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

Severe digestive complications of acquired immune deficiency syndrome (AIDS) were observed in 9 patients among a group of 17 patients from Zaire treated for AIDS in Belgium between May 1979-April 1983. Among the 9 cases, there were 10 ailments of the upper digestive tract, 7 of intestinal disorders, 3 of hepatic disorders, and 2 of pancreatic disorders. The average age of affected patients was 35 years. 4 men averaged 32 years and 5 women averaged 39 years. Their average stay in Belgium was 8 months. All 9 were anorexic and had lost at least 10 kg over the past year. 6 were pyretic and developed palpable adenopathies. 7 patients had episodic or continuous diarrhea in the early stages of illness and 8 had diarrhea in the later phase. 1 patient had bloody diarrhea. None were homosexual or drug addicted or had histories of transfusions. None was dysphagic. The patients exhibited lymphopenia affecting primarily the helper T lymphocytes. 7 patients had Candida albicans infections of upper digestive tract. 1 patient had an esophageal herpes infection. 4 patients had enterocolitis caused by opportunistic organisms: Cryptosporidium, Isospora Belli, cytomegalovirus, Clostridium Difficile, or Salmonella. 2 patients had septicemia caused by Salmonella and 1 had septicemia caused by Shigella. All 9 patients had at least 1 of the markers of hepatitis B. By April 1984, 8 patients had died and 1 who returned to Zaire had been lost to follow-up. The cause of death of the 3 patients for whom it was known was generally a nondigestive complication. Analysis of stool samples was found to be most useful means of diagnosing digestive complications of AIDS. Systemic infection with cytomegalovirus is very frequent in AIDS. The case in this series was diagnosed after discovery of inclusions in the intestinal mucus after repeated noncontributory analyses of the stools. In cases of enterocolitis, the endoscopic appearance of the mucus is not very specific and colposcopy is less useful than of stool samples. Upper endoscopy is very useful in diagnosis of Candida, which responds well to treatment. Hepatic biopsy and laparoscopy appear to be of limited usefulness, since liver and pancreatic involvement are usually self-limited with slight clinical manifestations. Endoscopic examinations pose the problem of possible contaminatin. The endoscope and all accessories should be systematically disinfected before and after use.
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PMID:[Severe digestive complications of AIDS in a group of patients from Zaire]. 652 66

Fourteen infants with clinical and laboratory features of an acquired immunodeficiency syndrome were identified in a single metropolitan area from November 1980 to July 1983. Patients were predominantly of Haitian parentage, although two cases occurred in offspring of non-Haitian intravenous drug abusers. Only one patient had received a blood transfusion before the development of clinical findings. The predominant clinical findings included failure to thrive, persistent infection of the oral mucosa by Candida albicans, chronic pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy, and diarrhea. Immunologic studies showed most of the infants to have inverted ratios of T-cell subsets, greatly increased immunoglobulin levels, and circulating immune complexes. Lymphopenia was not common, as it is in adult patients. Infectious agents responsible for opportunistic infections in this series included Pneumocystis carinii, herpesviruses, particularly cytomegalovirus, and C. albicans. Bacterial infections were common, and gram-negative sepsis was the major cause of death in the seven infants who have died. At autopsy, two infants had disseminated lymphadenopathic Kaposi's sarcoma. These observations suggest the likelihood of transplacental, perinatal, or postnatal transmission of an as yet unidentified infectious agent that causes this disease.
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PMID:Acquired immunodeficiency syndrome in infants. 660 81

The clinical course of 41 previously reported patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) on whom follow-up information has been obtained for five or more years is described. Of the 41 patients, 27 achieved a complete remission (CR). The durations of the CR ranged from two to 214 months, with a median of 48 months. Nine of these 27 complete responders are still alive and well without evidence of disease, whereas the remaining 18 patients have died of pneumonia, septicemia, immunoblastic lymphoma, or unrelated causes. These 27 patients had a significantly longer median survival (51 mos) than did the 14 patients who had partial or no response (9 mos) (P = 0.0006). Only two of these 14 patients who did not initially achieve a CR are alive (survivals, 66 months and 70 months). There was a trend suggesting that patients who received combination chemotherapy which included prednisone had a slightly longer survival than did the remaining patients (P = 0.087). Lymphocytopenia was evident in a higher proportion of dead patients than in those who remained alive (P = 0.089).
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PMID:Angioimmunoblastic lymphadenopathy. Long-term follow-up study. 686 Oct 74

A total of 59 infections were encountered in 29/46 patients with multiple myeloma (MM). Most infections arose in the urinary tract (31%), respiratory tract (29%), followed by blood (12%), oropharynx (12%), skin and soft tissue (7%). Gram-negative bacilli were identified in 51% of infections, most common being Enterobacteriaceae and Haemophilus influenzae. Gram-positive organisms were responsible for 7% of infections. 24% of patients with urinary tract infections had signs of cord compression Absolute lymphopenia was common, and was seen in 65% of patients with urinary infections, 75% of respiratory infections, and 86% of septicemic patients. In contrast, granulocytopenia was mainly observed in patients with septicemia (71%), followed by those with respiratory infections (31%). All patients were on cytotoxic chemotherapy, and most were hypoglobulinemic. About one third of septicemias, and one half of urinary and respiratory infections, respectively, were hospital-acquired. Results indicate that the current pattern of infections in MM seems to favor gram-negative organisms. The role of predisposing factors in the pathogenesis of infections in these patients is discussed.
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PMID:Changing patterns of infections in patients with multiple myeloma. 706 64

In this report, we present a 5 months old male baby, who suffered from watery diarrhea since 4 days old. From then on, he had been admitted 3 times in 3 different hospitals but the symptoms still bothered him off and on. During the days of hospitalization, sepsis with positive blood culture of Klebsiella was noted. The patient expired at 5 months of age. The T cell count was 20% active T was 0. Delayed hypersensitivity skin tests including Candida (10 X), PHA (10 micrograms), PHA (1 microgram), SK/SD (50 units) were negative. The granulocyte function study showed normal. Immunoglobulin analysis revealed IgG: 1320 mg%, IgA: 120 mg%, IgM: 100 mg%. Agenesis of thymus, failure of lymphoid differentiation and abnormal lymphoid architecture with absence of germinal centers were noted at autopsy. Combined immunodeficiency with normal immunoglobulins (Nezelof syndrome) is a disease of primary immunodeficiency characterized by recurrent infections, failure to thrive, lymphopenia, diminished lymphoid tissue, abnormal structure or agenesis of the thymus, and presence of normal or increased levels of one or more of the major immunoglobulin classes, but with impaired antibody synthesis. Since its original description by Nezelof and associates in 1964, it has been reported on the subsequent occasion. In this report, we present our one experience and review the clinical and laboratory data in 33 reported cases.
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PMID:Report of a case of Nezelof syndrome. 744 23

One hundred five trauma patients admitted to three trauma centers with injury Severity Scores of 20 or greater had lymphocyte phenotypic subsets characterized throughout their hospital course. Total lymphocytes, pan-T (CD2), helper T (CD4), suppressor T (CD8), pan B (CD20), and DR expressing lymphocytes were quantitated by monoclonal antibodies and flow cytometric analysis. Results were analyzed between three patient groups: uninfected, uneventful recovery (n = 64); major infection (n = 26); and dead (n = 15; 7 with sepsis). A significant lymphopenia, maximal at 3 days, occurred in the first postinjury week compared with controls (p < 0.05), which recovered over the study period. A hierarchical distribution was found between the three outcome groups with the lowest numbers of several lymphocyte phenotypes in those who died. T helper and suppressor cells were similarly affected, but lowest in patients destined to develop infection or die. The helper-suppressor ratio, however, was similar in all three outcome groups. Therefore, modulation early after injury aimed at restoring these subsets may reduce the risk of subsequent infection.
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PMID:Lymphocyte subset responses to trauma and sepsis. 826 80

Tumor necrosis factor (TNF) is considered to be a pivotal mediator of endotoxin-induced lethality. To assess the intermediate role of TNF in specific systemic inflammatory responses known to contribute to tissue injury in endotoxemia, eight healthy adult chimpanzees were intravenously injected with Escherichia coli endotoxin (4 ng/kg). In four of these animals the administration of endotoxin was followed immediately by a bolus intravenous injection of an anti-TNF monoclonal antibody (15 mg/kg). Treatment with anti-TNF completely prevented the endotoxin-induced increase in serum TNF activity, and profoundly reduced the appearance of interleukin-6 and -8 (both P < .05). Neutrophilia and lymphopenia were not affected by anti-TNF, whereas neutrophil degranulation, as measured by the plasma concentrations of elastase-alpha 1-antitrypsin complexes, was only slightly reduced (peak levels after endotoxin alone 31.0 +/- 3.4 ng/mL, versus 25.5 +/- 3.4 ng/mL after endotoxin with anti-TNF; P < .05). Anti-TNF did not influence endotoxin-induced activation of the coagulation system, as reflected by unchanged increases in the plasma concentrations of the prothrombin fragment F1 + 2 and thrombin-antithrombin III complexes. In contrast, anti-TNF strongly attenuated the activation of the fibrinolytic system, ie, peak plasma levels of plasmin-alpha 2-antiplasmin were 33.8 +/- 11.1 nmol/L after endotoxin alone and 17.0 +/- 2.9 nmol/L after endotoxin with anti-TNF (P < .05). These results suggest that TNF is not the common mediator of systemic inflammatory changes in low-grade endotoxemia. Moreover, the finding that in this mild model anti-TNF specifically inhibited fibrinolysis suggests that treatment with anti-TNF potentially may enhance the tendency towards microvascular thrombosis in sepsis.
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PMID:Differential effects of anti-tumor necrosis factor monoclonal antibodies on systemic inflammatory responses in experimental endotoxemia in chimpanzees. 828 42

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut rest, with operation reserved for unabated drainage. Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure). The average age was 3.1 years. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). There were no deaths in either group. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.
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PMID:Management of pediatric postoperative chylothorax. 837 18

Endotoxin challenge causes metabolic dysfunction mediated by TNF, and sequestration of leukocytes. NPC 15669, N-carboxy-L-leucine, N-[2,7-dimethylfluoren-9-yl)methyl] ester, inhibits leukocyte recruitment into inflammatory lesions in animals, and inhibits endotoxin-induced neutropenia and lymphopenia in mice. This study was carried out to determine whether the ability of NPC 15669 to inhibit leukocyte sequestration is sufficient to promote survival after endotoxin challenge. To inhibit leukocyte sequestration directly, mice were treated with anti-CD11a (LFA-1) or anti-CD11b (Mac-1) before endotoxin challenge. Anti-CD11b partly inhibited neutropenia and lymphopenia in response to challenge with LPS, but anti--CD11a had little effect on leukopenia. At doses of 100 and 1000 micrograms/kg, anti-CD11b increased survival to endotoxin challenge from 0 to 20 and 40%, respectively, whereas anti-CD11a was without effect. These observations, coupled with the finding that NPC 15669 does not inhibit endotoxin-induced TNF release suggest that inhibition of leukocyte sequestration can increase survival after endotoxin challenge, and that NPC 15669 or antibodies to Mac-1 may represent effective therapies for gram-negative sepsis and shock.
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PMID:Mice treated with a leumedin or antibody to Mac-1 to inhibit leukocyte sequestration survive endotoxin challenge. 846 78

The clinical files were reviewed of eight pediatric patients who died between 1976 and 1990, having the pathological diagnosis of aspergillosis. During the clinical evolution seven displayed malnutrition and respiratory symptomatology, four had slow evolving fever and oral candidiasis. The image in all the chest X-Rays was opaque. In the laboratory four had leukopenia, lymphopenia and neutropenia: two with a positive culture of Aspergillus. Five received four to eight different antibiotics during the last clinical evolution. All showed a combination of diverse forms of aspergillosis, all with the invasive form, five with the disseminated form, three bronchopulmonary allergic and one with aspergilloma. All had invasion of the respiratory system. Septicemia had the cause of death in four and three was direct relation with Aspergillosis.
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PMID:[Pulmonary aspergillosis. Report of 8 children]. 858 74


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