Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Incidence of bacterial infections in hospitalised patients with liver disease is high. Due to a liver dysfunction immune reactivity is significantly impaired and bacterial infections are more frequent. Also incidence of nosocomial infections is higher in patients with liver disease compared to patients hospitalised for other conditions. To make a differential diagnosis of infectious and non-infectious aetiology of an inflammation is very difficult. Characteristic laboratory tests for bacterial infection include test of a number of leucocytes in peripheral blood, differential count of leucocytes, erythrocyte sedimentation, procalcitonin, C-reactive protein, tumor necrosis factor alpha, interleukin-1, interleukin-6, interleukin-8, and complement fragment C3a. Clinically the most significant are C-reactive protein test and procalcitonin test. Procalcitonin is a protein, a calcitonin precursor, which is in healthy individuals produced by cells of thyroid gland. A half-life of procalcitonin in serum is 20-24 hours which makes it suitable for daily monitoring and enables to control a course of treatment and to distinguish bacterial infection from other types of inflammations. Procalcitonin levels rise in bacterial, parasite, and yeast infections. Elevated procalcitonin levels appear only in inflammations of an infectious etiology with systemic signs. In patients with liver cirrhosis bacterial infections are more frequent. They usually include spontaneous bacterial peritonitis, infection of the respiratory system, urinary infections, and bacteremia. A timely proof of a bacterial infection and an appropriate and effective antibiotic therapy lead to an improvement of the general state of a patient and to his/her better prognosis. Procalcitonin determination is appropriate for diagnosing infections and control of treatment.
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PMID:[Procalcitonin as an indicator of infection in patients with liver cirrhosis]. 1507 92

Streptococcus bovis is one of the nonenterococcal species included among the streptococci group D. It is part of the normal bowel flora in humans and animals, but it is also responsible for infectious diseases (10-15% of all cases of bacterial endocarditis). Many cases of bacteremia and metastatic abscesses (spleen, liver, soft tissues, bone, meninges, endocardium) caused by S. bovis were reported as associated with digestive tract diseases, mainly colonic disease, and, in particular colonic neoplasms, or chronic liver diseases. A role in carcinogenesis has been suggested for this microorganism. The authors report two cases of S. bovis sepsis, one associated with colonic neoplasm and the other with liver cirrhosis and gastric carcinoma. Discussion is focused on probable mechanisms that favor gastric colonization and systemic diffusion of S. bovis from the gut in patients with gastrointestinal neoplasms or chronic liver disease and provides clinical recommendations for patients with S. bovis infections.
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PMID:Non-life-threatening sepsis: report of two cases. 1516 50

Spontaneous bacterial peritonitis, urinary tract infections, respiratory infections and bacteremia are the most frequent infective complications in cirrhosis. These infections are due to the concomitant presence of different facilitating mechanisms including changes in the intestinal flora and in the intestinal barrier, depression of activity of the reticuloendothelial system, decreased opsonic activity of the ascitic fluid, neutrophil leukocyte dysfunction and iatrogenic factors among others. The fact, that the probability of having a microorganism responsible for the infection quinolone resistant is higher than 30% should be taken into account when treating any infection in a cirrhotic patient receiving selective intestinal decontamination with quinolones, and therefore, quinolones as empiric treatment are not indicated.
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PMID:Bacterial infections in cirrhosis. 1528 49

We report a 67-yr-old woman with hepatitis C-related liver cirrhosis and hepatoma who had developed severe bone marrow suppression after taking Cantharanthus roseus as an alternative anticancer treatment. The patient developed severe pancytopenia with initial presentations of vomiting, diarrhea, oral ulcer, and fever about 1 week after taking 5-days' course of Cantharanthus roseus. Bone marrow biopsy showed autolysis, which indicated massive necrosis of the hematopoietic cells. There was no malignant cell infiltration. The patient also had severe gastrointestinal disturbances, bacteremia, urinary tract infection, and impaired renal and liver function. Supportive care with broad-spectrum antibiotics, granulocyte colony-stimulating factor, repeated blood transfusions, and albumin supplement was given. She recovered and was discharged after 48 days hospitalization. Coadministration of Cantharanthus roseus and cisapride was noted, and these two drugs are both substrates of cytochrome P450 3A4 enzymes (CYP 3A4). Because the vinca alkaloids are extensively metabolized by the liver cytochrome P450 enzymes, poor hepatic function and drug-herb interaction might predispose the patient to develop the bone marrow toxicity. This case report demonstrated possible effect of oral dose of vinca alkaloids and also hinted that all the substrates and inhibitors of CYP 3A4 have propensity to interfere with metabolism of vinca alkaloids.
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PMID:Severe bone marrow depression induced by an anticancer herb Cantharanthus roseus. 1546 62

Transient bacteremia associated with various endoscopic procedures is a well-documented phenomenon. Clinically important bacteremias are very rarely seen, however, this malady has significant morbidity in susceptible patients with valvular heart disease, liver cirrhosis, malignancy and immune deficiency. This bacteremia is a complication that is generally observed secondary to upper endoscopy and other associated invasive procedures in at risk patients, and the more serious manifestations include spontaneous bacterial peritonitis, septic arthritis, meningitis, brain abscess and infective endocarditis. Infective endocarditis is an extremely rare complication of gastrointestinal endoscopy, and it has been convincingly documented in only seven cases. We report a case of native valve endocarditis due to Streptococcus intermedius in a patient with valvular heart disease as a consequence of routine upper endoscopy.
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PMID:Subacute bacterial endocarditis associated with upper endoscopy. 1551 8

Bacteremic necrotizing fasciitis caused by non-O1 Vibrio cholerae has rarely been reported. We describe a case of necrotizing fasciitis of the bilateral lower extremities in a 68-year-old man with liver cirrhosis and diabetes mellitus. Cultures of blood and the debrided tissue all yielded V. cholerae serogroup non-O1 (O56). Despite extensive radical debridement and antibiotic treatment with ceftazidime and doxycycline, the patient died on the 12th hospital day due to multiple organ failure. The present case is the first report of necrotizing fasciitis and bacteremia caused by V. cholerae serogroup O56.
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PMID:Bacteremic necrotizing fasciitis caused by Vibrio cholerae serogroup O56 in a patient with liver cirrhosis. 1562 44

Infections in patients affected with liver cirrhosis are frequent, recurrent and associated to unfavorable outcome. They are facilitated by acquired and progressive defects on the innate immune and reticuloendothelial system that are aggravated by alcohol consumption. Infections in patients with cirrhosis are typically bacterial or viral in origin and have in most cases a stereotyped clinical presentation, although diagnosis may be difficult in some cases. Pneumonia, urinary tract infection, bacteremia and spontaneous bacterial peritonitis explain more than 90% of the cases. The latter requires a high clinical suspicion and a standardized diagnostic work up. Preventive strategies are important in the management of these patients and include chemoprophylaxis against spontaneous bacterial peritonitis in selected cases, vaccines against pneumococcal and influenza infections, and hepatitis A and B vaccine in susceptible patients. Due to limited seroconversion, active immunization should be applied as earlier as possible, before clinical deterioration ensues.
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PMID:[Diagnosis, management and prevention of infections in cirrhotic patients]. 1579 72

To assess the effect of liver dysfunction on the production of C-reactive protein (CRP), CRP levels were evaluated in patients with Escherichia coli bacteremia with or without liver cirrhosis (LC). Thirty patients of each kind were selected as case and control groups, respectively. A matched control of 30 LC patients without acute infection was also included. In the patients with E. coli bacteremia, median CRP was 6.2 mg/dL (range 0.2-22.1) in the LC patients and 14.6 mg/dL (range 5.8-39.6) in the patients without liver dysfunction (P < 0.001). In the advanced LC patients in Child-Pugh class C, median CRP was 5.0 mg/dL (range 0.2-12.1) in patients with E. coli bacteremia and 0.5 mg/dL (range 0.1-1.2) in patients without acute infection (P < 0.001). Our data suggest that, although CRP levels are reduced in response to acute infection, production is nevertheless maintained even in patients with advanced liver dysfunction.
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PMID:Production of C-reactive protein in Escherichia coli-infected patients with liver dysfunction due to liver cirrhosis. 1580 12

Bacterial infection is a frequent and severe complication of cirrhosis that may present on admission or develop during hospitalization in 30-60% of hospitalized cirrhotic patients. The most frequent infective complications include spontaneous bacterial peritonitis, urinary tract infections, respiratory infections, and bacteremia, mostly due to the concomitant presence of various facilitating mechanisms such as changes in the reticuloendothelial system, decreased opsonic activity of the ascitic fluid, neutrophil leukocyte dysfunction, and iatrogenic factors. In fact, up to 25% of cases of death in cirrhotic patients are believed to be related to bacterial infections. This paper aims to provide a brief overview of the epidemiology, pathogenesis, treatment and prophylaxis of bacterial infection in cirrhosis.
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PMID:Bacterial infections in patients with cirrhosis. 1626 57

Vibrio cholerae are Gram-negative bacteria capable of producing serious infections. They are differentiated into O1 and non-O1 serogroups, depending on their ability to agglutinate with specific antiserum. In contrast to non-O1 V. cholerae, which are more prone to invading the bloodstream, V. cholerae O1 is rarely the cause of bacteremia. We describe 2 cases of O and non-O1 V. cholerae bacteremia in patients with hepatitis C virus cirrhosis. We postulate that the hemolytic properties of the isolates contributed to their virulence in immunocompromised hosts.
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PMID:O1 and non-O1 Vibrio cholerae bacteremia produced by hemolytic strains. 1642 94


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