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

Intravenous gammaglobulin is effective therapy of ITP and other autoantibody-mediated immune cytopenias. All children as well as adults unresponsive to splenectomy or with known immune deficiency are probably the best candidates for treatment with IVGG. Its major advantage, in addition to its efficacy of treatment and possible remission-inducing effect, is that it has the fewest side effects of any treatment of ITP so that it is the best maintenance therapy of patients when effective. Future uses of IVGG remain to be determined. Premature infants with a high mortality from sepsis and with hypogammaglobulinemia due to termination of pregnancy prior to transplacental antibody transfer may benefit from IVGG. A preliminary study suggested such benefit and also showed safety of IVGG treatment in that there was no impaired immune responsiveness of these prematures at 2 years of age (28). Another potential usage of IVGG involves the treatment of the hypogammaglobulinemia associated with certain types of malignancy. Patients with CLL, especially in the advanced stages, are often hypogammaglobulinemic. Multiple myeloma and Waldenstrom's macroglobulinemia are two other B-cell malignancies associated with antibody production defects which might benefit from antibody replacement therapy. Therapeutic IgG levels may be harder to obtain due to hypercatabolism of immunoglobulin. The issue of immune hyporesponsiveness during intensive chemotherapy is also unexplored. Secondary antibody responses do not seem to be impaired, but primary responses, as tested in numerous immunization studies, are decidedly impaired. Certain protocols, especially those treating high-risk acute leukemias and neuroblastoma during induction therapy are intensive with high rates of sepsis, and may warrant trials of prophylactic IVGG. Similarly, some form of humoral prophylaxis is becoming an important part of the handling of the patient undergoing bone marrow transplantation not only to prevent bacterial sepsis but also to prevent cytomegalovirus (CMV) interstitial pneumonitis. A likely additional usage is gammaglobulin replacement for patients undergoing plasmapheresis, especially if performed multiple times. Finally, the broad spectrum of antibacterial and antiviral antibodies present in the preparations (such as anti-CMV, anti-Group B strep, and antiendotoxin) and the ease and safety of delivery allow the preparations to be used in situations where a hyperimmune preparation might be desired and/or where more than one pathogen is possible. In summary, IVGG is a treatment capable of safely conferring significant benefits to selected patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Intravenous usage of gammaglobulin: humoral immunodeficiency, immune thrombocytopenic purpura, and newer indications. 404 Jul 95

High risk groups of infants with regard to sepsis are described. The first high risk group includes newborn babies, infants of the first 3 months of age, premature babies, the second babies with congenital defects of the immune system (classified and unclassified defects), the third babies with acquired immune deficiency conditions due predominantly to the pathology of therapy. Septicemia remains the main clinico-anatomical form of sepsis in infants. The morphological criteria of this form of sepsis are described. In the lack of decrease of sepsis incidence in infants pathology of a therapy plays a great role, but it should be remembered that sepsis nowadays is observed in babies who previously had died within a short period of time after birth or after the onset of the disease.
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PMID:[Features of sepsis in children today]. 720 Jul 66

Fungal infections of the heart are infrequent postoperative complications in children, yet, when present are often fatal. Children autopsied at The Johns Hopkins Hospital from 1889 to the present were studied for cardiac fungal infection. Among the 14 children so identified, 8 developed cardiac fungal infection after surgery. All postoperative cardiac infections were caused by Candida species. All were autopsied since 1959. Gastrointestinal surgery was performed in 6 patients and cardiac surgery in 2. Candida infection was not confined to the endocardium; endocarditis developed in 2 patients, pericarditis in 1, and myocarditis in 5. None received cytotoxic agents or corticosteroids. Two patients died from direct cardiac involvement. Other deaths were related to Candida sepsis or bronchopneumonia. A clinical diagnosis of cardiac fungal infection was never made. Prolonged administration of multiple antibiotics, central venous catheterization, prematurity and immune deficiency predisposed to cardiac and systemic candidiasis. Clinical features facilitating early diagnosis are discussed. Removal of central venous catheters infected with Candida did not eliminate the source of continued sepsis, since Candida-laden vegetations related to the catheter adhered to the superior vena cava and endocardial surface. Postoperative cardiac candidiasis is a relatively new and persistent problem of early diagnosis and therapy. The post-surgical pediatric patient has major predisposing factors for cardiac candidiasis, which, if unrecognized, may be a source for continued dissemination or may in itself be the cause of death.
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PMID:Postoperative Candida infections of the heart in children: clinicopathologic study of a continuing problem of diagnosis and therapy. 738 69

An investigation of the mortality rates of young adults born in the postwar period of large-scale atmospheric nuclear testing (1945-1965) in the United States and other western industrial nations reveals an increasingly anomalous rise in mortality from its previous secular decline. Beginning in the late 1970s and particularly since 1983, the deterioration in the health of the 25-44 age group is related to in utero exposure to fission products in the milk and diet, associated with an unprecedented rise in underweight births and neonatal mortality known to be accompanied by loss of immune resistance. The 1945-1965 rise in the percentage of live births below 2500 grams is highly correlated with the amount of strontium-90 in human bone, both peaking in the mid-1960s. In the 1980s, for the baby boom generation (those born between 1945 and 1965), cancer incidence and mortality due to infectious diseases associated with a rising degree of immune deficiency, such as pneumonia, septicemia, and AIDS, increased sharply. This process of increasing immune deficiency appears to have been exacerbated by continuing secondary exposures to accidental reactor releases and by an acceleration of radiation-induced mutation of pathogenic microorganisms increasingly resistant to drugs.
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PMID:Nuclear fallout, low birthweight, and immune deficiency. 803 95

The authors report their experience of the clinical and echocardiographic aspects and course of tricuspid infectious endocarditis, based upon 12 cases collected between September 1985 and December 1992. The diagnosis was confirmed on the basis of the association of signs of septicemia (12 cases), at least two positive blood cultures for the same organism (9 cases) and well-defined vegetations seen by trans-thoracic echocardiography (12 cases). All patients were young women: mean age = 21.8 +/- 4.7. None were heroin addicts but one was positive for human immune deficiency virus. Tricuspid infectious endocarditis was most often acute (9 cases), primary (10 cases, post-abortum (11 cases), due to Staphylococcus aureus (5 cases), and complicated by cardiac failure (12 cases) and lung abscess (4 cases). Four patients died of septicemia (2 cases), of cardiac failure and lung abscess (2 cases). One had severe tricuspid incompetence requiring surgery. It has not yet been possible to operate on this patient because of the lack of cardiac surgery facilities in Congo. The prevention of tricuspid infectious endocarditis depends above all on the fight against clandestine abortions and against the development of intravenous drug abuse.
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PMID:[Tricuspid infectious endocarditis in Brazzaville. Apropos of 12 cases]. 811 50

Attempts to augment immune function in infants or children with overwhelming sepsis or immune deficiency have focused on recombinant cytokines and interferons. Although early in their clinical use, the proinflammatory and antiinflammatory effects of the interleukins show promise in regulating the acute inflammatory response. The hematopoietic growth factors have demonstrated considerable clinical effect, especially in individuals with distinct hematopoietic disorders and in patients receiving immunosuppressive chemotherapy. The interferons gamma and alpha have received considerable attention over the last decade as potential immunomodulators. The stimulatory effects of INF-gamma on human neutrophils suggest its therapeutic usefulness in children with specific neutrophil dysfunction, and INF-alpha has shown broad clinical application both as an antitumor as well as an antiviral agent. The most recent studies of the integrins and selectins implicate their potential role in regulating a number of infectious disease states. As we learn more about the complexity of interactions and the delicate balance these molecules have in regulating the immune response, we will be better able to implement their use in regulating disease states in infants and children.
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PMID:Immunomodifiers applicable to the prevention and management of infectious diseases in children. 812 25

The familial occurrence of duodenal atresia is uncommon. This study evaluated the inheritance patterns, the nature and associations, and the presence of immunologic deficits in duodenal atresia recurring in at least three siblings each in two nonrelated families. In the first family, an association with Fanconi's anemia was observed in three of seven pregnancies (2 boys, 1 girl) suggesting an autosomal recessive mode of transmission. Patients died as a result of overwhelming (fungal) septicemia in association with pancytopenia. In a second family, identical multiple atresias occurred in two female siblings born 18 months apart and a third child with a duodenal stenosis. Overwhelming sepsis and a T-cell dysfunction was seen in the postoperative period, which had partially corrected by follow-up at 5 months. A history of family occurrence of duodenal atresia should alert the physician to the possibility of associated pathology including immune deficiency states.
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PMID:Immune deficiency in familial duodenal atresia. 898 5

Bacterial meningitis is usually associated with pleocytosis of the cerebrospinal fluid due to the presence of polymorphonuclear leucocytes. However, 75 cases of bacterial meningitis without pleocytosis have been published. Normocellular bacterial meningitis accounts for 3.5% (1-42%) of all patients suffering from bacterial meningitis and is seen in all age groups: The finding can be explained by three different mechanisms including 1) lumbar puncture performed early in the course of meningitis, 2) immune deficiency, and 3) relative leucopenia due to severe sepsis. Normocellular bacterial meningitis is in general associated with a good prognosis except for cases with severe underlying diseases. A high concentration of bacteria in a normocellular cerebrospinal fluid might also indicate a poor prognosis.
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PMID:[Normocellular bacterial meningitis]. 985 Jun 14

A previously healthy 10-year-old Greek boy born to nonconsanguineous healthy parents developed progressive liver disease after acute infectious mononucleosis. EBV-induced autoimmune hepatitis was suspected and treatment was started with high-dose prednisolone, acyclovir and intravenous immunoglobulins. Despite therapy, his liver function continuously deteriorated and the child died 9 months later in profound immune deficiency from candida septicemia. Flow cytometric analysis of his lymphocytes revealed a major subpopulation of atypical cells (20.3%) which were CD3+, fitted into the lymphocyte gate but showed a very low level of CD4 expression, comparable to that of monocytes. After short-time cell culture, the cells became adherent and developed granules and dendrites. We conclude that these cells may represent strongly activated CD4+ T lymphocytes with downregulated CD4 expression or a subtype of dendritic cells.
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PMID:Atypical CD3+ CD4(low) cell population in a boy with fatal EBV-infection. 992 66

Hemorrhage, nausea and vomiting and poor oral intake remain the most commonly encountered complications after adenotonsillectomy in the pediatric population. Life-threatening infectious complications such as meningitis have rarely been reported. We report a case of meningococcal septicemia complicating adenotonsillectomy in a 3-year-old male child. Possible etiologies postulated include: septicemia following transient bacteremia, increased meningococcal carrier rate, transient immune deficiency, and mucosal damage promoting bacterial translocation. This case highlights the responsibility of the otolaryngologist to maintain medical review, especially when recovery following TA is slow.
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PMID:Meningococcal septicemia post adenotonsillectomy in a child: case report. 1116 55


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