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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sphingolipids and glycosphingolipids are emerging as major players in many facets of cell physiology and pathophysiology. We now present an overview of sphingolipid biochemistry and physiology, followed by a brief presentation of recent advances in translational research related to sphingolipids. In discussing sphingolipid biochemistry, we focus on the structure of sphingolipids, and their biosynthetic pathways--the recent identification of most of the enzymes in this pathway has led to significant advances and better characterization of a number of the biosynthetic steps, and the relationship between them. We then discuss some roles of sphingolipids in cell physiology, particularly those of ceramide and sphingosine-1-phosphate, and mention current views about how these lipids act in signal transduction pathways. We end with a discussion of sphingolipids and glycosphingolipids in the etiology and pathology of a number of diseases, such as cancer, immunity, cystic fibrosis, emphysema, diabetes, and sepsis, areas in which sphingolipids are beginning to take a central position, even though many of the details remain to be elucidated.
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PMID:The metabolism and function of sphingolipids and glycosphingolipids. 1755 66

In cystic fibrosis (CF), infection with Burkholderia cepacia complex (Bcc) strains may cause long-term asymptomatic airway colonization, or severe lung infection leading to rapid pulmonary decline. To assess the virulence of Bcc strains, we established a lung infection model in mice with a null allele of the gene involved in X-linked chronic granulomatous disease (CGD). CGD mice, challenged intratracheally with 10(3) cells of the epidemic Burkholderia cenocepacia strain J2315, died within 3 days from sepsis after bacteria had multiplied to 3.3 x 10(8) cells. Infected mice developed neutrophil-dominated lung abscesses. Other B. cenocepacia strains and a B. cepacia strain were less virulent and one B. multivorans and one B. vietnamensis CF isolate were both avirulent. Bcc mutants, defective in exopolysaccharide synthesis or quorum sensing revealed diminished or no abscess formation and mortality. Immunofluorescence staining of Bcc-infected murine and CF lung tissues revealed colocalization of Bcc and neutrophils, suggesting Bcc persistence within neutrophils in CGD and CF. In vitro, Bcc cells were rapidly killed during aerobic neutrophil phagocytosis; however, the pathogens survived in neutrophils with blocked nicotinamide adenine dinucleotide phosphate oxidase activity and under anaerobic conditions. We conclude that the Bcc infection model in CGD mice is well suited for the assessment of Bcc virulence.
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PMID:Virulence of Burkholderia cepacia complex strains in gp91phox-/- mice. 1762 23

Since 1996, 102 patients with cystic fibrosis were accepted on our waiting list and 57 bilateral sequential lung transplants were performed in 56 patients. Before transplantation, the mean FEV1 was 0.64 l/s, the mean PaO2 with supplemental oxygen was 56 mmHg and the mean 6-min walking test was 320 m. Transplantation was performed through a 'clam shell incision' in the first 29 patients; in the rest of the patients we performed a bilateral anterolateral thoracotomy without sternal division. In 21 patients the donor lungs had to be trimmed by extra-anatomical wedge resections with mechanical staplers and bovine pericardium buttressing to fit the recipient chest size. Hospital mortality was 11.6%. Acute rejection occurred 1.6 times per patient/year; pulmonary infections occurred 1.4 times per patient in the first year after transplantation. The mean FEV1 increased to 82% 1 year after the operation. The 2-year survival rate was 79%. Fifteen patients had BOS: one died 26 months after the operation with fungal sepsis after reinduction of immunosuppression, one has been successfully retransplanted, five were stabilized after modifications of immunosuppression and four are continuing to deteriorate. Lung transplantation is a concrete therapeutic option for patients with cystic fibrosis.
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PMID:Improved results with lung transplantation for cystic fibrosis: a 6-year experience. 1767 Jan 68

Burkholderia cenocepacia is an important pulmonary pathogen in individuals with cystic fibrosis (CF). Infection is often associated with severe pulmonary inflammation, and some patients develop a fatal necrotizing pneumonia and sepsis ('cepacia syndrome'). The mechanisms by which this species causes severe pulmonary inflammation are poorly understood. Here, we demonstrate that B. cenocepacia BC7, a potentially virulent representative of the epidemic ET12 lineage, binds to tumour necrosis factor receptor 1 (TNFR1) and activates TNFR1-related signalling pathway similar to TNF-alpha, a natural ligand for TNFR1. This interaction participates in stimulating a robust IL-8 production from CF airway epithelial cells. In contrast, BC45, a less virulent ET12 representative, and ATCC 25416, an environmental B. cepacia strain, do not bind to TNFR1 and stimulate only minimal IL-8 production from CF cells. Further, TNFR1 expression is increased in CF airway epithelial cells compared with non-CF cells. We also show that B. cenocepacia ET12 strain colocaizes with TNFR1 in vitro and in the lungs of CF patients who died due to infection with B. cenocepacia, ET12 strain. Together, these results suggest that interaction of B. cenocepacia, ET12 strain with TNFR1 may contribute to robust inflammatory responses elicited by this organism.
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PMID:Burkholderia cenocepacia ET12 strain activates TNFR1 signalling in cystic fibrosis airway epithelial cells. 1769 31

Mycobacterium abscessus infection following lung transplantation (LT) has been described in a few cases. It is characterized by a variable initial location and subsequent course in this special risk group of patients, particularly those with cystic fibrosis (CF). Herein we have presented the case of a patient subjected to LT due to CF, who 1 year after transplantation developed a subcutaneous nodule produced by M abscessus, with subsequent hematogenous spread as well as bronchial and bone marrow involvement. Antecedents prior to LT included Staphylococcus aureus colonization and sputum positivity for Aspergillus fumigatus and Scedosporium apioespermum. Treatment with ciprofloxacin and linezolid was started on the basis of the antibiogram findings. The latter antibiotic was replaced by clarithromycin for 6 months. Two years later, the patient remains asymptomatic with respiratory function parameters in the normal range. The infected patient described herein was our only case with sepsis and multisystemic spread. The important mortality among such cases reported in the literature makes early diagnosis and treatment essential.
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PMID:Successful recovery after disseminated infection due to mycobacterium abscessus in a lung transplant patient: subcutaneous nodule as first manifestation--a case report. 1788 5

The historical change in the natural course of diffuse panbronchiolitis (DPB), a fatal disorder of the airways, following the introduction of erythromycin in its treatment has focused attention of researchers on the anti-inflammatory properties of macrolides. Chronic inflammation of the airways accompanied by infiltration by neutrophils and overproduction of mucus and pro-inflammatory cytokines is observed in bronchial asthma, cystic fibrosis (CF), DPB, chronic obstructive pulmonary disease (COPD) and bronchiectasis. The airways of these patients are often colonised by mucoid Pseudomonas aeruginosa attached to epithelium by a biofilm. Bacteria intercommunicate for biofilm formation by a system of lactones known as quorum sensing. Macrolides inhibit mobility and quorum sensing of P. aeruginosa; they also decrease production of mucus by epithelial cells and biosynthesis of pro-inflammatory cytokines from monocytes and epithelial cells by inhibiting nuclear factor-kappaB. Large, randomised clinical trials for the management of these disorders with macrolides are not available, with the sole exception of four trials denoting benefit following long-term administration of azithromycin in patients with CF. That benefit is consistent with an increase in forced expiratory volume in 1s (FEV(1)) and a decrease in the rate of bacterial exacerbations. Studies with small numbers of patients with COPD revealed attenuation of the inflammatory reaction by macrolides. Experimental studies of Gram-negative sepsis have shown considerable attenuation of the systemic inflammatory response following intravenous administration of clarithromycin. Results of the effects of clarithromycin in patients with ventilator-associated pneumonia and sepsis in a large, randomised study of 200 patients are awaited.
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PMID:Macrolides beyond the conventional antimicrobials: a class of potent immunomodulators. 1793 49

Pseudomonas aeruginosa is often involved in the aetiology of numerous infections, particularly those occurring in hospital. The infections in which P. aeruginosa most frequently has a pathogenic role include respiratory tract infections, particularly those occurring in patients with chronic obstructive pulmonary disease (COPD), nosocomial pneumonia, ventilator-associated pneumonia, and cystic fibrosis, as well as those developing in patients with AIDS, bacteraemia, sepsis, urinary tract infections, especially those related to catheterisation or kidney transplants, infections in neutropenic patients, and skin infections, particular those developing in surgical wounds or in burns. Thus, in practice, P. aeruginosa is ubiquitously present in all body districts. Particular attention should also be given to the presence of P. aeruginosa in the community setting, for example when it causes community-acquired pneumonia in the elderly or pneumonia in patients with advanced stage COPD. The mortality rate of patients with severe P. aeruginosa infections is very high. Treatment should be initiated very promptly with the most suitable drug, perhaps making use of combination therapy with a beta-lactam and a fluoroquinolone when indicated, and continued for a sufficiently long period. As far as concerns future therapeutic options for the treatment of P. aeruginosa infections, the only two new molecules that will probably become available are doripenem and ceftobiprole. Given this prospective, trust must be placed in the already known drugs, exploiting them more appropriately.
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PMID:[Strategies for management of difficult to treat Gram-negative infections: focus on Pseudomonas aeruginosa]. 1794 Apr 9

Cystic fibrosis is characterised by chronic bronchopulmonary sepsis. Various therapeutic modalities attempt to enhance the clearance of airway secretions. Dornase alfa (recombinant human deoxyribonuclease) reduces the viscoelasticity of sputum from patients with cystic fibrosis by depolymerising extracellular DNA. The drug is administered as an aerosol using a jet nebuliser at a dosage of 2.5mg once daily. It improves pulmonary function and reduces the risk of respiratory exacerbations requiring parenteral antibacterials. Various clinical trials have demonstrated a heterogeneous response to dornase alfa and have been unable to predict which groups of patients benefit from treatment. Patient selection is further complicated because some individuals do not exhibit improvements in lung function, but benefit in terms of a decrease in infective exacerbations. All patients with cystic fibrosis who produce purulent sputum are potential candidates for dornase alfa therapy. We suggest that compliant patients be considered for treatment with dornase alfa, irrespective of disease severity, but should be closely monitored and be assessed at regular intervals to monitor treatment response.
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PMID:Dornase alfa. 1803 Nov 6

Burkholderia cepacia complex (BCC) bacteria cause pulmonary infections that can evolve into fatal overwhelming septicemia in chronic granulomatous disease or cystic fibrosis patients. Burkholderia cenocepacia and Burkholderia multivorans are responsible for the majority of BCC infections in cystic fibrosis patients, but B. cenocepacia is generally associated with a poorer prognosis than B. multivorans. The present study investigated whether these pathogens could modulate the normal functions of primary human monocyte-derived dendritic cells (DCs), important phagocytic cells that act as critical orchestrators of the immune response. Effects of the bacteria on maturation of DCs were determined using flow cytometry. DCs co-incubated for 24 h with B. cenocepacia, but not B. multivorans, had reduced expression of costimulatory molecules when compared with standard BCC lipopolysaccharide-matured DCs. B. cenocepacia, but not B. multivorans, also induced necrosis in DCs after 24 h, as determined by annexin V and propidium iodide staining. DC necrosis only occurred after phagocytosis of live B. cenocepacia; DCs exposed to heat-killed bacteria, bacterial supernatant or those pre-treated with cytochalasin D then exposed to live bacteria remained viable. The ability of B. cenocepacia to interfere with normal DC maturation and induce necrosis may contribute to its pathogenicity in susceptible hosts.
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PMID:Differential modulation of innate immune cell functions by the Burkholderia cepacia complex: Burkholderia cenocepacia but not Burkholderia multivorans disrupts maturation and induces necrosis in human dendritic cells. 1862 97

Lung transplantation represents the only therapeutic option for patients affected by end-stage cystic fibrosis (CF). We performed 76 lung transplantations in 73 patients from 1996-2007. The mean time on the waiting list was 10+/-6 months. The median follow-up after the transplantation was 69.3 months. Twenty-one transplants (27.6%) were performed under cardiopulmonary bypass. Perioperative mortality, excluding retransplants, was 16.4% (12 patients) and the causes of death were sepsis, primary graft failure, and myocardial infarction. The overall survival was 74.5%+/-5%, 62.9%+/-5%, 54.1%+/-6%, and 43.4%+/-6% at 1, 3, 5, and 10 years, respectively. The accurate selection of potential recipients and the correct timing of referral and transplantation are factors that play crucial roles to obtain satisfactory results in term of improvement of quality of life and long-term survival.
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PMID:Lung transplantation for cystic fibrosis: ten years of experience. 1867 13


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