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

Freedom from infection is the result of many tiers of immune defenses that harmoniously interact to rid the body of microorganisms and their products, which are perceived as foreign. The ability to distinguish self from nonself is embodied in lymphocytes, which serve both effector and regulatory functions. Through the elaboration of cytokines and immunoglobulins, lymphocytes recruit nonspecific immune effectors, focus their activity, and modulate the intensity of the immune response. The phylogenetically more primitive complement system serves a similar function. Although congenital defects in immune function occur, by far the most common causes of immunodeficiency are acquired and occur in patients treated for cancer with myelosuppressive, cytolytic drugs and in transplant recipients treated with immunosuppressants. HIV infection and malnutrition are responsible for even larger numbers of immunocompromised patients worldwide. The nature and severity of infections that occur as a result of immunodeficiency vary as a function of the immune effector targeted and the degree to which it is dysfunctional. Granulocytopenia is well tolerated unless the absolute number of circulating cells falls below 500/mm3. Profound granulocytopenia and deficits of neutrophil function are often manifest as bacterial or fungal infections. Complement deficiency predisposes to infection with encapsulated bacteria such as pneumococci, meningococci, and Haemophilus influenzae. T cells play such a central role in the immune response that their derangement is associated with susceptibility to almost any potential pathogen. These patients often succumb to mortal opportunistic infections. Recent advances in hybridoma and recombinant DNA technology have provided us with immunologic reagents that enable us to manipulate the immune response. Anti-CD3 monoclonal antibody has permitted salvage of solid organ transplants in well-defined clinical settings. Monoclonal antibodies against TNF-alpha and lipopolysaccharide may alter the consequences of gram-negative sepsis. Alternatively, recombinant cytokines have been associated with clinically significant tumor regression in selected patients, presumably by enhancing the nascent antitumor immune response. The development of immunologic reagents such as these in concert with our growing understanding of the immune system may translate to improved care for immunocompromised patients.
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PMID:Immune function and dysfunction. A primer for the radiologist. 157 Mar 93

In a prospective study, we analysed the anorectal lesions observed in 148 human immunodeficiency virus-infected patients and compared the data with those reported in the literature. The majority of the patients (97.3%) were homosexual or bisexual men. The mean age of the population was 34.2 years. A history of previous sexually transmitted diseases was found in 79.7% of the male patients. The stage of HIV-related disease, according to the Centers for Disease Control classification, could be determined in 141 patients: 54.6% were stage II, 3.5% stage III and 41.8% stage IV. Anal condylomata were the most frequent manifestation, affecting 29.7% of the patients, 7.1% of whom showed moderate to severe dysplasia. The types were mainly 6, 11, 16 and 18, but types 31, 35 and 39 were also observed. Ulcerations were the most frequent non-condylomatous lesions, occurring in 41 patients; most (60%) were due to herpes viruses, and a large minority (21%) to cytomegalovirus. The etiology could not be determined in five cases. Anal sepsis was present in 11.4%, haemorrhoidal disease in 16.8% and fissures in 6%. Six patients developed Kaposi's sarcoma and seven, non-Hodgkin's lymphoma. No anal cancers were observed. Finally, wound healing was slowed in the patients operated on for haemorrhoids, fissures and suppuration. No statistical analysis could be performed because of the small number of patients.
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PMID:Anorectal lesions in human immunodeficiency virus-infected patients. 158 21

Immunological implications are important in every surgical operation, specially when it is necessary to remove the spleen. She plays an important role in immunological aspecific (filter, phagocytosis) and specific processes (production of IgM and regulation of T- and B-lymphocytic system). Splenectomy causes an immunodeficiency with frequent post-operative complications (the most important is OPSI). Each operated patient is considered generically immunodeficient because surgical trauma and anesthesiologic practice are at the base of immunological alterations (biological barriers, aspecific immunity, A.P.P., complement, specific immunity, NK cells). It's indispensable to know pathological situations that make "critical" the immunological state: caloric-proteic malnutrition, elderly (greater than 70 years old), immunosuppressive therapy, sepsis, shock, neoplasms. I. e.: a patient about seventy years old presents a reduced endocrine secretion of thymic hormone and, probably, a low synthesis of immunoglobulins. Besides the corticosteroids modify the answer of T-lymphocytes and NK cells. Sepsis induces metabolic and immunological alterations after early activation of humoral mediators, modified quantity and life of A.P.P., activation of complement, inhibition of cell-mediate immunity, modification of number and activity of haematic lymphocytes. Trauma induces a hypersecretion of corticosteroid, adrenalin, noradrenaline, glucagon with consequent hypercatabolism that causes malnutrition. The hormonal hypersecretion is a determining factor of reduced phagocytic activity (inhibited migration of neutrophils and monocytes), quantitative and qualitative alterations of complement, deficit of T-cells, hyporeactivity to skin test, depressed answer of antibodies to bacterial and viral antigens. Progressive neoplasms are characterized by modification of T-lymphocytes number, depressed macrophagic activity, hyporeactivity to skin tests.
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PMID:[Immunological implications of surgical intervention in critical and noncritical patients]. 175 43

The Wiskott-Aldrich Syndrome (WAS) is a rare X-linked immunohematological disorder characterized by eczema, profound thrombocytopenia, and progressive immunodeficiency. Severe hemorrhage, overwhelming sepsis, or lymphoreticular malignancy usually cause death in childhood. Recently, bone marrow transplantation (BMT) has been curative in some well-established cases, but there is no general agreement about the place of BMT in infants with WAS before the development of significant immunological abnormalities. We describe the successful use of early histocompatible BMT in a 10-month-old infant in whom WAS was diagnosed on the basis of eczema, thrombocytopenia, small platelets, and raised serum immunoglobulin A (Ig) and IgE, but before the development of immunodeficiency as evidenced clinically by recurrent infections, or immunologically by low serum IgM or consistently abnormal lymphocyte responses to mitogens. After an unstable period for several weeks posttransplantation when he developed marked hepatomegaly and severe interstitial pneumonitis, he made a good recovery. His eczema and thrombocytopenia resolved and he has shown no clinical or laboratory evidence of immunodeficiency. It is now over 2 years since his BMT. Because of the poor prognosis of WAS, where a histocompatible donor is available, BMT at the earliest opportunity, despite the inherent risks of such a procedure, may be the best option for an infant with WAS.
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PMID:Early bone marrow transplantation in an infant with Wiskott-Aldrich syndrome. 179 57

The influence of Staphylococcus alpha-toxin has been investigated on the duration of S-phase of lymphocyte mitotic cycle and on DNA replication in human fibroblasts in vitro. The duration of the S-phase of lymphocytes was measured by counting labeled metaphases and by making replication curves. Alpha-toxin in a dose of 3 micrograms/ml enhances the onset of S-phase, which is inhibited at a dose of 33 micrograms/ml of alpha-toxin. The action of alpha-toxin resulted in a decreased rate of replication fork and in a progressive activation of replicon groups. This effect was most prominent at 33 micrograms/ml of alpha-toxin. The data obtained allow to suggest that immunodeficiency of the second order, so characteristic of the staphylococcal sepsis, may be due, in many respects, to suppression of DNA replication.
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PMID:[The effect of staphylococcal alpha-toxin on DNA replication in human cells]. 182 1

The paper outlines early childhood sepsis as a systemic infectious disease acyclically proceeding in the presence of alterations in the body reactivity, analyzes the autopsy specimens obtained from over 200 infants who died from various sepsis types in the period of 1965-1989, describes the morphofunctional features of sepsis in infants, and yields a concept that immunodeficiency contributes to the disease.
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PMID:[Morphology of sepsis in young children]. 183 Sep 94

Cytomegalovirus (CMV) retinitis is the most common cause of blindness in patients infected with human immunodeficiency virus (HIV). Ganciclovir, a guanosine nucleoside, has been found to be effective in the short-term treatment of CMV retinitis and in the delay of progression to recurrence of the disease. However, ganciclovir has no intrinsic activity against HIV, and patients with the acquired immune deficiency syndrome often require treatment with zidovudine, the only currently approved therapy for HIV infection. Both agents have been associated with dose-limiting granulocytopenia in such patients, and death from sepsis in the setting of profound decreases in absolute granulocyte counts has been reported. However, recent investigation suggests that with careful patient selection and monitoring, relatively safe concomitant therapy may be possible. This article reviews the toxicity issues that influence the decision to employ concomitant therapy with ganciclovir and zidovudine. An approach to dosing ganciclovir, including a schema for modifying or interrupting the zidovudine dosage based on hematologic status, is also presented. A prospective study is presently under way to determine whether combined therapy in selected patients leads to prolonged survival and a decreased incidence of recurrence of active CMV retinitis.
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PMID:Concomitant ganciclovir and zidovudine treatment for cytomegalovirus retinitis in patients with HIV infection: an approach to treatment. 184 17

Five patients with AIDS and Listeria monocytogenes infection (three cases of bacteremia and two of meningitis) are reviewed. Four patients had prior or concurrent gastrointestinal illness. Two patients received corticosteroids. A 7- to 21-day course of ampicillin was administered with or without a 7- to 14-day course of gentamicin. This regimen was effective, with no evidence of relapse 7-8 months after therapy was discontinued. The relative infrequency of infection with L. monocytogenes in AIDS patients is unexpected. Tumor necrosis factor (TNF) appears to be essential in the inhibition of Listeria in vivo. Elevated levels of TNF in AIDS patients may be protective against listeriosis and thus help explain the low prevalence of listerial infection in this population. Nonetheless, although L. monocytogenes is an uncommon cause of illness in patients infected with the human immunodeficiency virus, it cannot be dismissed as a cause of undefined meningitis or sepsis.
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PMID:Listeria monocytogenes infections in patients with AIDS: report of five cases and review. 186 44

This working party was convened by the organizers of the World Congresses of Gastroenterology, Sydney 1990. Its remit was to produce a report on disinfection in endoscopy. Endoscopy plays an essential role in the management of gastrointestinal disorders; its benefits far outweigh the occasional complications which arise. Nevertheless, case reports and surveys performed over a 20-year period confirm that endoscopic procedures do occasionally cause cross-infection and the current epidemic with human immunodeficiency virus (HIV) has highlighted the potential for more serious disease transmission if suitable precautionary measures are not generally applied in endoscopy practice. Contaminated equipment may cause infection in three ways: transmission of pathogenic organisms from one patient to another, the commonest example being Salmonellosis; transmission of infection such as hepatitis B (HBV) from patient to staff by needle-stick injury; and introduction of opportunistic organisms which colonize endoscopic and ancillary equipment on storage. This may cause focal sepsis or septicaemia, particularly in the immunocompromised, or cholangitis and pancreatic sepsis following endoscopic retrograde cholangiopancreatography (ERCP). These risks can be eliminated by the use of effective cleaning and disinfection techniques, by providing suitable staff training and by paying attention to endoscopy room procedures. Both HBV and HIV are inactivated by all currently accepted disinfecting or sterilizing procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Disinfection and endoscopy: summary and recommendations. Working party report to the World Congresses of Gastroenterology, Sydney 1990. 188 72

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient-months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter-related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies.
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PMID:Risks and benefits of home parenteral nutrition in the acquired immunodeficiency syndrome. 190 Nov 11


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