Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 21-year-old Caucasian man received an allogeneic marrow transplant (BMT) from his HLA-identical brother because of myelodysplastic syndrome. He remained red blood cell (RBC) transfusion dependent with persistent antibodies against the donor's RBC. Six months following BMT the patient suddenly developed a severe akinetic syndrome with gait disturbance and frequent falls and bilateral symmetrical lesions in basal ganglia. Concomitantly, micrococcus species septicemia from an infected Hickman catheter developed. Despite antimicrobial therapy and withdrawal of cyclosporin A, neurologic abnormalities persisted and were unresponsive to various therapies. Ischemic damage due to a vascular event during severe infection could be the most probable reason for the lesions seen in our patient, although infectious or toxic complications cannot be ruled out.
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PMID:Symmetrical necrosis of globus pallidus with severe gait disturbance in a patient with myelodysplastic syndrome given allogeneic marrow transplantation. 943 82

A 21-year-old female who had developed ileus underwent abdominal surgery for adhesiolysis. Because of postoperative bleeding she required repeated surgical reexploration. Subsequently, the patient developed abdominal sepsis (Enterobacter cloacae) and, on day 11 of mechanical ventilation, severe adult respiratory distress syndrome (ARDS) (Lung injury score 3.5, paO2/FiO2 55 mmHg). Despite clearing the abdominal situation, chest films showed persisting and new pulmonary infiltrates, leucocytosis, fever and purulent bronchial secretion occurring over a period of five weeks. Despite aggressive antibiotic treatment the patient deteriorated further and disease progressed to multiple organ dysfunction syndrome. At the beginning of week six all bacteriological specimens (blood, bronchoalveolar lavage, urine, catheter tips) were negative for potential pathogens. Possible extrapulmonary infection sites were cleared by computed tomography and Tc 99 labeled antigranulocyte antibody scan. Open lung biopsy was performed on day 33 of ARDS and revealed severe diffuse alveolar damage in the fibroproliferative phase of ARDS. On day 37 after ARDS onset, antibiotic treatment was discontinued and methyl-prednisolone (32 mg every 6 hours, 2.5 mg/kg.day) was started. After five days a significant improvement of pulmonary function (lung injury score decreased from 3.5 to 2.5, paO2/FiO2 increased from 82 to > 200 mmHg) and of cardiovascular performance occurred. Corticosteroid treatment was continued for 29 days and was complicated by an episode of pneumonia (Klebsiella pneumoniae) requiring antibiotic therapy. The patient's trachea was successfully extubated on day 80. She was discharged from intensive care unit on day 93 and left hospital three weeks later. We conclude that late ARDS may cause systemic inflammatory response and persisting organ dysfunction without an identifiable source of infection. Corticosteroid therapy might improve fibroproliferative changes of the lung even if instituted weeks after the onset of ARDS.
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PMID:[Multiple organ failure with several weeks' persistence of ARDS: successful therapy with methylprednisolone]. 949 90

Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. Culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.
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PMID:Unexpected childhood death due to hemolytic uremic syndrome. 1073 36

A 21-month-old male child presented with malnutrition and painless abdominal masses. The masses were provisionally diagnosed as being abdominal lymphoma. Pre-operative investigations did not establish any other cause. The diagnosis of primary gastrointestinal aspergilloma was obtained only post-operatively by histopathology and tissue culture. Following surgery, the tumour grew rapidly and massively despite intravenous amphotericin-B, in the recommended doses. The tumour caused recurrent intestinal obstruction which necessitated multiple extensive surgical excisions. The patient finally died due to sepsis and gastrointestinal bleeding. We believe this to be the first description of a primary gastrointestinal aspergilloma with aggressive local infiltration in a non-neutropenic child.
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PMID:Primary locally infiltrative gastrointestinal aspergilloma in a non-neutropaenic child. 1107 84

A 21-year-old male patient was admitted with acute renal failure and intravascular hemolysis following suicidal parenteral copper sulfate poisoning. He developed metabolic acidosis and septicemia; and was treated with intensive hemodialysis, blood transfusions and antibiotics. After remaining anuric for 4 weeks, his urine output gradually increased. However his renal functions improved only partially. Renal biopsy done 8 weeks after the episode showed chronic tubulo-interstitial nephritis (CIN). This is the first reported case showing CIN following acute copper sulfate intoxication.
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PMID:Chronic interstitial nephritis following parenteral copper sulfate poisoning. 1172 21

A 21-year-old male patient with non-Hodgkin's lymphoma (diffuse large T-cell type, clinical stage IV) received allogeneic bone marrow transplantation (BMT) from a partially HLA-mismatched unrelated donor in July 1998 and achieved complete remission. Thereafter, he suffered from chronic graft-versus-host disease (GVHD) and was continuously administered immunosuppressive drugs for a long time. Two years after the BMT, he complained of severe pain in the right knee, which was swollen, and was diagnosed as having pneumococcal purulent genual arthritis. He underwent arthroscopic synovectomy and was administered systemic and intra-articular antibiotics, leading to a gradual improvement. Streptococcal infections are often seen in patients in the late phase after allogeneic BMT because of immunodeficiency associated with chronic GVHD and hyposplenism. Most streptococcal infections are respiratory tract infections and septicemia, and there have been very few reports on cases of purulent genual arthritis. Administration of prophylactic antibiotics and control of chronic GVHD, which is a risk factor of pneumococcal infection, seem to be important to prevent purulent genual arthritis.
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PMID:Pneumococcal purulent genual arthritis after allogeneic bone marrow transplantation. 1202 38

Diabetic ketoacidosis (DKA) and pancreatic pseudocysts are rare complications following treatment of hematological malignancies with L-asparaginase (L-asp). Persistent hyperglycemia with recurrent DKA presenting as a long-term complication of L-asp-induced pancreatitis is even rarer. A 21-year-old man with pre-B-type acute lymphoblastic leukemia (ALL) developed pancreatic pseudocysts, DKA and persistent hyperglycemia after L-asp therapy. The patient was treated with oral hypoglycemic agents (OHA) for sugar control thereafter. Ten months later, another episode of DKA developed during relapsed ALL without having obvious precipitating factors. Insulin was then instituted for control of his blood sugar until death. The leukemic process may play some role in glucose homeostasis and may be considered as a precipitating factor for DKA. The patient finally died of disease progression of ALL and sepsis 2 years after the initial diagnosis of ALL.
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PMID:Diabetic ketoacidosis and persistent hyperglycemia as long-term complications of L-asparaginase-induced pancreatitis. 1243 31

The objective of this study was to determine whether the serum of patients with sepsis could alter the capability of healthy human peripheral blood mononuclear cells (PBMC) to synthesize cAMP in response to beta-adrenergic stimulation and to evaluate the involvement of the inhibitory pathway (Gi) of adenylyl cyclase in the sepsis-induced alteration of beta-adrenergic signaling. First, PBMC from a healthy donor were incubated for 24 h in serum-containing medium according to three culture conditions: serum alone, serum with pertussis toxin, and serum with propranolol. Second, PBMC were stimulated with 10(-5) M isoproterenol or 10(-6) M forskolin, and measurement of cyclic adenosine monophosphate (cAMP) intracellular accumulation was performed. Serum samples were obtained from three groups of subjects: 14 patients with severe sepsis, 21 patients with septic shock, and 10 healthy control subjects. Basal and forskolin-stimulated cAMP levels were similar in PBMC cultured in control or in septic serum. Isoproterenol-stimulated accumulation was reduced in PBMC preincubated in septic serum. The lowest cAMP levels were found after exposure to serum from patients with septic shock. The addition of pertussis toxin in the incubation medium constantly increased cAMP response to isoproterenol, but more significantly in PBMC exposed to septic serum. Incubation in the presence of propranolol had no significant effect. The serum of patients with sepsis contained soluble depressant substances that inhibited adenylyl cyclase activation by beta-adrenergic agonists. Septic shock serum exhibited the most potent inhibitory effect. Hyperactivation of the Gi pathway of adenylyl cyclase was mainly responsible for the altered transmembrane beta-adrenergic signaling.
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PMID:Impairment of beta-adrenergic signaling in healthy peripheral blood mononuclear cells exposed to serum from patients with septic shock: involvement of the inhibitory pathway of adenylyl cyclase stimulation. 1257 16

A 21 year old woman with no past medical history presented to the emergency room (ER) with signs and symptoms of sepsis and subsequently went into acute respiratory failure. She was found to have myasthenia gravis which was exacerbated by the infection. This report highlights the need to consider myasthenia gravis in the differential diagnosis of an otherwise unexplained respiratory failure in the critical care setting.
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PMID:Case of the month: Unusual presentation of myasthenia gravis with acute respiratory failure in the emergency room. 1662 53

Bacterial lipopolysaccharides (LPS) are important triggers of the widespread inflammatory response, which contributes to the development of multiple organ failure during sepsis. The helical 37-amino-acid-long human antimicrobial peptide LL-37 not only possesses a broad-spectrum antimicrobial activity but also binds and neutralizes LPS. However, the use of LL-37 in sepsis treatment is hampered by the fact that it is also cytotoxic. To find a less toxic analog of LL-37, we used in silico analysis to identify amphipathic helical regions of LL-37. A 21-amino-acid fragment (GKE) was synthesized, the biological actions of which were compared to those of two equally long peptides derived from the N and C termini of LL-37 as well as native LL-37. GKE displayed antimicrobial activity against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans, and Candida parapsilosis that was similar to or even stronger than LL-37. GKE, as well as the equally long control peptides, attracted granulocytes in a fashion similar to that of LL-37, while only GKE was as potent as LL-37 in inhibiting LPS-induced vascular nitric oxide production. GKE caused less hemolysis and apoptosis in human cultured smooth muscle cells than LL-37. In summary, we have identified an active domain of LL-37, GKE, which displays antimicrobial activity in vitro and LPS-binding activity similar to those of LL-37 but is less toxic. GKE therefore holds promise as a template for the development of peptide antibiotics for the treatment of sepsis.
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PMID:In silico identification and biological evaluation of antimicrobial peptides based on human cathelicidin LL-37. 1694 92


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