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

A pathomorphological investigation of 115 lethal cases of various forms of meningococcal infection was carried out. Meningococcemia, its instantaneous forms in particular, are characterized by acute decompensation of the lymphoid system and generalized microangiopathy with the thrombohaemorrhagic syndrome. Haemorrhagic necrosis of the adrenals and damage of the hypophysis represented manifestations of the acute decompensation of the hormonal regulation. Inflammatory changes in meningococcemia were observed not in all the cases (they were absent in 1/4 of the deceased). In meningitis (meningoencephalitis) without sepsis no generalized angiopathy was noted, immunomorphological changes were of a proliferative character. Previous sensibilization of the macroorganism was an important prerequisite for the development of meningococcal infection.
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PMID:[Vascular and immunological processes in the pathogenesis of meningococcal infection]. 12 76

Meningococcal meningitis as well as meningococcal sepsis must be regarded as complications of an otherwise mild meningococcal infection of the nasopharynx. Only individuals without antibodies against a given meningococcal type will contract the above-mentioned diseases. Causal prophylactic measures have proved to be ineffective because of the great number of "carriers" of meningococci. Immunprophylaxis with specific polysaccharides is effective and presently available for use against types A and C but not against type B. Chemoprophylaxis is most effective when administered to those living in close quarters. Sulfonamides are the prophylaxis of choice agianst meningococci sensitive to sulfonamides. With the appearance of sulfonamide-resistant meningococci, the sulfonamide must be replaced by rifamycin or minocyclin. Though treatment with penicillin gives protection against infection, it does not eradicate the carrier state.
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PMID:[Prevention of meningococcal meningitis]. 40 42

A study was carried out to determine whether the preexisting decline in mortality rates from infectious diseases accelerated after the introduction of antibiotic and chemotherapeutic drugs. Linear regression curves showed that in Sweden mortality rates declined faster in septicemia, syphilis, and non-memingococcal meningitis after the introduction of these drugs. By contrast, for the ten other infectious diseases studied, (scarlet fever, erysipelas, acute rheumatic fever, puerperal sepsis, meningococcal infection, bronchitis, pneumonia, tuberculosis, typhoid fever, and acute gastroenteritis) no such accelerated decline in mortality could be detected. The findings suggest that antibiotic and chemotherapeutic drugs have not had the dramatic effect of the mortality of infectious diseases popularly attributed to them.
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PMID:The effect of antibiotics on mortality from infectious diseases in Sweden and Finland. 100 14

Patients whose blood is deficient in the terminal component of complement have an increased susceptibility to meningococcal infection. However, mortality from meningococcal infection is lower in these patients than in immunocompetent subjects. We studied a C6-deficient patient with meningococcal sepsis who received fresh frozen plasma (FFP). The patient's initial plasma endotoxin, C6, and terminal-complement-complex concentrations were low, but rose sharply after treatment with FFP. Samples of the patient's serum taken shortly after admission did not cause endotoxin release from Escherichia coli J5 in vitro, but endotoxin-releasing activity was restored in serum samples taken after infusion of FFP. It is possible that C6-deficient patients have reduced mortality from meningococcal infection because their serum cannot cause acute release of endotoxin from the invading organism and extensive tissue damage is thus avoided.
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PMID:Meningococcal septicaemia in a C6-deficient patient and effects of plasma transfusion on lipopolysaccharide release. 136 91

The present study describes the effect of plasma exchange or whole blood exchange (PEBE) on the survival rate among patients with fulminant meningococcal sepsis and on the level of circulating endotoxin. Since 1989 all patients with meningococcal disease and hypotension who were admitted to our intensive care unit were treated with PEBE. Results for our patients were compared with those for a historical control group conventionally treated between 1984 and 1989 (n = 10; mortality rate, 60%); the expected mortality rate, which was based on the Niklasson prognostic score and was calculated for seven patients in this control group, was 73%. A total of 15 patients were treated with PEBE, three (20%) of whom died, whereas the prognostic score (calculated for 14 patients) for this group was 62%. In two of the fatal cases, PEBE was started after a delay of greater than or equal to 40 hours. In the remaining 13 patients, PEBE was started within 5-30 hours after the first hospital admission. The mortality rate among this group was 8% (one of 13 patients); this rate was significantly different from that among the control group (P = .025). For seven patients treated with PEBE, plasma endotoxin concentrations were sequentially measured. The overall half-life (+/- SEM) of endotoxin was 181 +/- 18 minutes. This is approximately the same as reported values for patients who were not treated with PEBE. It is concluded that early initiation of PEBE may improve the rate of survival among patients with meningococcal infection and hypotension but that the mechanism of the beneficial effect is most likely not based on the elimination of endotoxin.
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PMID:Plasma and whole blood exchange in meningococcal sepsis. 152 Jul 89

The role of adhesivity as a factor of virulence in cases of N. meningitidis has not yet been established. Unlike other bacteria in which the presence of adhesivity reflects an enhanced virulence, a high capacity of adherence is associated with a low virulence and invasive capacity in cases of meningococcus. In order to gain more insight into the knowledge of this phenomenon we have studied the adhesivity of 109 strains of N. meningitidis to human pharyngeal epithelial cells. Twenty nine out of the 109 strains were isolated from blood or spinal fluid of patients with meningococcal infection (meningitis or septicemia), whereas the remaining 80 strains were obtained from pharyngeal smears of healthy carriers. The adhesivity was measured as the number of meningococci adhered to 50 epithelial cells according to Craven's scale. Strains of healthy carriers showed a greater adhesivity than that of patients (p less than 0.001). The relevance of the pharyngeal area in the evaluation of the adhesive capacity is in accordance with the hypothesis that meningococcal adhesivity decreases when the microorganism crosses the pharyngeal epithelium. The results would support the concept that the virulence of N. meningitidis is related to its adhesiveness.
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PMID:[Adhesiveness in Neisseria meningitidis. A virulence factor?]. 190 95

The study objective was to describe the clinical, biologic, and hemodynamic features of adult overwhelming meningococcal purpura and to examine the prognostic factors by multivariate analysis at the time of admission to the intensive care unit. Thirty-five patients (greater than or equal to 13 years of age) with meningococcal infection, circulatory shock, and generalized purpuric lesions of abrupt onset were recorded in eight intensive care units from 1977 to 1989. The patients were young (mean age, 26.6 years; range, 13 to 68 years) and had been previously healthy. The female-to-male ratio was 3:1. Mortality was 54.3%, with most deaths occurring within the first 48 hours, usually secondary to irreversible shock with multiple organ failure. Ischemic complications (eight cases), prolonged heart failure (seven cases), and secondary septicemia (five cases) were the chief complications among survivors. Initial hemodynamic study after volume loading showed low stroke volume index (mean +/- SD, 29.4 +/- 13 mL/m2) and tachycardia (mean +/- SD, 138 +/- 16 beats per minute), a profile suggesting a greater myocardial depression than usually observed in gram-negative bacillary septic shock. Univariate prognostic analysis showed that four variables at the time of admission were associated with fatal outcome: a plasma fibrinogen level of 1.5 g/L or less, a factor V concentration of 0.20 or less, a platelet count lower than 80 x 10(9)/L, and a cerebrospinal fluid leukocyte count of 20 x 10(6)/L or less. Stepwise regression analysis showed that low fibrinogen level (less than or equal to 1.5 g/L) was the sole adverse prognostic variable (odds ratio = 2, 95% confidence interval, 1.5 to 2.7). Adult overwhelming meningococcal purpura is still associated with high mortality and morbidity. Low fibrinogen level at time of admission may permit early recognition of the most severely ill patients.
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PMID:Adult overwhelming meningococcal purpura. A study of 35 cases, 1977-1989. 199 58

In recent decades infectious and parasitic diseases (class 1 according to the International Classification of Diseases-9) constitute 2-3% of causes in the total morbidity structures in the USSR. The main causes of death among diseases of class 1 are tuberculosis (37%), acute enteric infections (30%), septicemia (11%), viral hepatitides (11%), meningococcal infection (4%), measles (2%). The main groups are children aged up to 2 years (48% of fatal cases of diseases belonging to class 1). The territorial irregularity of mortality indices has been revealed.
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PMID:[Infectious disease mortality in the USSR]. 223 6

Meningococcal sepsis is usually a severe disease with very varied clinical manifestations. In our surrounding the most frequently appearing Neisseria meningitidis belongs to serogroup B, and only 10.2% belongs to group C. Both arthritis and exudative pericarditis are described as late, independent complications of N. Meningitidis C infections. The coexistence of both arthritis and suppurative pericarditis caused by this organism is extremely rare. A case of sepsis due to serogroup C N. Meningitidis in a patient who developed a right shoulder arthritis followed by septic shock and purulent pericarditis is presented. The characteristics of arthritis and pericarditis as complications of the acute meningococcal infection are analyzed, emphasizing the rareness of the coappearance of both as a form of clinical manifestation, as well as the purulent characteristic in order to keep them in mind and facilitate a prompt diagnosis and appropriate treatment.
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PMID:[Arthritis and purulent pericarditis as presenting form of sepsis caused by serogroup C meningococcus]. 262 51

An epidemic of meningococcal disease after an influenza outbreak in a community of 49 boys (14-18 years) and 8 adults in a boarding-school is reported. The first patient died with all symptoms of the Waterhouse-Friderichsen syndrome. Several hours later, two other boys developed severe septicemia with meningitis and meningitis respectively. N. meningitidis group B susceptible to penicillin and rifampin was isolated. Within the next 8 hours, chemoprophylaxis with rifampin (600 mg twice daily) was started and maintained for 4 days for the whole community. Throat cultures had not been obtained before prophylaxis. Ten other symptomatic boys were admitted to the hospital and treated by penicillin infusion. The results of blood and cerebrospinal fluid cultures were negative, and treatment was therefore discontinued. Five days after the death of the first boy, another boy died with full-blown Waterhouse-Friderichsen syndrome while on chemoprophylaxis. The neisseriae isolated from this patient were rifampin-resistant. Serological investigations in all patients admitted to hospital revealed the existence of concomitant epidemic infection with influenza A and B in this school. We assume that the viral infection made way for the outbreak of the meningococcal disease and for the high rate of secondary meningococcal infection. Chemoprophylaxis with rifampin should not be continued for longer than 2 to 3 days, otherwise the risk of occurrence of rifampin resistant strains of N. meningitidis increases. Hitherto such strains have rarely been isolated in clinically manifest disease.
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PMID:[Meningococcal epidemic in a boarding school: a rifampicin-resistant secondary case while under chemoprophylaxis]. 309 42


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