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

Necrotizing fasciitis are characterized by the necrosis of fascias, and their severe consequences in terms of morbidity and mortality. An early diagnosis, based on sometimes subtle cutaneous lesions (associated to a sepsis syndrome) allows to start resuscitation and decide on a probable surgery. 3 major forms can be distinguished: streptococcal fasciitis, due to beta-hemolytic streptococci, often following minor trauma, and increasingly associated to a streptococcal toxic shock syndrome (STTS); clostridial gangrene (often polymicrobial when developed on a open wound or after surgery); and synergistic gangrene due to a mixed aerobic-anaerobic flora. Other apparently "primitive" necrotizing fasciitis, caused by specific organisms, may occur in debilitated patients. The prognosis depends on age, comorbidity, and above all on the severity of the sepsis syndrome. Initial resuscitation involves controlling the hypotension and organ dysfunction associated with severe sepsis, and is usually dominated by a severe hypovolemia. Penicillin G remains the key antibiotic for streptococcal and clostridial fasciitis, with a broad spectrum including enterobacteriaceae, streptococci and enterococci, and anaerobes (including Bacteroides spp.) in other types or when the etiology is unknown. In patients presenting with STSS, a combination of clindamycin (or rifampin) to penicillin is recommended, because of their effect on exotoxin production; administration of non-specific immunoglobulins also appears to improve the outcome of patients affected. Hyperbaric oxygen therapy has not proved effective. Early surgical debridement largely influences the prognosis. The prevention of complications associated with long-term intensive care, including early nutritional support and prevention of a thromboembolic disease, is also important.
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PMID:[The therapeutic approach to necrotizing fasciitis]. 1131 71

Acute gangrenous dermo-hypodermitis and necrotizing fasciitis are potentially life-threatening infections of skin and soft tissues, which may be difficult to recognize at an early stage. A combination of local signs (erythema, mottling, bullous formation) and of symptoms suggestive of sepsis should prompt early suspicion and therapeutic intervention. Group A streptococci remain the major pathogen involved in necrotizing fasciitis involving extremities, following minor trauma or surgery, and sometimes apparently spontaneously. The most severe form is streptococcal toxic shock syndrome, where production of exotoxins (superantigens) is a major factor contributing to the severity of the syndrome. A number of other pathogens, often combined in mixed aerobic-anaerobic infections may be involved, especially in post-surgical and perineal gangrene. Surgery remains the mainstay of therapy, and should be considered as soon as the clinical suspicion arises. Antibiotic therapy is based on penicillins (penicillin G for streptococcal gangrene, or beta-lactamases penicillins in polymicrobial infections). New therapeutic approaches (clindamycin and immunoglobulins) may be useful in streptococcal toxic shock. The prognosis appears to have improved in recent years with early therapeutic intervention, but remains largely dependent on the severity of the septic response and underlying diseases.
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PMID:[Dermo-hypodermitis and necrotizing fasciitis]. 1134 64

The staphylococci have been recognized as serious pathogens for over a century and are the etiological agent of a variety of diseases ranging from mild cutaneous infections to often fatal forms of septic arthritis, endocarditis, toxic shock syndrome and sepsis. Despite intensive efforts to halt their spread, they remain the most common cause of community- and nosocomially acquired bacteremia. Murine models of Staphylocococus aureus-mediated arthritis and sepsis exist and are being used to gain a better understanding of the host-bacterium relationship as well to develop better methods of prevention and treatment.
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PMID:Model systems: modeling human staphylococcal arthritis and sepsis in the mouse. 1143 6

The state of the vitally significant functions in patients with sepsis and infective-toxic shock (ITS), to whom operative intervention was done, was studied. The expediency of application in postoperative period of hypertonic and hypertonic hyperoncotic solutions in combination adrenomimetic preparations was proved. The advantages of multicomponent anesthesia, based on oxybate and ketamine in comparison with neuroleptanalgesia and ataralgesia were substantiated. The method of the anesthesiological securing was proposed, application of which have permitted to raise essentially the safety of the operative intervention in patients with ITS.
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PMID:[Anesthesiological support of operative treatment in patients with infectious-toxic shock]. 1148 27

A PEDIATRIC PATHOGEN: Staphylococci remain one of the most important pathogenic agents leading to community-acquired infection in children. Over the last decades, there has been an evolution in the localizations of these infections: dramatic pleuropulmonary staphylococcal infection in newborns has almost entirely disappeared in developed countries. Conversely, skin infections and soft tissue infections as well as bone and joint localizations are frequent. The severity of these bone and joint infections has however declined allowing less aggressive therapeutic regimens. One of the current problems is the risk of emergence of meticillin-resistant strains causing community-acquired infections. Such infections have been very rare in France but careful monitoring is nevertheless necessary. NOSOCOMIAL INFECTION: Staphylococci are however the leading cause of nosocomial infections in children, particularly in intensive care units. All localizations are concerned, especially catheter-related septicemia and pneumonia. There has been an increasing trend for Staphylococcus aureus and coagulase-negative staphylococci infections. Most of the strains isolated are meticillin-resistant. TOXINS: Staphylococcus aureus secretes toxins leading to specific diseases: enterotoxins cause food-poisoning and exofoliatines cause generalized exfoliation and bullous impetigo. Staphylococcal scarlatina is related to the shock provoked by staphylococcal toxins: TSST-1 and entrotoxins. Staphylococcal toxic shock syndrome is a relatively new entity more frequently observed in adults but which was initially described in children. The disease may develop during any staphylococcal infection, particularly after superinfection of a skin burn or varicella. MECHANISM OF ACTION OF TOXINS: Staphylococcal toxins act like superantigens, capable of provoking polyclonal activation of a large number of T cells. This leads to the release of an important quantity of cytokines that intervene in the pathogenesis of toxic diseases. This polyclonal activation has been observed in other pediatric diseases of unknown origin but in which the involvement of staphylococcal toxins can be suspected. There is solid evidence in favor of staphylococcal toxins in Kawasaki syndrome. Likewise, these toxins could be implicated in sudden death syndrome in infants and in acute exacerbations of atopic exzema.
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PMID:[Current problems posed by staphylococcal infections in pediatric patients]. 1177 6

Streptococcus pyogenes causes severe invasive diseases in humans, including necrotizing fasciitis, sepsis, and streptococcal toxic shock syndrome (STSS). We found that mice infected intramuscularly (i.m.) with S. pyogenes strains developed bacteremia and subsequent sudden death after at least 10 days of a convalescent period. Mostly, it occurred more than 21 days after muscle infection. We provisionally designate this phenomenon as "delayed death." Just after muscle infection, all the mice lost weight and activity, but recovered completely within 3 days. They had kept good activity and a fine coat of fur till one or two days before their death. Some of the dead mice were found to have soft-tissue necrosis. There was no correlation between the virulence leading to the delayed death and the severity of diseases from which strains were isolated. It was also found that the production of neither streptococcal pyrogenic exotoxin (SPE) A nor B correlated to the virulence leading to delayed death. The bacteria obtained from the organs of the mice with delayed death expressed capsule. We suggest that the mice with delayed onset of systemic bacterial dissemination and subsequent death after muscle infection with S. pyogenes are the animal models of STSS, because the pathophysiology is extremely similar to that of human STSS.
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PMID:Delayed onset of systemic bacterial dissemination and subsequent death in mice injected intramuscularly with Streptococcus pyogenes strains. 1179 71

Intravenous immunoglobulins (IVIg) are widely used as prophylaxis against and as supplemental treatment of sepsis and septic shock, although this concept does not belong to the currently approved medical indications for IVIg products. A reduction in mortality by pooled IVIgGMA more than by IVIgG alone was reported in the recent Cochrane database (eight trials, 492 patients). However, the failure to reduce mortality by IVIgG in the score-based immunoglobulin treatment in sepsis study (653 patients) seriously questions whether IVIgG may reduce mortality. Patients with streptococcal toxic shock syndrome might benefit from IVIg, although it remains questionable whether large controlled trials will ever be available. Intravenous immunoglobulin prophylaxis can undoubtedly reduce the occurrence of infections-especially pneumonias-in at-risk patients. More data are necessary to ascertain whether this beneficial effect is linked with a reduction of infection-related morbidity and mortality. Ongoing studies will document whether cardiac surgery patients with escalating systemic inflammatory response syndrome or mediastinitis will benefit from IVIg. IgM-specific complement inactivation may further stimulate the discussion of IVIgGMA superiority over IVIgG.
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PMID:Intravenous immunoglobulin for prophylaxis and therapy of sepsis. 1180 33

OBJECTIVE: To investigate if exposure to exotoxins results in augmented serum cytokine response of patients with Staphylococcus aureus septicemia. METHODS: Serum samples and strains from 63 patients with S. aureus septicemia were collected in a prospective study. Toxin production by strains in vitro was determined by enzyme immunoassay (EIA) or reversed passive latex agglutination (RPLA). Antibodies against the toxins and cytokine levels in serum on admission were analyzed with EIA. RESULTS: Patients infected with strains producing staphylococcal enterotoxins (SEs) A, B, C and D and/or toxic shock syndrome toxin-1 (TSST-1) in vitro (n=37) showed higher serum TNF-alpha levels than those infected with non-toxigenic strains (p=0.04). A significant titer rise against the corresponding SE and/or TSST-1 produced by the isolate (14/35), indirectly reflecting exposure to the antigen, was associated with higher TNF-alpha concentrations on admission than in those without titer rise (p=0.03). Patients with low antibody titers against SE and/or TSST-1 on admission (19/37) were found to have higher serum TNF-alpha concentrations on admission than those with elevated antibody titers on admission (p=0.03). CONCLUSION: Patients infected with toxigenic S. aureus strains produce significantly higher levels of serum TNF-alpha on admission compared to patients infected with non-toxigenic strains.
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PMID:Cytokine response to staphylococcal exotoxins in Staphylococcus aureus septicemia. 1186 51

Lactoferrin (Lf) is an iron-binding protein of external secretions and neutrophil secondary granules with antimicrobial and immunomodulatory activities. To further define these properties of Lf, we have investigated the response to Staphylococcus aureus infection in transgenic mice carrying a functional human Lf gene. The transgenic mice cleared bacteria significantly better than congenic littermates, associated with a trend to reduced incidence of arthritis, septicemia, and mortality. We identified two pathways by which S. aureus clearance was enhanced. First, human Lf directly inhibited the growth of S. aureus LS-1 in vitro. Second, S. aureus-infected transgenic mice exhibited enhanced Th1 immune polarization. Thus, spleen cells from infected transgenic mice produced higher levels of TNF-alpha and IFN-gamma and less IL-5 and IL-10 upon stimulation ex vivo with the exotoxin toxic shock syndrome toxin-1 compared with congenic controls. To confirm that these effects of Lf transgene expression could occur in the absence of live bacterial infection, we also showed that Lf-transgenic DBA/1 mice exhibited enhanced severity of collagen-induced arthritis, an established model of Th1-induced articular inflammation. Higher levels of stainable iron in the spleens of transgenic mice correlated with human Lf distribution, but all other parameters of iron metabolism did not differ between transgenic mice and wild-type littermates. These results demonstrate that human Lf can mediate both antimicrobial and immunomodulatory activities with downstream effects on the outcome of immune pathology in infectious and inflammatory disease.
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PMID:Enhanced Th1 response to Staphylococcus aureus infection in human lactoferrin-transgenic mice. 1193 51

The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10-15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock-like syndrome has been described; Streptococcus mitis has been the causative species in most cases. Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome. Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of antimicrobial prophylaxis for neutropenic patients with cancer should be reconsidered.
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PMID:Infections caused by viridans streptococci in patients with neutropenia. 1201


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