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

Recently, among adults and children, an increase in the incidence of invasive disease caused by group A beta hemolytic streptococcus (GABHS) has been noted. From December 6, 1981 to January 19, 1991, we experienced six cases of serious infection caused by GABHS in previously well children. Among them, five cases were found in recent two years. The clinical manifestations were varied. One child had sepsis, one had streptococcal toxic shock-like syndrome, two had pyogenic arthritis, and the other two newborn infants had empyema and cellulitis associated with sepsis. Early diagnosis and treatment with appropriate antibiotic are necessary for a good outcome. In addition, empyema and pyoarthritis of the hip often need surgical drainage.
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PMID:Serious suppurative group A beta-hemolytic streptococcal infection in previously well children: report of six cases. 818 93

Three infants with clinical features of sepsis, hypovolaemia and an acute abdomen were referred to a paediatric surgical unit. Subsequent clinical signs of diffuse macular erythema followed by desquamation and isolation of Staphylococcus aureus from nasal or umbilical swabs led to a diagnosis of staphylococcal toxic shock syndrome. Surgical intervention was not indicated.
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PMID:Surgical presentation of toxic shock syndrome. 826 Mar 45

In recent years, the importance of gram-negative organisms in the genesis of sepsis has been emphasized. However, this emphasis may no longer be correct; recent studies show an increasing incidence of gram-positive sources of sepsis, and its is possible that these cases may predominate in the coming years. This increase results from more than just a greater prevalence of infection--it appears that gram-positive organisms may also be more virulent in fomenting the disease, as can be evidenced by the emergence of streptococcal toxic shock syndrome and the resurgence of acute rheumatic fever. This may result from the ability of gram-positive organisms to produce more inflammation-causing cell wall constituents, as well as unbound exotoxins. Despite the recent emphasis on gram-negative causes, sepsis resulting from gram-positive sources is increasingly common. Research on these causes of sepsis should be encouraged.
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PMID:Gram-positive organisms and sepsis. 826 86

Lancefield group A streptococci (GAS) account for 3-17% cases of septic arthritis, but other beta haemolytic streptococci (BHS) (groups B, C, and G) are being increasingly implicated. Epidemiological evidence suggests that the increase of BHS sepsis in adults is a true increase and not simply a reflection of better reporting. While underlying predisposing disease and old age are common concomitants of BHS sepsis, some subjects with devastating disease have been young and healthy. This is particularly the case for highly virulent M1 serotypes of GAS, where a toxic shock-like syndrome has led to a number of deaths in young adults in the United Kingdom and elsewhere. Musculoskeletal features, such as myalgias, painful swollen limbs, myositis, and fasciitis, are important features of this condition, so that rheumatologists may be involved in management. Group C and G musculoskeletal sepsis remains uncommon, with a high prevalence of underlying predisposing disease, or pre-existing arthritis in the septic joint. Group B BHS septic disease appears to be increasing in incidence. Musculoskeletal sepsis with these organisms usually takes place in subjects with other diseases, but healthy subjects have not been spared. Multiple septic foci and a rapidly destructive arthritis are not uncommon, and a recently described extra-articular feature is potentially blinding metastatic endophthalmitis. Clinicians need to be aware of an apparently increasing incidence of BHS musculoskeletal sepsis in adults so that early identification can lead to aggressive management in these potentially fatal infections.
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PMID:Beta haemolytic streptococci and musculoskeletal sepsis in adults. 832 4

Five patients with burns and toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus sepsis (TSS group) were treated in a 5-year period at Kyorin University Hospital's Traumatology and Critical Care Center Burn Unit. Hemodynamic and metabolic differences in these patients were compared retrospectively with those in another five patients who were matched by burn index and age and in whom endotoxin-producing gram-negative rod sepsis developed (End group). Both groups showed hypermetabolic and hyperdynamic changes at the point sepsis developed. There were no significant differences between the two groups in any parameter. At the point septic shock developed, the TSS group showed significantly lower mean (+/- SD) arterial pressure (TSS vs End group, 64 +/- 5 vs 74 +/- 5 mm Hg; p < 0.05), significantly lower systemic vascular resistance index (TSS vs End group, 579 +/- 62 vs 729 +/- 75 dynes.sec.cm-5/m2; p < 0.05), and higher oxygen consumption (TSS vs End group, 190 +/- 7 vs 163 +/- 11 L/min/m2; p < 0.05) compared with the End group. This is the first clinical report that asserts that TSST-1-producing gram-positive sepsis may result in more hypermetabolic and hyperdynamic differences than does endotoxin-producing gram-negative rod septic shock. These responses may indicate a stronger stimulation of cytokine and nitrous oxide synthetic activity by TSST-1 than by endotoxin.
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PMID:Comparison of hemodynamic changes resulting from toxic shock syndrome toxin-1-producing Staphylococcus aureus sepsis and endotoxin-producing gram-negative rod sepsis in patients with severe burns. 858 41

We report a rare case of non-menstrual toxic shock syndrome (TSS) in the course of Staphylococcus aureus sepsis in a 31-year-old primigravida who developed high fever and severe pulmonary and cardiovascular failure within a few hours at the end of the 29th week of a twin pregnancy. Mechanical ventilation was necessary due to signs of adult respiratory distress syndrome (ARDS) and catecholamines were needed to maintain a somewhat adequate blood pressure. A forceps delivery was performed immediately. Postoperatively, the patient was brought to the intensive care unit (ICU) due to the suspicion of severe septic shock. In addition to the extreme cardiovascular instability and massive disturbance of pulmonary gas exchange, the clinical picture was characterised by a disseminated intravascular coagulopathy (DIC) with marked petechial bleeding and ecchymoses on all extremities. Moreover, a confluent, spotty exanthem of the trunk and extremities could be seen. Despite all therapeutic efforts, the patient died within a few hours after admission to the ICU with signs of multiorgan failure. Post-mortem, multiple staphylococcal abscesses were found in the kidneys, liver, and uterus. Moreover, acute ulcerous endocarditis of the mitral valve and septic myocardial foci with myocarditis were seen. The Staph. aureus strain isolated from the blood cultures was shown to produce TSS toxin 1 (TSST-1) and enterotoxin B. In summary, the clinical picture can be interpreted as severe staphylococcal sepsis complicated by TSS. TSS is a specific type of infectious disease, occurring mainly in young women during the menstrual period (80%-90%), but it has also been reported in non-menstrual cases (10%-20%). It is characterised by sudden-onset high fever, hypotension, rash, mucosal hyperaemia, and various additional symptoms such as myalgia, vomiting, and diarrhoea. The clinical course depends on the extent of the organ failure due to decreased tissue perfusion during hypotension. Severe cases are accompanied by multiple organ-system failure including impaired renal function, which is reversible in nearly all cases. Respiratory failure ranges from interstitial and alveolar aedema to ARDS in 10% of cases; severe DIC is seen in 10%-15%. Another severe clinical complication is cardiac insufficiency. The etiology of TSS is based on a localized or, rarely, systemic infection with certain Staph. aureus strains that are capable of producing toxins, the most important one being TSST-1. Staph. aureus strains can also produce various other enterotoxins that may be involved in the pathogenesis of TSS. The pathogenetic importance of the toxins is supported by the antibody titers in TSS patients: more than 80% of healthy adults show high levels of antibody titers, whereas 90% of TSS patients exhibit low levels in the acute phase followed by a significant increase during convalescence. It is not clear whether the toxins cause TSS by a direct effect or by release of mediators due to their function as superantigens. The clinical characteristics of non-menstrual TSS are identical to those of menstrual TSS, but it can occur in many clinical settings in both sexes at any age. Severe clinical courses are more frequent in non-menstrual TSS: the mortality is about 8%-11% in non-menstrual TSS compared to 2%-5% in menstrual TSS. The diagnosis is based mainly on clinical signs and the isolation of toxin-producing Staph. aureus strains. Besides antibiotic therapy, treatment is primarily directed to the correction of hypotension and additional organ-system failure. Other therapeutic measures such as the elimination of toxins by plasma separation or the administration of antibodies or gamma-globulins are subjects of investigation with no general recommendations at this time.
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PMID:[Lethal, non-menstrual toxic shock syndrome associated with Staphylococcus aureus sepsis]. 859 62

Since 1987, reports have appeared of a streptococcal toxic shock syndrome in various clinical settings. None have appeared in the orthopaedic literature. Between 1989 and 1991 at our institution three patients with relatively minor orthopaedic injuries or procedures died of group A streptococcal infections complicated by toxic shock syndrome. The manifestations of this syndrome included rapid progression of systemic sepsis, necrotizing soft-tissue infections, acute renal failure, adult respiratory distress syndrome, and coagulopathy. All three patients died despite aggressive resuscitative measures and surgical debridement. Optimal treatment of this life-threatening process requires early recognition, aggressive surgical debridement, appropriate antibiotic management, and intensive care unit support.
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PMID:Fatal group A streptococcal infection with toxic shock syndrome: complicating minor orthopedic trauma. 866 5

Group A streptococci (S. pyogenes) possess a number of capsule and cell wall associated components and release many extracellular proteins (toxins and hydrolytic enzymes) that are known or thought to contribute to the virulence and pathogenicity of the microorganism. Groupe A streptococci cause a wide array of infections, the most frequent of which are acute pharyngitis and pyoderma with two severe sequelae (acute rheumatic fever and glomerulonephritis). Other manifestations are scarlet fever and various soft tissue infections as well as sepsis and the recently characterized streptococcal toxic shock syndrome. The somatic components of group A streptococci include cell wall M protein, capsular hyaluronic acid, lipoteichoic acid, peptidoglycan, fibronectin binding protein, C5a peptidase and receptors for various human plasma proteins particularly IgA and IgG. The extracellular products are numerous and consist of among others the hemolytic toxins streptolysins S and O, hyaluronidase, streptokinase and cysteinyl proteinase as well as the superantigens erythrogenic toxins A and C also known as pyrogenic exotoxins.
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PMID:[Cellular constituents and extracellular proteins involved in the pathogenic capacity of Streptococcus group A]. 873 28

A fourteen-year-old girl with acute otitis media died from gram positive sepsis and toxic shock despite intensive treatment. The definitive bacteriological results showed positive cultures for both S. aureus and S. pyogenes serotype A. In vitro the bacteria produced the bacterial superantigens TSST-1, enterotoxin A, enterotoxin C (S. aureus) and erythrogenic toxin C (S. pyogenes). The patient presented with large flaccid sterile bullae on her chest and arms as well as necrotizing fasciitis. Tzanck test showed keratinozytes without necrosis and no inflammatory cells. Frozen-section and conventional skin biopsy specimens revealed subcorneal intraepidermal cleavage. These cytological and histological findings are those of staphylococcal scalded skin syndrome (SSSS) and differ from bullous erysipelas or toxic epidermal necrolysis (TEN). Therefore bacterial exotoxins are most likely responsible for the intraepidermal blistering in our case just as in SSSS. Bullae are an unfavorable prognostic sign in gram positive toxic shock syndrome. Both Tzanck test and frozen-section biopsy are easy to perform and useful in the early and rapid recognition of gram positive bullous toxic shock syndrome.
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PMID:[Gram-positive septic-toxic shock with bullae. Intraepidermal splitting as an indication of toxin effect]. 903 30

Endotoxin (lipopolysaccharide; LPS) and superantigens (exotoxins) have been identified as potent inducers of lethal shock. While endotoxin primarily interacts with CD14 receptors on macrophages, superantigens like the staphylococcal enterotoxin B (SEB) preferentially activate T cells. Both cell types are triggered to release pro-inflammatory cytokines that in turn induce lethal shock. We analyzed whether endotoxin and superantigen interact during the induction phase of lethal shock. We report that LPS and SEB operate synergistically. Lethal doses of both inducers were reduced 100-fold when given in combination. The induced serum levels of tumor necrosis factor, interleukin-6, and interferon-gamma (IFN-gamma) were elevated and remained high for a prolonged period. Moreover, synergistic action of LPS and SEB induced lethal toxic shock even without presensitization of mice with D-galactosamine (D-GalN). Opposed to D-GalN-pretreated mice, mice injected with LPS and SEB showed less liver damage, but rather apoptosis of epithelial cells in the bowel. Cyclosporin A and treatment with anti-IFN-gamma monoclonal antibody blocked the synergistic action of LPS and SEB, indicating that T cell-derived IFN-gamma is the mediator of the observed synergism. Concomitant injection of LPS and SEB had no influence on SEB-induced T cell deletion and anergy induction. Since Gram-positive and Gram-negative bacteria can be recovered from septic blood samples, the synergistic action of endotoxin and superantigens might be relevant during lethal septicemia.
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PMID:Superantigen and endotoxin synergize in the induction of lethal shock. 913 Jun 31


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