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

Ten patients with infections (8 neonates and 2 infants) were treated with 10.2 mg/10.2 mg/kg-37.7 mg/37.7 mg/kg of imipenem/cilastatin sodium (IPM/CS) b.i.d. or t.i.d. by a 1-hour intravenous drip infusion. The plasma concentrations of IPM/CS were determined in 5 of the 10 patients and in the cerebrospinal fluid of 1 patient of the 5. 1. The patients studied included 5 with pneumonia and 1 each with urinary tract infection, omphalitis, suspected meningitis, periproctal abscess and suspected septicemia. Clinical efficacy was evaluated in 9 patients: the patient with suspected meningitis was excluded from the clinical evaluation because the infection was doubtfully due to bacteria. Responses were excellent in 4 and good in 5 patients. No patient with a poor response was observed. All of the 6 etiological isolates obtained from 5 patients (2 strains of Staphylococcus aureus and 1 each of Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae and Bacteroides fragilis) were eradicated. 2. As for side effects, rash was observed in 1 patient and petechiae accompanied by decreases in platelets and reticulocytes and increases in GOT and GPT were observed in another. Other abnormal laboratory test values in addition to the above abnormalities consisted of an increase in GPT in 1 patient and increases in GOT and GPT in another. These side effects and abnormalities in laboratory test values were mild and normalized after discontinuation or completion of IPM/CS administration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of imipenem/cilastatin sodium in neonatal infections]. 321 Mar 3

The clinical, pathomorphological and microbiological findings during meat inspection in 599 pigs with endocarditis at slaughter were studied. Clinical signs were observed in 41 per cent of the pigs on ante-mortem inspection. Lameness was the most common sign. However, this symptom is not very specific of endocarditis. This is also true of various other symptoms. Only dyspnoea and drowsiness were indicative of endocarditis to some extent, but occurred only sporadically. Extracardial lesions were observed in 66 per cent of the pigs with endocarditis on post-mortem inspection. Metastatic processes (infarction or inflammatory foci) were most frequently detected in the kidneys. These were highly specific of endocarditis. In addition, the following changes were observed in decreasing incidence: signs of sepsis (hyperplastic splenitis, petechiae and degradation of organs), inflammatory lesions of the joints and legs, metastatic pneumonia and inflammation of the tail. Bacteriological examination was positive in 62 per cent of the cases. Streptococci were the organisms most frequently isolated (36 per cent), followed by Corynebacterium pyogenes (19 per cent) and Erysipelothrix rhusiopathiae (14 per cent). The discussion is concerned with the significance of these bacteria to meat-consumers.
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PMID:[Endocarditis and meat inspection in slaughtering pigs. 1. Clinical, pathological and microbiological aspects]. 368 3

Neisseria meningitidis is an important cause of fulminant septicemia and meningitis in children. Only limited reports of mild disease associated with this organism exist. In this study, we describe eight children, ages 2.5-19 months, with mild meningococcal disease and characterize the meningococcal isolates from some of these patients. Children with mild meningococcal disease presented with a mean fever of 40.1 degrees C, but without purpura or petechiae. Five were diagnosed as having otitis media and were not thought to be seriously ill when initially observed. Six of the eight children had complete resolution of their clinical symptoms as outpatients. One had apparent meningococcal meningitis that sterilized without antibiotic therapy, and one had persistent low grade bacteremia that cleared within 48 hours after institution of parenteral antibiotics. Characterization of the meningococcal isolates from three of the patients revealed that the organisms were encapsulated, piliated, and contained similar outer membrane proteins. This report confirms that blood stream invasion by N. meningitidis organisms may result in clinically mild disease.
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PMID:Clinical features of mild systemic meningococcal disease with characterization of bacterial isolates. 393 50

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chemotherapy of severe bacterial infections in pediatrics]. 631 69

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (greater than 38 degrees C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P less than .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P less than .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 +/- 11.4 [SE] hours) was significantly shorter (P less than .05) than with meningococcal infection (120 +/- 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.
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PMID:Apparent meningococcemia: clinical features of disease due to Haemophilus influenzae and Neisseria meningitidis. 641 7

In an attempt to develop a rational basis for performing lumbar puncture in sepsis workups, the hypothesis was tested that, for each of eight variables with a known association with bacteremia, the frequencies for patients having bacterial meningitis would be significantly greater than those in patients having bacteremia alone. In a one-year period, 168 lumbar punctures were performed in children having a mean age of 7.3 months. Patients were assigned to four groups: bacterial meningitis, bacteremia only, aseptic meningitis, and normal. Mean age, frequencies of symptoms, clinical appearances, ethnic groups, and sex ratio were determined for all groups. Frequencies of eight variables were determined and compared between Groups I and II.Results indicated that frequencies were not significantly different for groups I and II and that lethargy and petechiae, although distinguishing between groups I and IV, did not distinguish among the three groups having serious disease. It was concluded that since one cannot distinguish among groups having serious disease, all such patients suspected of sepsis should undergo lumbar puncture.
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PMID:Should lumbar puncture be routinely performed in patients with suspected bacteremia? 665 17

Neisseria meningitidis is a rare cause of infection in infants younger than 2 months of age, presumably because of transplacental passage of protective maternal antibodies. In most reported cases of meningococcal disease in neonates, a relatively mild clinical course has been observed. A 25-day-old infant survived acute, severe meningococcemia due to group B N meningitidis. This organism should be considered when neonates have signs of septicemia, especially in the presence of cutaneous petechiae and purpura.
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PMID:Fulminant neonatal meningococcemia. 676 85

A 2-month-old girl presented with enlarged head girth, generalized petechiae, anemia, coagulopathy and hepatosplenomegaly. Imaging studies showed a huge, dumbbell-shaped intracranial hemangioma located between the falx, and involving the supra- and infra-tentorium, extending through the posterior fontanel to involve the subgaleal area. A urine culture grew cytomegalovirus. Severe thrombocytopenia was refractory to a massive platelet transfusion, intravenous immunoglobulin and corticosteroid therapy. Hypertension, pulmonary hemorrhage and sepsis complicated the course. After establishing a diagnosis of Kasabach-Merritt syndrome, subcutaneous injections of alpha-interferon were given with an initial dose of 1 x 10(6) IU/m2 followed by 3 x 10(6) IU/m2 per day for 12.5 mo. Her platelet count rose gradually and became stable after 1.5 mo of interferon treatment. The intracranial hemangioma regressed remarkably and the hepatosplenomegaly was also resolved. The infant showed good growth and development, without obvious side-effects during the 23-month follow-up period. The treatment with recombinant alpha-interferon appeared to be effective in reversing thrombocytopenia associated with the patient's massive intracranial hemangioma.
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PMID:Recombinant alpha-interferon treatment of intracranial hemangioma and Kasabach-Merritt syndrome in an infant with cytomegalovirus. 761 60

The fat embolism syndrome is an uncommon clinical disorder that typically occurs as a complication of severe trauma. We report the case of a 60-year-old single-lung transplant recipient who died of massive fat emboli. Before lung transplantation, the patient had been treated with corticosteroids for at least 1 year because of chronic obstructive pulmonary disease caused by centrilobular emphysema and asthmatic bronchitis. After receiving his lung transplant, he was treated with triple-drug immunosuppression, which included 25 mg of prednisone per day. He was discharged from the hospital 2 months after transplantation only to be readmitted 2 weeks later with cytomegalovirus pneumonia, from which he recovered. Concomitantly, he had new lumbar compression fractures with severe back pain and lost approximately 3 cm in height during a 3-week period. On the eleventh day after hospital readmission, he suddenly had a "sepsis-like" illness without a known infectious cause, numerous petechiae and ecchymoses, marked pulmonary edema with worsening diffuse pulmonary infiltrates, profound hypoxemia, decreased mentation, and mild thrombocytopenia. He died 3 days later. With the exception of a positive sputum culture for cytomegalovirus, all cultures were negative. The postmortem examination showed severe osteoporosis, multiple vertebral compression fractures, and widespread massive fat emboli. This is the first reported case of fat emboli as the cause of death in a lung transplant recipient, and the case suggests that the fat embolism syndrome should be considered in the differential diagnosis of a sepsis-like illness in patients who have received steroids during a long period, particularly in the setting of vertebral compression fractures.
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PMID:Fatal fat embolism syndrome after numerous vertebral body compression fractures in a lung transplant recipient. 780 19

A 26-year-old male who had been diagnosed as pulmonary tuberculosis three years ago with an antituberculous chemotherapy of only two months, complained of tiredness, exertional dyspnea and fever since a month ago. Bloody sputum, bloody stool and hematuria have developed three days before admission. Petechiae over the body trunk and lower extremities were observed on admission. Peripheral blood examination revealed lymphocytopenia (672/microliters), low hemoglobin content (6.2 g/dl), thrombocytopenia (3,000/microliters), elevated FDP (36.2 micrograms/ml) and D-dimer (25.0 micrograms/ml) values. Chest radiograph showed a massive pleural effusion in the right hemithorax, bilateral pulmonary infiltrates and a cavity on CT scan. Together with positive acid-fast bacilli in sputum, diagnoses of relapsed pulmonary tuberculosis, tuberculous pleurisy associated with DIC (disseminated intravascular coagulation) were made. Left hydronephrosis which was presumed to be a consequence of infundibulum stenosis due to renal tuberculosis, was detected by abdominal ultrasonography. Treatment with antituberculous drugs and protease inhibitors were started with thoracic tube drainage. DIC condition was improved by the 20th hospital day and sputum culture turned to be negative after the 4th week, however, fever up to 38 degrees C continued until the end of the 7th week and a D-dimer which is a representative marker for secondary fibrinolysis, continuously showed a high level up to the 10th week of hospitalization. The patient was uneventful during the three months follow up period after discharge. DIC is a well known complication of sepsis including miliary tuberculosis, whereas it is rarely associated with cavitary tuberculosis and no case of prolonged elevation of D-dimer have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of pulmonary, pleural, and renal tuberculosis associated with DIC and a prolonged increase in D-dimer]. 804 Oct 60


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