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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A chronic hemodialysis patient, previously splenectomized because of trauma in conjunction with gastrectomy, developed bacteremia with type 18 Streptococcus pneumoniae and died within 13 hours of onset of symptoms. Characteristics of this illness were severe hypoglycemia, pneumococci visible on peripheral blood smear, disseminated intravascular coagulation, neutropenia, and in vitro hemolysis. Splenectomy should be considered with caution in uremic patients and in renal transplant recipients because of the increased risk of fulminant bacteremia. Polyvalent pneumococcal vaccine may be helpful in preventing this syndrome in such asplenic patients.
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PMID:Fulminant pneumococcal bacteremia in an asplenic chronic hemodialysis patient. 3 5

To determine if antimicrobial synergism might affect the results of treatment of gram-negative rod infections, 444 bacteremias from 1972 through 1974 were studied. On these, 173 were treated with two antibiotics to which the infecting organisms were sensitive. Clinical responses were observed in 80% of 83 cases where antibiotic activity was synergistic, as defined by a minimum inhibitory concentration (MIC) of each antibiotic in combination being one-fourth or less than the MICs of individual drugs. This response rate was significantly better than the 64% response seen in patients treated with nonsynergistic combinations (p less than 0.05). Synergism correlated with significantly better clinical responses in those patients with "rapidly fatal" and "ultimately fatal" underlying disease (p less than 0.005), neutropenia (p less than 0.001), shock (p less than 0.01) and Pseudomonas aeruginosa infections (p less than 0.05). These results suggest that the use of antibiotic combinations to treat patients with gram-negative rod bacteremia who have the poorest prognosis is clinically justified and the improved results may be related to the synergistic activity of antimicrobial agents.
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PMID:Antimicrobial synergism in the therapy of gram-negative rod bacteremia. 41 48

Mezlocillin, a new semisynthetic penicillin chemically related to ampicillin which is more active than carbenicillin against Ps. aeruginosa, B. fragilis and Strep. faecalis and which inhibits many Klebsiella, was evaluated in the therapy of 34 episodes of infection in 26 patients. Infection sites included pulmonary, urinary tract and tissue infections, including peritonitis. Seven patients had bacteremia. Clinical cures were achieved in 83 per cent and bacteria cures in 76 per cent of infections. Cure was achieved with mezlocillin in patients with infections caused by carbenicillin-resistant species. Adverse effects of therapy were minimal, one rash and one episode of reversible neutropenia. Serum and body flevels of susceptible organisms.uid levels were easily maintained above the inhibitory levels of susceptible organisms. Mezlocillin was a safe, well tolerated and effective antibiotic in the treatment of infections due to susceptible organisms.
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PMID:Mezlocillin in the therapy of serious infections. 50 86

All of these experiments demonstrate that despite many microbiologic differences between Pseudomonas and the enteric rods, there is a close immunologic relationship between their endotoxin cores. These studies also show that by genetic manipulation we can unmask a protective antigen for preparing antiserum with a broad range of activity, even in the face of neutropenia. Production of potent human J5 antiserum is a safe, simple procedure, making it possible to consider endotoxin core antibody treatment of all Gram negative bacteremia in patients regardless of the causative organism.
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PMID:Prevention of lethal pseudomonas bacteremia with epimerase-deficient E. coli antiserum. 77 22

Pseudomonas aeruginosa is thought to be one of the main species of bacteria producing infection in leukemic patients, especially in those with neutropenia. Although bacteremia is frequent, hematogenous spread causing secondary meningitis is rarely seen. The mortality rate is extremely high. This is believed to be the first report of a successfully treated secondary meningitis caused by Pseudomonas aeruginosa in an adult leukemic patient with a decreased neutrophil count. The patient was treated with intravenous Carbenicillin and gentamicin, and intrathecal gentamicin. The good clinical response was supported by a prompt return of the CSF to normal and by appropriate CSF antimicrobial concentration and bacteriostatic activity.
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PMID:Successful treatment of Pseudomonas meningitis and septicemia in a leukemic neutropenic adult. 80 43

Congenital neutropenia is characterized by a marked decrease in or lack of circulating PMN's in children with no prior history of drug intake. The neutropenia is persistent and the clinical course is one of early onset of severe, recurrent, and eventually fatal infections. Bone marrow studies show a maturation arrest of neutrophilic precursors. Because of their greatly increased susceptibility to infection, patients with congenital neutropenia present a difficult dental management problem. A case of congenital neutropenia has been presented, as well as a biorationale for dental treatment. On the basis of reports in the literature, the following recommendations for the management of patients with congenital neutropenia are made: 1. The prevention and control of infection and the interception of dental disease before surgical intervention becomes necessary should be the overriding considerations in the management of patients with congenital neutropenia. 2. The carious breakdown of teeth should be prevented by the daily application of a 0.4 per cent stannous fluoride gel in addition to oral hygiene and limitation of sucrose intake. 3. Periodontal therapy should be palliative only, since alveolar bone loss is progressive despite frequent oral hygiene instruction and prophylaxis. The goal of periodontal therapy for patients with congenital neutropenia should therefore be a decrease in gingival inflammation to make the patient's mouth more comfortable and to slow down alveolar bone loss. Periodontal surgery is contraindicated. 4. Bacteremia and subsequent septicemia should be prevented since a minor infection can become life threatening in patients with congenital neutropenia. The patient should rinse for 30 seconds and the gingival sulci should be irrigated with a phenolated antiseptic mouthwash prior to all dental manipulations of the soft tissue. This will significantly reduce the incidence of bacteremia. 5. Surgery should be avoided if at all possible because of the high risk of post-operative infection. All surgery sholld be performed in the hospital, and the patient should be given antibiotics as determined by his physician. Primary closure should be done with fine polyglycolic acid sutures to reduce the chance of infection. If postoperative infection can be prevented, wound healing will progress normally despite the complete absence of PMN's.
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PMID:Congenital neutropenia. Report of a case and a biorationale for dental management. 106 18

During the 20-year period, 1972-1991, 27 episodes of Staphylococcus aureus bacteremia, including 10 with methicillin-resistant strains (MRSA), were documented in 26 patients with hematologic disorders, mainly acute leukemia and malignant lymphoma, representing 6% of all 433 episodes of bacteremia in a hematology unit. MRSA replaced methicillin-sensitive strains (MSSA) in the last four years. The skin and upper respiratory tract were the two most common primary foci. Most episodes occurred during neutropenia. Pharyngeal colonization often preceded the development of bacteremia. Antibiotic therapy predisposed to MRSA acquisition during hospitalization, whereas MSSA was mostly detected in admission cultures. Among 22 patients with monomicrobial bacteremia, 19 (86%) survived longer than one week, including all four with MRSA bacteremia who received vancomycin. The survival rate did not differ materially between MRSA and MSSA bacteremias. Secondary foci, chiefly located in the lung, were found in 30% of all patients with S. aureus bacteremia. Prolonged antibiotic therapy, therefore, seems warranted in patients with evident metastatic lesions, although abbreviated therapy is proposed in neutropenic cancer patients.
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PMID:Staphylococcus aureus bacteremia in patients with hematologic disorders. 129 23

Ecthyma gangrenosum due to Pseudomonas aeruginosa is a skin infection in which necrotic ulcerations surrounded by a red areola develop. The diaper area is the region most often involved in infants. Typically, ecthyma gangrenosum occurs in patients with septicemia and risk factors (chemotherapy, neutropenia). However, transient bacteremia or an infection confined to the skin may be the cause in some patients, with maceration in the diaper area and previous antibiotic therapy as risk factors.
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PMID:[Gangrenous ecthyma of the diaper area in infants]. 141 66

We evaluated serum C-reactive protein (CRP) level and serum sodium concentration as early indicators of bacteremia in neutropenic children in two different series in 1983-1984 (49 bacteremias) and 1989-1990 (29 bacteremias). During the earlier period, the goal was to avoid unnecessary antimicrobial therapy. Currently a neutropenic patient is placed on antimicrobial therapy at the first sign of fever. In 1983-1984 the serum CRP concentration was elevated in every case, whereas in 1989-1990 it was normal in 34% cases (P = .0001). Hyponatremia was detected on admission in 84% and 52% cases (P = .0001). The urinary sodium concentration was elevated in most cases. The mortality in bacteremia was 22% in 1983-1984 compared to 3% (P = .025) in 1989-1990. Prompt initiation of empirical antimicrobial therapy in children with fever and neutropenia invalidates the use of hyponatremia and an elevated CRP level as early indicators of sepsis.
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PMID:Changing pattern of treatment policies invalidates the use of C-reactive protein level and hyponatremia as indicators of sepsis in children with malignancies. 146 70

During a three-year period eight patients with blood cultures positive for Stomatococcus mucilaginosus were identified at two university hospitals. One patient without any signs of infection had a central venous catheter that was colonized with this organism, two patients had transient bacteremia without definite relationship to underlying disease, whereas the remaining five patients suffered from clinically significant infections. Of these last five patients, one had undergone prior head and neck surgery and four had hematologic malignancy with mild to severe neutropenia; two of the latter patients developed the infection subsequent to dental surgery. Besides neutropenia and mucosal damage in the oropharynx, quinolone antibacterial prophylaxis may have been an additional risk factor for the development of S. mucilaginosus bacteremia in these patients. A thorough review of the literature revealed that in addition to our findings, endocarditis and foreign body infections are further typical clinical manifestations. Although the overall antibiotic susceptibility pattern of S. mucilaginosus resembles that of streptococci, it is suggested that penicillin G may not be the drug of choice for initial therapy of particularly severe infections. S. mucilaginosus can be easily differentiated from other gram-positive bacteria when certain key criteria (e.g. adherence to agar surfaces, poor growth on Mueller-Hinton agar, presence of a capsule) as well as an array of biochemical tests, including commercially available identification systems, are applied. Our own and published data emphasize that both microbiologists and clinicians should be increasingly aware of this opportunistic pathogen.
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PMID:Bacteremia caused by Stomatococcus mucilaginosus: report of seven cases and review of the literature. 152 87


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