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

The global mortality for Fournier's gangrene is one in five. In half the cases, the infection is polymicrobial with either anaerobes or gram negative bacilli. Factors which worsen prognosis include renal insufficiency, streptococcal infection, or need for hospital admission. Diagnosis must be prompt and treatment multidisciplinary involving the surgeon, intensivist, and infectious disease specialist; early and adequate surgical debridement must be accompanied by well-chosen antibiotics and hyperbaric oxygen therapy. Post-debridement therapy requires a long period of dressing changes and skin grafting to achieve final wound closure. This is an aggressive disease with a high mortality, but the depth and extent of invasive infection does not determine prognosis; the first priority is prompt and wide surgical excision/debridement of infected tissues to pre-empt the development of systemic sepsis; this should not be deferred while arranging transfer to a facility with a hyperbaric chamber.
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PMID:[Life-threatening cellulitis, or Fournier's gangrene of the perineum]. 1270 49

Within a four-week period, five patients were admitted to the maternity ward of the Utrecht Children's Hospital diagnosed with puerperal sepsis due to group-A streptococcal infection. The clinical presentation was different for each patient. All patients recovered upon adequate antibiotic treatment. One of the children died, possibly due to sepsis and hypotension of his mother. As group-A streptococci can be extremely contagious and an epidemic was suspected, measures for additional hygiene were taken. Furthermore, all personnel at the maternity ward and the obstetric centre were tested. T-serotyping, M-genotyping, exotoxin A- and C-gene amplification and pulsed field gel electrophoresis were used to characterize the cultured group-A streptococci. Cross-contamination was not found. Therefore, this increase in puerperal sepsis was attributed to polyclonal expansion rather than an epidemic. All mothers of newly born children who present with fever and lower abdominal pain should be suspected of group-A streptococcal infection. Evaluation and treatment in hospital is indicated due to a sometimes fulminant course. When group-A streptococci are cultured again in a new pregnancy, eradication therapy during pregnancy or prophylactic treatment during birth should be considered to prevent recurrent infection.
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PMID:[A pseudo-epidemic of puerperal sepsis]. 1507 84

A complete history and systematic physical examination are important first steps in assessing any infant. In some instances these steps may provide immediate clues to a potentially life-threatening illness. This article presents the case of a former 26-week male infant, who presented on day of life 42, 32 weeks gestation corrected, with increased respiratory distress and an evolving lesion on the left lower cheek. The classic location and progressive erythema, warmth, induration, and tenderness in the submandibular region strongly suggested the diagnosis of group B streptococcal (GBS) cellulitis. Despite the presence of concurrent GBS septicemia, the infant had complete resolution of focal and systemic symptoms with 10 days of treatment. One month later, the infant developed pneumonia with respiratory failure, shock, culture-positive septicemia, and presumed meningitis and was again treated with broad-spectrum antibiotics. Diagnosis at that time was late-onset group B streptococcal infection. Serotypes were not available to aid in distinguishing between recurrent or persistent GBS versus a new occurrence of late-onset disease. A brief overview of late-onset GBS infections and their cutaneous manifestations, along with a step-by-step guide to physical examination, is provided. The differential diagnosis for facial cellulitis is reviewed with an emphasis on early recognition and treatment in light of the escalated risks for persistent or recurrent GBS infection in infants with GBS cellulitis.
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PMID:Facial submandibular cellulitis associated with late-onset group B streptococcal infection. 1498 76

The severity of infection with Streptococcus pyogenes is strongly influenced by the host's genetics. This observation extends to the murine model of streptococcal infection, where the background of the mouse strain determines the infection outcome (BALB/c are resistant, whereas C3H/HeN are susceptible). To determine the extent to which the MHC complex (H2) contributed to diseases susceptibility, the response to S. pyogenes of congenic BALB mice from a resistant background (BALB/c), but carrying the H2(k) region of susceptible C3H/HeN mice (BALB/k), was examined. BALB/k were as susceptible as the H2 donor strain (C3H/HeN). Linkage analysis performed in F(2) backcross ([BALB/c x C3H/HeN] x BALB/c) mice confirmed the presence of a susceptibility locus within the H2 region on proximal chromosome 17. The possibility that modulation of T cell responses to streptococcal superantigens (GAS-SAgs) by different H2 haplotypes may influence disease severity was examined. BALB/k exhibited a significantly stronger response at the level of cell proliferation and cytokine production to GAS-SAgs than did BALB/c mice. However, the fact that T cell-deficient SCID-C3H/HeN mice also exhibited a susceptible phenotype suggests a more important contribution of innate effector cells to disease susceptibility. Lower transcriptional levels of certain inflammation-related regulatory genes located on chromosome 17 were detected in macrophages from susceptible than in those from resistant mice in response to infection. These results suggest that susceptibility to S. pyogenes may be associated with an altered transcription of specific genes that may compromise the endogenous regulatory processes controlling the inflammatory cascade and favor the progression to sepsis.
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PMID:The role of the MHC on resistance to group a streptococci in mice. 1614 32

Ecthyma gangrenosum is a cutaneous infection associated most commonly with pseudomonal sepsis in the immunocompromised patient. We describe a previously healthy 4-year-old boy who developed ecthyma gangrenosum-like lesions secondary to antibiotic treatment for possible streptococcal infection. The skin, ears, and extremities were involved. This presentation emphasizes the importance of awareness of the rare complication of ecthyma gangrenosum-like lesions associated with non-Pseudomonas bacterial infection treated with antibiotics, even in a previously healthy child.
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PMID:Ecthyma gangrenosum-like lesions in a healthy child after infection treated with antibiotics. 1619 Oct 1

We present the case of a 980-g, female, premature infant with a late-onset maternofetal sepsis, of which the first sign was a diaper-shaped cellulitis. This dermatologic sign in a premature infant is very unusual and needs prompt investigation. Late-onset group B Streptococcus infection can be manifested by a cellulitis-adenitis syndrome.
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PMID:Unusual report of diaper rash in a premature infant with group B streptococcal infection. 1687 80

Most publications on the subject of group B streptococcus since December 1996 have concentrated on supporting and to some degree extending our existing knowledge of the epidemiology of group B streptococcus and of intrapartum antimicrobial prophylaxis, which is the only approach available for reducing the incidence of group B streptococcal infection. Of greatest importance clinically are the reviews and studies on intrapartum antimicrobial prophylaxis, which continue to show that this is a worthwhile intervention as it significantly reduces the incidence of early onset group B streptococcal sepsis. The best approach to the detection of carriage is also covered, as is the changing epidemiology as a result of the implementation of intrapartum antimicrobial prophylaxis in some centres. Finally, the prospect of a vaccine is discussed.
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PMID:Prevention of group B streptococcal infection in neonates. 1703 99

Group B Streptococcus commonly colonises healthy adults without symptoms, yet under certain circumstances displays the ability to invade host tissues, evade immune detection and cause serious invasive disease. Consequently, Group B Streptococcus remains a leading cause of neonatal pneumonia, sepsis and meningitis. Here we review recent information on the bacterial factors and mechanisms that direct host-pathogen interactions involved in the pathogenesis of Group B Streptococcus infection. New research on host signalling and inflammatory responses to Group B Streptococcus infection is summarised. An understanding of the complex interplay between Group B Streptococcus and host provides valuable insight into pathogen evolution and highlights molecular targets for therapeutic intervention.
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PMID:Recent advances in understanding the molecular basis of group B Streptococcus virulence. 1880 86

Failure to thrive is frequently seen in breastfed infants. The most common diagnosis is insufficiency of breast milk in an otherwise healthy child. However, several differential diagnoses need to be considered. Progressive feeding difficulties and failure to thrive can be the first manifestation of group B streptococcal ventriculitis. This rare disease does not present with acute symptoms of sepsis or meningitis but evolves insidiously with no fever. Diagnosis is therefore often delayed and made only when intracranial hypertension develops. Cerebrospinal fluid (CSF) culture confirming the group B streptococcal infection and cerebral imaging are the necessary investigations for diagnosis. To our knowledge, only 10 cases have been previously reported.
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PMID:[A 6-week-old infant with failure to thrive: insidious presentation of group B streptococcal ventriculitis]. 1924 27

The authors describe a patient with right upper and lower eyelid necrosis combined with facial, neck, and chest edema and sepsis secondary to Group A streptococcal infection after minor trauma. This is an uncommon, life-threatening condition that was successfully treated with limited surgical debridement, antimicrobial therapy, and intravenous immunoglobulin. Oculoplastic surgeons should be aware of the indications and potential benefit of adjunctive intravenous immunoglobulin therapy for Group A Streptococcus-induced necrotizing fasciitis.
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PMID:Group A streptococcal necrotizing fasciitis of the eyelids and face managed with debridement and adjunctive intravenous immunoglobulin. 2081 7


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