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

This report describes the experience with disseminated histoplasmosis in seven of 15 patients with the acquired immune deficiency syndrome (AIDS) diagnosed in Indianapolis since 1981. Three were homosexual, two were intravenous drug addicts, one was the spouse of another patient with AIDS and disseminated histoplasmosis, and the seventh was a hemophiliac. Six had associated infections: candidiasis in three, Pneumocystis carinii pneumonia, recurrent mucocutaneous herpes simplex infection, and disseminated Mycobacterium avium infection in two each, and disseminated infection with an unidentified mycobacterium in one. Clinical diseases suggested sepsis in four. Histoplasma fungemia occurred in five, but the diagnosis was established first by visualization of organisms in blood or bone marrow in three. Results of Histoplasma serologic tests were positive in each. Three died before receiving 50 mg of amphotericin B, three had prompt improvement with amphotericin B, and one was treated with ketoconazole to prevent dissemination. However, two of the three patients treated with amphotericin B had relapses after a 35 mg/kg course, and the third died within a month following therapy. Disseminated histoplasmosis is a major opportunistic infection in patients with AIDS from endemic areas. AIDS should be strongly considered in otherwise healthy persons with disseminated histoplasmosis, especially if risk factors for AIDS are present. Amphotericin B is not curative in these patients.
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PMID:Histoplasmosis in the acquired immune deficiency syndrome. 387 88

The Isolator 1.5 Microbial tube (E. I. du Pont de Nemours & Co., Inc., Wilmington, Del.) is a commercially available blood culture system for use in pediatrics. The methodology is based on blood lysis followed by direct plating of the sample on culture media to detect bacteria and fungi. Comparative recovery rates of pathogens from blood collected in this and a conventional broth system were similar. The Isolator detected 104 of 120 clinically significant isolates, whereas 106 of 120 isolates were detected by the broth system. The major advantage of the Isolator methodology was early detection of septicemia. Initial detection of gram-negative bacteria occurred an average of 14.2 h earlier by the Isolator system than by the conventional broth method. The Isolator also permitted quantitation of bacteremia and fungemia. Probable contaminants were recovered from 10.0% of the cultures processed by the Isolator, but steps which could be taken to minimize this problem were identified. The Isolator is a useful method for pediatric blood cultures.
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PMID:Evaluation of a lysis direct plating method for pediatric blood cultures. 389 74

Thirteen episodes of intravascular cannula-related sepsis were seen during a two year period. Staphylococcus aureus was the most common pathogen. Fungaemia occurred in four patients all receiving total parenteral nutrition. Culture of the cannula tip and swabs of the insertion site were useful in confirming the diagnosis. Three patients with infection due to S aureus died while receiving treatment for their infections. Care with insertion and maintenance of intravascular cannulae should reduce the frequency of this iatrogenic infection.
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PMID:Intravascular cannula-related sepsis: two years experience. 393 2

Consider where the patient acquired the infection--in the community or the hospital. Gram-negative sepsis that develops after admission to a hospital or extended-care facility is likely to be caused by multiply-resistant organisms. Lack of fever does not reliably exclude sepsis in elderly patients. Among 27 afebrile patients found to have bacteremia-fungemia, diagnosis was made in one-third only after blood cultures were drawn, and almost one-half were already receiving antibiotics.
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PMID:Managing sepsis--a common cause of geriatric death. 394 67

Eighty-three patients with 117 episodes of candidemia were reviewed to examine the clinically significant variables and the results of treatment for this problem. Mortality was 52%. Patients who had bacteremia either synchronously or metachronously in association with Candida species had poorer survival rates. Staphylococcal and enterococcal species were the most frequently associated bacteria. Patients with Candida parapsilosis had better survival rates than patients with other species. Portals of entry for fungemia were catheters, wounds, the urinary tract, and the peritoneal cavity, but were undefined in 54% of patients. Antifungal chemotherapy could not be identified as affecting the outcome in these patients. It is suggested that candidemia in most patients represents a failure of host defense, and that septicemia of either bacteria or fungi may arise from the gastrointestinal tract in critically ill, immunocompromised patients.
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PMID:Candida sepsis. Implications of polymicrobial blood-borne infection. 397 Jun 69

Opportunistic systemic fungal infections are more frequent than generally realized. Increased awareness and a high index of suspicion of fungal super-infection in the presence of sepsis is required to bring about recognition and therapy. The intravenous catheter is an important portal of entry or may act as a foreign body favoring localization of a septic process. In its presence, fungemia must be guarded against. Whenever an intravenous catheter is removed, its tip should be cultured. Removal alone may be a critical item in therapy. In febrile patients, in whom the course of fever is not established, frequent blood cultures with attention directed specifically at fungi should be obtained. Fungi are not easily isolated and identified and only by requesting special attention from the microbiologist can the diagnosis be established in the average institutional laboratory in time to permit appropriate therapy. Since available therapeutic measures are strikingly effective when instituted early, awareness and alertness on the part of the clinician constitute the key to cure.
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PMID:Fungal septicemia in surgical patients. 421 22

Gas-liquid chromatography (GLC) was used to study normal serum and serum from patients with septicemia caused by a variety of bacteria and by Candida albicans. The gas chromatograms of seven sera from six patients with septicemia due to C. albicans were found to be significantly and reproducibly different from those of normal sera. Chromatograms of serum from 19 bacteremic patients were indistinguishable from normals. The major peaks present in chromatograms of normal sera were identified by GLC and mass spectroscopy as the methyl esters of palmitic, oleic, linoleic, and stearic acids. In addition to these peaks, serum from patients with candidemia contained abnormal peaks that were also present in cultures of C. albicans grown in normal serum and in washed C. albicans harvested from cultures in yeast nitrogen base broth. Chromatograms from 11 cases of mucosal candidates differed little from normal and were easily distinguished from those of fungemia patients. Chromatograms of serum from two of four patients with deep-invasive candidiasis were indistinguishable from those of fungemia and reverted to normal after infections were eradicated.
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PMID:Rapid identification of Candida albicans septicemia in man by gas-liquid chromatography. 460 12

Blood cultures obtained with a lysis-centrifugation (L-C) system and a conventional two-bottle broth system were compared for the recovery of bacteria and yeasts from 7,000 cultures. The L-C system recovered significantly more total organisms, Escherichia coli, and Candida spp. and detected more patients with bacteremia and fungemia due to members of the family Enterobacteriaceae and yeasts. The broth system recovered significantly more streptococci and detected significantly more low-level Pseudomonas bacteremias. Polymicrobic bacteremia and fungemia were detected equally well by either culture system. Aerobic organisms grew equally well on blood, chocolate, or brain heart infusion agar plates used for L-C inoculation. A total of 82% of colony counts measured no more than 10 CFU/ml of blood, and it was at these low levels that enhanced detection of organisms by either system was observed. The L-C system isolated organisms and detected yeasts more rapidly than did the broth system. Contaminants occurred in 8.2% of L-C cultures and 1.9% of broth cultures. Low colony counts on L-C plates occurred for both Staphylococcus epidermidis contamination and septicemia.
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PMID:Comparative recovery of bacteria and yeasts from lysis-centrifugation and a conventional blood culture system. 635 32

Malassezia furfur, a lipophilic fungus commonly found on the skin of healthy adult, was isolated from Broviac catheter blood cultures in five sick infants who were receiving fat emulsions intravenously. The most common manifestations of sepsis included apnea and bradycardia, low-grade fever, interstitial pneumonia, elevated neutrophil band counts, and thrombocytopenia. All infants recovered without antifungal therapy after removal of the Broviac catheters. Early onset of fungemia after catheter placement in these five infants and the recovery of M. furfur from the skin of nearly 33% of hospitalized premature neonates indicate that contamination of the Broviac catheter at time of placement may be the most likely origin of infection.
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PMID:Broviac catheter-related Malassezia furfur sepsis in five infants receiving intravenous fat emulsions. 654 35

A 33-yr-old Puerto Rican women was hospitalized for chemotherapy and multiple antibiotic treatment for relapse of acute myelomonocytic leukemia. While she was already receiving amphotericin for suspected Aspergillus infection, she developed hepatomegaly and abnormal liver enzymes with high serum bilirubin. The blood cultures were negative. Percutaneous liver biopsy revealed granulomatous fungal hepatitis identified by cultures as Trichosporon cutaneum. In spite of the continued administration of amphotericin, with the addition of 5-fluorocytosine, Trichosporon was later cultured from her blood, and she succumbed to fungemia and polymicrobial sepsis.
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PMID:Trichosporon hepatitis. 657 26


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