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

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
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PMID:Shigella septicemia: prevalence, presentation, risk factors, and outcome. 404 31

It is well-known that cirrhosis is a predisposing factor to Yersinia septicemia. This study includes 73 cirrhotics and shows a high number of positive serologic tests (47/73 : 64.4%). However, there is no correlation with clinical features or bacteriological findings. The most frequent serotypes, i.e. pseudotuberculosis IV and enterocolitica 0:9, differ from those which are usually found in Yersinia septicemias. Iron overload in cirrhosis, increased intestinal load of gram-negative bacilli and possible latent bacteremia may partly explain these results. However, the role probably played by as yet poorly known cross-reactions between Yersinia and other pathogens (Shigella, E. Coli...) must be underscored. The authors conclude that slightly positive, stable, serodiagnostic tests have little meaning in cirrhotics.
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PMID:[Serodiagnosis of Yersinia infections in cirrhotic patients. Study apropos of 73 patients]. 631 24

The hemolytic-uremic syndrome (HUS) following dysentery caused by S. dysenteriae Type 1, characterized by microangiopathic hemolytic anemia and acute renal insufficiency, is clinically similar but not identical to the idiopathic HUS. We studied renal necropsy specimens of nine children who died of HUS following shigellosis by light and immunofluorescent microscopy and compared them to 12 controls: six cases with severe shigellosis without HUS, and six with pneumonia or sepsis. Eight of nine HUS cases showed cortical necrosis, extensive glomerular thrombosis or arterial thrombosis. Cases without HUS showed only scattered glomerular fibrin thrombin and widening of the mesangium. Among seven HUS cases studied by immunofluorescent microscopy, three demonstrated deposition of glomerular IgM and complement (C3) and one of the three had IgG and IgA as well; four cases had neither immunoglobulin or complement deposits. Among nine controls, two demonstrated IgM and three IgG, but none had C3. Both HUS and non-HUS cases had fibrin deposition. In the three HUS cases studied by electron microscopy intracapillary material (fibrin and platelets) was seen in all three, and sparse electron-dense deposits in mesangial matrix in one. The data indicate that the renal histopathology in the HUS following shigellosis consistently presents as a severe thrombotic microangiopathy, but lacks the characteristic endothelial and mesangial lesions of idiopathic HUS. The infrequent demonstration of glomerular immunoglobulin deposition fails to support an immunoglobulin-mediated pathogenesis.
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PMID:Renal histopathology in the hemolytic-uremic syndrome following shigellosis. 637 79

Severe digestive complications of acquired immune deficiency syndrome (AIDS) were observed in 9 patients among a group of 17 patients from Zaire treated for AIDS in Belgium between May 1979-April 1983. Among the 9 cases, there were 10 ailments of the upper digestive tract, 7 of intestinal disorders, 3 of hepatic disorders, and 2 of pancreatic disorders. The average age of affected patients was 35 years. 4 men averaged 32 years and 5 women averaged 39 years. Their average stay in Belgium was 8 months. All 9 were anorexic and had lost at least 10 kg over the past year. 6 were pyretic and developed palpable adenopathies. 7 patients had episodic or continuous diarrhea in the early stages of illness and 8 had diarrhea in the later phase. 1 patient had bloody diarrhea. None were homosexual or drug addicted or had histories of transfusions. None was dysphagic. The patients exhibited lymphopenia affecting primarily the helper T lymphocytes. 7 patients had Candida albicans infections of upper digestive tract. 1 patient had an esophageal herpes infection. 4 patients had enterocolitis caused by opportunistic organisms: Cryptosporidium, Isospora Belli, cytomegalovirus, Clostridium Difficile, or Salmonella. 2 patients had septicemia caused by Salmonella and 1 had septicemia caused by Shigella. All 9 patients had at least 1 of the markers of hepatitis B. By April 1984, 8 patients had died and 1 who returned to Zaire had been lost to follow-up. The cause of death of the 3 patients for whom it was known was generally a nondigestive complication. Analysis of stool samples was found to be most useful means of diagnosing digestive complications of AIDS. Systemic infection with cytomegalovirus is very frequent in AIDS. The case in this series was diagnosed after discovery of inclusions in the intestinal mucus after repeated noncontributory analyses of the stools. In cases of enterocolitis, the endoscopic appearance of the mucus is not very specific and colposcopy is less useful than of stool samples. Upper endoscopy is very useful in diagnosis of Candida, which responds well to treatment. Hepatic biopsy and laparoscopy appear to be of limited usefulness, since liver and pancreatic involvement are usually self-limited with slight clinical manifestations. Endoscopic examinations pose the problem of possible contaminatin. The endoscope and all accessories should be systematically disinfected before and after use.
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PMID:[Severe digestive complications of AIDS in a group of patients from Zaire]. 652 66

Campylobacter jejuni was isolated from 135 infants and children seen at the Oklahoma Children's Memorial Hospital over a 3-year period. The comparative frequency of isolation of C. jejuni, Salmonella, and Shigella were 1.5 percent, 2.2 percent, and 3.1 percent, respectively. Campylobacter enteritis was most prevalent during the warm months from May to October, peaking in July. Seventy percent of the afflicted children were 2 years old or younger; only 13 percent were older than 5 years. There were the usual clinical presentations (acute onset of diarrhea, fever, abdominal pain, and bloody stools) of Campylobacter enteritis, but other, less common, patterns also were seen. These included chronic diarrhea without significant systemic manifestations; asymptomatic bloody stools, particularly in neonates; and fever and abdominal pain without diarrhea. Severe complications included hemolytic-uremic syndrome, sepsis associated with septic arthritis and osteomyelitis, and failure to thrive.
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PMID:Campylobacter enteritis. A 3-year experience. 660 93

Thrombocytopenia is characteristically associated with septicemia and hemolytic uremic syndrome (HUS), a subset of which has been shown to be associated with endotoxemia and shigellosis. An experimental model that closely resembles these clinical conditions is the generalized Shwartzman reaction modified with a continuous intravenous infusion of endotoxin for 5 hr in rabbits. In addition to exhibiting the triad of HUS (thrombocytopenia, hemolytic anemia, and azotemia), these animals also had circulating platelet aggregates, leukocytosis, lipidemia, hemoglobinemia, hyperfibrinogenemia, and prolonged partial thromboplastin time. Platelets that remained in circulation were chemically exhausted in serotonin content and functionally impaired in aggregation activities. Plasma from animals during thrombocytopenia and platelet functional deficiency had no effect of the aggregation responses of normal platelets. Although the single triggering event of endotoxin infusion was stopped at hour 5, recovery from abnormalities was only partial on day 2 and within normal limits by day 3. In vitro studies supported platelet exhaustion as a mechanism for decreased platelet function after endotoxin infusion. The presence of circulating platelet aggregates and exhausted platelets suggested that the process of platelet activation took place at as long as 24 hr after the cessation of LPS infusion. Endotoxin and other mechanism(s) are likely to be operative in the pathogenesis leading to platelet activation. Further studies to reveal the mechanism of platelet exhaustion in the experimental model may help our understanding of corresponding events in clinical endotoxic injury and HUS associated with endotoxemia.
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PMID:Impaired and exhausted platelets in modified generalized Shwartzman reaction: an analogue of hemolytic uremic syndrome associated with endotoxemia. 664 55

This survey through the Association of Clinical Pathologists was continued and extended for 1980-81, with the help of the Institute of Medical Laboratory Sciences. Hepatitis maintained a low attack rate of 26/100 000 person-years, including only three cases of hepatitis B probably attributable to laboratory work (attack rate 9). Nineteen cases of tuberculosis (attack rate 56) included 14 of probable occupational origin (attack rate 41) half of which involved post-mortem or mortuary work. Thirteen bacterial infections of the bowel (attack rate 38, predominantly shigellosis) involved almost exclusively microbiology MLSOs, with 10 attributed to laboratory work (attack rate 29). The seven other infections included 4 of occupational sepsis in morbid anatomy and post-mortem workers. There appears to be scope for improvement in bacteriological bench techniques particularly at the faeces bench and for reduction in the hazards of tuberculosis and sepsis for morbid anatomy and mortuary workers.
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PMID:Infections in British clinical laboratories 1980-81. 682 67

Thirty-six patients were operated upon for terminal ileal perforations in a two-year period; four cases were due to trauma, four to ascariasis and 28 to typhoid. Ileal perforations due to ascaris worms are differentiated from typhoid ileal perforations because worms are usually found lying freely in the peritoneal cavity or in close association with the perforations. Also, tests for Salmonellae and Shigella are usually negative. Factors affecting mortality and morbidity in typhoid ileal perforation include the age of the patient, duration of perforation before surgery, presence of additional complications, such as massive rectal bleeding, the extent of the surgery, and the number of perforations present. Chloramphenicol in massive doses is indicated for all these patients. Our experience suggests that the hematoxicity of this drug has been over-rated. Postoperative complications are: wound infection (about 95% of cases), malarial fever, septicemia, fecal fistula, intraabdominal abscess, pulmonary infection, jaundice and transient psychosis.
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PMID:Typhoid perforation: factors affecting mortality and morbidity. 716 Sep 89

It is generally believed that bacteremia rarely occurs with enteric Shigella infections. During a five-year period, 110 children were admitted to the University Hospital of the Arizona Health Sciences Center, Tucson, with Shigella enteritis. Eight (7%) had Shigella bacteremia/septicemia, and four of the eight died. An analysis of these patients and their course disclosed clinical characteristics that were of potential prognostic importance. Some of these indicators are identifiable early and hence could be useful in management. The patients at greatest risk were afebrile; 10% or more dehydrated; malnourished, with a low serum albumin level; infected with ampicillin-resistant strains; had leukopenia during the course of the illness; and had persistent watery hemoglobin-positive stools.
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PMID:Shigella sepsis. 746 48

The epidemiological, clinical, and bacteriological aspects of shigellosis were studied in a population of hospitalized children in northern Israel. During the 6-year period 1987-92, 262 children were hospitalized due to shigella infection. Shigellosis represented 10% of pediatric admissions for diarrhea. Admissions for the disease peaked during the summer and autumn. The median age of the patients was 3 years. Shigella sonnei was isolated in 74% of patients and S. flexneri in 21%, compared with relative frequencies of 87% and 10%, respectively, in the non-hospitalized population of the area, detected during the same period (p < 0.001). Shigella sonnei represented 82% of isolates of hospitalized Jewish patients but only 60% of hospitalized Arab children, many of whom live in poverty and overcrowding (p < 0.001). Shigella flexneri was particularly frequent among hospitalized infants, and was associated with Arab origin, large families and residence in agricultural settlements. Duration of hospitalization was 4.7 +/- 2.3 days for S. sonnei infections and 5.8 +/- 3.6 days for S. flexneri (p < 0.005). No cases of shigella sepsis, hemolytic uremic syndrome, or fatalities were observed. Overall 37% of all shigella isolates from hospitalized children were resistant to ampicillin, 71% to cotrimoxazole, 28% to both and 13% were resistant to > or = 3 different drugs. It is concluded that shigellosis is an important cause of hospitalization in northern Israel. Resistance to antimicrobial drugs is widespread among all Shigella spp. Although S. sonnei is the most common species, S. flexneri is particularly frequent in infants.
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PMID:Epidemiological, clinical and microbiological features of shigellosis among hospitalized children in northern Israel. 766 77


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