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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Plesiomonas shigelloides is a gram-negative, facultatively anaerobic rod whose appropriate taxonomic position is presently under investigation. The isolation and identification of this microorganism in contaminated specimens (e.g., feces) by a clinical laboratory depend on the screening of gram-negative colonies for oxidase and indole positivity and the appropriate use of selective and differential agars. Plesiomonads have been associated with extraintestinal diseases (bacteremia, meningitis) on rare occasions; they have been recovered sporadically from patients presenting with acute gastroenteritis. Although case reports and epidemiologic data support a role for P. shigelloides in diarrheal disease, laboratory investigations have failed to identify an enteropathogenic mechanism in these bacteria consistently or to reveal an animal model that faithfully reproduces the disease. Moreover, studies with volunteers have failed to establish an etiologic relation between Plesiomonas and bacterial gastroenteritis. An accurate picture of the role of this bacterium in human disease must await future studies.
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PMID:Clinical disease spectrum and pathogenic factors associated with Plesiomonas shigelloides infections in humans. 328 61

While salmonellosis is often considered to affect primarily the gastrointestinal tract, infection at other sites may occur, producing characteristic clinical syndromes. We reviewed cases from our institutions and the literature on focal manifestations of salmonella infections. In the past, most extra-intestinal salmonella infections were caused by S. choleraesuis; however, we found S. typhimurium to be the predominant serotype. The mortality rate for patients in our series was considerably lower than the rate described for focal infections in other reviews. This may in part be due to lower proportion of infections due to S. choleraesuis, improved microbiologic and diagnostic techniques, increased use of ampicillin, and improved surgical techniques. Salmonella endocarditis usually occurs in patients with preexisting heart disease. Unlike other salmonella infections, S. choleraesuis is the most frequent serotype. Salmonella endocarditis is often very destructive, with a fatality rate of 70%. Nonvalvular (mural) endocarditis occurs in one-fourth of patients and survival has not been reported. While antibiotic therapy should be tried initially, if response is not prompt the clinician should look for an associated site of infection (intra- or extra-cardiac abscess), which will often require surgery. Salmonella pericarditis often presents with cardiac or pulmonary symptoms, but typical signs of pericardial disease (pulsus paradoxus, friction rub) or characteristic electrocardiographic changes (low voltage, elevated ST segments) are uncommon. Early diagnosis, before infection involves other areas of the heart, is crucial for survival. In addition to antibiotic therapy, pericardiocentesis or pericardiectomy is required. Salmonella may infect the peripheral or visceral arteries, but the abdominal aorta is the most frequent site of vascular infection. Most patients are men over age 50 with preexisting atherosclerosis of the aorta who do not have a previous history of gastroenteritis. About one-fourth of patients have associated lumbar osteomyelitis. No patients have been reported to survive with medical therapy alone. Specific guidelines for surgical removal of infected aneurysms have been proposed and these (in addition to increased use of ampicillin) may be responsible for higher survival rates in recent years. Due to the high incidence of relapses, postoperative blood cultures should be done routinely. Arterial infection should be considered in any elderly patient with salmonella bacteremia especially with prolonged fever or bacteremia after an "adequate course" of antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Extra-intestinal manifestations of salmonella infections. 330 60

Shigella bacteremia is rare, occurring mainly in children. We describe five adult patients with Shigella bacteremia and review data on 22 cases reported in the English-language medical literature. Eighteen (67%) of 27 patients had either an underlying condition or were aged older than 65 years. Most patients had clinical signs of acute febrile gastroenteritis. However, in six patients, the organism was not isolated from stool. Species isolated from blood included Shigella flexneri in 11 patients, Shigella sonnei in eight, and Shigella boydii and Shigella dysenteriae in one patient each. Isolation of the bacterium from blood only was associated with a high mortality rate, in contrast to its isolation both from blood and stool. It is suggested that blood cultures should be obtained from elderly or immunocompromised patients with acute febrile gastroenteritis to detect shigellemia as well as bacteremia caused by other enteric pathogens, such as Salmonella or Campylobacter.
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PMID:Shigella bacteremia in adults. A report of five cases and review of the literature. 331 66

Five weeks before the development of acquired immunodeficiency syndrome (AIDS), a 38-yr-old homosexual man had symptomatic gastroenteritis that resolved without antibiotic treatment. His stool culture was positive for Salmonella typhimurium at that time. The patient subsequently developed Pneumocystis carinii pneumonia and received a 10-day course of intravenous trimethoprim-sulfamethoxazole. He developed salmonella bacteremia 4 months later. The salmonella isolates from the stool and blood were susceptible to trimethoprim-sulfamethoxazole. Comparison of cryptic plasmids showed a pattern identical to the initial salmonella infection, so infection with a new strain did not cause the bacteremia. This finding illustrates the utility of plasmid fingerprinting as a diagnostic tool, and suggests that persons with AIDS, or those at high risk with prodromal symptoms, should receive prompt, effective therapy for nontyphoidal salmonella gastroenteritis.
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PMID:Recurrent salmonella infection with a single strain in the acquired immunodeficiency syndrome. Confirmation by plasmid fingerprinting. 351 Aug 6

Four children, ages 3 to 8 years, developed pneumatosis intestinalis (PI) after allogeneic bone marrow transplantation (BMT) for acute leukemia or severe aplastic anemia. PI was detected at a median of 48 days (range, 10-63 days) after BMT and was associated with abdominal symptoms and clinical signs. All patients had severe systemic and/or high-grade cutaneous acute graft-versus-host disease (AGVHD) at some time after BMT and were receiving corticosteroids at the time of development of PI; however, PI was associated with concomitant severe AGVHD in only one patient. One patient with PI had Hafnia alvei bacteremia and another patient had gastroenteritis due to rotavirus and adenovirus. All patients were treated with supportive care and systemic broad-spectrum antibiotics, and PI resolved 2-16 days after onset. Two patients died with BMT-associated complications unrelated to PI. Multiple factors contribute to the development of PI after BMT, and the prognosis for recovery from PI is good with medical management alone. Overall survival in these patients is dependent on the frequency and severity of other conditions, such as AGVHD and opportunistic infections, after BMT.
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PMID:Pneumatosis intestinalis in children after allogeneic bone marrow transplantation. 354 76

A chronically constipated, mentally retarded male adolescent was admitted on two occasions with gastroenteritis symptoms and stool positive for group G Streptococcus. The first episode was also associated with group G streptococcal bacteremia. This case of group G streptococcal disease is unique in that the primary symptoms were those of gastroenteritis. In the context of chronic constipation in colonic distention, the case appears to support the hypothesis of Watsky et al that group G streptococcal bacteremia is promoted by processes which breach anatomic mucosal or epithelial infection barriers.
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PMID:Group G streptococcal bacteremia in a chronically constipated adolescent. 361 8

Four hundred thirty-four febrile infants two months of age or younger were evaluated in the emergency departments of five major teaching hospitals over a one-year period. A culture-proven bacterial infection was present in 3.5% of the infants; bacteremia was detected in 3.3%. Bacterial meningitis was present in 2.4%, and aseptic meningitis was noted in 13.4%. Twenty-one percent had clinically apparent serious disease including pneumonia, otitis media, and gastroenteritis with dehydration. Six variables (age less than 1 month, lethargy, no contact with an ill individual, breast-feeding, total polymorphonuclear greater than or equal to 10,000/mm3 and band count greater than or equal to 500/mm3) were correlated with bacterial infection by step-wise discriminant analysis. However, these findings were neither sensitive nor specific enough to be clinically useful. Management varied, and 62% of the infants were hospitalized. Fifty-four percent, some of whom were managed as outpatients, received antibiotics. Febrile infants two months of age or younger require a comprehensive emergency department assessment, including appropriate laboratory studies (CBC, differential, urinalysis and culture, lumbar puncture, and blood culture), since 3.5% have bacterial infection that may be life-threatening. Hospitalization is warranted if the infant appears ill, laboratory studies indicate serious infection, or follow-up care is uncertain.
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PMID:Fever in infants less than two months of age: spectrum of disease and predictors of outcome. 384 82

We have reviewed the clinical course of 32 children with Salmonella enteritidis bacteremia and compared them with 135 children with acute gastroenteritis caused by S. enteritidis at Wyler Children's Hospital over 4.5 years. Analysis of symptoms of infection, the initial laboratory evaluation, the initial impression of the severity of illness, the clinical course, and the eventual outcome showed no differences between children with bacteremia and those with acute gastroenteritis, nor did a comparison between older children (one year of age or older) and younger children, with either bacteremia or acute gastroenteritis, show appreciable differences. We conclude that bacteremia occurring with acute gastroenteritis was clinically elusive and more common than previously recognized. Furthermore, in the absence of documented risk factors, bacteremia occurring with acute gastroenteritis was not associated with any greater morbidity than was acute gastroenteritis occurring alone.
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PMID:Salmonella enteritidis bacteremia in childhood. 389 84

A study was done of 117 children with nontyphoidal salmonellosis from the clinic and inpatient populations of The Montreal Children's Hospital. Uncomplicated gastroenteritis was the most common clinical presentation and the mean duration of illness was 8.7 days. Eleven (24%) of 45 patients tested had bacteremia; retrospective analysis of these patients did not reveal major differences in clinical presentation, laboratory findings, underlying disease or complications when compared with the patients from whom blood cultures were not taken. There were no complications in any of the patients and no deaths. Prolonged stool carriage beyond eight weeks was not a problem except in infants under the age of 3 months, of whom 27% were carriers eight weeks after the onset of illness. Antibiotic therapy was not effective in treating the acute illness and seemed to prolong carriage in young infants.
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PMID:Clinical spectrum and carrier state of nontyphoidal salmonella infections in infants and children. 485 58

During a one-year period, 315 of 5,397 children admitted to the general pediatric wards of a hospital had bacteremia. The commonest causative organisms were Streptococcus pneumoniae, Salmonella enteritidis, Hemophilus influenzae, and Escherichia coli. Most episodes of bacteremia were associated with gastroenteritis, pneumonia, or meningitis. Seventy-eight episodes occurred in children with severe protein-energy malnutrition, and 46 episodes were hospital acquired. The overall case fatality rate was 23.2%, being highest in children with severe malnutrition and in those with other underlying conditions. The high proportion of bacteremias due to S pneumoniae and S enteritidis possibly reflects infections occurring in a lower socioeconomic group living in a temperate climate in crowded conditions. The most appropriate antimicrobial therapy for children who have suspected bacteremia in association with gastroenteritis or severe malnutrition is a combination of ampicillin sodium and gentamicin sulfate.
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PMID:Bacteremia in hospitalized black South African children. A one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children. 637 39


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