Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection remains a major cause of death and complication in pediatric surgery today. Impaired host resistance from such circumstances as immaturity, cancer chemotherapy, or AIDS predisposes to opportunistic infection by fungi, viruses, mycobacteria, and even protozoa. This review considers recent advances in five areas: 1) sepsis, 2) soft-tissue and wound infections, 3) chest infections, 4) abdominal infections, and 5) miscellaneous (including nosocomial) infections. Of particular importance are the new concepts of sepsis. The new terminology distinguishes stages in the septic process and a complex interaction of inflammatory mediators. The systemic inflammatory response syndrome may progress independently of the original infection to multiorgan dysfunction syndrome, and death. The reports cited herein are, for the most part, retrospective observational studies. There is a great need for prospective, randomized trials to answer questions about the optimal management of, and prevention of, pediatric surgical infections.
 ...
PMID:Surgical infections in children. 806 46

Several recent reviews have suggested that aggressive surgical intervention can reduce morbidity and mortality associated with intra-abdominal crises in AIDS patients. We reviewed our experience with 57 AIDS patients with 63 emergent laparotomies performed at 4 hospitals affiliated with the University of California in San Francisco. Fifty-five patients (96%) were homosexual men. Thirty-nine (68%) had been treated for an opportunistic infection. Indications for exploration included right lower quadrant pain consistent with appendicitis in 24 patients (38%), visceral perforation or obstruction in 11 (17%), right upper quadrant pain in 9 (14%), diffuse peritonitis in 8 (13%), and uncontrollable hemorrhage in 8 (13%). Perioperative mortality was 12% (7/57). Fifteen patients (26%) suffered major complications including pneumonia, sepsis, multi-organ failure, and intra-abdominal abscess. Forty-five of 50 survivors (90%) were receiving some type of chronic antimicrobial or antineoplastic chemotherapy, compared to only 2 of the 7 patients who died (28.6%) (P < 0.001). Lack of ongoing prophylactic treatment for AIDS-related disease, active opportunistic infections, Walter Reed VI classification, and ongoing sepsis at the time of exploration were noted to be associated with increased morbidity and mortality.
 ...
PMID:Emergent abdominal surgery in AIDS: experience in San Francisco. 808 60

Neutropenic colitis is a complication of the treatment of hematologic malignancies and, less commonly, of other disease entities. The septic, inflammatory process has a predilection for the terminal ileum and right colon. While the pathogenesis is not clear, mucosal injury caused by several different mechanisms and local opportunistic infection play significant roles. An association has been recognized between neutropenic colitis and sepsis caused by C. septicum. Patients present with fever, diarrhea, and acute abdominal pain and tenderness often localized in the right lower quadrant. Sonography and CT are helpful in demonstrating colonic wall thickening and pericolic fluid. Peritoneal lavage has been used to exclude perforation in these critically ill patients. Although there has been debate about whether medical or operative management is best, the optimal initial therapy includes supportive care with gastric decompression, fluid and blood product replacement, and broad-spectrum antibiotics. The indications for surgery include continued intestinal bleeding despite correction of coagulopathy and pancytopenia, free intraperitoneal air, and uncontrolled sepsis. At operation, a right colectomy with ileostomy and mucous fistula or, in selected patients, primary anastomosis is the procedure of choice. Timely return of functioning neutrophils and the eventual prognosis of the primary disease are crucial to the overall success or failure of treatment of neutropenic colitis.
 ...
PMID:Collagenous colitis, eosinophilic colitis, and neutropenic colitis. 837 36

During 1982-1992, physicians at the Johannesburg General hospital in South Africa treated 49 patients aged 23-59 with biopsy-confirmed Kaposi's sarcoma (KS). Single chemotherapeutic agents used included vinblastine, actinomycin D, bleomycin, and vincristine. Most combined regimens used included doxorubicin/vincristine/bleomycin or etoposide/methotrexate. 17 patients, all of whom were men, had endemic African KS (AKS). 32 patients had AIDS-related KS. 58% of AKS patients experienced partial remission. 23% experienced complete remission compared to none of the patients with AIDS-related KS. 19% of AKS patients experienced complete treatment failure and died quickly. Deteriorating performance status or debilitating side effects (e.g., severe mucositis and neutropenic sepsis) necessitated completion of therapy in most patients with AIDS-related KS. Opportunistic infections claimed the lives of many patients with AIDS-related KS. Any response to therapy among AIDS-related KS patients was of short duration. These findings indicate that AKS responds to chemotherapy, while AIDS-related KS does not. In fact, AIDS-related KS has a poor prognosis.
 ...
PMID:Chemotherapy for AIDS-related and endemic African Kaposi's sarcoma in southern Africa. 853 66

Because high circulating levels of glucocorticoids impair immunity and predispose to infections, we evaluated whether indices of cortisol (F) production could predict infections in patients with Cushing syndrome (CS) caused by ectopic production of ACTH (EA). Charts of 54 consecutive patients with untreated EA, without underlying diagnosis of small cell carcinoma of the lung, were reviewed, and types of infections, white blood cell (WBC) count, fever, as well as the glucocorticoid indices [0800 h F, daily urine F excretion (UFC), and daily urine 17-hydroxysteroid/g creatinine excretion (17OHS)], were recorded. Thirty-five patients had no or clinically mild infection; the remaining 19 patients had severe, systemic infection (n = 13) and/or sepsis (n = 6), including either bacterial or opportunistic pathogens or both (73.7%, 42.1%, and 13.8%, respectively). The latter group of patients had significantly higher indices of hypercortisolism (F, UFC, and 17OHS) than those with mild or no infections, but these indices did not correlate with temperature or WBC count. Thresholds for identifying severe infection were selected for maximal positive predictive value and were: F, 43.1 microg/dL; UFC, 2000 microg/day; and 17OHS, 35 mg/g creatinine. The most accurate discriminator for severe infection was 17OHS, based on a positive predictive value of 64.7%. Our data strongly suggests that the likelihood for a bacterial or opportunistic infection in CS patients, even without underlying small cell carcinoma of the lung, is greatest in patients with extreme hypercortisolism. The predictive value of total WBC count or the presence of an elevated temperature is not sufficient to identify patients with severe, life-threatening infection.
 ...
PMID:Cortisolemic indices predict severe infections in Cushing syndrome due to ectopic production of adrenocorticotropin. 1115 75

The authors report the case of a 43-year-old woman suffering from severe systemic lupus erythematosus treated with long-term prednisone, who developed Nocardia nova infection on a hip prosthesis. Sepsis occurred about two years after an episode of pulmonary nocardiosis with the same Nocardia species, that was successfully treated by 12 months of antibiotics. A good outcome of the joint infection was observed in response to antibiotics and removal of the prosthesis. Nocardiosis is a rare infection, acting as an opportunistic infection, facilitated in the present case by systemic lupus erythematosus and chronic corticosteroid therapy. Nocardia infections mainly affect the lungs, skin and central nervous system; these last two sites are mostly due to haematogenous spread, a frequent event. Treatment is based on antibiotics, usually continued for 3-12 months, especially because of the risk of relapse. The imipenem-amikacin combination appears to be more effective than trimethoprim sulfamethoxazole. To our knowledge, this is the first case report of Nocardia nova joint prosthesis infection also presenting as late septic spread of pulmonary nocardiosis, complicating corticosteroid-treated systemic lupus erythematosus.
 ...
PMID:Nocardia infection of a joint prosthesis complicating systemic lupus erythematosus. 1086 3

In 1998, an outbreak of systemic infections caused by Bacillus cereus occurred in the Neonatal Intensive Care Unit of the University Hospital Vrije Universiteit, Amsterdam, The Netherlands. Three neonates developed sepsis with positive blood cultures. One neonate died, and the other two neonates recovered. An environmental survey, a prospective surveillance study of neonates, and a case control study were performed, in combination with molecular typing, in order to identify potential sources and transmission routes of infection. Genotypic fingerprinting by amplified-fragment length polymorphism (AFLP) showed that the three infections were caused by a single clonal type of B. cereus. The same strain was found in trachea aspirate specimens of 35 other neonates. The case control study showed mechanical ventilation with a Sensormedics ventilation machine to be a risk factor for colonization and/or infection (odds ratio, 9.8; 95% confidence interval, 1.1 to 88.2). Prospective surveillance showed that colonization with B. cereus occurred exclusively in the respiratory tract of mechanically ventilated neonates. The epidemic strain of B. cereus was found on the hands of nursing staff and in balloons used for manual ventilation. Sterilization of these balloons ended the outbreak. We conclude that B. cereus can cause outbreaks of severe opportunistic infection in neonates. Typing by AFLP proved very useful in the identification of the outbreak and in the analysis of strains recovered from the environment to trace the cause of the epidemic.
 ...
PMID:Outbreak of Bacillus cereus infections in a neonatal intensive care unit traced to balloons used in manual ventilation. 1106 80

Opportunistic infections (OIs) continue to be a leading cause of death in persons with AIDS, and have been found to be more prevalent in some populations than others. Researchers investigated which OIs occured most among three categories of HIV transmission: homosexual and bisexual men, intravenous drug users, and female partners. Death from cytomegalovirus (CMV), toxoplasmosis, and Kaposi's sarcoma occurs in homosexual and bisexual groups. Women have a much higher risk of bacterial pneumonia and bacterial sepsis. Injection drug users suffer greater risks of bacterial pneumonia and non-HIV related causes such as liver damage, heart attack, suicide and drug overdose. Female drug users had the poorest prognosis of any group studied, due to lower income and educational levels, and less healthy lifestyles.
 ...
PMID:Death waits for no man, but OIs do. 1136 84

Accurate interpretation of labeled leukocyte images requires knowledge of pulmonary labeled leukocyte uptake: its prevalence and patterns and its correlation with technical, physiologic, and pathologic conditions as well as with other imaging findings. Images obtained shortly after injection of labeled cells are characterized by diffuse pulmonary activity, which decreases over time, until about 4 hours after injection when it becomes indistinguishable from background activity, remaining constant thereafter. Focal pulmonary uptake that is segmental or lobar in appearance is most often associated with bacterial pneumonia. Focal pulmonary uptake that is not segmental or lobar results from technical problems during labeling or reinfusion and is not usually associated with infection. Diffuse pulmonary uptake on images obtained more than 4 hours after reinjection of labeled cells is associated with a variety of pathologic conditions, some of the more common being opportunistic infection, radiation pneumonitis, pulmonary drug toxicity, adult respiratory distress syndrome, and sepsis. However, this pattern is almost never seen in bacterial pneumonia. When pulmonary uptake patterns are analyzed and correlated with the clinical situation, labeled leukocyte scintigraphy can provide useful information about pulmonary disease.
 ...
PMID:Pulmonary activity on labeled leukocyte images: physiologic, pathologic, and imaging correlation. 1243 9

Listeriosis is an emerging opportunistic infection in the immunocompromised host. A case of sepsis due to Listeria monocytogenes in a patient with advanced HIV infection and severe neutropenia, treated for an underlying non-Hodgkin's lymphoma, is described. Therapy with cotrimoxazole associated with rHuG-CSF (filgrastim) led to a rapidly favourable clinical and microbiological outcome, and to the correction of concurrent neutropenia. The case report is discussed according to a literature review of all cases of listeriosis reported until now in the setting of HIV infection and AIDS. In particular, the role of both cotrimoxazole and rHuG-CSF adjunct in the treatment of listeriosis in the immunocompromised patient is focused.
 ...
PMID:[A case report of Listeria monocytogenes infection in a patient with AIDS. Efficacy of treatment with cotrimoxazole associated with rHuG-CSF (filgrastim)]. 1496 99


<< Previous 1 2 3 4 5 6 Next >>