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

Cytomegalovirus (CMV) infection involving the skin in three transplant patients is presented. Patient 1, whose infection apparently was localized only to a cutaneous wound induced by extravasated ionotropic solution, survived. Mixed CMV and Candida infections developed in patient 2 in the cutaneous ulcer. He died of disseminated herpes simplex virus infection in two weeks. Patient 3 had CMV pneumonia and purpuric maculopapular eruption. He died of Pseudomonas sepsis 17 weeks later. Eighteen cases with CMV skin lesions are reported in the English literature. The clinical findings and the outcome of the current and the reported cases are analyzed. All patients were immunocompromised. CMV infection, when detected in the skin, appears to be associated with grave prognosis. Seventeen of 20 patients whose final outcome was recorded died within six months after the onset of CMV skin lesions. The outcome of one case is unknown. The mortality was 85%. The fatal cases had either concurrent disseminated CMV infection or mixed cutaneous or systemic infections. When the infection is localized in the skin wounds, the prognosis seems fairly good. All three such patients survived.
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PMID:Cytomegalovirus infection involving the skin in immunocompromised hosts. A clinicopathologic study. 254 21

Before treatment of 181 patients with bone marrow transplantation (BMT) for leukemia, severe aplastic anemia, or metabolic disorders, the oral condition was examined clinically and roentgenologically. Fifty-three patients (29%) had chronic dental infections (osteitis) that needed treatment before BMT. In 10 of 181 cases (6%), BMT was postponed because of oral infections. Septicemia during the neutropenic phase was caused by oral microorganisms (alpha streptococci) in 24 of 59 (41%) patients with microbiologically proven septicemia. Septicemia with alpha streptococci was associated with graft-versus-host disease prophylaxis with methotrexate and subsequent increased frequency of oral ulcerations. No difference was observed in the frequency of reactivation of latent herpes simplex virus infection between different graft-versus-host disease prophylaxis regimens. Reactivation was more frequent in patients conditioned with total body irradiation than in patients conditioned without total body irradiation. Antiviral prophylaxis, with subsequent decreased frequency of oral herpes simplex reactivation, appeared to contribute to a low frequency of septicemia with alpha streptococci.
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PMID:The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. 259 18

A number of viruses cause acute central nervous system disease. The two major clinical presentations are aseptic meningitis and the less common meningoencephalitis. Clinical virology laboratories are now more widely available than a decade ago; they can be operated on a modest scale and can be tailored to the needs of the patients they serve. Most laboratories can provide diagnostic information on diseases caused by enteroviruses, herpesviruses, and human immunodeficiency virus. Antiviral therapy for herpes simplex virus is now available. By providing a rapid diagnostic test or isolation of the virus or both, the virology laboratory plays a direct role in guiding antiviral therapy for patients with herpes simplex encephalitis. Although there is no specific drug available for enteroviruses, attention needs to be paid to these viruses since they are the most common cause of nonbacterial meningitis and the most common pathogens causing hospitalization for suspected sepsis in young infants in the United States during the warm months of the year. When the virology laboratory maximizes the speed of viral detection or isolation, it can make a significant impact on management of these patients. Early viral diagnosis benefits patients with enteroviral meningitis, most of whom are hospitalized and treated for bacterial sepsis or meningitis or both; these patients have the advantage of early withdrawal of antibiotics and intravenous therapy, early hospital discharge, and avoidance of the risks and costs of unnecessary tests and treatment. Enteroviral infection in young infants also is a risk factor for possible long-term sequelae. For compromised patients, the diagnostic information helps in selecting specific immunoglobulin therapy. Good communication between the physician and the laboratory will result in the most benefit to patients with central nervous system viral infection.
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PMID:Role of the virology laboratory in diagnosis and management of patients with central nervous system disease. 264 21

Total serum IgE levels were followed in 135 bone marrow transplant recipients in order to determine the clinical significance of post-transplant serum IgE monitoring. Patients with IgE levels less than 60 U/ml at the time of bone marrow transplantation (BMT) (59%) experienced at least one IgE peak. Patients with pretransplant IgE levels greater than or equal to 60 U/ml (16%) showed decreasing values following BMT. In 19% of patients, IgE levels were low and did not change up to 3 months after BMT. Increase in IgE levels coincided in time with engraftment (p less than 0.01) and acute graft-versus-host disease (GVHD) (p less than 0.01). Early IgE peaks were also seen in patients without GVHD. Maximal IgE values did not differ during grades II-IV GVHD compared with grades 0-1, but two or more peaks were more common in patients with grades II-IV (p less than 0.001). IgE peaks also appeared in patients receiving T cell-depleted marrow without GVHD. Syngeneic bone marrow recipients had high IgE levels after BMT. Two patients had increasing IgE values following reconditioning and retransplantation, but booster grafts had no effect on IgE levels. IgE levels were not changed during septicemia, herpes simplex virus or cytomegalovirus infections, and chronic GVHD. No linear correlation was found between serum IgE levels and CD4+/CD8+ ratios, percentages, or absolute numbers of either group of cells. It was concluded that serum IgE elevation is found in association with engraftment and acute GVHD, but is mainly caused by the conditioning treatment.
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PMID:Serum IgE levels after bone marrow transplantation. 265 11

Cyclosporin (CYA) is now recognized as an effective immunosuppressant to lead to a marked improvement in graft survival in organ transplant recipients. Although the incidence of infection in the CYA group has been decreased compared with that in the azathioprine group, infectious diseases in 400 kidney transplant recipients treated with CYA were noted in our single center. Treatment strategy for infectious diseases: Antibiotics and/or gamma-Globulin were administered to all recipients with bacterial infections. Aciclovir was added in recipients with herpes simplex virus (HSV) infection or varicella zoster virus (VZV) infection. Human interferon-beta (HuIFN-beta) was used in recipients who had life-threatening viral infection, especially cytomegalovirus (CMV) pneumonitis. Glycyrrhizin was used for acute hemorrhagic cystitis and nephropathy due to adenovirus (AV). Trimethoprim sulfamethoxazole and/or pentamidine were added in recipients complicated with Pneumocystis carinii (Pc) pneumonitis or in order to prevent Pc pneumonitis. Infectious diseases: One hundred and six recipients had infectious diseases 129 times in this series, seventy-six percent of all infections occurred during the first 4 months after the transplantation. Urinary tract infection (UTI), herpes zoster and pulmonary infection were the most common infectious diseases, occurring in 28.7%, 24.0% and 23.2%, respectively. Septicemia or bacteremia developed in 9 recipients, secondary to UTI in 8 and to surgical wound infection in one. Sixty-one symptomatic viral infections occurred in 57 recipients. A total of 5 recipients (1.3%) died of interstitial pneumonitis. Infectious organisms: Viral and bacterial infections were most common, occurring in 47.3% and 41.9%, respectively. Viral species detected in these recipients with the frequency were HSV 14 times, CMV 9 times, VZV 31 times and AV 7 times. 1) The incidence of viral infections in kidney transplant recipients treated with CYA is relatively high compared to bacterial infections. 2) HuIFN-beta therapy is effective in the treatment of serious opportunistic herpes virus infections, especially CMV pneumonitis. 3) Glycyrrhizin therapy is effective in the treatment of acute hemorrhagic cystitis and nephropathy due to AV and hepatic dysfunction. 4) Aerosolised pentamidine therapy is very useful for prophylaxis of Pc pneumonitis.
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PMID:[Infectious diseases in kidney transplant recipients treated with cyclosporin]. 266 94

We report seven elderly patients with COPD who developed serious infectious complications during prolonged treatment with high doses of corticosteroids. Infections included invasive pulmonary aspergillosis, Herpes simplex stomatitis and esophagitis, cytomegalovirus pneumonia, bacterial sepsis, fungemia and meningitis due to Cryptococcus neoformans. Each of the three patients who developed invasive aspergillus pneumonia died. The efficacy of prolonged therapy with high doses of corticosteroids in patients with COPD is not proven. These cases illustrate the potential for serious infections in patients with COPD treated with corticosteroids.
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PMID:Serious infectious complications of corticosteroid therapy for COPD. 272 Dec 49

'Spontaneous' blood mononuclear cell DNA synthesis was studied in 83 bone marrow transplantation (BMT) recipients and 58 controls. Prior to BMT, patients with chronic myeloid leukemia had increased DNA synthesis, which decreased dramatically after conditioning and transplantation. After engraftment, patients with syngeneic marrow or allogeneic marrow without graft-versus-host disease (GVHD) had increased DNA synthesis compared to healthy controls. However, patients with acute GVHD (AGVHD) had a significantly increased DNA synthesis compared to patients without GVHD (p less than 0.001). DNA synthesis increased with increasing grade of AGVHD. Among patients with severe AGVHD, recipients of HLA-mismatched marrow had higher lymphocyte DNA synthesis at diagnosis of GVHD and maximum values compared to HLA-matched siblings (p less than 0.05). At diagnosis of GVHD, patients who developed grades II-IV GVHD with progressive disease had higher DNA synthesis, 23.9 +/- 4.0 x 10(3) c.p.m. (mean +/- SE) compared to 11.1 +/- 2.7 x 10(3) c.p.m. in patients in whom GVHD resolved (p less than 0.02). DNA synthesis during GVHD was lower in sheep erythrocyte rosette-forming cells (E-RFC) compared to enriched non-E-RFC. Herpes simplex virus, cytomegalovirus, bacterial septicemia and chronic GVHD had no major effect on lymphocyte DNA synthesis in these patients.
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PMID:DNA synthesis in human blood mononuclear cells correlates with severity of acute graft-versus-host disease. 284 39

Herpesvirus infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We prospectively studied 52 patients with severe burn injuries in order to determine the prevalence of viral infections in this group of patients. Serologic testing was done each week to diagnose primary and reactivation infections. Twenty-seven of 52 patients (52%) became infected with either herpes simplex virus (HSV) or cytomegalovirus (CMV) or both. HSV infection was associated with older age, tracheal intubation, facial burn, inhalation injury, length of hospitalization, and the presence of full-thickness burn. CMV infection was associated with duration of hospitalization and full-thickness burn. Transfusion of blood products was not correlated with an increased incidence of primary or reactivation CMV infections. There was a significant correlation between the presence of these viral infections and bacterial sepsis (p less than 0.05). There was no significant association of HSV or CMV infections with mortality.
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PMID:Herpes simplex virus and cytomegalovirus infections in burned patients. 298 25

A case of neonatal Herpes simplex infection is being described, which was diagnosed clinically as well as serologically. It concerns a child, which was born after 35 weeks of gestation. Two days after the delivery the mother showed typically efflorescences of Herpes simplex infection in the abdominal region. On the fifth day after birth the child showed a vesico-bullous exanthema beginning on the head and spreading out on breast and back. On day 14th a serious sepsis-like pattern of the disease with respiratory insufficiency and encephalitic symptoms could be seen. Treatment with Vidarabinphosphat and Acyclovir-Natrium was without definite success. At the age of five months the child showed a pseudobulbar-paralysis with tetra-spasticity. The cranial computer-tomography demonstrated a distinct hydrocephalus e vacuo and the electroencephalography registered only sporadic brain activity.
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PMID:[Herpes simplex infection in the newborn infant]. 298 61

The case was a one year and four months old boy, who had been diagnosed as congenital nephrotic syndrome on the 4th day of life. He died of septicemia from peritonitis. Large pale kidneys, dilated trunk of pulmonary artery, and thickened left atrial endocardium were observed at autopsy. Renal histology seemed to be compatible with congenital nephrotic syndrome of the Finnish type. Viral antigens of herpes simplex type 1 and varicella-zoster in paraffin-embedded sections were proven to be negative. Besides renal change, increased number of pancreatic islets without hypertrophy was noticed.
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PMID:Congenital nephrotic syndrome (Finnish type). 299 30


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