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

Consecutive serum samples from patients with Staphylococcus aureus endocarditis or septicemia or non-S. aureus endocarditis and febrile nonsepticemic controls were tested for antibodies against S. aureus capsular polysaccharide (CP) types 5 and 8 by ELISA. The upper normal antibody levels were defined as the upper 99.5% confidence limits of the values from the febrile controls. All available patient isolates were tested for the presence of CP type 5 or 8 (85% of the isolates expressed either serotype), and all five patients with S. aureus endocarditis had positive antibody levels against the corresponding serotype within the first 10 days of infection. Three other endocarditis patients lacked isolates for CP testing but two of these were positive. Positive antibody levels were found in 0 of 28 septicemia patients, in 1 of 12 non-S. aureus endocarditis patients, and in 3 of 37 febrile controls. Thus, testing for anti-CP 5 or 8 antibodies, especially together with CP serotyping of the patient's isolate, seems to provide important information in the differential diagnosis of endocarditis in patients with S. aureus septicemia.
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PMID:Diagnosing Staphylococcus aureus endocarditis by detecting antibodies against S. aureus capsular polysaccharide types 5 and 8. 199 26

The outcome of 30 consecutive patients with active aortic prosthetic valve endocarditis and root abscesses treated by the technique of homograft aortic root replacement with reimplantation of the coronary arteries is detailed. The principles of this technique are the removal of all abscesses and infected areas likely to drain into the infected mediastinum, excision of infected tissues down to healthy noninfected tissue and replacement with an antibiotic-impregnated homograft aortic root. All patients had evidence of progressive cardiac failure and ongoing sepsis. Mean patient age (+/- SD) at the time of operation was 42 +/- 18 years. The mean number of previous aortic valve replacements per patient was 1.6 +/- 0.7; 14 patients (47%) had undergone greater than or equal to 2 previous replacements. At operation, aortic root abscesses were found in all patients; abscess extension to adjacent structures and partial valve dehiscence had occurred in 23. In-hospital death occurred in 9 (30%) of the 30 patients. The 21 hospital survivors have been followed up for a mean of 66 +/- 42 months (range 9 to 144). Overall, 17 (81%) of the 21 hospital survivors have remained free of major adverse events (recurrence of endocarditis, need for reoperation or death). The results of our study suggest that homograft aortic root replacement should be considered favorably in the treatment of patients with aortic prosthetic valve endocarditis and root abscesses.
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PMID:Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement. 200 19

The authors report 10 cases of spontaneous pyogenic spinal osteomyelitis encountered within a 3-year period. There were six women and four men, ranging in age from 60 to 84 years. Six cases occurred at the thoracic level, three at the lumbar level, and one in the cervical spine. No patient was diabetic, immunocompromised, or receiving steroid therapy, and none had a history of endocarditis or intravenous drug abuse. No patient had undergone previous spinal surgery. There were no instances of coexisting tuberculosis or malignancy. Contemporaneous cases with known predisposing factors have been excluded from this report; however, three patients did have a recent history of somatic infection, one with known sepsis. All 10 patients had been previously misdiagnosed, frequently by neurosurgeons and orthopedists as well as by internists and family practitioners. Three had undergone inappropriate or unnecessary surgical procedures, and two had received inappropriate radiation therapy. Seven cases were caused by Staphylococcus species. Gram-negative bacteria, or anaerobic infections. In the other three, no bacteriological diagnosis was made, secondary to prolonged antibiotic therapy before surgery. Each patient had developed symptomatic neural element compression, spinal instability, or both by the time of their referral. The patients with subcervical pyogenic spinal osteomyelitis underwent transthoracic or retroperitoneal decompression and corpectomy with simultaneous autologous bone grafting, followed by 6 weeks of bed rest and 6 weeks of intravenous broad-spectrum or organism-specific antibiotic therapy. They were then mobilized in orthoses for an additional 6 weeks. In no case were foreign implants employed or further stabilization procedures necessitated. One patient required an additional 6 weeks of antibiotics for recalcitrant Pseudomonas colonization. Despite the patients' advanced age and the extensive surgical procedures, there was no mortality and no neurological morbidity. All patients were asymptomatic or demonstrated objective improvement upon discharge from the hospital. In this subset of patients with spontaneous pyogenic vertebral osteomyelitis, the only predisposing factor was advanced age.
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PMID:Pyogenic osteomyelitis of the spine in the elderly. 179 49

An infection of a young male roe deer caused by Erysipelothrix rhusiopathiae with a pronounced thrombotic endocarditis in the left valves and focal necrosis in the septum of the heart leading to bacterial sepsis is described. Findings of this kind are extremely rare in roe deer. However, they document the wide host range, which is also illustrated by the numerous publications on such infections in other species.
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PMID:[Erysipelas in the roe deer--a case report]. 204 8

Staphylococcus epidermidis is becoming increasingly important as a cause of clinical illness. In the past, its presence in the wound, blood and urine culture was generally dismissed as contamination and went undocumented. However, more recently its pathogenic role is being recognized notably in bacterial endocarditis, postcardiotomy endocarditis, bacteraemia secondary to colonised prosthetic heart valves, postsurgical wound infection and urinary tract infection. The ability of the organism to cause local sepsis in superficial tissues is a matter of debate. A case of pyogenic infection due to multidrug resistant coagulase negative staphylococci is reported here.
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PMID:Pathogenic infection caused by coagulase negative multiple drug resistant Staphylococcus. 205 Oct 34

There have been only a few investigations that have considered renal disease or any disturbance of renal function in the calculation of risk in cardiac surgery. Risks of cardiac surgery have to be considered for renal disease without direct connection to heart disease (e.g., infections of the kidney and of the urinary tract, primary and secondary glomerulonephritis, parenchymal renal disease, and impaired renal function of unknown origin), as well as in renal disease with concomitant influence on heart and kidney (e.g., infective endocarditis, arterial hypertension, systemic disease of heart and kidney such as with diabetes mellitus, disturbance of kidney function or electrolyte balance due to heart failure). In most cases, the problem is solved by therapeutic intervention and postponement of cardiac surgery. A limited or negative operative indication is found with untreatable infection of the kidney or urinary tract, with untreatable nephrotic syndrome, in advanced renal disease with heart transplantation, as well as in case of severe arterial hypertension with possible organ complications, and in advanced diabetes mellitus with ESRD and multiorgan involvement. After cardiac surgery, acute renal failure represents a critically important complication. Primary therapeutic procedures must include prophylaxis of hemodynamic unstable situations, as well as prophylaxis of infectious complications. Cardiac surgery in dialysis patients and post-transplant patients is basically possible and only has a slightly increased risk compared to patients with normal renal function. Seventy-seven dialysis patients were operated (49 aorto-coronary bypass operations, 19 single-valve and multiple-valve replacements, five patients with valve replacement and aorto-coronary bypass, and four other cardiac surgical operations). Only in valve replacement, was mortality significantly higher than in renal healthy persons, the main causes of death being cerebrovascular complications and septicemia.
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PMID:[Extracardiac risk factors in heart surgery--the kidney]. 208 10

A 17-year-old woman with mitral and tricuspid valve prolapse and myxomatous degeneration presented puerperal infection by Staphylococcus aureus with clinical picture of sepsis and multiple septic embolism (right eye, left thumb, spleen, and left calf). She underwent total hysterectomy on the 10th day postdelivery and right eye enucleation on the 16th. Temporary total AV block occurred on the 14th day with temporary external pacing during the next couple of days. Acute endocarditis with acute mitral regurgitation was diagnosed on the 13th day, demanding immediate valve replacement. On the 46th day she developed moderate tricuspid valve regurgitation due to another episode of endocarditis. Final clinical discharge took place on the 62nd day after antibiotic therapy completion.
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PMID:[Staphylococcus aureus endocarditis in a puerperal woman with mitral and tricuspid valve prolapse]. 209 20

Although listeriosis is an uncommon infection in patients with human immunodeficiency virus (HIV) infection, the frequency of listeriosis in New York City has increased because of the increase in the number of HIV-infected patients. The medical records of 30 patients admitted to three medical centers in New York City from 1981 to 1988 with infections due to Listeria monocytogenes were reviewed. Six patients had AIDS, one was seropositive and asymptomatic, and four had risk factors for HIV infection. While the annual number of cases of listeriosis in patients without risk factors for HIV infection was constant, 9 of the 11 patients with AIDS or with risk factors for HIV infection presented with listeriosis between 1985 and 1988, the last half of the survey period. These patients were male homosexuals or intravenous drug abusers, and all but one were black or Hispanic. Manifestations of listeriosis in patients with AIDS or with risk factors for HIV infection included bacteremia without apparent source in seven, meningitis in three, and endocarditis in one, syndromes that were similar to those in patients without risk factors for HIV infection. Ten of 11 patients were treated with penicillin or ampicillin, and 7 were also given an aminoglycoside. All patients responded well to therapy and no relapses were observed. Physicians should include antibiotics effective against L. monocytogenes when treating AIDS patients with meningitis of unknown origin and consider the diagnosis of listeriosis in patients with sepsis of unknown origin.
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PMID:Listeriosis in patients with HIV infection: clinical manifestations and response to therapy. 210 31

Five cases of neonatal infective endocarditis are reported. The mitral, tricuspid and pulmonary valves were involved either alone or in association. The predisposing factors were multiple: umbilical catheter, respiratory distress with assisted ventilation, septicemia, osteoarthritis or gastroenteritis. Only one child had a minor cardiac malformation. The causal organism was a staphylococcus aureus in all cases. All children had disseminated intravascular coagulation and a cardiac murmur. The diagnosis was confirmed by echocardiographic demonstration of bacterial vegetations. Three of the 5 children died despite long-term antibiotic therapy. In one case, a vegetation embolised to the pulmonary artery. In the two cured neonates the vegetations disappeared. These cases illustrate the value of echocardiography which should be performed in all neonates with septicemia or disseminated intravascular coagulation, especially when there is an associated cardiac murmur.
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PMID:[Neonatal infectious endocarditis. Apropos of 5 cases]. 211 75

68 patients presented to the Veterans General Hospital, Taipei with nonenterococcal group D streptococcal septicemia in the years 1985-1987. 36 patients (53%) had nonenterococci as part of a polymicrobial bacteremia. The large intestine was not examined in most patients. Five patients (7%) had associated colonic carcinoma, and 17 patients (25%) had colorectal diseases. Only 7/68 patients (10%) were clinically diagnosed as having infective endocarditis by the doctors in charge. The others were regarded as having septicemia. The charts of these patients were reviewed retrospectively to diagnose infective endocarditis based on strict definitions. One (1%) had definite endocarditis proved at autopsy. 16 patients (24%) had probable endocarditis due to the presence of either a new regurgitant murmur or both a predisposing heart disease and embolic phenomena; 39 (57%) had possible endocarditis based on evidence of having either a predisposing heart disease or embolic phenomena; and only 12 (18%) had no evidence of endocarditis. 27 patients (40%) had at least one predisposing heart disease associated with endocarditis. 51 patients (75%) had at least one lesion suggesting embolic phenomena. 30 patients (44%) had electrocardiographic abnormalities. This high incidence of arrhythmia in nonenterococcal septicemia is of particular interest and could be related to cardiac involvement in some patients. The overall mortality, 62% (42/68), was extremely high in our series, but in those who were clinically diagnosed and treated as infective endocarditis, the mortality was low, 14% (1/7). We suggest all patients with nonenterococcal septicemia associated with either heart disease or lesions of CNS, lung, heart, kidney or limbs suggesting embolic phenomena should be regarded as having possible or probable endocarditis. Treating such patients as having infective endocarditis may reduce the mortality in nonenterococcal septicemia.
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PMID:Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis. 212 42


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