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

We present a patient with Posterior Reversible Encephalopathy Syndrome (PRES). A 74-year-old woman was admitted with sepsis, which originated from erysipelas on her neck the following day. She developed respiratory obstruction due to oedema, septic shock, disseminated intravascular coagulation (DIC), acute renal failure and atrial fibrillation. She responded well to treatment and improved rapidly, despite of her serious condition. When she had almost fully recovered after 15 days, her general condition worsened, and she developed confusion, blindness and pareses. MRI showed vasogenic oedema in the parietooccipital regions of the brain and in the cerebellum, consistent with PRES. PRES is a clinical and radiological diagnosis consisting of headache, confusion, cortical blindness, convulsions and sometimes pareses. MRI of the cerebrum with diffusion-weighted imaging (DWI) and Apparent Diffusion Coefficient (ADC) map are decisive to the diagnosis, and usually shows a characteristic bilateral vasogenic oedema in the parietooccipital region. This can distinguish PRES from brain infarction, which shows a cytotoxic oedema on MRI. We discuss our patient in the light of different conditions leading to PRES, possible pathophysiological factors and treatment options.
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PMID:[An old woman with sudden pareses and blindness]. 1735 25

Erysipelas is an acute superficial cutaneous cellulitis that commonly occurs not only in elderly and immunocompromised persons, but also in neonates and small children subsequent to bacterial inoculation through a break in the skin barrier. Group A Beta-hemolytic streptococcus (GABHS, Streptoccocus pyogenes) is the usual etiologic agent. Factors that predispose pediatric patients to the development of erysipelas include very young age, diabetes mellitus, an immunocompromised state, and nephrotic syndrome. Patients typically have a well-demarcated, erythematous, indurated, rapidly spreading patch with a palpable advancing border on the face or extremities. Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. However, potential complications include abscess formation, necrotizing fasciitis, septicemia, recurrent infection, and lymphedema.
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PMID:Erysipelas: a common potentially dangerous infection. 1799 73

The severity of streptococcal infections depends upon different virulence of individual strains of its causative agent. The most important species are beta-haemolytic group A streptococci (GAS). Clinical manifestations include skin affections, respiratory tract infections and, in particular, serious systemic invasive infections. The pathogenicity of GAS is derived from cell wall components and extracellular products, especially toxins with properties of the so-called superantigens. Less invasive forms of the disease are include necrotizing fasciitis, myositis, pneumonia, sepsis without focus, arthritis, meningitis, puerperal sepsis, streptococcal toxic shock syndrome (STSS) and severe course of erysipelas and cellulitis with blood culture positive for GAS. In most cases, soft tissue infections dominate, often accompanied by chronic diseases of lower extremities in elderly patients. The other clinical forms are rather rare. In children, the condition is clearly frequently related to chickenpox. The generally accepted therapeutic management comprises comprehensive intensive care, early administration of penicillin in combination with clindamycin, and surgical intervention. The use of intravenous immunoglobulins (IVIG), elimination methods and hyperbaric oxygen are under discussion. The slight increase in cases and ineffective prevention require rapid assessment of diagnosis and adequate treatment as a protracted course of the condition is connected with a high mortality rate.
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PMID:[Invasive streptococcal infections]. 1832 May

Erysipelothrix rhusiopathiae causes erysipelas in swine and is considered a reemerging disease contributing substantially to economic losses in the swine industry. Since an attenuated live vaccine was commercialized in 1974 in Japan, outbreaks of acute septicemia or subacute urticaria of erysipelas have decreased dramatically. In contrast, a chronic form of erysipelas found during meat inspections in slaughterhouses has been increasing. In this study, a new strain-typing method was developed based on nucleotide sequencing of a hypervariable region in the surface protective antigen (spaA) gene for discrimination of the live vaccine strain from field isolates. Sixteen strains isolated from arthritic lesions found in slaughtered pigs were segregated into 4 major patterns: 1) identical nucleotide sequence with the vaccine strain: 3 isolates; 2) 1 nucleotide substitution (C to A) at position 555: 5 isolates; 3) 1 nucleotide substitution at various positions: 5 isolates; and 4) 2 nucleotide substitutions: 3 isolates. Isolates with the same nucleotide sequence as the vaccine strain were further characterized by other properties, including the mouse pathogenicity test. One strain isolated from pigs on a farm where the live vaccine had been used was found to be closely related to the vaccine strain. The phylogenetic tree constructed based on the spaA sequence suggests that the evolutionary distance of the isolates is related to the pathogenicity in mice. The new strain-typing system based on nucleotide sequencing of the spaA region is useful to discriminate the vaccine strain from field isolates.
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PMID:Differentiation of Erysipelothrix rhusiopathiae strains by nucleotide sequence analysis of a hypervariable region in the spaA gene: discrimination of a live vaccine strain from field isolates. 1846 Jun 22

In ancient India and Persia surgeons were highly respected and their operating skill with nose plastic and catatact couching is documented. In mediaeval Europe surgery was classified as a handicraft profession and belonged to the barbers guild with the soapcup as symbol, much inferior to the academic trained medical doctors. In war surgery leg amputation after shotwounds demanded great rapidity, since no anestetic but alcohol was available. In the 18th century surgeons becamea accepted as medical doctors e.g. John Hunter in London and OlofAcrel in Stockholm. A great step in the development of surgery was Mortons introduction of eter narcosis 1846. Now surgeons could work carefully without hurry. The next step took Joseph Lister. Born in 1827 he studied medicine in London and then qualified as surgeon at the famous James Syme's clinic in Edinburgh- In 1860 he became professor of surgery in Glasgow. His clinic like all others was afflicted with suppuration, septicemia, erysipelas and gangrene. He happened to read a thesis by Louis Pasteur, who proved that fermentation and putrefaction in wine production were caused by bacteria. Lister saw the similarity with wound suppuration. Carbolic acid was used in wood industri to prevent putrefaction and Lister now introduced this as a mean to cure or prevent suppuration and septicemia. He washed the wound and soaked the bandage with carbolic acid, which he also sprayed in the air of the operation theatre to prevent air carried infection. In 1867 he published his experiences in the Lancet: Out of 11 complicated fractures (where the bone-ends penetrated the skin) 9 healed without complications. Earlier such fractures ended with dead or amputation. The wards were now free from infected wounds. Abroad Listers findings were received with entusiasm, Ernst von Bergmann i Berlin modified the antiseptic method into a aseptic one and sterilized the room, the instruments and clothes and could so avoid the carbolic acid spray, which was irritating for the surgeons breath. Lister applied the aseptic method from 1887. Abdominal and thoracic surgery now became possible and developed rapidly. In England his ideas were accepted with some delay. In 1877 he was appointed professor in London, was made a peer and president of the Royal Society nad was celebrated all over the world. He died 1912, 85 years old.
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PMID:[The birth of modern surgery]. 1854 47

This study examines the diversity of superantigen gene profiles between and within emm-genotypes of 92 clinical group A streptococcal isolates (30 STSS, 24 sepsis, 25 erysipelas, and 12 tonsillitis) collected in Sweden between 1986 and 2001. The emm-genotype and the distribution of smeZ, speG, speJ, speA, speC, speH, speI, speK/L, speL/M, speM, and ssa genes, and the smeZ allelic variant were determined using PCR and DNA sequencing. Forty-five emm1 isolates revealed 10 superantigen gene profiles. One profile dominated and was identified in 22 isolates collected over 14 years. The results indicate that a selective advantage maintained this genotype in circulation. The superantigen content among the emm1 isolates ranged from three to seven, with smeZ-1, speG, and speA present in all but one profile. The 47 isolates of 27 other emm-genotypes exhibited 29 superantigen gene profiles. Thus, the distribution of superantigen genes was highly variable within isolates regardless of emm-genotype. Two novel emm1 subtypes and 14 novel smeZ allelic variants were identified. The 22 smeZ alleles were generally linked to the emm-genotype. The results of the investigation show that superantigen gene profiling is useful for tracking spread of clones in the community.
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PMID:Superantigen gene profile diversity among clinical group A streptococcal isolates. 1875 83

We investigated 66 Erysipelothrix rhusiopathiae strains isolated from pigs affected with swine erysipelas in Japan from 1994 to 2001 for serotype, pathogenicity towards mice, protection in vaccinated mice and antimicrobial susceptibility. Most of the isolates (84.8%) were serotype 1 or 2. For the first time, strains belonging to serotype 21 were isolated from cases of septicemia. Fifty isolates (75.8%) were highly virulent, 12 isolates (18.2%) were weakly virulent and 4 isolates were avirulent strains. All the mice vaccinated with the Koganei 65-0.15 vaccine strain survived challenge exposure with 50 highly virulent isolates. Six isolates (9.1%) grew on TPB-T80 agar containing 0.02% of acriflavine, and this was identical to the growth of the vaccine strain. Forty-seven isolates (71.2%) were resistant to oxytetracycline. The number of strains resistant to oxytetracycline among field isolates increased rapidly each year. Tylosin-resistant strains were also isolated (6.1%). These results suggest that certain characteristics, particularly antimicrobial susceptibility of E. rhusiopathiae isolates, change yearly in the field. Therefore, further investigation of the characteristics of E. rhusiopathiae field isolates is necessary.
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PMID:Etiological and biological characteristics of Erysipelothrix rhusiopathiae isolated between 1994 and 2001 from pigs with swine erysipelas in Japan. 1957 75

In the United States organisms, which culturally are mouse septicemia or swine erysipelas bacilli, have been isolated from the tonsils of five of sixteen pigs examined. These pigs all had hog-cholera, but it is probable that the bacilli were in the tonsils before they were infected with hog-cholera, and there is no evidence that they played any part in the disease. The distribution of the infection seemed to be restricted as most of the pigs from which the bacilli were obtained came from one litter. As we do not have clinical rotlauf, or swine erysipelas, in this country, as these organisms, in Europe, have been found in a large percentage of apparently normal swine, and as the disease is produced with difficulty by the injection of cultures, the question may be raised whether they are not secondary invaders rather than the primary cause of the disease with which they have been associated, or else whether the resistance of swine on the European continent does not differ from that of our breeds as a result of differences in foods. It is possible that the mouse septicemia bacilli found in this country may differ culturally from those present in animals with swine erysipelas. With this in mind, the carbohydrate reactions, as well as other cultural characters not necessary for the identification of the bacilli isolated, have been studied. The disease produced by the injection of these bacilli into mice and pigeons has been studied and shown to be largely an intracellular process. The organisms are taken up by the endothelial cells lining the veins and capillaries; there they multiply and soon kill the cells. It has also been shown that the only type of cell in the blood stream which contains bacteria is the endothelial leucocyte, and the probabilities are that the free phagocytes have been detached from the lining of the vessels. The disease is acute, and the indications are that in the cells the bacilli find a favorable medium for their growth. While phagocytosis may in general be an immune reaction, in this case it appears to favor the parasite rather than the host.
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PMID:STUDIES ON BACILLUS MURISEPTICUS, OR THE ROTLAUF BACILLUS, ISOLATED FROM SWINE IN THE UNITED STATES. 1986 48

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.
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PMID:Necrotizing fasciitis. 2055 17

A longitudinal study investigated the courses of mortality in commercial free-range organic layer flocks in Denmark. In total, 15 organic egg-producing flocks from 11 farms were randomly selected among 80 farms registered in Denmark. Four farms with confined egg production on deep litter were included for comparison. Flock sizes ranged from 2260 to 5940 layers. The flocks were monitored from introduction to the layer farm until slaughter. Flock mortalities ranged from approximately 2% to 91%, with a mean of 20.8% for organic flocks compared with 7% for confined flocks on deep litter. In total, 4608 layers were submitted for postmortem examination, representing > 40% of all the dead layers in the investigated flocks. Outbreaks of erysipelas (Erysipelothrix rhusiopathiae) and fowl cholera (Pasteurella multocida) were observed in two and three organic flocks, respectively. The mortality rate reached 91% in one organic flock dually affected by erysipelas and fowl cholera. In six organic flocks, outbreaks of blackhead were diagnosed. Concurrent infections of erysipelas and blackhead were diagnosed in one organic flock. Escherichia coli infections in the form of septicemia were identified in all organic flocks. In addition, cannibalism and constipation contributed significantly to the mortality in some organic flocks. In the confined deep litter flocks, E. coli infection, constipation, and cannibalism represented the most common causes of mortality.
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PMID:Causes of mortality in commercial organic layers in Denmark. 2131 46


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