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)

We sought to develop a rodent model of spontaneous bacterial peritonitis and report here the preliminary results of carbon tetrachloride-induced cirrhosis in which ascites and bacterial peritonitis predictably develop. Of 41 rats that survived the initial carbon tetrachloride toxicity, 38 (92.7%) developed cirrhosis with ascites. Of these 38, 21 (55.3%) developed 24 episodes of ascitic fluid infection without iatrogenic colonization. No surgically treatable source of infection was identified at autopsy in any rat; therefore, the infections were presumed to be "spontaneous." Eight (50%) of the 16 rats with culture-positive ascitic fluid at postmortem examination also had spontaneous pleural fluid infection with the same organism. Escherichia coli and Proteus sp. were the organisms most commonly isolated. This rodent model of cirrhosis with ascites appears to be the first high-yield animal model of spontaneous bacterial peritonitis. Ascitic fluid infection in these rats resembles ascitic fluid infection in humans. This model will allow further investigation of the mechanisms of pathogenesis of ascitic fluid infection and provide insight into the prevention and treatment of spontaneous bacterial peritonitis and pleural fluid infection in patients with cirrhosis.
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PMID:A rodent model of cirrhosis, ascites, and bacterial peritonitis. 198 46

In 1981, 1984 and 1986 relatively more episodes of bacteremia with Corynebacterium in one or two tubes out of twelve were found in alcoholics and these normally negligible episodes may be a iatrogenic marker of intubation and esophagoscopy in alcoholics. Definite bacteremic episodes with E. coli, Staphylococcus aureus, Klebsiella, Streptococcus pneumoniae, Proteus, Pseudomonas aeruginosa, Enterobacter, Streptococcus faecalis, haemolytic Streptococcus and Bacteroides were found in 0.79% of alcoholics and 0.37% of non-alcoholics (0.01 greater than p greater than 0.001). The frequency per 100,000 discharged patients with positive blood cultures irrespective of bacteriological diagnosis, and also alcoholic liver cirrhosis was 8.12 = about two thirds of the number of deaths from cirrhosis per year. In selected cases of severe infections in alcoholics, the frequency of cirrhosis or steatosis was 29/48 = 60%. Foci were more often demonstrated bacteriologically in patients without cirrhosis or steatosis (0.01 greater than p greater than 0.001). Bacteremia with Staphylococcus aureus was a complication of treatment 6-18 days from admission, whereas bacteremia with E. coli and Pneumococci was present on admission. Serious bacteremia in alcoholics was not found in patients over 70 years of age and the many geriatric alcoholics (4.7%) did not show a greater morbidity than the average geriatric patient. The mortality of bacteremic alcoholics was more than 45% over a 6-year period.
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PMID:[Serious infections in alcoholics. 2. Etiology of bacteremia and meningitis in alcoholics discharged from hospitals in Funen 1981, 1984 and 1986]. 291 57

The pharmacokinetics of cefoperazone, a semi-synthetic cephalosporin for parenteral use with a spectrum covering P. aeruginosa, E. cloacae, indole-positive Proteus and S. Marcescens, was studied after a 2-h intravenous infusion of 2 g of the drug in 6 patients with moderate liver function impairment (viral hepatitis in 4 cases, alcoholic fatty liver and cirrhosis in 2 cases). At the end of the infusion, mean serum concentrations (determined by a bioassay) were 208 microgram/ml in the patients and 134 microgram/ml in healthy volunteers. The half-life was 4.3 h in patients and 1.6 h in healthy volunteers. Volume of distribution and renal clearance were similar in the two groups. Extrarenal clearance of cefoperazone was lower in the patients (7.3 ml/min) than in the control group (59.4 mg/min). Urinary excretion of biologically active drug was markedly increased in the patients (79% of the dose) compared with healthy volunteers (24%). This study provides evidence that liver function impairment increases with both the apparent half-life of elimination and the urinary excretion of the drug. The results raise the question of the desirability of cefoperazone dosage adjustment in patients with hepatic diseases.
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PMID:[Pharmacokinetic study of a cephalosporin, cefoperazone, in liver failure]. 645 23

Urease is an enzyme found in plants and bacteria, but not mammals. It catalyzes the conversion of urea to carbon dioxide and ammonia. Ammonia shortens the life span of cells; and higher concentrations cause tissue necrosis and cytolysis. Twenty percent of total body urea is converted to ammonia by bacterial urease in the colon. Small injections of urease immunize animals by producing antiurease, a gamma globulin, which inactivates urease. Immunization eliminates the colonic conversion of urea to ammonia. Injection of urease produces ammonia intoxication making immunization hazardous. Although previously impossible, a non enzymatic urease antigen was synthesized by covalently bonding jack bean urease with glutaraldehyde. This antigen stimulated the production of antiurease that inactivates native urease. Helicobacter pylori, a potent urease producer, has been implicated in peptic ulcer, gastritis and other inflammatory bowel lesions. The pathogenicity of H pylori is dependent on its urease production. Immunization to urease can render H pylori non pathogenic. Cirrhotics develop encephalopathy and hyperammonemia because their livers fail to convert all the ammonia in portal venous blood to urea and collaterals develop by passing the liver. Colonic ammonia increases the turnover rate of colonic mucosa. Ammonia absorbed into the portal venous system is transported to the liver where it is reconverted to urea. Absorbed ammonia adversely influences liver function. Infections with urease producing organisms destroy the renal parenchyma and produce struvite stones. Urease immunization aids colonic healing and prevents uremic colitis. Absorbed ammonia is a noxious influence on the liver. Animals immunized to urease regenerate the liver faster and are less susceptible to hepatotoxins. Immunization to urease ameliorates cirrhosis. Proteus and other urease producers become non toxic and do not damage the renal parenchyma. Urease is responsible for the pathogenicity of infections with urease producing organisms. Immunization to urease renders urease producing organisms non pathogenic.
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PMID:Awakenings to the pathogenicity of urease and the requirement for continuous long term therapy. 799 80

Eight episodes of gram-negative bacillary cellulitis in seven patients with hepatic cirrhosis are reported. The patients comprised five women and two men (mean age 59.6 years). The diagnosis was based on a positive culture of specimens obtained by needle aspiration from cutaneous lesions. All patients had grade C cirrhosis according to Pugh's classification. Cellulitis involved the lower extremities in all cases. Five patients developed bullous lesions, three ulcers, two abscesses and two extensive cutaneous necrosis. A single bacterial species was found in seven cases. Organisms isolated were Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), Pseudomonas aeruginosa (2 cases), Proteus mirabilis (1 case) and Aeromonas hydrophila (1 case). Bacteremia was documented in six cases. Four patients died, death being related to sepsis in three of them. It is concluded that gram-negative bacilli should be considered as possible pathogens in severe infectious cellulitis in patients with advanced cirrhosis. Microbiological study of cutaneous specimens obtained by needle aspiration may be of high diagnostic value in these cases.
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PMID:Gram-negative bacillary cellulitis in patients with hepatic cirrhosis. 816 54

We carried out quantitative culturing of stools from 31 hospitalized alcoholic patients with cirrhosis and ascites, before treatment with 400 mg of norfloxacin per day, weekly for the first month, and then every 2 weeks thereafter for 15 to 229 days (median, 54 days). Members of the family Enterobacteriaceae virtually disappeared from the stools (< 10(2)/g), but treatment had little effect on enterococci. No selection of resistant organisms occurred in 15 patients, but the remaining 16 patients developed fecal organisms resistant to fluoroquinolones between days 14 and 43 of treatment (median, 25 days). Staphylococcus aureus was isolated four times, coagulase-negative Staphylococcus spp. were isolated six times, Citrobacter freundii was isolated four times, Enterobacter cloacae was isolated three times, Klebsiella oxytoca was isolated twice, Proteus rettgeri was isolated once, and untypeable streptococci were isolated six times. Some isolates persisted, while others were transient (one to seven consecutively positive cultures). The MICs of four quinolones (nalidixic acid, norfloxacin, ofloxacin, and ciprofloxacin) were determined by use of experimental microwell strips (ATB CMI; Biomerieux S.A.). All the strains isolated before treatment were susceptible to the four quinolones, with low MICs, whereas those isolated during norfloxacin treatment were highly resistant. Long-term norfloxacin administration thus carries a risk of disturbing the bacterial ecology in these patients, suggesting that digestive decontamination should no longer be prescribed routinely to cirrhotic patients with ascites.
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PMID:Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis. 819 61

In order to evaluate the clinical manifestations, management and outcome of childhood lung abscess, a retrospective chart review of 27 pediatric patients with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9 CM) code of 503.1 (lung abscess) from August 1987 to August 2003 was conducted. Among the 27 patients (14 males and 13 females), 30% (8/27) were primary lung abscess and 70% (19/27) had underlying chronic diseases (secondary lung abscess). The predisposing factors of the primary group (n = 8) included 6 cases of respiratory tract infection, 1 with choking during swimming, and 1 with laceration wound. The underlying diseases in the secondary group (n = 19) included 10 cases of hematologic disorder (52%), 3 of congenital heart disease, 2 of central nervous system anomalies, and 1 each of hyperimmunoglobulin E syndrome, chronic lung disease, liver cirrhosis with fistula formation, and Swyer-James syndrome. Eleven patients (41%) underwent diagnostic tapping, including echo-guided aspiration (10 cases) and computed tomography-guided percutaneous needle aspiration (1 case). Positive yield rate from aspiration of lung abscess was 63.6% (7/11). Surgical intervention was performed in 8 (42%) of the secondary group and in 1 patient from the primary group. The pathogens were identified in 11 patients (41%): 5 with oral flora, 2 with Staphylococcus aureus plus other pathogens, 1 with S. aureus alone, 1 with Pseudomonas aeruginosa plus Proteus mirabilis, 1 with P. aeruginosa alone, and 1 with Aspergillus. The average duration of parenteral antibiotic use was 40 days. Five cases (18.5%) died due to poor control of the underlying diseases, and 4 of the patients (15%) had sequelae (2 with bronchiectasis and 2 with lung fibrosis). Seventy percent of lung abscess occurred in children with underlying medical conditions. Early percutaneous aspiration has an important role in identification of pathogens. Oral anaerobes and S. aureus are the core pathogens in primary lung abscess and gram-negative pathogens should also be considered in secondary lung abscess.
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PMID:Clinical management and outcome of childhood lung abscess: a 16-year experience. 1598 68

Bacterial infections occur frequently in patients with cirrhosis and may worsen the disease outcome. We investigated the prevalence of bacteriuria in 500 consecutive patients with cirrhosis, in different Child-Pugh stages (41.4% A; 40.8% B; 17% C) and analysed the associated risk factors. Most of the cirrhosis cases were virus related; alcohol abuse was recorded in 6.2% of the patients. Bacteriuria was detected in 139 (27.8%) cases: 32.4% were more than 100,000 cfu/ml; 7.9% between 100,000 and 1.000,000 cfu/ml and the remaining cases more than 1000,000 cfu/ml. Escherichia coli was the most frequent isolated agent (84.5%); Proteus spp. strains were detected only in bacteriuria with more than 100,000 cfu/ml. At univariate analysis, female gender, age and presence of diabetes were significantly associated to bacteriuria, while Child-Pugh stage and the presence of hepatocellular carcinoma were not. In a multivariate model, only female gender and diabetes were significantly associated to bacteriuria. These results indicate that advanced cirrhosis was not a risk for bacteriuria, that was associated rather to gender and diabetes, which are common risk factors for bacteriuria in non-cirrhotic patients.
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PMID:[Prevalence and risk factors for bacteriuria in patients with cirrhosis]. 1622 30