alone are insufficient to distinguish reliably among these clinical types. If the urine is found to contain candidal organisms, the condition of the patient should be considered for determination of appropriate therapy. When infection is thought to be confined to the bladder, patients without indwelling bladder catheters should be considered for flucytosine therapy. For patients requiring indwelling bladder catheterization, irrigation with amphotericin B is usually successful. Although flucytosine alone may be useful for renal parenchymal candidal infection, iv amphotericin B alone or the combination of amphotericin B and flucytosine is indicated when systemic candidiasis cannot be excluded.
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PMID:Urinary tract infections due to Candida albicans. 676 Mar 38

Analysis of causes of death in a population of 3,113 diabetics was carried out for a period of eight years and those patients dying of some form of diabetic coma identified. Of 1,274 deaths, only 22 (1.73%) were primarily due to coma; 7 hypoglycaemia, 8 ketoacidosis, 3 hyperosmolar coma and 4 lactic acidosis. Three of the ketoacidosis patients may have died from other causes. Most deaths occurred in patients with long-standing diabetes. In the hypoglycaemic group all were on insulin and several had been difficult to control for many years. Infection was an important precipitating factor for ketoacidosis and hyperosmolar coma. Phenformin was the cause of all cases of fatal lactic acidosis. It is reassuring that death from coma is a comparatively rare event in known treated diabetic patients.
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PMID:Fatal coma in diabetes. 677 28

Although many viral agents may be associated with inflammatory hepatic changes, the vast majority of clinically important viral hepatitis is caused by hepatitis A, hepatitis B and the non A, non B agents. Infection of the liver of man by these hepatotropic agents is still a major public health problem in all parts of the world and constitutes a major hazard of the transfusion of blood and plasma derivatives. The magnitude of this hepatitis problem is not only documented by the about 200 million carriers of the hepatitis-B virus throughout the world, many of them asymptomatic, but also by the fact, that hepatitis B and non A, non B may progress to chronic liver disease, including cirrhosis and probably primary liver cancer. Potentially important pathogenetic determinants include viral factors such as subtype, dosage and mode of transmission and host factors such as age, sex, preexisting liver disease, coexisting non-liver disease (diabetes etc.), genetics and immune response to viral or autoantigens. As the virus itself seems not directly cytopathic, the diversity of lesions has been attributed to variation in the capacity of the host's response.
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PMID:[Virus-induced liver diseases in humans. I. Viral hepatitis]. 681 82

Between 1967 and 1978 41 patients were transplanted at an age of 60 years or more. The patient survival was approximately 50% at two years. Most of the dead patients died with functioning grafts. Infections and cardiovascular complications dominated as causes of death. Main complications were cardiovascular diseases, infections, musculosceletal diseases and diabetes. During the last three years results have improved and we will continue to offer kidney transplantation to elderly patients in terminal renal failure.
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PMID:Kidney transplantation in patients 60 years and older. 701 26

Infections of the head and neck were identified in 12 (9%) of 128 consecutive patients undergoing renal transplantation. The infections included sinusitis, otitis media, dental abscess, Ludwig's angina, parotitis, and nasal abscess. A significant correlation was found between the development of infection and juvenile-onset diabetes but not with previous splenectomy. None of the infections occurred during treatment of rejection episodes with corticosteroids. The clinical presentations and microbiologic agents causing the infections were similar to those found in nonimmunosuppressed patients.
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PMID:Head and neck infection after renal transplantation. 704 19

Mucormycosis of the temporal bone is described in a 60-year-old female with uncontrolled diabetes mellitus whose symptoms related to cranial nerve palsies and hearing loss, following spread of infection from the nasopharynx. The infection spread along the eustachian tube and tensor tympani muscle to the base of the skull, involving the internal carotid artery with mycotic thrombosis and rupture. Subsequent spread occurred from this area predominantly along nerve pathways and as mycotic emboli in blood vessels of the labyrinth and middle ear. Infection also spread from the anterior middle ear wall through the oval window into the vestibule. The temporal bone changes were those of granulomatous inflammation with necrosis and ischemic infarction.
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PMID:Mucormycosis of the temporal bone. 707 74

Dystrophic vulvar conditions are found to increase with age and to predominate in postmenopausal women. The differentiation of this entity from infectious lesions and from precancerous conditions by clinical examination is extremely difficult. Therefore, diagnostic procedures are necessary which supplement local inspection and palpation. Photography is useful for documentation and follow-up control and colposcopy is suited for examination of lesions exhibiting erythroplakia, but not for leukoplakia which is much more frequent. Exfoliative cytology occupies a key position in vulvar diagnosis, since negative findings almost rule out a precancerous process, so long as the criteria of malignancy are sufficiently extended to include all abnormalities of the horny cells. Infections frequently cause equivocal cytological findings which disappear after appropriate treatment. Such infections can be diagnosed by phase contrast cytology, cultures, or serological tests. In many cases, further investigation will reveal diabetes mellitus or other metabolic disorders (internal consultant), urinary incontinence (urological consultant), allergic dermatoses (dermatological consultant) or psychoneurotic disease (neurologic consultant). Positive cytological findings always prompt biopsy; but equivocal and negative findings will also lead to histologic examination, if repeated control reveals constancy or exacerbation of a lesion in spite of the use of different diagnostic and therapeutic procedures. Vital staining with the toluidine blue method (so-called Collins test) is well suited for marking para- or dyskeratotic skin areas which then can be removed by surgery.
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PMID:[Diagnosis of vulvar diseases. 2. Discussion and conclusions for practice]. 707 77

Melioidosis is being diagnosed with increasing frequency in the northern part of the Northern Territory, but the mortality rate remains high in the acute septicaemic form of the disease largely because of associated chronic debilitating illnesses. This paper reviews epidemiological and clinical features of human melioidosis in 37 cases seen between 1960 and 1979. Infection with Pseudomonas pseudomallei is most often contracted during the wet season by persons who have regular contact with soil or ground water, probably through pre-existing skin lesions or penetrating wounds and, occasionally, through the genitourinary tract. The clinical features of melioidosis are protean, and definitive diagnosis can only be made by bacterial culture. Certain strongly indicative features, however, may justify vigorous early treatment with antibiotics (tetracycline or doxycycline in some combination with chloramphenicol, kanamycin or trimethoprim/sulphamethoxazole) which can be life-saving in fulminant septicaemic melioidosis. These indicative features are a severely prostrating fever with signs of respiratory tract infection in a patient with a chronic debilitating condition (particularly chronic alcoholism, diabetes mellitus, malnutrition or leprosy), with regular soil contact, and with chronic or recurrent skin lesions or a recent history of a penetrating wound. In subacute or chronic forms of melioidosis, which usually localize in an organ system, the diagnosis is commonly an unexpected bacteriological finding and the prognosis is generally good.
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PMID:Melioidosis in the Northern Territory of Australia. 723 Dec 82

To address the mechanisms of tolerance to extrathymic proteins, we have generated transgenic mice expressing the lymphocytic choriomeningitis virus (LCMV) glycoprotein (GP) in the beta islet cells of the pancreas. The fate of LCMV-GP-specific T cells was followed by breeding the GP transgenic mice with T cell receptor transgenic mice, specific for LCMV-GP and H-2Db. These studies suggest that "Peripheral tolerance" of self-reactive T cells does not involve clonal deletion, clonal anergy, or a decrease in the density of T cell receptors or accessory molecules. Instead, this model indicates that potentially self-reactive cytotoxic T cells may remain functionally unresponsive, owing to a lack of appropriate T cell activation. Infection of transgenic mice with LCMV readily abolishes peripheral unresponsiveness to the self LCMV-GP antigen, resulting in a CD8+ T cell-mediated diabetes. These data suggest that similar mechanisms may operate in several so called "T cell-mediated autoimmune diseases". A synthetic peptide corresponding to an immunodominant epitope of lymphocytic choriomeningitis virus glycoprotein (LCMV-GP) was used to prime or to tolerize CD8+ T cells in vivo, dependent on the mode of immunization. Peptide-specific tolerance was then examined in transgenic mice expressing LCMV-GP in the beta islet cells of the pancreas; these mice develop CD8+ T cell-mediated diabetes within 8-14 days after LCMV infection. Specific peptide-induced tolerance prevented autoimmune destruction of beta islet cells and diabetes in this transgenic mouse model.
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PMID:[Viral antigen induced autoimmunity: an animal model for diabetes mellitus type I]. 753 82

In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994). Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS). Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03). Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04). Nine (41%) patients with GBSB were i.v. drug abusers; nevertheless, none of the subjects with GBSB were i.v. drug abusers (p < 0.001). The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02). Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia. In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis.
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PMID:[Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults]. 756


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