Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thrombopoietin (TPO), interleukin (IL)-6, and platelets were measured serially in 9 patients with fulminant meningococcal septicemia and consumption coagulopathy. The results were compared with those of patients with meningococcal meningitis and mild meningococcemia (n=10) and with those of healthy control subjects (n=19). TPO levels in control subjects were below the detection limit (<63 pg/mL). In patients with fulminant meningococcal septicemia, the median TPO level on admission was 193 pg/mL (range, 133-401 pg/mL), and the level peaked within 3-7 days (median, 488 pg/mL; range, 239-1334 pg/mL). Platelet counts remained low, despite the elevated TPO levels. In patients with meningitis or meningococcemia, the median TPO level on admission was 112 pg/mL (range, <63-695 pg/mL), and the TPO level was not detectable within 48 h. Platelet counts for these patients remained within normal limits. Maximum IL-6 levels in patients with septicemia were observed on admission (median, 5317 pg/mL; range, 188-651,000 pg/mL) and increased earlier than TPO levels. In patients with fulminant septicemia, TPO level increases significantly whereas the level of circulating platelets does not.
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PMID:Fulminant meningococcal septicemia: dissociation between plasma thrombopoietin levels and platelet counts. 1077 Jul 23

Sepsis is often associated with a downward spiral through a spectrum of systemic inflammatory response syndrome (SIRS) culminating in organ failure and death. Here we present a 3-year-old girl with Hemophilus influenzae septic meningitis who developed SIRS and acute renal failure. In the initial stage, the patient showed uremia, cytopenia, disseminated intravascular coagulation, elevation of tissue enzyme and ferritin values, hemophagocytosis and overproduction of nitric oxide. The serum cytokine profile revealed increased levels of soluble interleukin (IL)-2 receptor, IL-6, IL-10 and tumor necrosis factor alpha. The patient responded positively to early and intensive interventions including antibiotics, repeated exchange transfusions, dexamethasone and high-dose gamma-globulin. The above laboratory abnormalities almost normalized with clinical improvement. We consider that SIRS was probably responsible for the sequence of events resulting in renal failure in this case, and suggest that renal failure should be included among the serious complications of SIRS associated with Hemophilus influenzae septic meningitis.
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PMID:Systemic inflammatory response syndrome and acute renal failure associated with Hemophilus influenzae septic meningitis. 1087 2

Leptospirosis, a zoonosis with worldwide distribution, may have a broad spectrum of clinical manifestations that can delay the diagnosis, especially in wet climates where other conditions may dissimulate the main aspects. The authors describe 42 cases of patients with leptospirosis admitted to the Infectious Diseases Unit of a general hospital since 1990. The goal was to analyse epidemiological features, clinical manifestations, laboratory findings, treatment and evolution. There were 23 males (54.7%) and 19 females (45.2%), with ages ranging from 17 to 82 years. Most cases occurred in occupational settings, especially in those in contact with animals or stagnant water. All the cases had serological confirmation (by MAT or ELISA methods). Anicteric forms represented 42.9% of the total, which implies that in many cases a diagnosis is not immediately evident. The main symptoms, other than fever (97.6%) and jaundice (57.1%), were myalgia (71.4%), headache (42.8%) and nausea (33.3%). Renal involvement was common (52%), but the most severe forms occurred in 3 patients who required hemodialysis; followed by D.I.C. in 9.5%; meningitis in 4.7% and pulmonary involvement in 2.3% of the cases. The serovars most commonly identified were L. icterohaemorraghiae (28.5%), L. australis (14.3%), L. grippothyphosa (11.9%) and L. canicola (9.5%). The patients were treated with penicillin G (83.3%) or doxycyclin (9.5%). Two of them deceased (4.7%) and the remainder had a good evolution. The diagnosis of leptospirosis may be delayed if physicians fail to include this infection in the initial differential diagnosis. In view of this, the authors emphasize that when nonspecific clinical manifestations occur, a good epidemiological history is useful in proposing this diagnosis.
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PMID:[Human leptospirosis. A short review concerning a caseload]. 1089 35

Meningitis and meningococcal sepsis are emergency conditions associated with high mortality. The outcome is worsened by the onset of disseminated intravascular coagulation. This may present, particularly in children, with the clinical picture of purpura fulminans, characterized by extensive necrotic-hemorrhagic skin lesions, ischemia of the extremities and multiorgan failure. It has been observed that depletion of coagulation inhibitors, particularly protein C, plays a key role in the development of this severe complication. We describe the case of a woman who presented in the Emergency Room with signs of meningitis, drowsiness, hypotension and petechie. Bacterioscopic examination of the cerebrospinal fluid evidenced characteristic gram-negative diplococci. Laboratory data disclosed initial disseminated intravascular coagulation with low levels of proteins C and S. Following intravenous infusion of antibiotics, fluids and fresh frozen plasma, the patient's condition rapidly improved. However, multiple skin lesions appeared on her fingers, toes and heels. It is likely that the infusion of coagulation inhibitors contained in fresh frozen plasma, prevented evolution to full-blown purpura fulminans. The first choice treatment for purpura fulminans in meningococcal sepsis is infusion of protein C concentrate, which is not, however, currently available on the market.
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PMID:[Meningococcal meningitis in the adult complicated by cutaneous necrosis: description of a clinical case]. 1120 31

The influence of social disruption stress (SDR) on the susceptibility to endotoxic shock was investigated. SDR was found to increase the mortality of mice when they were challenged with the bacterial endotoxin lipopolysaccharide (LPS). Histological examination of SDR animals after LPS injection revealed widespread disseminated intravascular coagulation in the brain and lung, extensive meningitis in the brain, severe hemorrhage in the lung, necrosis in the liver, and lymphoid hyperplasia in the spleen, indicating inflammatory organ damage. In situ hybridization histochemical analysis showed that the expression of the glucocorticoid receptor mRNA was down-regulated in the brain and spleen of SDR animals while the ratio of expression of AVP/CRH-the two adrenocorticotropic hormone secretagogue, increased. After LPS injection, the expression of pro-inflammatory cytokines, IL-1beta and TNF-alpha, was found significantly higher in the lung, liver, spleen, and brain of the SDR mice as compared with the LPS-injected home cage control animals. Taken together, these results show that SDR stress increases the susceptibility to endotoxic shock and suggest that the development of glucocorticoid resistance and increased production of pro-inflammatory cytokines are the mechanisms for this behavior-induced susceptibility to endotoxic shock.
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PMID:Social stress increases the susceptibility to endotoxic shock. 1128 52

We analyzed 143 cases of skull base surgery collected from the eight institutions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by olfactory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The most frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8). For repair of dura matter, fascia lata was used in 37 cases. galeopericranial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65%) in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 10), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malignant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease. Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases. liquorrhea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral thrombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large enough database for comparison of results, and prognosis for each histological entity and further define the role of multidisciplinary treatment.
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PMID:Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan. 1168 48

BACKGROUND: Leptospirosis (LS) and Hantavirus (HV) infection have many common clinical manifestations, including acute renal failure. In as much as clinical experience with these diseases is quite limited in urban centers, we identified cases of Leptospira and HV-induced acute renal failure and compared the clinical course and evolution of these diseases. METHODS: Patients hospitalized with acute renal failure, suspected to be caused by infection, were retrospectively studied over a 13-year period (1985-1998). Based on pertinent clinical data and positive serology, a total of 26 patients were included in the study, 17 patients with LS and 9 patients with HV infection. RESULTS: Both diseases presented as flu-like syndromes with high fever. In LS, 2 patients presented with acute meningitis and died soon after admission. Symptoms and signs from other organs began after the fifth day of illness. Jaundice occurred in 71% of LS patients but not in HV. Hemorrhagic phenomena occurred in both diseases but affected predominantly patients with icteric LS. Anuria or oliguria occurred in 76% of patients with LS and 78% with HV infection. Laboratory studies demonstrated minor transaminase elevations in all patients with LS and in 44% with HV. Hypoprothrombinemia or thrombocytopenia was uncommon, although disseminated intravascular coagulation (DIC) developed in 2 patients that had icteric Ls and major bleeding. Nephropathy was associated with haematuria in 71% with LS and all patients with HV. Proteinuria was evident in 35% of patients with LS compared to 78% with HV. Abnormal chest radiographs were seen in 24% with LS and in 33% with HV. In both diseases, aggressive supportive treatment was given, including hemodialysis or peritoneal dialysis in 4/26 patients. Of the 26 patients, 22 survived and four died. The latter all had LS, and the causes of death were meningitis and DIC with multiple organ failure. Follow-up, after 6 months, showed that renal function had returned to normal in the 22 survivors. CONCLUSION: It is important to include LS and HV infection in the differential diagnosis of acute renal failure. Both diseases present with flu-like symptoms and may be complicated by thrombotic microangiopathy with hemorrhagic phenomena and hepatic and pulmonary involvement. Jaundice should alert the physician to icteric LS, a severe disease associated with significant mortality that requires antimicrobial treatment.
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PMID:Acute renal failure caused by leptospirosis and Hantavirus infection in an urban hospital. 1206 23

Sixty adult Klebsiella meningitis patients have been identified at Kaohsiung Chang Gung Memorial Hospital in a period of 13 years. Most cases were associated with debilitating diseases, and devastating metastatic septic abscesses are common in diabetic patients with K. pneumoniae meningitis. Although the mortality rate has been significantly reduced in recent years, there has been an increase in nosocomial infections and the emergence of multi-antibiotic resistant strains. Significant prognostic factors include appropriate antibiotic therapy, the presence of septic shock, disseminated intravascular coagulation, and high cerebrospinal fluid protein levels and white blood cell counts. Initial empiric therapy with a third generation cephalosporin should be considered for community-acquired meningitis while antibiotics such as carbapenems should be considered as initial empiric therapy for patients with postneurosurgical meningitis. Early diagnosis and the use of appropriate antibiotics are of crucial importance.
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PMID:Klebsiella meningitis in adults: clinical features, prognostic factors and therapeutic outcomes. 1238 10

A hundred and thirty five patients admitted to Moscow Tuberculosis Hospital No. 7 for disseminated and progressive forms of tuberculosis were examined. Among neurological disorders in tuberculosis, acute toxic encephalopathy (ATE) should be placed in the first place in terms of their severity, problems of diagnosis and treatment. In patients with acutely progressive forms of tuberculosis, the development of ATE is brought about by two factors: 1) significant tuberculous toxemia concurrent, in 37% of cases, with severe alcoholic intoxication that leads to generalized toxic and allergic vasculitis and as a result DIC syndrome; 2) cerebral hypoxia with dyscirculatory disorders due to progressive cardiopulmonary failure. The status of patients with tuberculosis and ATE is generally critical or extremely critical. These are actually resuscitative patients. Most patients have disseminated bilateral lung lesions with multiple decay cavities, with massive bacterial isolation found at sputum bacterioscopy. With this, mycobacterial resistance to at least one antituberculous drug was found in 83% of cases. Primary multidrug resistance was detected in 29.6% of patients. The diagnosis of ATE in patients with tuberculosis is difficult and requires that tuberculous meningitis shall be excluded. Acute progression, no spinal fluid changes, significant signs of cooagulopathy and thrombcytopathy with multiorgan failure and progressive DIC syndrome may diagnose ATE in patients with acutely progressive tuberculosis. The specific features of treatment in patients with tuberculosis and ATE are intensive antituberculous therapy with predominantly parenteral administration of drugs and intensive therapy for the DIC syndrome. Despite the treatment, 48 (35.6%) patients died from progressive tuberculosis and ATE, in 40 (29.6%), therapeutic efficiency was low due to multidrug myobacterial resistance.
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PMID:[Acute toxic encephalopathy in patients with tuberculosis]. 1261 36

This article describes the microbiology, diagnosis, and management of human and animal bite wound infections. Various organisms can be recovered from bite wounds that generally result from aerobic and anaerobic microbial flora of the oral cavity of the biting animal, rather than the victim's own skin flora. The role of anaerobes in bite wound infections has been increasingly appreciated. Anaerobes were isolated from more than two thirds of human and animal bite wound infections, especially those associated with abscess formation. This article describes several of the organisms found in the bites of various species. In addition to local wound infection, other complications may occur, including lymphangitis, local abscess, septic arthritis, tenosynovitis, and osteomyelitis. Rare complications include endocarditis, meningitis, brain abscess, and sepsis with disseminated intravascular coagulation, especially in immunocompromised individuals. Wound management includes the administration of proper local care and the use of proper antimicrobial agents when needed.
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PMID:Microbiology and management of human and animal bite wound infections. 1282 49


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