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

Septic or toxic shock is a life threatening complication after abdominal operations. The etiologic analysis of our 102 patients showed the following conditions: 1. diseases, which have already preoperatively a high incidence of septic complications, 2. sepsis developing after primary aseptic diseases, 3. septis without any etiologic connection to the primary disease or operation. An initial standarised intensive therapy must start before any irreversible organ damage may occur. First aim of all surgical measures is the eradication of the source of infection. Early relaparotomy is the only possibility for correction of intraoperativ technical defects. Only by longstanding combination of intensive personal and technical support prognosis of septic shock after abdominal operations can be improved.
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PMID:[Septic shock following abdominal operations (author's transl)]. 83 27

Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. Bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.
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PMID:Emergence of invasive group A streptococcal disease among young children. 139 66

The appearance of the "streptococcal toxic shock-like syndrome" led to a growing interest in infections caused by Streptococcus pyogenes (group-A-streptococci). Since 1987 some 800 cases with a lethality of 20% or more were observed. Contrary to toxic scarlet fever the site of primary infection are the lower respiratory tract or soft tissue infections. Erythrogenic toxins and low molecular weight mitogens, inducing cytokines (IL-2, IL-3, IL-6, TNF-alpha, IFN-gamma) seem to be involved in the pathogenesis of these severe infections. Morphologically and culturally the strains isolated from cases of toxic shock-like syndrome cannot be differentiated from isolates of epidemic scarlet fever or sporadic cases. At the same time, when in Scandinavia an epidemic by S.pyogenes type 1 with many cases of toxic shock was observed, the same type caused a scarlet fever epidemic without complications in eastern Germany. Erythrogenic toxin type A or its toxoid, respectively, can be used for successful immunizations of rabbits. Another--antibacterial-immunization can be done with the M-protein of S.pyogenes, which is limited by its type-specificity. Streptococcal vaccination is required especially for developing countries with a high incidence of rheumatic fever. Infections due to Streptococcus agalactiae (group-B streptococci) are often underestimated though they have a first position in septicemia and meningitis of newborns. Taxonomy and nomenclature of streptococci are often changing; a list of the presently known species is presented in table I.
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PMID:[Epidemiology and pathogenesis of streptococcal infection]. 150 78

In burn patients, MRSA was detected in the wound from the early stage to the wound closure stage. It is after the middle stage that sepsis by MRSA occurs. In comparison with Gram-negative bacilli, MRSA caused fewer sudden deaths, except for complications of toxic shock syndrome (TSS); MRSA was not considered to have a significant effect. The presence of a path of invasion into the blood other than the wound was suspected. Investigation of 35 Staphylococcus aureus sepsis patients (25 infected with MRSA) revealed that diagnosis is difficult when severe TSS occurs as a complication in sepsis. No correlation was found between toxic shock syndrome toxin-1 production by the bacterium detected and the onset of TSS. These findings suggest strong dependency upon the action of another toxin or endotoxin produced by Staphylococcus aureus and upon the immune condition of the host.
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PMID:[MRSA infection and toxic shock syndrome in burn patients]. 150 35

Toxic shock syndrome (TSS), first described by Todd et al. in 1978, can be a life-threatening entity. Familiarity with the pathogenesis and clinical presentation of TSS may help achieve early diagnosis and prompt appropriate intervention. TSS is not a septicemia, but a toxemia. The most extensively described pathogenesis involves a focus of specific Staphylococcus aureus strains capable of producing an exotoxin (TSST-1). We report two patients who developed TSS while in external fixators and describe their initial symptoms, management, and subsequent problems. This report will serve to alert pediatric orthopaedic surgeons to this entity and enable them to recognize its rather precipitous presentation and initiate appropriate treatment.
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PMID:Toxic shock syndrome in patients with external fixators. 151 30

The spread of group A streptococcal infection to close contacts of infected persons is well recognized. With the resurgence of invasive group A streptococcal infections, there is an increased potential for clusters of patients with invasive disease. We reviewed data collected since December 1988 at the Centers for Disease Control (Atlanta) to identify clusters of infection in which one or more patients had invasive disease. Twelve family clusters were identified. Infection in index cases included the toxic shock-like syndrome and septicemia. Infection in family contacts included invasive infections, pharyngitis, or asymptomatic carriage. Most invasive disease occurred in adults, while the majority of noninvasive infections were in children. Five nosocomial clusters with spread of infection from patients to hospital personnel were documented. All index patients had the toxic shock-like syndrome; secondary infections included the toxic shock-like syndrome, pneumonia, bullous cellulitis, lymphangitis, and pharyngitis. Clusters of invasive infections also were identified in five nursing homes. Pneumonia, cutaneous infections, and the toxic shock-like syndrome occurred most commonly. Clustering by nursing home unit occurred in three outbreaks. In hospitals and nursing homes, improved infection control will likely decrease secondary spread; in families, spread of disease may be prevented by identifying and treating those harboring the organism or by chemoprophylaxis. Studies that characterize the rate of secondary infection are needed before definitive recommendations can be made.
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PMID:Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. 152 Jul 63

We describe two patients with group A beta hemolytic streptococcal septicemia from minor foci in the skin. They developed extreme toxemia, mental obtundation and multi-system organ failure associated with diffuse erythema. They both survived after appropriate antibiotic and intense supportive therapy. These are examples of the "toxic strept syndrome" which is similar to staphylococcal toxic shock.
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PMID:The toxic strept syndrome: two case reports. 141 83

The most frequent cause of toxic shock in our area is meningococcal sepsis. It is currently assumed that endotoxin produce by this bacteria, a lipopolysaccharide with toxic properties, is able to trigger shock and DIC by stimulating both arachidonic acid pathways, among other actions. Previous studies in our laboratory demonstrated significant differences (p +/- 0.001) in the amounts of endotoxins released in vitro by strains from patients and healthy carriers and statistically related criteria of severity with mortality in 256 patients in our center over the last 10 years. In the present study we attempted to establish whether plasma levels of endotoxin were correlated with the severity of the disease. We studied 32 patients with meningococcal sepsis, dividing the subjects into two groups: those in whom six or more criteria of severity were present, and those in whom less than six criteria were found. Blood levels of endotoxin were determined upon admission and after the administration of antibiotics (penicillin and chloramphenicol) using the limulus test with a chromogenic substrate (Coatest, Endotoxin, Kabivitrum, Sweden). Levels of endotoxins were significantly higher in patients with more than six criteria of severity both upon admission (0.6 +/- 0.03) ng/ml) and 4 h. afterward (0.74 +/- 0.006 ng/ml) in comparison to children in whom the clinical picture was less serious (0.27 +/- 0.18 ng/ml and 0.27 +/- 0.18 ng/ml and 0.27 +/- 0.16 ng/ml7 t = 5.8 y t = 5.6 respectively. Endotoxin levels were highest in patients presenting shock, disseminated intravascular coagulation in the hypocoagulability phase and more than 8 criteria.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Studying the levels of endotoxemia in meningococcal sepsis. Its relations to pregnancy and antibiotic treatment]. 188 9

We describe two female patients presenting with spontaneous peritonitis and fulminant Streptococcus pyogenes (Strep. pyogenes) septicemia and shock. Both patients recovered completely upon immediate antibiotic therapy, initially with broad range combination therapy effective against Strep. pyogenes, which was switched to penicillin G when culture results became available. This isolated strain in case 1 was M-type 28, which is the M-type most often isolated from vaginal swabs (as commensal) and from blood from patients with puerperal sepsis. Patient 1 had signs and symptoms of a toxic shock-like syndrome, including rapid onset of fever and shock, skin rash, desquamation of palms and soles, and multisystem involvement with vomiting, diarrhea, myalgia, renal failure, and severe disorientation without focal neurological deficits.
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PMID:Fulminant group A streptococcal infections. Report of two cases. 219 45

We studied hemorheological variables in ten consecutive patients with sepsis or septic shock. One patient with sepsis, eight with septic shock, and one with the toxic shock syndrome were included. The patients were studied during the first 3 days and the eighth day of their illness. All patients except one survived 1 week. Final outcome showed a 50% mortality. A decrease in low shear blood viscosity of red blood cells (RBC) suspended in plasma was observed. This indicates a decrease in RBC aggregation. These changes persisted during the first week. The decrease in RBC aggregation occurred despite a normal plasma viscosity. No correlations were found between the reduction in RBC aggregation and changes in blood chemistry, amounts of dopamine or plasma administered, or with the APACHE II score. A decrease in RBC deformability was observed, due to changes in the RBC membrane. After 1 week, these changes had disappeared. The change in RBC deformability during the study period was significantly related to changes in the amount of dopamine administered.
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PMID:Changes in hemorheology in patients with sepsis or septic shock. 259 Oct 31


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