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

The causes of death were investigated in 315 adults with acute leukemia during a 7-year period (1966-1972). Infection alone or in combination was the most common cause (75%), followed by hemorrhage (24%) and organ failure (9%). Most of the infections were either systemic or pulmonary. Seventy-five percent of the systemic infections and 72% of the pneumonias were caused by bacteria. Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were the most frequent organisms isolated. After 1968, there was a sharp decrease in the number of fatal infections caused by Pseudomonas aeruginosa and a marked increase in the incidence of fatal infections caused by Klebsiella spp. and E. coli. Infections caused by Gram-positive cocci occurred in only 3% of the cases. The incidence of systemic fungal infections was 13%; most common fungi causing infection were Candida spp. and Aspergillus spp. Eighty-five percent of 159 patients with a terminal neutrophil count of less than 100/mm3 died of infection, compared to 48% of 62 patients with a terminal neutrophil count of greater than 1000/mm3. Hemorrhage was mostly due to thrombocytopenia (61%) and disseminated intravascular coagulation (12%). This study indicates that infection continues to be the most common cause of death in patients with acute leukemia. Although advances in antibiotic therapy have changed the distribution of causative organisms, ultimate control of infection requires further improvements in supportive care measures which rectify impairments in the patients' host defense mechanisms.
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PMID:Causes of death in adults with acute leukemia. 106 11

A 51-year-old male, who had a history of excessive drinking and chronic hepatitis, was admitted to our hospital because of high fever and shock. Physical examinations, chest X-ray films and hemodynamic data revealed that he had progressed to septic shock due to pneumonia. Combination chemotherapy of latamoxef plus piperacillin was immediately started. After Klebsiella pneumoniae was isolated from bronchoalveolar lavage fluid, the antibiotics were changed to ceftizoxime plus amikacin. Furthermore human gamma globulin preparations and frozen fractional plasma were administered because of granulocytopenia and a decrease in complement. Gabexate mesylate, methylprednisolone (MP) and branched chain amino acids were given to prevent disseminated intravascular coagulation and/or multiple organ failure. With this intensive care, he recovered from shock and pneumonia. The effects of MP on the whole blood chemiluminescence (CL) were examined. Incubation of whole blood with 25, 50 or 100 micrograms/ml of MP for 10 to 60 minutes had no effects on the CL response. This indicates that MP does not affect the production of reactive oxygen species from phagocytic cells at concentrations comparable to those used in drug therapy.
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PMID:[A case of septic shock due to pneumonia caused by Klebsiella pneumoniae]. 250 4

Septicemia encountered at Kawasaki Municipal Hospital between 1985 and 1986 were studied clinically. Forty six patients had monomicrobial and 5 has polymicrobial infections, respectively. Out of these 46 patients with septicemia, 17 were due to Escherichia coli, 7 were due to Klebsiella pneumoniae and 4 were due to Staphylococcus aureus. Ten patients had hepatobiliary, 7 had hematological, 7 had malignant diseases as underlying diseases, respectively. Out of 10 patients complicated with septic shock, 7 died. Twenty three patients were community acquired infections. The age of most of the patients were over 50. The mortality rate of more than 65-year-old patients were higher than that of other patients. Our of 5 patients with septicemia due to polymicrobial infection, only 1 patient with erythroleukemia died. Fifty patients were treated mainly with beta-lactam antibiotics such as piperacillin or cefmetazole alone or in combination with aminoglycosides and so on. Three patients with infective endocarditis were encountered during this period. Two were due to alpha-streptococcus and 1 was due to Enterococcus. A 41-year-old patient with mitral valve insufficiency and metastatic gastric carcinoma to the bone marrow were complicated with disseminated intravascular coagulation. This patient, however, was successfully treated with a daily dose of 24 mega units of benzylpenicillin, and was given gabexate mesilate, concomitantly.
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PMID:[Clinical studies on septicemia and infective endocarditis encountered between 1985-1986]. 250 8

Two cases of infectious complications after liver biopsy are reported. Klebsiella pneumoniae and beta-hemolytic Streptococcus were cultured. In both cases the biopsy was obtained under laparoscopic control. A 28-year-old woman with liver cirrhosis died 24 hours after liver biopsy as a result of septic shock and disseminated intravascular coagulation. A 67-year-old man with hepatic fibrosis suffered from transient bacteremia and recovered uneventfully after antibiotic therapy. In these patients, there was evidence to implicate pre-existing cholangitis as factor predisposing to postbiopsy bacteremia.
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PMID:Septic shock and bacteremia associated with laparoscopic guided liver biopsy, report on two cases. 267 94

A total of 368 episodes of Klebsiella bacteremia occurred in 330 cancer patients, representing a rate of four episodes per 1000 hospital admissions. Eighty-eight percent of these infections were acquired nosocomically and 58% of the patients received antibiotics during the preceding 10-day period. There was pulmonary infection in 24% of the patients, shock in 25%, and disseminated intravascular coagulation in 7%. The overall response rate was 69%. Response rates were significantly lower among patients with shock (25% versus 83%), hemorrhage (29% versus 76%), and pneumonia (37% versus 79%). The combination of a cephalosporin plus an aminoglycoside produced the highest response rate (79%). Klebsiella sp continue to be an important cause of infection in patients with cancer.
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PMID:Klebsiella bacteremia. A 10-year review in a cancer institution. 280 29

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

A 60-year-old woman with rheumatoid arthritis developed acute emphysematous septic arthritis of the knee due to Klebsiella pneumoniae. She was brought to the hospital in septic shock with disseminated intravascular coagulation and had striking physical signs and roentgenograms showing distention of the knee with gas. She also had an infection of the hand with subcutaneous gas. After surgical drainage and institution of antibiotic therapy, she remained critically ill for several days but gradually improved. Two months later, she was ambulating independently. Emphysematous septic arthritis is rare. Four cases have previously been reported, but none were caused by Klebsiella.
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PMID:Emphysematous septic arthritis due to Klebsiella pneumoniae. 327 11

During a five-year period, 204 patients had klebsiella bacteremia at this institution; these cases constituted 6.6% of the total episodes of bacteremia. The incidence was 2.3 cases per 1,000 admitted patients. A random group of 100 cases was chosen for analysis in the present study. The disease was community acquired in 23%, nosocomially acquired in 77%, unimicrobial in 88%, or part of a polymicrobial bacteremia in 12% of episodes. Three-quarters of the episodes were caused by Klebsiella pneumoniae and the remaining one-quarter, by Klebsiella oxytoca. Portals of entry, in decreasing order of frequency, were urinary, respiratory, and biliary tracts. Twenty-four percent of the Klebsiella isolates were resistant to gentamicin. The most frequent clinical finding (in 96% of the cases) was fever. Shock occurred in 22% and pyogenic metastatic foci, in 5% of the patients. None of the patients had evidence of disseminated intravascular coagulation. Overall mortality was 25%, and factors associated with poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, and clinical condition of the patients.
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PMID:Klebsiella bacteremia: an analysis of 100 episodes. 389 94

Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. The alpha-adrenergic vasoconstriction effects of dopamine would not be expected from the doses employed in these patients. Thus, other factors beside pure alpha vasoconstriction are responsible for tissue necrosis after the use of dopamine. We believe that the embolic complications of disseminated intravascular coagulation and hypovolemia are serious risk factors in the development of dopamine gangrene. Peripheral vasoconstriction from dopamine, even at low doses, may set the stage for thrombotic complications of disseminated intravascular coagulation and lead to tissue damage. In laboratory models of disseminated intravascular coagulation, an alpha-adrenergic drug is required to produce peripheral ischemic tissue damage. Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.
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PMID:Dopamine gangrene. Association with disseminated intravascular coagulation. 730 16

A therapeutic trial of transfusions with polymorphonuclear leukocyte concentrates was performed in newborn infants with bacterial sepsis proven by blood culture. With each transfusion, 20 ml/kg of a preparation obtained by continuous flow filtration leukapheresis, and containing 0.5 to 1 x 10(9) WBC, with less than 6% lymphocytes, was administered. Twenty newborn infants with sepsis received from 2 to 15 PMN transfusions. Results were compared with findings in 18 newborn infants with sepsis admitted during the trial period, and not treated because of unavailability of the PMN preparation (Group B). Infants with fulminant illness were excluded from both groups. Groups A and B were similar with respect to clinical characteristics and to etiology (in the majority cases a highly antibiotic-resistant Klebsiella). The mortality rate was significantly lower in Group A than in Group B in the whole series (10% vs 72%, P < 0.001), and also in the subgroups with birth weight equal or below 1,500 gm (10% vs 91%, P < 0.001). Major complications and associated conditions (i.e., necrotizing enterocolitis, meningitis, pneumonia, peritonitis, osteoarthritis, disseminated intravascular coagulation) were observed in 12 patients of Group B, and in only three infants of Group A. Untoward effects attributable to PMN transfusions were never observed. PMN transfusion was a highly effective therapeutic tool in our population of infected newborn infants.
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PMID:Polymorphonuclear leukocyte transfusion for the treatment of sepsis in the newborn infant. 745 87


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