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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of anaerobic or microaerophillic bacteria in spontaneous peritonitis of cirrhosis has not been clearly defined. Among 126 cases recorded in the literature, in only eight (6 per cent), including the two reported here, was bacterascites associated with anaerobic or microaerophilic bacteria. Clinical features in these cases were indistinguishable from those associated with aerobic bacteria. However, polymicrobial bacterascites occurred in four of eight cases associated with anaerobes, as contrasted with only 10 of 118 cases (8 per cent) associated with aerobes alone. On the other hand, concurrent bacteremia occurred in only one of eight cases associated with anaerobes as contrasted with 52 of 118 cases (44 per cent) of aerobic spontaneous peritonitis. Experimental evidence is cited in an attempt to explain this relatively low incidence of spontaneous peritonitis associated with anaerobic or microaerophilic bacteria, despite the high density of these organisms in the normal bowel flora.
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PMID:Role of anaerobic bacteria in spontaneous peritonitis of cirrhosis: report of two cases and review of the literature. 19 Aug 83

Transient bacteremia associated with percutaneous liver biopsy was studied by pour-plate blood cultures, which were obtained immediately before and after the procedure and 5, 10, 15, and 30 min later in 89 patients. Part of the liver tissue was also cultured in all patients. Histological diagnoses included hepatitis, cirrhosis, cholangitis, fatty liver, granulomata, metastatic liver disease, lymphoma, and miscellaneous disorders. All blood cultures obtained before liver biopsy were sterile. Bacteremia was demonstrable in 12 patients (13.48%). In most of these patients, blood cultures were positive for as long as 15 min after liver biopsy; all cultures were negative at 30 min. Among the bacteria associated with 12 episodes of bacteremia were Escherichia coli, Klebsiella, Bacteroides, enterococci, diphtheroids, Staphylococcus aureus, alpha-hemolytic Streptococcus, and Streptococcus pneumoniae. The patients with positive liver biopsies had a higher incidence of bacteremia (83.3%) than did the patients whose liver biopsies were sterile (8.r%); this difference is stastically significant (P smaller than 0.01). Thus, liver biopsy can be associated with transient bactermia.
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PMID:Transient bacteremia associated with percutaneous liver biopsy. 109 72

Listeria monocytogenes is a Gram-positive bacillus that is pathogenic in both the normal and compromised host. We describe Listeria peritonitis and cerebritis in a patient with cirrhosis due to non-A, non-B hepatitis, and review the 11 other cases of Listeria peritonitis reported in the English-language literature. Listeria is a rare cause of peritonitis in debilitated, older patients, with two-thirds of the cases occurring in patients with chronic liver disease. Listeria peritonitis may also occur in patients undergoing peritoneal dialysis, or in those with malignancy. Peritonitis due to Listeria is clinically similar to spontaneous bacterial peritonitis, and is associated with fever, variable abdominal pain, and neutrocytic ascites; bacteremia commonly accompanies Listeria peritonitis. This syndrome can be successfully treated with antimicrobial drugs, although the third-generation cephalosporins commonly used in the therapy of spontaneous bacterial peritonitis are not recommended. Ampicillin may be the drug of choice, with combination therapy with an aminoglycoside reserved for cases that do not respond to ampicillin alone.
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PMID:Listeria monocytogenes peritonitis: case report and literature review. 144 54

Pasteurella multocida should be considered as a possible etiologic agent in any infection that is the result of an animal bite or scratch. Because of its opportunistic capability, it should be included among the possible pathogens in bacteremia, particularly in any patient with immunosuppression or liver cirrhosis, especially if there is a history of animal exposure.
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PMID:Bacteremia due to Pasteurella multocida. 156 54

Infections are frequent in patients with liver cirrhosis, as their defenses against infectious agents are altered. But bacteremia occurring in cirrhotic patients has seldom been reported in the literature. From 1981 to 1986, we collected 197 cases with 228 episodes of bacteremia for this retrospective study. The incidence of bacteremia in cirrhotic patients was 8.8%; no significant difference was noted between cirrhotic patients with variant etiologies of HBV(+), HBV(-) and alcohol. But the incidence increased with the severity of the disease (1%, 4.8%, 17.1% in Child's A, B, C groups, respectively). Gram-negative bacteria were the predominant microorganisms of bacteremia (75.6%). Among them, Escherichia coli, Klebsiella pneumoniae and Aeromonas hydrophilia were the three most commonly detected microorganisms. Gram-positive bacterias were detected in 21.2% of patients with bacteremia, with predominance of the Streptococcus group and Staphylococcus aureus. In about 26.3% of cases the infectious sources were the same by bacteria cultures as from blood. The most common sources were spontaneous bacterial peritonitis, urinary tract infection, pneumonia and biliary tree infection. In cirrhotic patients with and without bacteremia, the mortality rate increased significantly in the bacteremia group (54.8% vs 23.2%, P less than 0.05). By Child's classification, the mortality of patients with classes B and C increased significantly after onset of bacteremia. There was no significant difference in mortality between bacteremic patients in the HBV(+), HBV(-) and alcohol groups. In conclusion, bacteremia is a severe complication of liver cirrhosis and a sign of a poor prognosis.
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PMID:Bacteremia in patients with cirrhosis of the liver. 177 12

We analyze retrospectively all bacteremic episodes seen between January and December, 1987 in our institution. From a total number of blood cultures performed of 897, 145 were positive (16%), and 67 of them considered as contamination (7.5%). There were 78 episodes of bacteremia in 74 patients, 38 males and 36 females. Forty-eight episodes were community-acquired and 30 were nosocomial bacteremia episodes. Aerobic bacteria were isolated in 64 cases, anaerobic bacteria in 9 cases and polymicrobial bacteremia in 5 cases. The most commonly isolated microorganism was S. epidermidis in nosocomial cases and E. coli in community-acquired cases. Predisposing conditions registered were diabetes mellitus in 16 cases (20%), cirrhosis of the liver in 3 (4%), corticosteroid therapy in 7 (9%) and surgical procedures in 19 (24%). Shock was seen in 16 cases (20%), DIC in 8 cases (10%) and ARDS in 5 (6.5%). Appropriate antibiotic treatment was used in 60 episodes (77%). Seventeen patients (22%) died. Prognostic factors identified were: nosocomial bacteremia (p less than 0.05), corticosteroid prior therapy (p less than 0.05), underlying disease UF or RF (p less than 0.0001) and the presence of shock (p less than 0.0001). Mean hospital stay was 20.1 days in bacteremic patients vs. 7.6 days in non bacteremic patients (p less than 0.00001).
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PMID:[Bacteremia in a community hospital. Review of 78 cases]. 193 41

Cirrhotic rats have decreased pulmonary bactericidal activity and increased bacteremia after experimental pneumococcal pneumonia. To determine if this finding is due to impaired pulmonary recruitment of polymorphonuclear leukocytes (PMNL), bronchoalveolar lavage (BAL) was done on cirrhotic and normal rats after transtracheal challenge with pneumococcal types 3 and 1. Mean absolute numbers of recruited PMNL in BAL fluid (BALF) at 2, 4, 6, 8, and 24 h after 10(7) cfu of type 3 challenge were similar in cirrhotic and normal rats. In both groups, lower numbers of PMNL were recruited after challenge with 10(5) cfu of type 3. Type 1 pneumococci stimulated recruitment of similar mean absolute numbers of PMNL (x10(7] in BALF (cirrhotics vs. normals) at 24 h after challenges with 10(5) cfu (0.3 +/- 0.1 vs. 0.3 +/- 0.1) and 10(7) cfu (2.9 +/- 1.3 vs. 2.8 +/- 0.7). Peripheral blood PMNL from cirrhotic and normal rats did not differ in adherence to nylon wool columns or in chemotaxis toward lipopolysaccharide-activated normal rat serum. Thus the impaired pulmonary defense against pneumococcal pneumonia in cirrhosis is not due to deficient pulmonary PMNL recruitment.
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PMID:Pulmonary recruitment, adherence, and chemotaxis of neutrophils in a rat model of cirrhosis and pneumococcal pneumonia. 195 20

In 1985, 100 episodes of klebsiella pneumoniae bacteremia in 98 patients were treated at the Veterans General Hospital--Taipei. The disease was community acquired in 58% and nosocomially acquired in 42%; unimicrobial in 86% and part of a polymicrobial bacteremia in 14%. Medical records of 90 episodes were available and were analyzed. Portals of entry, in decreasing order of frequency, were hepatobiliary (24%), respiratory (20%), and urinary tract (19%). Diabetes mellitus, which was found in 25 (28%) patients, was the most common underlying disease, followed by malignancies in 13 (14%), biliary tract abnormalities in 9 (10%), and cirrhosis of the liver in 8 (9%). The most frequent clinical findings were fever (89%) and leukocytosis (60%), followed by thrombocytopenia (27%), jaundice secondary to bacteremia (22%) and shock (21%). The course of one (1%) patient, who was diabetic and had a liver abscess, was complicated by metastatic septic endophthalmitis and meningitis. Overall case fatality was 46%. Poor prognostic factors included inappropriate antibiotic therapy, respiratory tract as a portal of entry and the presence of shock. Cephalosporins and aminoglycosides were the most active antibiotics. The use of one or more antibiotics, which included at least one cephalosporin, with in vitro activity against the corresponding isolate, with adequate dosage and an appropriate route of administration significantly reduced deaths directly attributed to K. pneumoniae septicemia, 32% (18/57), compared with 88% (21/24) in patients who were not treated appropriately (p less than 0.001). Combination therapy with a cephalosporin and aminoglycoside in conjunction with surgery in selected cases is the treatment of choice for K. pneumoniae bacteremia.
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PMID:Klebsiella pneumoniae bacteremia: analysis of 100 episodes. 198 35

To study alterations in host defense mechanisms that enhance pneumococcal virulence, a model of Streptococcus pneumoniae pneumonia was developed in cirrhotic rats. Cirrhosis, with or without ascites, was produced in rats by intragastric administration of carbon tetrachloride (CCl4). Histopathologic and laboratory studies demonstrated that CCl4-induced cirrhosis was similar to alcoholic cirrhosis in humans. Cirrhotic rats were more susceptible to type 3 pneumococcal pneumonia induced by intratracheal challenge than controls, and the presence of ascites was associated with the lowest LD50. More cirrhotic rats with ascites had bacteremia and elevated levels of circulating capsular antigen after challenge compared with cirrhotic rats without ascites or controls. Pulmonary clearance of pneumococci was markedly reduced in rats with cirrhosis and ascites and was associated with reduced serum complement levels. This model may be useful in further studies of the pathogenesis and therapy of pneumococcal infections in the compromised host.
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PMID:Pneumococcal pneumonia in a rat model of cirrhosis: effects of cirrhosis on pulmonary defense mechanisms against Streptococcus pneumoniae. 198 56

Between 1987 and 1990, seven patients hospitalized in our hospital had bacteremia caused by Streptococcus bovis. Complete gastrointestinal evaluation was routinely carried out for digestive portal of entry and liver disease screening. In four cases (2 bacteremia, 2 endocarditis), a colonic growth was detected: sigmoid adenoma (n = 1) and rectosigmoid carcinoma (n = 4); in one case (endocarditis), several rectosigmoid carcinomas were associated with alcoholic cirrhosis; in one case (bacteremia), alcoholic cirrhosis was diagnosed; in one case (endocarditis), no gastrointestinal or hepatic portal of entry was found. These cases emphasize the need for simultaneous detection of endocarditis and gastrointestinal portal of entry such as colonic tumor and/or cirrhosis, in case of Streptococcus bovis bacteremia.
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PMID:[Prospective study of routine screening for cirrhosis and colonic tumors associated with Streptococcus bovis bacteremia]. 206 Jul 42


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