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

Candida sepsis during pregnancy is a rare but life-threatening complication of infection with Candida albicans. In contrast to the situation with other antimicrobial agents, there exists only limited experience with systemic antifungal therapy during pregnancy. A recent report focuses on amphotericin B treatment in systemic fungal infection during pregnancy. The present report discusses a pregnant patient with Candida albicans sepsis and endophthalmitis as well as candida infection of the oral and genital mucous membranes, after hyperalimentation and broad spectrum antibiotic therapy via a central venous catheter. The patient was treated with 10 mg/kg fluconazole from week 16 of gestation for a total duration of 50 days. Adverse effects did not occur and the rest of the pregnancy proceeded favourably for both the mother and the baby.
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PMID:Fluconazole in Candida albicans sepsis during pregnancy: case report and review of the literature. 881 69

The authors describe the case of a 53-year-old woman who suffered from an Aspergillus fumigatus infection of the L2/3 intervertebral disc space unrelated to previous operations on her lumbar spine. After surgical debridement combined with amphotericin therapy she died on the 23rd postoperative day from a fulminant bacterial sepsis of pulmonary origin. Although she had intermittently used steroids for bronchial asthma, this is an unusual case of fungal infection of the lumbar spine in an apparently immunocompetent patient.
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PMID:Intervertebral disc space infection caused by Aspergillus fumigatus. 883 Nov 27

We report the outcome of eight patients with different hematological malignancies who were transplanted with allogeneic CD34-selected mononuclear cells following myeloablative therapy. Four patients received G-CSF mobilized CD34-enriched peripheral blood progenitor cells (PBPC) together with CD34-enriched bone marrow (BM), two patients were transplanted with allogeneic G-CSF mobilized CD34-enriched PBPC alone, and two patients received only allogeneic CD34-enriched BM cells. On average, patients received 2.66 x 10(6) CD34+-cells/kg BW (range: 0.53-8.40 x 10(6) CD34+-cells/kg body weight) and 0.57 x 10(6) CD3+-cells/kg BW (range: 0.20-1.10 x 10(6) CD3+-cells/kg BW), respectively. Seven of the eight patients engrafted (ANC > 0.5 x 10(9)/L median: day +19 (range: 16-23 days); platelets > 20 x 10(9)/L median: day +34 (range: 21-47 days); one patient died on day +16 after transplantation and was not evaluable for engraftment. Three of seven patients evaluable for acute graft-versus-host disease (GvHD) developed acute GvHD grade II which resolved upon steroid treatment. Five of the eight patients are still alive and in remission with a median follow-up of 215 days (range: 80-420 days). Causes of death included fungal infection, cerebral bleeding and sepsis. These preliminary data suggest that CD34-enriched cells can be successfully given during for allogenic transplantation following myeloablative therapy in hematological malignancies. The impact of T-cell depletion by enrichment for CD34+-cells in an attempt to reducing the incidence and/or severity of acute and/or chronic GvHD still remains to be determined.
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PMID:Allogeneic transplantation with CD34+-selected cells. 913 Jun 22

Recent advances in the diagnosis and therapy of infections in patients with hematological diseases are reviewed. In general, 40-60% of febrile episodes lack clinical or microbiological evidence of infection and are thus treated empirically. Among the cases of microbiologically documented bacteremia treated in our department, the incidence of Gram-negative bacteria was high (47.1%) and the incidence of Gram-positive bacteremia is increasing. To improve the diagnostic rate of Gram-negative sepsis, the measurement of plasma endotoxin was performed. Of 147 febrile neutropenic episodes, endotoxemia was observed in 58 (39.5%) and the causative microorganisms of these infections were deemed Gram-negative bacteria. The measurement of plasma (1-->3)-beta-D-glucan, a ubiquitous component of fungi, was also performed for making early diagnosis of deep mycosis; the sensitivity of this assay was 90% and the specificity was 100%. The detection of (1-->3)-beta-D-glucan appears to be useful as a screening test of deep mycosis. The effects of the concomitant use of granulocyte-colony stimulating factor (G-CSF) and empiric antibiotic therapy for febrile neutropenia were studied in a randomized fashion. G-CSF did not affect the rate of the response to the empiric antibiotic therapy, although a significant effect of G-CSF on neutrophil recovery was observed. Guidelines for empiric antibiotic and antifungal therapy combined with serological diagnosis are proposed.
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PMID:Infections in patients with hematological diseases: recent advances in serological diagnosis and empiric therapy. 940 Dec 73

Thirty-four patients with burns were subjected to the clinicopathological study with special reference to culture of the wound and histological examination of the burned tissue. The commonest cause of burn was thermal burn (91.18%) followed by electric burn (5.88%) and chemical burn (2.94%). The maximum number of patients belonged to second and third decades of life (61.78%). Females were commonest victims, with male:female ratio was 1:1.6. On the 1st to 3rd postburn day (PBD) most of the wound remained sterile and Strept haemolyticus was first bacteria isolated on 1st PBD. Gram-positive and Gram-negative bacteria, specially pseudomonas, invaded the burn wound as early as 3rd PBD, it was more so with the patients of extensive burn. Among the Gram-positive bacteria Staph aureus was most notorious and invaded burn wound very early. Pseudomonas had maximum growth followed by klebsiella and Esch coli, multidrug resistance was more common with pseudomonas. Among the fungal infections Candida albicans had maximum incidence. Positive blood cultures for bacteria were seen during 2nd, 3rd and 4th postburn weeks. Pseudomonas was the commonest bacteria isolated. Biopsies were done in 17 patients and showed maximum incidence of bacterial infection followed by fungal infection. Patients with burn more than 60% of total body surface area (TBSA) had 100% mortality, while patients with 20-30% of TBSA burn had 20% mortality, the overall mortality was 50%. Biopsies of the burn wound played an important role in the accurate diagnosis and thus helped in starting early specific therapy to prevent death from sepsis.
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PMID:A clinicopathological study of infections in burn patients and importance of biopsy. 956 84

The bacteriological study of wound discharge indicated no changes in the structure of the microflora in the allogenic kidneys of recipients throughout the follow-up. Among microbes isolated there were prevalent gram-positive microbes whose proportion has slightly increased in the past year, with Staphylococcus, mainly epidermal Staphylococcus, which contributes to the etiology. At the same time, studies of wound discharge in the past years showed that the incidence of mixed infections had increased from 4.3 in 1989-1991 to 15.6% in 1994-1997. Bacteriological urinalysis found no great differences in the etiological structures of the microflora. Gram-negative microbes are prevalent in all patients in three periods of follow-up. Noteworthy, there was an increase in the amount of yeast fungi (from 5.7 to 21.1%). Urinalysis showed that the rates in the isolation of bacterial and bacterial and fungal associations were steady-state and higher in all patients (20, 4-23, 5%). Examining the etiological structure of the pathogens of sepsis ascertained that patients of the early observation were found to isolate gram-negative microorganisms more frequently, while those of other observation periods have gram-positive ones. The overall proportion of microbial and microbe-fungal associations was 10.3% in the past 9 years. Since the patient's body is occupied by other pathogens due to immunosuppression, sepsis or wound infection was accompanied by high bacteriuria, cytomegalovirus infection, pneumocystic pneumonia, fungal infection, etc. For this reason, the patients had actually much higher quantities of mixed infections in sepsis, wound infection, or urinary infection than those taken into account while studying the only type of an infectious complication. The above leads to the conclusion that the incidence of mixed infection of recipients of allogenic kidneys is rather high. This infection substantially makes the choice of drugs and therapy difficult, the course of a wound process aggravated. For successful control of mixed infections, it is necessary to introduce new drugs having a high activity against bacteria, fungi, viruses, and protozoa and to use the latest differentially diagnostic culture media, to make diagnosis and treatment of pyoseptic diseases better.
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PMID:[Pyogenic infectious complications in recipients with allogenic kidneys: clinical and bacteriological aspects]. 977 Nov 18

We did a retrospective study of all acute lymphoblastic leukaemia (ALL) patients on United Kingdom ALL protocol who were admitted for febrile neutropenia. The aim of the study was to document the types of infections and aetiological agents associated with febrile neutropenia and to document the factors affecting mortality. Over the 8 1/2-year period from 1986 to June 1995, there were 77 episodes in 32 children with a mean of 2.4 episodes. Morbidity due to infection was 61%; unknown causes of fever contributed 39%. Of the microbiologically documented infections, majority were Gram-negative bacteraemia. There were 7 deaths (22%) during the study period, 3 (9%) of which were due to overwhelming sepsis, with 4 contributed by the relapse status of the leukaemia. Mortality was increased by prolonged neutropenia, relapse of the leukaemia and invasive fungal infection.
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PMID:Infections in acute lymphoblastic leukaemia. 979 52

In surgery, deep-seated fungal infection is not rare. In our institute, fungal infection was analyzed during postoperative periods. As pathogen, fungus was the second frequent pathogen after the operations for esophageal cancer and gastric cancer, and the third pathogen after hepatobiliopancreatic cancer and colon cancer. Furthermore, fungus was found more frequently pathogen from distant infection than that from local foci. Especially in CV catheter sepsis, fungus was main pathogen (60 %). In order to inhibit CV catheter sepsis, nutrition support team (NST) has been induced in our institute for prevention of external pathway of fungus. After NST, the frequency of CV catheter sepsis decreased from 12 % to 3.6 %, and the isolated frequency of fungus in catheter sepsis patients also decreased from 84 % to 16 %, respectively. It demonstrates that the activity of NST successfully prevents the external pathway of fungus in CV catheter indwelling patients. However, internal pathway (fungal translocation) still remains, and that issue has to be overcome. Molecular biological technique was applied for diagnosis of fungemia. PCR-RFLPs was performed by using specific primer of 18s rRNA in V4 region. Clinical samples were applied for PCR-RFLPs, and antifungal therapy was performed according as the results of PCR-RFLPs. It indicated that molecular biological technique was useful for diagnosis of fungemia.
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PMID:[Deep-seated fungal infection in surgery]. 979 64

Episodes of bacteraemia during the aplastic phase were studied in 500 allogeneic bone marrow (BMT) recipients, regarding incidence, microbial aetiology, risk factors, mortality and causes of death. One hundred and sixty-four patients (33%) had at least one positive blood culture. Gram-positive cocci (alpha-streptococci and coagulase-negative staphylococci) were found in 146/164 cases (89%). Gram-negative bacteria were present in only seven cases. Receiving marrow from an unrelated donor was the only significant risk factor for bacteraemia in univariate regression analysis. Within 60 days after BMT, 69/500 patients died. The mortality rate was significantly higher among those with positive blood cultures during the aplastic phase, 44/164 (27%) than in those without bacteraemia, 25/336 (7%). Death directly caused by sepsis was unusual in patients with alpha-streptococci or CNS-bacteraemia (8/146, 5%). In contrast, three of seven patients with gram-negative bacteraemia died of the infection. However, in patients with bacteraemia, 21 of 44 deaths were attributable to invasive fungal infections (18 candida, three aspergillus; autopsy findings). Among patients with negative blood cultures during the aplastic phase, 6/25 died of invasive fungal infection (three candida, one saccharomyces and two aspergillus). This indicates that early bacteraemia is associated with death from invasive fungal infection. Therefore, efforts to shorten the neutropenic period after BMT, prevention, early detection of invasive fungal infections and adjustments of immunosuppressive regimens when marrow from an unrelated donor is used, may improve the outcome after BMT.
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PMID:Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. 982 78

A retrospective review of 100 liver transplantations in 98 children was performed to determine the incidence of infection caused by Candida organism in these patients and to identify risk factors that may predispose to serious fungal infection. Thirty-one infections caused by Candida organisms developed during the initial 28 days posttransplantation: 19 were definite invasive infections (one deep site or one positive blood culture), 2 were probable invasive infections (three superficial sites), and 10 were urinary tract infections. Eleven of 19 patients had fungemia or a disseminated infection (two noncontiguous deep organs involved and/or positive blood cultures) and 8 of 19 had peritoneal candidiasis. Infection caused by Candida organisms was a contributing factor to mortality in 7 of 21 patients (case fatality rate of 33%) with invasive infection. Risk factors that were predictive for invasive infection by univariate analysis included the following: pretransplantation antibiotic therapy, length of transplant operation, transfusion requirement, number of days in the intensive care unit, number of days intubated, number of concurrent bacterial infections, number of antibiotics administered, number of laparotomies performed posttransplantation, retransplantation, hepatic artery thrombosis, bile leaks, and renal and respiratory failure. By logistic regression analysis, bile leak, hepatic artery thrombosis, preoperative steroid use, transfusion requirement, and the number of days intubated were identified as independent risk factors for invasive infection caused by Candida organisms. The use of prophylactic antifungal agents in high-risk patients may be important in reducing the serious morbidity and mortality associated with sepsis caused by Candida organisms in pediatric liver transplant recipients.
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PMID:Candida infection in pediatric liver transplant recipients. 987 87


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