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

Upon admission to Box Hill Hospital in Victoria, Australia, a 38-year old woman was pale and febrile (328.6 degrees Celsius) and had a pulse of 88 beats/minute. She had had midabdominal pain for 1 week and severe lower abdominal pain for 2 days. Her menses were heavy. Other than pain during examination, rectal and vaginal examinations were normal. She had considerable neutrophilia (leukocyte count = 21.2 x 1 billion). The X-ray revealed free fluid. Ultrasonography indicated an IUD which she had had for 10 years, a mass with small cystic areas near the right ovary, and fluid in the rectouterine pouch. The physicians suspected peritonitis and administered iv broad spectrum antibiotics (1 mg ampicillin, 80 mg gentamicin, and 500 mg metronidazole) every 8 hours. They did a laparotomy. An abscess containing much green pus, the necrotic right ovary, and the appendix, which appeared normal and later shown not to be infected, occupied the right iliac fossa. The tubes were fine. The surgeons removed the appendix and right ovary. They washed out the abdomen with saline and inserted a drain to the right iliac fossa. The woman improved immediately so the physicians stopped antibiotics 3 days after surgery. Histological tests revealed actinomycosis caused by fast-growing aerobic bacteria which is known to cause necrosis, fibrosis, and suppuration. During recovery, the physicians removed the IUD and performed dilation and curettage. Actinomyces normally just dwell in the mouth and intestines, but, in this case, probably migrated up the IUD tail after spreading from the bowel to the perineum to the vagina. The physicians suspected that the presence of Mycoplasma hominis provided the mucosal breach needed to permit actinomyces' invasion. Physicians should consider actinomycosis in acute abdominal sepsis cases with a longterm use of an IUD. They can treat it with antibiotics since Actinomyces tend to be sensitive to broad spectrum antibiotics.
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PMID:Ovarian actinomycosis presenting as acute peritonitis. 158 8

A randomized study in 121 pregnant women carrier of group B streptococci is undertaken in order to assess the administration of 500 mg of intrapartum ampicillin intravenously to interrupt mother-to-fetus group B streptococcal transmission. In the prophylaxis group there was a significant reduction in neonatal colonization (3.7 vs. 42.9%) and in severe neonatal colonization (0 vs. 25%). There was no case of group B streptococcal sepsis in the prophylaxis group compared to 4.6% (3 cases) in the control group (P greater than 0.05). Clinically infected newborns represented 3.3% in the prophylaxis group vs. 13.8% in the control group. When the organism was isolated during delivery in the vagina or amniotic fluid, prophylaxis was quickly followed by second negative cultures. Ampicillin levels in the amniotic fluid were detected early, and they increased significantly till the third hour. Bactericidal levels in the umbilical cord were detected in 60% of newborns. All these findings support the usefulness of ampicillin prophylaxis in the prevention of early-onset group B streptococcal sepsis.
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PMID:Intrapartum chemoprophylaxis of early-onset group B streptococcal disease. 185 7

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recognition and prevention of barium enema complications. 188 35

Even though the isolation rate of Candida species in the vagina stands at 30% during pregnancy, only 8 cases of candida sepsis connected with pregnancy were documented as of early 1991. Effective antifungal treatment began in 1956 and the 1st reported case was in 1954. She and the next 2 cases (1962 and 1971) did not recover. Possible predisposing factors in the 8 cases included antibiotic treatment, especially those in the beta lactam group; and IUD in situ; and intravenous (IV) line; or a urinary catheter. (Presumably antibiotics encourage C. albicans growth and pathogenicity. Foreign objects provide a portal of entry or a foothold for Candida.) In fact, a combination of these factors probably fostered candida sepsis in 4 cases. The 4 mildest cases experienced fever and impaired liver functions or reduced vision. 1 case had a hysterectomy. 2 had generalized convulsions. The 4 more severe cases experienced pneumonia, acute renal failure, osteomyelitis, or shock. In Haifa, Israel, physicians admitted a 24 year old woman with a fever to the Bnai Zion Medical Center for a presumed septic abortion at 15 weeks gestation. They performed a dilation and curettage (D&C) which included removal of an IUD. Laboratory personnel cultured the contents and later blood since her temperature rose .7 degrees. They started IV antibiotic treatment to no avail. Later her temperature hit 40 degrees Celsius and on day 5 she had convulsions. 1 blood sample and D&C materials grew C. albicans. They also observed multiple chorioretinal cotton wool lesions typical of Candida. They changed her medication to the antifungal medication, amphotericin B. Before discharge, they also prescribed 5-fluorocytosine. She had decreased hearing in the right ear, many hot spots over the iliac crests and thoracic vertebrae, and almost complete destruction of the body of D7 in the spine. She completely recovered.
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PMID:Candida sepsis in pregnancy and the postpartum period. 201 14

Listeria monocytogenes can cause sepsis and meningitis during the neonatal period. Six cases of early onset neonatal sepsis caused by Listeria monocytogenes are reported here. These cases were diagnosed in a private hospital at Santiago, Chile from December 1984 throughout November 1986. The incidence rate was 1.4 x 1,000 liveborns. Clinical findings included prematurity (6), meconium stained amniotic fluid (6), hepatomegaly (6), splenomegaly (6), maculopapular exanthem (4), anal prolapse (3) and meningitis (1). Additionally 5 patients developed respiratory distress and 4 required ventilatory support. Overall mortality was 50% (3/6). All deaths were related to respiratory failure and occurred during the first week of disease. All patients received ampicillin and amikacin early in the course of their infection. Listeriosis of the newborn infant might be preventable by prompt recognition and treatment of maternal infections. Since Listeria infection in pregnancy is usually mild and symptoms and signs are nonspecific, prevention may be difficult. Pregnant women with fever of no clear origin or with an influenza like syndrome should be screened for listeriosis with cultures from blood, vagina and cervix samples.
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PMID:[Early onset neonatal septicemia caused by Listeria monocytogenes]. 215 19

Investigations of nursery outbreaks of Citrobacter diversus sepsis and meningitis have been hampered by lack of adequate epidemiologic markers for the organism. We studied outer membrane protein profiles from clinical isolates of C. diversus by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to determine whether this method might be useful in the epidemiologic differentiation of strains. Paired cerebrospinal fluid isolates from each of three separate nursery outbreaks of C. diversus meningitis, paired isolates from the vagina of a postpartum woman and the cerebrospinal fluid of her newborn infant, one isolate from an infant with pneumonia and two from colonized nursery cohorts, and 30 epidemiologically unrelated clinical isolates were included. Eleven distinct profiles were differentiated by the presence or absence of five outer membrane proteins. Complete concordance of profiles was observed for epidemiologically related isolates. Unrelated epidemic strains had outer membrane protein profiles distinct from one another. Biotyping complemented determination of outer membrane protein profiles; the two markers differentiated each of the five epidemic strains from all but one of 30 unrelated nonepidemic isolates. Determination of outer membrane protein profiles is potentially useful in epidemiologic investigations of disease caused by C. diversus.
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PMID:Epidemiologic marker system for Citrobacter diversus using outer membrane protein profiles. 267 Oct 30

In the absence of previous published studies from Italy on the epidemiology of group B streptococci we investigated 1516 mothers at delivery and 1294 neonates in three hospitals. Of mothers in labour, 7.5% were colonized with group B streptococci and 4.9% of their babies. Of the neonates born to a positive mother 45.1% were colonized, whilst only 2.2% of babies born to a negative mother were colonized. For the mothers, the vagina was colonized more often (7.3% of all women) than the cervix (6.0%), the urethral meatus (3.9%) or the rectum (2.9%). For the neonates, the rates of colonization of the throat, external auditory canal, and the umbilicus were 3.2%, 3.0% and 2.6%, respectively. The distributions of the serotypes were similar to that reported from other parts of Europe and the USA and vertical transmission of group B streptococci was demonstrated in most of the mothers and their neonates. Of 30 mother-neonate pairs, 25% of mothers carried group B streptococci intermittently and 58% had persistent carriage until the 90th day postpartum, the rectum being the commonest positive site. Of 20 infants that were positive at birth, only six were still positive on the 15th day and none by the 90th day of life. Of 1294 infants, four (0.3%) developed early-onset sepsis with group B streptococci and one died. The overall incidence of clinical infection amongst colonized infants was 6.2%.
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PMID:Colonization and infection of mothers and neonates with group B streptococci in three Italian hospitals. 286 91

Veillonella species is a gram-negative coccus which is part of the anaerobic normal flora in the oral cavity, small intestine, upper respiratory tract, vagina, and urinary tract. The role that this organism plays in infection is not well known, and it is generally associated with other bacteria. We present a case of bilateral abscessed orchiepididymitis associated with septicemia due to Veillonella parvula and, later, to Clostridium perfringens, with the development of severe renal insufficiency and septic shock, which resolved favorably with antibiotic therapy, treatment of shock, and hyperbaric oxygen therapy. In reviewing the literature, we have not found any other case of sepsis due to Veillonella sp. associated with urological disorders.
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PMID:Bilateral abscessed orchiepididymitis associated with sepsis caused by Veillonella parvula and Clostridium perfringens: case report and review of the literature. 288 84

24 cases of disruption of the perineum from 8 Centres of Pediatric Surgery in France, were studied. The patients were aged between 4 months and 13 years, with an average age of 6.7 years, and 70% were boys. The cause of the injury was crushing in 13 cases. The associated were complex. Fractures of the pelvis (18) and associated multiple fractures (13), as were as profuse pelvi-peritoneal haemorrhages arising from fractures (3) or lower limb amputations (3) determined the care of associated soft-tissue injuries. Disruptions of the skin were almost constant and displayed a high rate of sepsis. There were noted lesions of the ureter (9), the vagina (5), the anus and rectum (17), the ano rectal sphincter (10) and the penis (1). The care of each of these lesions followed the usual practices of Reparative Surgery specific to each organ, but was also adapted to each case. In effect, disruptions of the perineum take place in a context of serious polytrauma, where the hierarchy of urgency determines the choice of therapeutic attitudes.
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PMID:[Lacerations of the perineum in children]. 304 39

The complication of the infected Ivalon-sponge after rectopexy is described in five patients. In two patients the pelvic sepsis perforated spontaneously into the vagina and in another two patients the pelvic abscess perforated through the levator muscles into the ischio-rectal fossa formating a typical horse-shoe abscess in one case. The management of choice in cases of pelvic sepsis is the complete removal of the infected Ivalon-sponge. We personally prefer the laparotomy for the complete removal of the prosthesis and not the removal through the vagina or through the rectum.
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PMID:[Problems of pelvic infection following rectopexy using synthetics and its treatment]. 360 96


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