Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dental disorders have been recognized as major sources of infection in patients with hematologic malignancies (HM). Management of severe dental infections usually includes dental extractions (DE), but the safety of extractions in patients with HM who are at risk for bleeding, sepsis, and poor wound healing has not been well established. In conjunction with an aggressive program of dental care, 142 DE were performed in 26 patients with acute leukemia, myelodysplastic syndromes, and myeloproliferative disorders. Granulocytopenia (less than 1,000 granulocytes/microL) was present during or within ten days following surgery in 14 patients. In these 14 patients (101 DE), the mean granulocyte count was less than 450/microL, with a median duration of granulocytopenia following surgery of 32 days (range, four to 169 days). Thrombocytopenia (less than 100,000 platelets/microL) occurred during or within two days following surgery in 13 patients (80 DE), with a mean platelet count of 63,500/microL. Transfusions were given for platelet counts less than 50,000/microL. All DE were performed without significant complications. Bleeding was minor to moderate and easily controlled with local measures; no patient required transfusion due to hemorrhage. Average maximum temperature 24 hours after DE was 37.7 degrees C. No episodes of bacteremia were documented within ten days of DE. Minor delay in wound healing was observed in two patients. We conclude that DE can be safely performed in patients with HM in combination with aggressive supportive care.
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PMID:The safety of dental extractions in patients with hematologic malignancies. 252 58

19 children between 3 and 23 years underwent 79 leukapheres for collection of blood stem cells. In children suffering from acute lymphoblastic leukemia (ALL), Non Hodgkin's Lymphoma (NHL) and Ewing's Sarcoma (ES) we collected 6.87 x 10(4) CFU-GM/kg (range 2,65-21.7), if collections were started with the first platelet rise. In children with peripheral primitive neuroectodermal tumors (PNET) and neuroblastoma (NBL) we gained only 1.20 x 10(4) CFU-GM/kg (range 0.09-2.24). 17 children received high dose chemoradiotherapy and peripheral stem cell +/- bone marrow rescue. 9 suffered from solid tumors, 8 from hematopoietic malignancies. 9 were transfused with peripheral stem cells only, 8 received bone marrow in addition. Time to reach 0.5 x 10(9)/l granulocytes was very short-median 31 days (12-65), in 4 children receiving more than 5 x 10(4) CFU-GM/kg 12 to 13 days, only. On January 31st, 1989 6/17 children are alive in complete remission after a median observation time of 14.5 months (3-26) after autologous stem cell transfusion, one child is alive in "no remission", 7 died with relapse, 3 died because of infections (2 x aspergillosis, 1 x pseudomonas septicemia). The collection of blood derived stem cells by leukaphereses was well tolerated even in very small children and easily repeatable. With optimal timing high stem cell numbers were obtainable, resulting in a very short duration of posttransplant granulocytopenia.
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PMID:[Autologous peripheral stem cell transplantation in children]. 257 Aug 82

Two hundred fifty-seven patients with acute leukemia were admitted into our hospital on 346 occasions. There were 433 episodes of infection, with an average of 1.25 episodes per hospitalization; 126 patients (49.0%) died. Infection was the major predisposing factor and cause of death. The incidence of infection increased significantly with prolonged duration of hospitalization, the degree of granulocytopenia, the degree of chemotherapeutic failure, and the use of glucocorticoids. Pulmonary infection (17.3%) was the most common type of infection. Septicemia (12.0%) was also common and was associated with high mortality (71.2%). Of 22 patients with perirectal abscess, 10 had septicemia. Gram-negative bacilli were responsible for 66.1% of laboratory-documented bacterial infections. For the treatment of infection, empiric use of an aminoglycoside combined with either an antipseudomonal penicillin or a cephalosporin at the first sign of infection was emphasized. Antibiotic administration should be continued for at least 7 days after the patient's temperature becomes normal.
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PMID:Infection in acute leukemia: an analysis of 433 episodes. 260 79

Among infections in leukemia patients during their first induction treatment pneumonia was the third most frequent infection (11.4%) following fever of unknown origin and sepsis. Granulocytopenia was suggested to be very closely related to the onset of pneumonia. Laminar air flow rooms seemed very effective for preventing exogenous infections including pneumonia. They reduced pneumonia from 30 to 0 in 106 patients with acute leukemia during their first induction treatment. Bone marrow transplantation (BMT) is one of the most intensive immunosuppressive treatments. Major causes of failure were interstitial pneumonitis (IP) due to cytomegalovirus (CMV), relapse of leukemia and bacterial and fungal infections. The incidence of IP was reduced by fractionation of total body irradiation and selection of CMV antibody negative donor for platelet transfusion. Administration of anti CMV immunoglobulin has also reduced the incidence of IP significantly from 37.5% to 11.5%. Colony stimulating factor appeared to stimulate the recovery of leukocytes after BMT. By several modifications of BMT techniques, mainly for the prevention of infection and IP, the survival of patients after BMT has improved significantly from 20% to 85%. In conclusion, prevention and treatment of respiratory infections are important in the treatment of leukemia, both for chemotherapy and BMT.
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PMID:[Prevention and treatment of respiratory infections in leukemia patients]. 261 86

Forty cases of drug-induced agranulocytosis from the Department of Medicine, Faculty of Medicine, Chiang Mai University during the 12 year period 1975-1987 were analysed. In 32 cases, the related etiologic drugs were identified. These were thiacetazone and isoniazid in 10 cases (25%), propylthiouracil in 6 cases (15%) sulfa drugs in 5 cases (12.5%) combination of analgesic and antibiotics in 3 cases (7.5%), anti-psychotic in 2 cases (5%), antibiotics in 5 cases including, ampicillin (2 cases) and others (3 cases), and ether in 1 case (2.5%). The other 8 cases (20%) received unknown drugs from private clinics. Twenty-four cases had complete recovery in 13-14 days after withdrawal of the incriminating drugs, and sixteen cases (40%) died with septicemia.
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PMID:Drug-induced agranulocytosis. 262 33

Dapsone has been suggested as a useful drug in the treatment of granuloma annulare; however, adverse reactions include a potentially life-threatening agranulocytosis. We report the case of a 50-year-old woman in whom agranulocytosis and septicemia developed after 7 weeks of therapy with dapsone for granuloma annulare. Full recovery followed cessation of this drug, but caution is advised in prescribing dapsone for relatively benign skin conditions.
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PMID:Agranulocytosis caused by dapsone therapy for granuloma annulare. 264 42

A review of two third-generation cephalosporins, ceftazidime and cefotaxime, is presented. Ceftazidime, often used as a single agent, has shown greater activity than cefotaxime against Pseudomonas aeruginosa and other Pseudomonas species, Enterobacteriaceae, Acinetobacter sp, and Enterobacter sp. It has been effective as monotherapy in the treatment of peritonitis, gynecologic infections, chronic bronchitis, and infections in patients with leukemia and granulocytopenia, as has cefotaxime when in combination with an aminoglycoside. Cefotaxime has shown good activity against most aerobic gram-negative bacilli and against Staphylococcus. It has been used in respiratory infections, urinary tract infections, and septicemia. In contrast to first-generation and most second-generation cephalosporins, third-generation cephalosporins have proven useful in some types of meningitis. Ceftazidime and cefotaxime successfully penetrate into the cerebrospinal fluid and cures of bacterial meningitis have been reported with both drugs. Both ceftazidime and cefotaxime have been successfully used in children, infants, and neonates, as well as adults. Safety profiles of ceftazidime compare favorably with those of other third-generation cephalosporins.
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PMID:Ceftazidime and cefotaxime--the clinician's choice. 266 Sep 95

Clinical effects of the monotherapy with ceftazidime (CAZ) were evaluated in patients with severe infections associated with febrile granulocytopenia in hematological disorders in 10 institutions. CAZ (4-6g/day) was administered intravenously by drip infusion divided into 2 to 4 doses. 83% of the underlying diseases were hematological malignancies. Infections mainly consisted of documented sepsis (10%), presumed sepsis (60%). Overall efficacy rate was 65%, and that of septic patients was 83.3%. Adverse reactions were minimal, and this study revealed safety of CAZ.
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PMID:[Clinical evaluation of monotherapy with ceftazidime for severe infections complicating hematological disorders. Hyogo Cooperative Study Group of Infectious Diseases Complicating Hematological Disorders]. 267 34

In order to determine the effect of parenteral antibiotherapy on the fecal flora in patients with profound and prolonged granulocytopenia, we initiated a prospective study of 62 cases of autologous bone marrow transplantation following high-dose chemotherapy. All patients were children from 2 to 18 years old, isolated in a protective environment, receiving a diet low in viable microbial content but no oral non-absorbable prophylactic antibiotics to decontaminate the gastrointestinal tract. Bacteriological analysis of fecal flora was conducted at least once a week before and during parenteral antibiotherapy, administered at the first greater than 38 degrees C febrile episode in these granulocytopenic patients (granulocyte count less than 0.5 X 10(9)/l). The 58 evaluable patients fell into three groups with regard to the systemic antibiotherapy: group A (n = 16): moxalactam + mezlocillin; group B (n = 15): moxalactam + tobramycin; and group C (n = 27): cefotaxime plus gentamicin. Fecal flora suppression was observed in 51/58 cases (88%) (group A: 15/16, group B: 13/15, group C: 23/27). It always occurred within 5 days of initiating parenteral antibiotherapy and persisted in 88% of the 51 patients over the whole period of systemic antibiotherapy. During the latter, fecal recolonization was observed in seven cases (12%), always by Enterobacteriaceae sensitive to the prescribed systemic antibiotherapy, never responsible for septicemia. Since parenteral antibiotherapy alone was able to suppress the gastrointestinal tract flora, the effects of this treatment should be considered in all trials of digestive tract decontamination.
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PMID:Role of parenteral antibiotherapy in gastrointestinal tract flora suppression. A study in children treated with high-dose chemotherapy and autologous bone marrow transplantation. 267 59

Gram-negative infections in neutropenic patients frequently originate from the intestinal flora. Attempts to decrease the incidence of these infections include several regimens for gastrointestinal decontamination, some of which have proved to be clinically useful. The orally administered nonabsorbable antibiotics such as aminoglycosides and polymyxins can decrease the incidence of Gram-negative sepsis during neutropenia. However, tolerance of these agents, with the possible exception of netilmicin, is very poor, and patient compliance is low. Cotrimoxazole (trimethoprim/sulfamethoxazole) has been widely used for prophylaxis of infections in neutropenic patients with variable clinical results. Its efficacy is clearly related to epidemiologic patterns of resistance to cotrimoxazole from potential pathogens in the population under study. More recently, the quinolones, which are well tolerated and inhibit most Enterobacteriaceae, have been associated with the virtual eradication of Gram-negative infections in neutropenic patients. These results are paralleled by an increase in the frequency of Gram-positive infections, for which the mortality rate is fortunately much lower than that seen in Gram-negative sepsis. In addition, quinolone antibiotics are absorbed systematically and this might help to explain their efficacy as chemoprophylaxis during neutropenia. Synergy, as demonstrated in vitro, and adequate bactericidal activity in the serum both correlate with improved clinical effectiveness in severe infections that occur during granulocytopenia. Whereas empiric antimicrobial therapy in febrile granulocytopenic cancer patients has become accepted medical practice, controversy still remains as to the optimal therapeutic regimen that should be used.
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PMID:A review of chemoprophylaxis and therapy of bacterial infections in neutropenic patients. 268 21


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