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

The clinical and laboratory findings in seven children with Kawasaki disease are reviewed. Four of the patients had the more complicated course that has characterized the cases diagnosed in North America. This suggests that the benign forms are often mistaken for other febrile illnesses. The patients were two girls and five boys ranging in age from 4 months to 7 years; six were Caucasian and one was a North American Indian. Fever, redness of the oral mucosa, an erythematous or scarlatiniform rash and cervical adenopathy were seen in all; six patients had the characteristic fingertip desquamation and nonexudative conjunctivitis. Cardiac involvement occurred in four patients, two of whom had coronary artery aneurysm or thrombosis. Arthritis or arthralgia was seen in six patients, and aseptic meningitis occurred in four. Of the three patients with jaundice two underwent laparotomy and excision of a hydropic gallbladder; one of them died from Klebsiella pneumoniae sepsis and disseminated intravascular coagulopathy.
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PMID:Kawasaki disease, or mucocutaneous lymph node syndrome: report of seven cases in North America. 737 Aug 80

We undertook a retrospective chart review of 27 patients less than 60 days of age, hospitalized for possible serious bacterial illness (SBI), but who were culture negative, and then readmitted within seven days for the same reason. Upon repeat evaluation for sepsis, five of these infants had significant illnesses; two (7.4%) had SBIs (one had pneumococcal bacteremia and the other a urinary tract infection), and three (11.1%) had aseptic meningitis. Our results suggest that young infants, despite recent hospitalization for possible SBI, may be at risk for a serious infectious process and need reevaluation if symptoms recur.
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PMID:Serious bacterial illnesses in recently hospitalized young infants. 789 16

We prospectively evaluated 7 observation variables (level of activity, level of alertness, respiratory status/effort, peripheral perfusion, muscle tone, affect, feeding pattern) which qualify patient clinical appearance in order to determine reliability in distinguishing the infectious outcome of 233 febrile infants ages 0 to 8 weeks. Each variable was graded either 1, 3, or 5, with a higher score indicative of a greater degree of compromise. All infants received physical examination and sepsis evaluation (lumbar puncture, complete blood count/blood culture, urinalysis/urine culture). The 3 outcome groups compared were 29 cases of serious bacterial infections, (+SBI; 10 with bacterial meningitis, 12 with bacteremia, 7 with urinary tract infection), 45 cases of aseptic meningitis (AM) and 159 cases culture-negative with normal cerebrospinal fluid (CN-NCSF). The mean score for each of the 7 variables was significantly greater in the +SBI group compared with both the AM and CN-NCSF groups (P < 0.05), whereas there was no significant difference in mean score for each of the 7 variables between the AM and CN-NCSF groups. Stepwise discriminant analysis identified 3 variables that best distinguished outcome: affect; respiratory status/effort; and peripheral perfusion, which constituted the Young Infant Observation Scale. The mean total Young Infant Observation Scale score generated from assessing these 3 variables was significantly greater (P = 0.0001) in the +SBI, group (9) compared with both the AM (5) and CN-NCSF (5) groups. A total Young Infant Observation Scale score > or = 7 had a sensitivity of 76%, specificity of 75% and negative-predictive value of 96% for outcome of +SBI.
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PMID:Reliability of observation variables in distinguishing infectious outcome of febrile young infants. 842 66

Patients with deficiency of the complement regulatory protein factor I typically present with systemic pyogenic bacterial infections, including meningitis. We report a novel case with total deficiency of factor I in serum and plasma; the patient experienced nine consecutive episodes of aseptic meningitis within a 2-year period. There was no history of previous bacterial sepsis. Aseptic meningitis recurred despite attempted penicillin prophylaxis. Each episode resolved rapidly without sequelae, with or without antibiotic treatment. Serum complement profiles showed persistently low levels of C3, factor B, and factor H and undetectable factor I protein. Family complement studies could not be performed. Except for a minimally increased titer of antinuclear antibody, no other immunologic abnormality was detected. Results of an oral ibuprofen challenge were negative. We conclude that deficiency of factor I may predispose to aseptic, as well as pyogenic bacterial, meningitis.
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PMID:Complement factor I deficiency with recurrent aseptic meningitis. 850 28

Fever may be the sole clinically evident presentation of serious bacterial infection (SBI) in a very young infant, and therefore lumbar puncture is still widely regarded as a mandatory procedure in the sepsis workup of febrile infants under 2 months of age. In this retrospective study, we evaluated the frequency and the diagnostic value of cerebrospinal fluid examination in 492 infants aged less than 3 months who were hospitalized because of fever during 1988-1994. The patients were categorized as being at "high risk" or "low risk" for SBI according to current clinical and laboratory criteria. Among the 492 infants, 196 (40%) were identified as "high-risk" for SBI, and 296 (60%) were at low risk. Among the overall series of infants, 60 babies (12%) were subsequently proven with bacterial infection. Among the 196 "high-risk" babies, 26% had bacterial infection, compared to only 3% of the 296 infants at low risk (p < 0.0001), denoting a sensitivity of 85% and a specificity of 65% of the clinical classification criteria. Lumbar puncture was done to 186 (46%) infants upon hospital admission; 176 punctures yielded satisfactory samples of cerebrospinal fluid (CSF). Sixteen (3%) patients had abnormal CSF findings: 2 of them had positive bacterial cultures and 14 were compatible with aseptic meningitis. The 2 patients with purulent meningitis were clinically very ill and were immediately recognized as deserving a lumbar puncture. Of the 14 patients with aseptic meningitis, 13 were initially screened as being at high risk for serious infection, and therefore underwent a lumbar puncture. Over the years of this survey, a declining trend for performing lumbar puncture in "low-risk" young febrile infants became evident: during 1988-1992, evaluation of sepsis included a lumbar puncture in 45% of the infants, compared to 27% during the following 2 years (p < 0.0001). Not one instance of purulent meningitis evolved among the infants in whom lumbar puncture was not performed. Our observations suggest that hospitalized young febrile infants may safely be spared a lumbar puncture when they do not meet the proposed criteria for being at high risk, or when their clinical and laboratory picture suggests being at low risk for SBI.
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PMID:Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted? 925 69

Most of the neonatal enteroviral infections reported in the literature are associated with Coxsackievirus B2-B5 and echovirus 9 and 11. We report a retrospective Coxsackievirus B1 (CB1) infection in infants less than 2 months of age. Seventeen patients had aseptic meningitis and 8 had systemic sepsis (multi-organ involvement including meningitis, impaired liver function, and abnormality in coagulation). The symptoms and signs were nonspecific and could not be distinguished with bacterial infection on clinical grounds. Virus isolation was mandatory for diagnosis. Impaired liver function and coagulation profiles were noted in patients with systemic sepsis, but not in patients with meningitis only. CSF examination showed some uncommon features of viral meningitis: predominance of polymorphonuclear cells (PMN) was noted in 62.5% of patients and hypoglycorrhachia in 64% of patients. The patients with only meningitis recovered completely without any sequela. One of the eight patients with systemic sepsis died with case fatality rate 12.5%. Physicians should be aware of the possibility of CB1 virus infection in young infants during prevalent seasons. Specimens should be sent for viral culture in patients with meningitis and sepsis to make a definite diagnosis.
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PMID:Coxsackievirus B1 infection in infants less than 2 months of age. 957 69

Human enteroviruses (family Picornaviridae) are the major cause of aseptic meningitis and also cause a wide range of other acute illnesses, including neonatal sepsis-like disease, acute flaccid paralysis, and acute hemorrhagic conjunctivitis. The neutralization assay is usually used for enterovirus typing, but it is labor-intensive and time-consuming and standardized antisera are in limited supply. We have developed a molecular typing system based on reverse transcription-PCR and nucleotide sequencing of the 3' half of the genomic region encoding VP1. The standard PCR primers amplify approximately 450 bp of VP1 for most known human enterovirus serotypes. The serotype of an "unknown" may be inferred by comparison of the partial VP1 sequence to those in a database containing VP1 sequences for the prototype strains of all 66 human enterovirus serotypes. Fifty-one clinical isolates of known serotypes from the years 1991 to 1998 were amplified and sequenced, and the antigenic and molecular typing results agreed for all isolates. With one exception, the nucleotide sequences of homologous strains were at least 75% identical to one another (>88% amino acid identity). Strains with homologous serotypes were easily discriminated from those with heterologous serotypes by using these criteria for identification. This method can greatly reduce the time required to type an enterovirus isolate and can be used to type isolates that are difficult or impossible to type with standard immunological reagents. The technique may also be useful for the rapid determination of whether viruses isolated during an outbreak are epidemiologically related.
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PMID:Typing of human enteroviruses by partial sequencing of VP1. 1020 72

While the enterovirus diagnostic test positive rate is very low in Sweden, many enterovirus diagnoses are probably missed, owing to inappropriate testing, in patients with acute aseptic meningitis. In the article it is recommended that the cerebrospinal fluid PCR (polymerase chain reaction) test should be performed routinely in cases of acute aseptic meningitis. Serology and virus isolation in stool are indicated in cases of acute pericarditis or myocarditis, or certain chronic heart diseases. The PCR test should be performed in serum in the few cases of sepsis-like diseases in newborns or patients with hypogammaglobulinaemia. Otherwise, enterovirus diagnosis is very seldom justified on clinical grounds. For the purpose of poliovirus surveillance, enterovirus isolation may be important for virus typing, especially in cases of paralytic conditions.
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PMID:[Enterovirus diagnosis is important, but should be used cautiously]. 1049 54

We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in Hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis. Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving.
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PMID:Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis. 1094 3

We evaluated the incidence and implications of coexistent bacterial urinary tract infection and aseptic meningitis in 1629 young febrile infants (age 1 to 60 days) who underwent sepsis work-up. Urinary tract infection was diagnosed in 13.2% and aseptic meningitis in 8.8%. Eleven patients (0.7%) had both infections. In view of possible coinfection initial laboratory results may be insufficient for decision-making regarding treatment in young febrile infants.
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PMID:Concomitant aseptic meningitis and bacterial urinary tract infection in young febrile infants. 1141 10


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