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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A previously healthy 19-year-old woman had a febrile illness with hypotension, progressive cyanosis, and an evolving petechial rash. Despite aggressive therapy in the face of shock and disseminated intravascular coagulation, the patient suffered a cardiac arrest and could not be resuscitated. Haemophilus influenzae type b was cultured from the blood and echovirus 30 from the cerebrospinal fluid post mortem. Fulminant H influenzae type b infection in an immunocompetent adult is rare but should be recognized as a possible cause of the Waterhouse-Friderichsen syndrome.
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PMID:Waterhouse-Friderichsen syndrome caused by Haemophilus influenzae type b in an immunocompetent young adult. 259 28

Using an enzyme-linked immunosorbent assay, we measured plasma levels of tumor necrosis factor (TNF) in 38 patients who were treated with either antilipid A antibody or a placebo for presumed gram-negative bacteremia. Sixteen of the 38 patients had positive blood cultures: 14 with gram-negative rods and 2 with Streptococcus pneumoniae. Initial serum samples for TNF determinations were obtained within 2 to 72 hours (mean, 18.8 hours) after the onset of clinical signs of sepsis. Six (16%) of 38 patients had detectable TNF levels: 4 of 14 with positive blood cultures for gram-negative rods but only 2 of 22 with negative blood cultures (odds ratio, 4; 95% confidence limits, 0.5 and 24.3). Of the 6 patients, 4 had received the placebo and 2 had received the antibody. Tumor necrosis factor levels did not predict adult respiratory distress syndrome, shock, disseminated intravascular coagulation, renal failure, or mortality. The highest TNF levels (500 and 250 pg/mL) were observed in 2 patients with Enterobacter cloacae bacteremia who had received the placebo and antilipid A antibody, respectively. The other 2 patients with bacteremia and detectable TNF levels had positive blood cultures for Haemophilus influenzae (50 pg/mL) and Bacteroides fragilis (120 pg/mL), respectively. Despite negative blood cultures, the remaining 2 patients repeatedly had detectable TNF levels and a clinical picture consistent with gram-negative sepsis.
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PMID:Plasma tumor necrosis factor levels in patients with presumed sepsis. Results in those treated with antilipid A antibody vs placebo. 230 78

Sputum cultures are not helpful in the immediate management of patients with bacterial pneumonia. Sputum Gram stains may provide a presumptive identification of an etiologic agent; this procedure, however, is insensitive (approximately 50%). Consequently, during the last decade, other more sensitive and specific methods of providing a rapid etiologic diagnosis have been sought. This article discusses data on antigen detection in various body fluids by counterimmunoelectrophoresis and agglutination tests. Results from our own laboratory as well as those reported in the literature are presented. The best estimates of antigen detection rates, by the most sensitive assays, in pneumococcal pneumonia, are as follows: serum, 45%-80%; urine, 50%-64%; and sputum, 75%-100%. There is less information for Haemophilus, Klebsiella, and Pseudomonas pneumonias, but the diagnostic yield is approximately 50%-100%. Data will also be presented on the association between free and complexed antigens and morbidity and mortality in pneumococcal pneumonia. Indicators of morbidity discussed include disseminated intravascular coagulation, duration and severity of illness, and occurrence of nephritis.
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PMID:Antigen detection in the diagnosis and in the prognostic assessment of bacterial pneumonias. 293 73

An otherwise healthy 36-year-old man had abdominal pain, vomiting, sepsis, and disseminated intravascular coagulation (DIC). Negative exploratory laparotomy was shortly followed by death. Autopsy showed Haemophilus influenzae (type B) meningitis, multiple organ involvement with DIC, and bilateral adrenal hemorrhagic necrosis (Waterhouse-Friderichsen syndrome). This patient is the fourth reported adult with H influenzae meningitis and hemorrhagic infarction of the adrenals, and the first such patient with an apparent abdominal catastrophe.
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PMID:Haemophilus influenzae meningitis and Waterhouse-Friderichsen syndrome in an adult. 373 79

The frequency and distribution of fibrin thrombi (microthrombi) in the main organs of spontaneously infected cattle were investigated to evaluate disseminated intravascular coagulation (DIC) in Haemophilus somnus infection. This infection is well known as infectious thrombo-embolic meningo-encephalitis (ITEME) and is characterized histopathologically by formation of thrombi, necrosis of blood vessels and neutrophil infiltration. The precise pathogenic mechanism of this disease has not yet been fully elucidated. The liver, spleen, kidney, lung, heart and brain of 11 cattle showing thromboembolic meningo-encephalitis were examined histopathologically and special attention was paid to fibrin thrombi. PTAH staining showed a high frequency of fibrin thrombi in the small vessels and capillaries in more than 3 organs and all the cases were regarded as falling within the histopathological criterion of DIC. The results of the present study indicate that the pathogenesis of the infection is closely related to the DIC.
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PMID:Histopathological evaluation of disseminated intravascular coagulation in Haemophilus somnus infection in cattle. 397 8

Four adult patients had life-threatening soft-tissue infections of the neck. One had Hemophilus influenzae infection, one had Streptococcus pyogenes infection, and two had polymicrobial mixed aerobic and anaerobic infections. Three of the four patients died despite appropriate antimicrobial therapy and surgical intervention. These cases demonstrate the spectrum of serious soft-tissue infections of the neck in both the compromised and the uncompromised host. Soft-tissue infections of the neck may be necrotizing or nonnecrotizing. Cellulitis secondary to H. influenzae and beta-hemolytic streptococci is usually non-necrotizing, whereas necrotizing infections are caused most commonly by synergistic organisms. Potential complications include septic shock, disseminated intravascular coagulation, acute renal failure, adult respiratory distress syndrome, mediastinitis, and pericarditis. Early recognition with aggressive medical and surgical therapy is essential to reduce the mortality.
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PMID:Life-threatening soft-tissue infections of the neck. 636 10

Acute bacterial meningitis still represents a therapeutic problem. Successful management depends on early administration of large doses of bactericidal antibiotics and adequate treatment of complications, i.e. shock, acute cerebral edema, consumption coagulopathy, convulsions and electrolyte disturbances. Meningitis caused by Neisseria meningitidis or Streptococcus pneumoniae should be treated with benzylpenicillin. If benzylpenicillin cannot be given, chloramphenicol has remained the best substitute. However, cefuroxime or ceftriaxone now seems to offer an alternative to chloramphenicol. The prevalence of beta-lactamase-producing Haemophilus influenzae strains is increasing and chloramphenicol has replaced ampicillin in the treatment of H. influenzae meningitis. Recent studies indicate that cefuroxime, ceftriaxone or moxalactam may be as effective as chloramphenicol in this type of meningitis. In neonatal meningitis, cefotaxime or moxalactam may constitute alternatives to the present regimens with ampicillin-gentamicin, gentamicin-chloramphenicol, cotrimoxazole or gentamicin. Promising results have also been obtained with cefotaxime or moxalactam in elderly patients with meningitis due to Gram-negative enteric bacilli. However, more extensive studies are needed to determine the role of the newer cephalosporins in the treatment of acute bacterial meningitis.
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PMID:Treatment of acute bacterial meningitis with special emphasis on beta-lactam antibiotics. 659 56

Four cases of fulminant pneumococcal septicemia in splenectomized patients are reported. Three had undergone splenectomy for trauma 42, 28 and 14 years prior to the septicemia. The fourth had been splenectomized for suspected lymphoma 3 years earlier. In 3 out of 4 patients the symptomatology was so rapidly progressive that a physician was consulted within 12 hours. Two patients hospitalized after a second consultation and 20 hours after the first symptoms had evidence of septic shock, disseminated intravascular coagulation and hypoglycemia, and died within a few hours despite early antibiotherapy. Diplococci were seen in peripheral smears of these 2 patients and in the buffy coat of the 3 cases in which this was carried out. These four cases reemphasize the fact that during their entire life splenectomized patients are at risk for development of overwhelming septicemia even when the splenectomy was performed because of trauma. Therefore, such patients should be aware of this risk, should be treated promptly with antibiotics in the event of a febrile episode, and should be vaccinated against pneumococci and possibly other encapsulated bacteria such as Haemophilus influenzae and Neisseria meningitidis.
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PMID:[Fulminant pneumococcal septicemia in splenectomized patients]. 731 55

In a prospective study at a hospital for infectious diseases 151 patients, 110 with proved and 41 with probable septicemia, were analysed. Clinical, laboratory, therapeutic data and prognostic experiences, partly from a follow-up study, are described. Secondary manifestations, mostly from skin, mucous membranes, nervous system and lungs, were present in 72%. They were more often caused by gram-positive cocci than by gram-negative baccilli and in some cases not revealed until autopsy. Lesions in the nervous system were most often caused by strepto- or penumococci or Haemophilus influenzae. In 2 splenectomized patients with extensive hemorrhages, pneumococci were isolated. Subacute courses were rare even in alpha-streptococcal infection and its "classical signs" were never observed. Shock and thrombocytopenia suggesting disseminated intravascular coagulation occurred together in 11%, and in one-third in the lethal cases. Gram-positive bacteria were often involved. Leukocytosis was absent in 53 patients; 20 were alcohol or narcotic drug abusers, and 7 died. ECG changes were registered in 33%. Initial antibiotic treatment was applied according to a fixed schedule, with cure in 61% on this first treatment, and especially so in infections with gram-positive cocci. During the initial hospital stay 20% died from uncontrolled infection. All had underlying diseases or factors, often major causes of death. The infection was regarded as hospital-acquired in 40% among the lethal cases. During a one-year follow-up period 3 patients died from a new septicemia and 10 from their underlying disease.
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PMID:A prospective study on septicemia. II. Clinical manifestations and complications, results of antimicrobial treatment and report of a follow-up study. 743 19

Six patients with deep obstetrical and gynecological infections due to non-typeable Haemophilus influenzae are presented. 3 patients had tubo-ovarian abscesses, 2 septic abortions and 1 postpartum sepsis. All our patients with tubo-ovarian abscesses had used intra-uterine contraceptive devices until admission and all had a protracted course of illness. Both patients with septic abortion had a severe course, one of them with disseminated intravascular coagulation demanding treatment in the intensive care unit. The patient with postpartum infection had a milder course. The possibility of infection with H. influenzae and the emergence of beta-lactamase producing strains warrant adequate culture procedures in women with obstetrical and gynecological infections in order to ensure proper treatment.
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PMID:Deep obstetrical and gynecological infections caused by non-typeable Haemophilus influenzae. 836 30


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