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

This is a retrospective review of four patients in whom a pattern of growth disturbance of the proximal femur with the bony bridge developed. They were born prematurely with low birth weight at birth and they had a suspicious sepsis, but they did not have any signs of localized infection. All presented with a progressive gait disturbance and a leg-length discrepancy. Radiographs showed an anterior tilting of the capital femoral epiphysis. Computed tomography and magnetic resonance imaging showed partial physeal closure with bony bridges. This case series suggests an association between neonatal sepsis of prematurity and growth disturbance of the proximal femur.
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PMID:Lateral growth disturbance of the proximal femur in premature infants who had neonatal sepsis. 1660 85

Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.
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PMID:Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents. 1721 45

We report a case of fulminant massive hemolysis due to Clostridium perfringens septicemia in an elderly patient with non-systematic or local predisposing disorder. The patient presented with atypical symptoms but the progress of the disease was extremely rapid and he died almost 3h after his hospital admission. A focal infection or a possible portal of bacterial access was not found.
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PMID:Fatal massive hemolysis as the first manifestation of Clostridium perfringens septicemia in a patient with non-systematic or local predisposing disorder. 1722 73

Through a literature review, the epidemiology and pathophysiology, including alterations in inflammation, coagulation, and impaired fibrinolysis that occur in the course of severe sepsis, is presented. Treatment guidelines that are evidence-based and endorsed by 11 professional societies representing multispecialty groups are described. Severe sepsis is common; 750,000 cases are estimated to occur annually in the United States. The mortality rate for severe sepsis still ranges from 30 to 50%, and is as high as 80 to 90% for septic shock and multiple organ dysfunction. Severe sepsis exists along a continuum initiated by a localized infection that triggers a systemic response. A cascade of inflammation and activation of the coagulation system associated with impaired fibrinolysis leads to alterations in microvascular circulation associated with organ dysfunction, severe sepsis, multiple organ dysfunction syndrome, and death. In an attempt to improve care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement (IHI) have created two sepsis treatment bundles.
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PMID:Recognizing and managing severe sepsis: a common and deadly threat. 1759 13

The Staphylococcus aureus cell surface protein clumping factor A (ClfA) and the enzyme sortase A (SrtA), which attach surface proteins to the cell wall, have both been shown to be virulence factors in models of septic arthritis and sepsis. The mRNA levels of clfA, srtA and the putative housekeeping gene gyrase B (gyrB) in S. aureus were determined using real-time PCR during the course of sepsis/septic arthritis. Expression was measured in joints, being a target of localized infection, and in kidneys, representing a systemic compartment. In infected kidneys, the mRNA levels of clfA, srtA and gyrB were all decreasing over time, from day 3 of infection to day 14. The transcript numbers of clfA and srtA decreased faster in septic mice than in mice with a non-septic disease. The mRNA levels of clfA and gyrB in joints, though, were increasing during the course of infection. These differences suggest that the specific tissue environment is decisive for the differentiation of staphylococci. Also, there was a negative relationship between bacterial load in a tissue and the numbers of clfA, srtA and gyrB transcripts per colony-forming unit. Possibly enters the majority of bacteria a metabolically dormant steady state at high bacterial loads.
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PMID:In vivo sortase A and clumping factor A mRNA expression during Staphylococcus aureus infection. 1789 45

Melioidosis is an infection caused by Burkholderia pseudomallei that usually involves the respiratory tract. It may manifest as pneumonia, septicemia, or localized infection. We present here a case of melioidosis initially manifesting as a mass over the supraclavicular area and subsequently progressing to necrotizing fasciitis. With appropriate antimicrobial treatment and adequate surgical debridement, localized melioidosis can be treated successfully. Melioidosis should be considered in the differential diagnosis of neck masses, especially in patients who have traveled to or stayed in an endemic area.
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PMID:Melioidotic necrotizing fasciitis presenting as a supraclavicular mass. 1836 10

Markers of inflammation, coagulation, and fibrinolysis predict an adverse outcome in patients with sepsis. These markers also seem predictive of an adverse outcome in patients with localized infection and inflammation, such as in acute lung injury. Whether this is entirely related to the disease or is also due to ventilation strategies that may be harmful for the lungs, however, is not clear. In the present issue of Critical Care, McClintock and colleagues demonstrate that these biomarkers retain their predictive effect even if lung-protective ventilation strategies are applied. Besides being biomarkers that predict outcome in patients with acute lung injury, their activation of inflammation and coagulation seems also to play a pivotal role in the pathogenesis of acute lung injury, and may thereby represent an interesting novel target for therapeutic intervention.
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PMID:The inflammation-coagulation axis as an important intermediate pathway in acute lung injury. 1835 78

Despite impressive advances in biomedical research, few noteworthy breakthroughs have been made in the treatment of sepsis during the past several decades. This stalemate is primarily due to the intricate and heterogenic nature of the systemic immune responses characterized as the sepsis syndrome. In general, such complexity must be approached with in vivo models. Several animal models have been described, suggesting that none adequately address all of the pressing needs in sepsis research. The most clinically applicable models involve a localized infection, such as surgically induced polymicrobial sepsis, that gradually propagates a systemic immune response. Because relevant models must mimic a severe and chronic syndrome, animal well-being is often a concern in sepsis research. A balance between the needs of sepsis research and animal welfare can only be achieved through knowledge of the strengths and weaknesses of and alternatives to in vivo sepsis models.
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PMID:Modeling sepsis in the laboratory: merging sound science with animal well-being. 1852 69

Chromobacterium violaceum infection in humans is a rare tropical and subtropical disease. The awareness of this organism is limited in spite its ubiquitous distribution. Several cases have been reported from Southeast Asia. A localized infection followed by an overwhelming septicemia and metastatic lesions is the usual pattern of this illness. Optimal antimicrobial treatment and duration are unknown. Consequently, the outcome is usually fatal. The study reported two patients who suffered from fulminant Chromobacterium violaceum sepsis with disseminated infection, and reviews the literature for cases reported from Southeast Asia.
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PMID:Human Chromobacterium violaceum infection in Southeast Asia: case reports and literature review. 1856 84

Phagocytes of the reticuloendothelial system are important in clearing systemic infection; however, the role of the reticuloendothelial system in the response to localized infection is not well-documented. The major goals of this study were to investigate the roles of phagocytes in the reticuloendothelial system in terms of bacterial clearance and inflammatory modulation in sepsis caused by Pseudomonas pneumonia. Macrophages in liver and spleen were depleted by administering liposome encapsulated dichloromethylene diphosphonate (clodronate) intravenously 36 h before the instillation of Pseudomonas aeruginosa into the lungs of anesthetized rabbits. Blood samples were analyzed for bacteria and cytokine concentrations. Lung injury was assessed by the bidirectional flux of albumin and by wet-to-dry weight ratios. Blood pressure and cardiac outputs decreased more rapidly and bacteremia occurred earlier in the clodronate-treated rabbits compared with the nondepleted rabbits. Plasma TNF-alpha (1.08 +/- 0.54 vs. 0.08 +/- 0.02 ng/ml) and IL-8 (6.8 +/- 1.5 vs. 0.0 +/- 0.0 ng/ml) were higher in the depleted rabbits. The concentration of IL-10 in liver of the macrophage-depleted rabbits was significantly lower than in normal rabbits at 5 h. Treatment of macrophage-depleted rabbits with intravenous IL-10 reduced plasma proinflammatory cytokine concentrations and reduced the decline in blood pressure and cardiac output. These results show that macrophages in the reticuloendothelial system have critical roles in controlling systemic bacteremia and reducing systemic inflammation, thereby limiting the systemic effects of a severe pulmonary bacterial infection.
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PMID:Depletion of phagocytes in the reticuloendothelial system causes increased inflammation and mortality in rabbits with Pseudomonas aeruginosa pneumonia. 1902 78


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