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

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, is steroid therapy ever of benefit to patients in the intensive care unit going into septic shock? Using the reported search 1505 papers were identified. Fourteen papers represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. Recent guidelines from the Surviving Sepsis Campaign recommend using stress doses of corticosteroids for septic shock regardless of adrenal function. All patients undergoing cardiothoracic surgery are at risk of developing septic shock. The 14 papers demonstrated that 28-day mortality is unaffected by hydrocortisone, however, the time to shock reversal is significantly reduced. Steroids reduced inflammatory mediators (IL-6, IL-8 and CRP) and neutrophil activation whilst maintaining neutrophil phagocytic functions. Haemodynamically, they increased systemic vascular resistance (SVR) and mean arterial pressure (MAP) and reduced heart rate (HR) and glomerular permeability. We conclude that steroids have no effect on mortality but shorten time to shock reversal, therefore they have a limited capacity in septic shock patients. Their immunological and haemodynamic effects cannot be discounted and could benefit patients in severe septic shock with adrenal insufficiency.
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PMID:Is steroid therapy ever of benefit to patients in the intensive care unit going into septic shock. 1864 22

The French Indian Ocean island Mayotte was hit by an outbreak of chikungunya in January 2005. The purpose of this retrospective study is to report data recorded over a five-month period (February - June 2006) in the pediatric-neonatal department of the Hospital Center in Mayotte. The study cohort includes a total of 50 children in whom chikungunya was confirmed by molecular tools. Mean age was 9.3 years and the male-to-female sex ratio was 1:5. The main symptoms were intense pain (88%), high fever (82%), and skin rash (80%) that was less common in children under 2 years of age. Neurological complications were observed in 46% of patients including hypotonia (22%) that occurred mainly in newborns, meningitis syndrome (18%) and convulsions (16%) that occurred mainly in children over 2 years of age. Infectious complications included pneumonia (4%), pyelonephritis (2%), and possible nosocomial septicemia due to Pseudomonas (6%). The main hematological abnormalities were lymphopenia (27%) and thrombopenia (16%). Serum CRP values were moderately high (mean, 25 mg/l). Elevated AST (24%) and ALT (10%) values were observed. High CSF protein levels were noted in 30% of cases. A total of 25 children required hospitalization for more than 10 days. There were two deaths in newborns infected before the seventh day of life. The main risk factors for hospitalization longer than 10 days were premature birth and age at the time of chikungunya infection.
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PMID:[Confirmed chikungunya in children in Mayotte. Description of 50 patients hospitalized from February to June 2006]. 1906 81

Chronic kidney disease (CKD) carries an increased risk of cardiovascular disease (CVD). Macrophage migration inhibiting factor (MIF) is a proinflammatory cytokine implicated in the pathogenesis of sepsis, autoimmune disease, atherogenesis, and plaque instability, and is a known cardiac depressant. This post-hoc, cross-sectional study examined whether MIF serum concentrations are elevated in CKD patients. Our study included CKD 3-5 patients with moderate to severe renal dysfunction (n = 257) (mean age SD; 55 +/- 12 years) and 53 controls (60 +/- 12 years). Serum MIF concentrations, measured by enzyme-linked immunosorbent assay (ELISA), were studied in relation to glomerular filtration rate (GFR), presence of CVD, outcome and inflammatory and oxidative stress markers. MIF was significantly elevated in CKD patients compared with controls (CKD: median 676 [range 118-8275 pg/mL] controls: 433 [142-4707] pg/mL; P = 0.008). MIF was also associated with 8-hydroxy-2-deoxyguanosine (8-OH-dG) levels (rho = 0.26; P = 0.001), a marker of oxidative stress, and ICAM-1 levels (rho = 0.14; P = 0.02), a marker of endothelial activation. However, the elevated MIF concentrations were neither correlated with glomerular filtration rate (GFR) nor inflammatory markers such as CRP, IL-6, and TNF. When combining MIF and IL-6 as a marker of inflammation, a significant increase in risk for CVD was found, but when analyzing all-cause mortality, this did not differ significantly with regard to mortality from inflamed patients with low MIF levels. The data suggest that increased serum MIF levels found in CKD is not caused primarily by poor renal function, but is associated with markers of oxidative stress and endothelial activation and may play a role in vascular disease associated with CKD.
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PMID:Elevated serum macrophage migration inhibitory factor (MIF) concentrations in chronic kidney disease (CKD) are associated with markers of oxidative stress and endothelial activation. 1908 68

For the treatment of septic patients, it is important to perform a rapid and accurate identification of the causative microorganisms of the syndrome, and to use appropriate medicine. Blood culture has been an established method for the identification of causative bacteria in patients with sepsis, and the measurement of CRP has been used to estimate the severity of disorders. However, the blood culture method has a low sensitivity for detecting surviving bacteria in patients with sepsis because of the possible administration of antibiotics in advance of the test. Although the identification of causative bacteria must be performed quickly, the method requires several days to detect and identify the bacteria and to test for susceptibility to antibiotics. In addition, CRP measurement is not able to distinguish systemic bacterial infection from nonbacterial infection or non-infectious inflammation. To overcome the disadvantages of these tests for the diagnosis of sepsis, new methods have been developed. In this issue, we introduce two new methods for the diagnosis of sepsis. One involves the detection of the bacterial gene ingested by neutrophils by the in-situ hybridization method, and the other is the measurement of procalcitonin in blood samples. Since these tests have several advantages in comparison with the conventional blood culture method or the measurement of CRP to verify the presence of bacterial infection and identify the causal bacteria in a shorter period, we need to combine these tests with the conventional methods to facilitate an accurate diagnosis and administer appropriate antibiotics to septic patients.
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PMID:[New methods for diagnosis of sepsis]. 1908 61

Carbon monoxide, a classical respiratory inhibitor, also exerts vasodilatory, anti-inflammatory, and antiapoptotic effects. CO-releasing molecules have therapeutic value, increasing phagocytosis and reducing sepsis-induced lethality. Here we identify for the first time the bacterial targets of Ru(CO)(3)Cl(glycinate) (CORM-3), a ruthenium-based carbonyl that liberates CO rapidly under physiological conditions. Contrary to the expectation that CO would be preferentially inhibitory at low oxygen tensions or anaerobically, Escherichia coli cultures were also sensitive to CORM-3 at concentrations equimolar with oxygen. CORM-3, assayed as ruthenium, was taken up by bacteria and rapidly delivered CO intracellularly to terminal oxidases. Microarray analysis of CORM-3-treated cells revealed extensively modified gene expression, notably down-regulation of genes encoding key aerobic respiratory complexes. Genes involved in metal metabolism, homeostasis, or transport were also differentially expressed, and free intracellular zinc levels were elevated. Probabilistic modeling of transcriptomic data identified the global transcription regulators ArcA, CRP, Fis, FNR, Fur, BaeR, CpxR, and IHF as targets and potential CO sensors. Our discovery that CORM-3 is an effective inhibitor and global regulator of gene expression, especially under aerobic conditions, has important implications for administration of CO-releasing agents in sepsis and inflammation.
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PMID:Carbon monoxide-releasing antibacterial molecules target respiration and global transcriptional regulators. 1909 47

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to determine the role of micro-ESR and immature and total neutrophil (I/T) ratio in early diagnosis of neonatal septicaemia. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. I/T ratio detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Micro-ESR more than age of the patient in days+3 mm in 1st hour were considered significant for sepsis. I/T ratio more than 0.2 was considered positive for sepsis. Sensitivity and specificity of micro-ESR was 63.3% and 60% respectively. Sensitivity and specificity of I/T ratio was 70% and 56% respectively. Combination of micro-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%).
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PMID:Role of micro-ESR and I/T ratio in the early diagnosis of neonatal sepsis. 1918 51

This prospective study was undertaken in Dhaka Shishu hospital, Bangladesh from 15th Oct. 2005 to 15th October 2006 to determine the Risk factors, Clinical manifestation and bacteriological profile of neonatal sepsis. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients, who had history of perinatal asphyxia, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without signs & symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent, detailed history was obtained from mother or relatives accompanying the baby. Hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Low socioeconomic conditions, place of delivery, low birth weight, prolong rupture of membrane appears to be the principal predisposing factors for neonatal sepsis. Clinical presentation includes reluctant to feed (96.7%), lethargy (73.4%), abdominal distention (70%), Hypothermia (40%), Jaundice (50%) are more common. Predominant organism was gram negative. Among them: Klebsiella (60%), Serratia (20%), Acenetobactor (13.3%). This isolates were most often sensitive to third generation cephalosporin. Imipenam is highly sensitive and is recommended when other therapy fails. Periodic surveillance for agent of infection & their antimicrobial sensitivity profile is recommended.
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PMID:Risk factors, clinical manifestation and bacteriological profile of neonatal sepsis in a tertiary level pediatric hospital. 1937 35

The essential trace element selenium (Se), in the form of selenoproteins, plays a pivotal role in the antioxidant defense system of the cell. There is evidence that Se may confer benefits in patients with inflammatory disease and even infectious diseases like HIV. Furthermore, in patients with severe sepsis, characterized by an increase in reactive oxygen species and low endogenous anti-oxidative capacity, as well as in patients with systemic inflammatory response syndrome, Se supplementation may reduce mortality and improve the clinical outcome, respectively. The nuclear factor kappa-B (NF-kappaB) signaling pathway has been associated with enhanced inflammatory response and its activation has been significantly correlated with interleukin-6 and TNF-alpha production. Selenium may inhibit the activation of NF-kappaB by modulating selenoprotein genes expression. Moreover, Se supplementation in chronic inflammation restores the depleted hepatic and serum Se levels by increasing selenoprotein biosynthesis leading to suppressed CRP production thereby attenuating the inflammatory process. Se increases shedding of L-selectin from monocytes while decreasing soluble L-selectin, which has been reported to be associated with high mortality in patients with sepsis. These mechanisms are likely to contribute to the modulatory effects of an increased Se status on the inflammatory response. This review evaluates some apparently key mechanisms of the anti-inflammatory action of selenium and advocates Se supplementation as a modulator of inflammatory response in infectious and autoimmune disease. Prospective, randomized, controlled studies must be performed to provide a greater degree of certainty.
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PMID:Selenium and inflammation: underlying anti-inflammatory mechanisms. 1941 16

Dynamic measurements of blood TNF-a, IL-IRA, CRP, oligopeptide, and lactoferrin levels in patients with systemic and local soft tissue infections revealed direct correlation between them which allowed to use these indicators for the diagnosis of systemic infections. Results of clinical and laboratory analyses provided a basis for distinguishing short-term systemic inflammatory response syndrome and sepsis and developing relevant diagnostic criteria. Sepsis combined with systemic inflammatory response syndrome persisting for more than 72 hours after the onset of adequate therapy was characterized by CRP levels > 30 mg/l, oligopeptides > 0.34 U, lactoferrin > 1900 ng/ml, TNF-a > 6 pg/ml, ILL-IRA < 1500 pg/ml Patients with systemic inflammatory response syndrome for less than 72 hours had lower TNF-a, CRP, oligopeptide, and lactoferrin levels with IL-IRA > 1500 pg/ml. This new approach to early diagnosis of systemic infections makes it possible to optimize their treatment and thereby enhance its efficiency.
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PMID:[A new approach to clinical and laboratory diagnosis of systemic and local soft tissue infections]. 1951 7

We present a patient who developed carbamazepine (CBZ)-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with high serum procalcitonin (PCT). The presentation (high fever, hepatosplenomegaly, leukocytosis), high PCT and CRP initially suggested sepsis, and he was treated with antibiotics, while CBZ was continued. The rash and hepatitis worsened. After withdrawal of CBZ, corticosteroid therapy was administered and the patient recovered with normalization of PCT. This case demonstrates that PCT may be increased in patients with DRESS. This is the first report of CBZ-induced DRESS associated with high PCT, and the second case of increased PCT in DRESS.
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PMID:High procalcitonin in a patient with drug hypersensitivity syndrome. 1968 1


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