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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 46 year old female was admitted to our emergency room because of cardiopulmonary arrest by hanging. After ten minutes cardiopulmonary resuscitation, she was resuscitated but her consciousness did'nt recover. CT-scans on the day of admission showed no abnormalities but on the second hospital day it showed symmetrical low density areas within the basal ganglia, the thalamus, the hippocampus, and the occipital lobe. There were marked enhanced effect in cerebral sulci due to cytotoxic edema of hypoxic encephalopathy. She was comatose for a week, her pupils were dilated, light reflex and other brain stem reflex were absent. CT-scans on the sixth hospital day showed marked brain swelling with disappearance of the ventricular systems (so called brain tamponade). Brain death was confirmed on the basis of Japanese Criteria on the seventh and tenth day of admission. She had been suffering from pneumonia and urinary tract infection with an elevation of temperature since the fourth hospital day. We detected Enterobacter Cloacae (E. Cloacae), Klebsiella Oxytoca from the cultures of sputum and urine. On the tenth hospital day her temperature was running up to 39.4 degrees C and blood count revealed a peripheral blood leucocytosis of 40,300/mm3 with a shift to the left. E. Cloacae was also detected from the cultures of blood. Skull roentgenogram showed multiple gas collections in the ventricular systems. CT-scans on the fourteenth hospital day showed multiple gas-containing brain abscess. The etiology of this infection was considered due to septicemia of E. Cloacae. She died from acute renal failure on the fifteenth hospital day. Consent for autopsy was not accepted.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Non-clostridial gas-producing brain abscess in a brain death patient--report of a case]. 329 38

We analyzed the clinical and bacteriologic features of 12 episodes of spontaneous bacterial peritonitis (SBP) in 11 children (four boys, median age 5.5 years) with chronic liver disease. All patients had cirrhosis and ascites; four had hypersplenism, and one was asplenic. Symptoms included increasing abdominal distention, pyrexia, abdominal pain, gastrointestinal disturbance, and encephalopathy. Nine had rebound tenderness on abdominal palpation, and 12 had reduced bowel sounds. The most frequent organisms isolated from culture of ascitic fluid were Streptococcus pneumoniae (nine). Klebsiella (two), and Haemophilus influenzae (one); blood cultures grew identical organisms in nine. Seven patients died despite intensive antibiotic therapy. In the 3 months prior to onset of SBP, defective yeast opsonization and reduced serum concentration of C4 were found in all nine children tested; eight had reduced concentration of C3. Functional deficiency of all complement components was present in four tested within 1 to 5 months of the onset. In contrast, only eight of 59 cirrhotic children without SBP had low C3, and eight had defective yeast opsonization, although 35 had low C4 values. Four of the patients with SBP and low C3 and C4 concentrations had normal concentrations at the time of diagnosis of liver disease 2 to 5 years previously. Opsonization of type III pneumococci was reduced in sera from three patients who subsequently developed pneumococcal peritonitis. The incidence of SBP in children with chronic liver disease is similar to that in adults, as are the clinical features. Our observations suggest that complement deficiency induced by chronic liver disease may be important in the pathogenesis of SBP.
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PMID:Spontaneous bacterial peritonitis in children with chronic liver disease: clinical features and etiologic factors. 399 46

Hemolytic uremic syndrome (HUS) is defined as microangiopathic hemolytic anemia, thrombocytopenia and uremia. It is an important cause of acute renal failure (ARF) in children all over the world. The present study was carried out to assess the incidence, clinical presentation, hematological and biochemical profile of children presenting with HUS from 1987 to 1990. Out of the 100 cases who presented with ARF 22 had HUS. A majority of these children were males below 1 year of age, and had a prodromal phase of mainly gastrointestinal manifestations lasting for about a week. Anemia was a constant feature followed by bleeding diathesis, mainly melena and purpura. Neurological manifestations included altered sensorium, irritability, coma, hypertensive encephalopathy and convulsions. Renal problems mainly included oliguria, hypertension, hematuria and edema. Investigations revealed thrombocytopenia and microangiopathic hemolytic anemia in all cases. Evidence of disseminated intravascular coagulation (DIC) was observed in 3 cases as decreased fibrinogen levels, increased fibrinogen degradation products and deranged clotting studies. Blood biochemistry revealed azotemia in all cases, hyponatremia in 5 cases, hypernatremia in 3 cases and hyperkalemia in 12 cases. Stool culture showed the presence of Shigella in 8, E. coli in 6 and Klebsiella in 4 cases. Out of 22 cases of HUS, 15 were treated conservatively; of these 2 died. Both of these deaths were due to DIC 7 children were put on peritoneal dialysis; only 1 child died in this group. Factors affecting the outcome were duration of oliguria, levels of blood urea and presence of encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A clinico-hematological profile of hemolytic-uremic syndrome. 788 99

A boy with a neuropathic bladder and a single hydronephrotic kidney developed hyperammonaemic encephalopathy during a urinary tract infection with Klebsiella oxytoca. Although particularly associated with Proteus infections and prune belly syndrome, hyperammonaemia can complicate infection with any urease-producing bacteria if there is urinary stasis.
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PMID:Hyperammonaemia due to Klebsiella infection in a neuropathic bladder. 981 90

Cirrhosis of the liver results from a variety of mechanisms that cause progressive hepatic injury. It is the sixth leading cause of death in all patients between the ages of 35 and 55. This study attempts to correlate the morbidity and mortality of spontaneous bacterial peritonitis in liver failure patients to numerous etiologic and clinical variables. A retrospective review of 26 patients with spontaneous bacterial peritonitis associated with chronic liver disease was performed in a university hospital. Demographics (age and gender), clinical variables (etiology of liver failure, Child's classification, prior history of ascites, fever, abdominal pain, encephalopathy, and upper gastrointestinal hemorrhage), and laboratory variables (ascitic polymorphonuclearcyte count and cultures, serum albumin, bilirubin, creatinine, and prothrombin time) were studied. All of the patients had Child's C liver disease. Mortality rate was 46 per cent. Alcohol (46%) and hepatitis (30%) were the most common etiologies. Escherichia coli and Klebsiella pneumoniae were the most common culture isolates. All of the infections were monomicrobial. The only significant predictor of mortality (P < 0.05) in this study was the peritoneal fluid polymorphonuclear (PMN) cell count. PMN count >1000 PMN/mm3 was associated with a mortality of 88 per cent. Few patients with spontaneous bacterial peritonitis are ultimately transplanted.
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PMID:Spontaneous bacterial peritonitis in liver failure. 984 34

Spontaneous bacterial peritonitis (SBP) is a frequent form of decompensation of end-stage liver disease, with an incidence of 15-20% and a short-term mortality of 10-33%. The usual causative agents (90% of SBP) are enteric Gram-negative bacteria-Escherichia coli and Klebsiella pneumoniae. Brucella is known to be a possible, but exceedingly rare, causative agent of SBP. We present the case of a 47-year-old Egyptian man, with hepatitis C cirrhosis, and a 2 week history of ascites, jaundice, encephalopathy, fever and pain on his right shoulder that started while travelling in the Middle East. Laboratory and imaging studies were undertaken and he was diagnosed an SBP that failed to respond to Imipenem. Brucella was identified both in the ascitic fluid and blood; he was started on doxycycline plus rifampin with immediate clinical improvement. The antibiotic regimen was kept for 8 weeks. The patient is currently under evaluation for liver transplantation.
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PMID:Spontaneous bacterial peritonitis by Brucella in a cirrhotic patient. 2356 82

The value of clinical cluster nursing in the prevention of multi-drug resistant (MDR) infection in patients with severe encephalopathy in ICU was evaluated. ICU patients (n=129) diagnosed with severe encephalopathy between 2012 and 2014 were selected as the study group, while 106 cases of ICU patients diagnosed with severe encephalopathy between 2010 and 2012 were retrospectively selected as the control group. Control group patients were offered conventional integrated nursing care, while the study group patients were offered cluster nursing care. The differences in infection rate, colony and quantity, infection time, number, mortality rate and hospital stays between the two groups were compared and analyzed. Observations on the infection rate, diagnosis time, total number of infection, mortality rate caused by infection and hospital stays were lower in the study group patients than in controls (P<0.05). The patients in the study group had a much lower drug-resistant infection rate than that in the control group (P<0.05). In the patient groups there were infections with methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, although the quantities of the above pathogenic microbe colonies in the study group were notably less than those in the control group (P<0.05). In conclusion, cluster nursing care effectively prevents MDR infections of ICU patients with severe encephalopathy and reduces the mortality rate, thus having an excellent clinical significance.
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PMID:Clinical study on cluster care to prevent multi-drug resistant infection in ICU patients with severe encephalopathy. 2810 27

To date, ceftazidime-avibactam (CAZ-AVI) neurotoxicity in patients with normal renal function has not been reported in the literature, and no data about its penetration into the CNS through the blood-brain barrier are available. We report the occurrence of severe encephalopathy in a patient with normal renal function, after the infusion of CAZ-AVI to treat a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) sepsis. The radiological and clinical pictures of our patient, and particularly the encephalopathy resolution after drug discontinuation, support the hypothesis of a drug-induced aseptic meningitis (DIAM). The brain MRI-supported meningeal inflammation, along with the increase in blood-CSF-barrier permeability detected on the CSF analysis, could have paved the way for the drug's neurotoxicity by increasing its CNS entering (the CSF CAZ-AVI level in our patient was higher than the highest value reported in a study on children with meningitis). Neurotoxicity of CAZ-AVI and, by analogy, of other cephalosporins should be recognized as a potential adverse effect even in patients with normal renal function, with an increased risk of severe encephalopathy.
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PMID:Ceftazidime/avibactam neurotoxicity in an adult patient with normal renal function. 3328 78