Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Upon admission to Box Hill Hospital in Victoria, Australia, a 38-year old woman was pale and febrile (328.6 degrees Celsius) and had a pulse of 88 beats/minute. She had had midabdominal pain for 1 week and severe lower abdominal pain for 2 days. Her menses were heavy. Other than pain during examination, rectal and vaginal examinations were normal. She had considerable neutrophilia (leukocyte count = 21.2 x 1 billion). The X-ray revealed free fluid. Ultrasonography indicated an IUD which she had had for 10 years, a mass with small cystic areas near the right ovary, and fluid in the rectouterine pouch. The physicians suspected peritonitis and administered iv broad spectrum antibiotics (1 mg ampicillin, 80 mg gentamicin, and 500 mg metronidazole) every 8 hours. They did a laparotomy. An abscess containing much green pus, the necrotic right ovary, and the appendix, which appeared normal and later shown not to be infected, occupied the right iliac fossa. The tubes were fine. The surgeons removed the appendix and right ovary. They washed out the abdomen with saline and inserted a drain to the right iliac fossa. The woman improved immediately so the physicians stopped antibiotics 3 days after surgery. Histological tests revealed actinomycosis caused by fast-growing aerobic bacteria which is known to cause necrosis, fibrosis, and suppuration. During recovery, the physicians removed the IUD and performed dilation and curettage. Actinomyces normally just dwell in the mouth and intestines, but, in this case, probably migrated up the IUD tail after spreading from the bowel to the perineum to the vagina. The physicians suspected that the presence of Mycoplasma hominis provided the mucosal breach needed to permit actinomyces' invasion. Physicians should consider actinomycosis in acute abdominal sepsis cases with a longterm use of an IUD. They can treat it with antibiotics since Actinomyces tend to be sensitive to broad spectrum antibiotics.
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PMID:Ovarian actinomycosis presenting as acute peritonitis. 158 8

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.
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PMID:IUD-associated ovarian actinomycosis causing bowel obstruction. 374 Sep 65

The incidence of pelvic inflammatory disease (PID) attributable to IUD use has been increasing, especially after the removal of the Dalkon shield from the market, but this relationship has not been settled conclusively. In recent decades PID included a variety of infections, but lately the definition of PID has meant acute ascending infections of the female genital tract. Its most common risk factors include promiscuity of IUD use, although this can be reduced to one fourth by regular checkups and proper hygiene. The frequency of PID is estimated at 2-5% of IUD users. Microorganisms contributing to PID include Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Escherichia coli, Proteus, Staphylococcus epidermis, Haemophilus influenzae, Bacteroides, Peptococcus, Peptostreptococcus, Clostridium, and Actinomyces israelii, The differentiation of actinomycosis (AC) and pseudoactinomycosis (PAC) is well advised. The potential of IUD use in increasing the risk of AIDS should not be discounted. The clinical picture of PID is varied, it can be mild requiring conservative drug therapy; with medium severity requiring removal of the IUD and drug therapy; severe necessitating removal, antibiotics and sulfonamide treatment and laparotomy; and very severe with potentially fatal generalized sepsis. In addition to antibiotics, e.g., penicillin, treatment can include the so called catastrophy combination of Mandokef- Metronidazol-Gentamycin. An analysis of the data of 8536 IUD fittings in Debrecen, Hungary showed 1.4% removals due to PID after 4 years, 694 patients (8.1%) had lower abdominal pain 73 of which (0.9%) had palpable resistance, and suppuration occurred in only 30 cases (0.4%). Treatment included Semicillin or Tetran, or removal of the IUD, and even surgery if no improvement resulted. Prevention of PID include elimination of risk factors, the careful selection of IUD users, regular checkups, the use of copper (Cu) T device, and strict adherence to professional standards.
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PMID:[The role of intrauterine contraceptive devices in the development of inflammatory processes in the small pelvis]. 376 5

Alternating chemoradiotherapy has recently been reported to produce encouraging results in patients with advanced head and neck cancer. We have treated 17 patients with squamous cell carcinoma of the upper esophagus by alternating chemoradiotherapy and by following the patients for 2 to 5 years, or until their death. Chemotherapy (cisplatin and 5-fluorouracil) was delivered during weeks 1, 4, and 7, and radiotherapy (180 to 200 cGy twice each day to 2,000 cGy) during weeks 2, 5, and 8 (total 6,000 cGy). Three patients (18%) died of toxicity (nadir sepsis). All 14 patients who survived the treatment achieved a complete response as shown by endoscopy and biopsy specimens, with restoration of swallowing, and none experienced a local relapse. Three patients died of distant metastases (actuarial incidence 32% at 3 years). The 5-year survival rate was only 16%, however, because 8 other patients with no evidence of the cancer died of a variety of other causes: radiation pneumonitis (1), chronic neutropenia (1), esophageal actinomycosis (1), pneumonia (2), stroke (1), myocardial infarction (1), and small-cell lung cancer (1). Conceivably, some further improvement in the results might occur from cytokines, stem cells, and brachytherapy (by decreasing deaths due to toxicity), but with so many causes of comorbidity it seems unlikely, for the foreseeable future, that the 5-year survival rate could be much improved by better treatment of esophageal cancer.
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PMID:Patterns of failure in carcinoma of the upper esophagus after alternating chemoradiotherapy. 797 65

The microbiologists use the term corynebacteria to describe aerobically growing, asporogenous, irregularly sharped gram-positive rods. They comprise strictly aerobic bacteria isolated from environment as well as preferentially anaerobic bacteria found in clinical specimens. A large part of these bacteria is considered as commensal of skin and mucous membranes. This group of organisms has recently been subjected to considerable taxonomic revisions, which have resulted in the proposal of several new species, many of them representing previous Centers for Diseases Control coryneform groups. Moreover, recent investigations demonstrated the existence of a pathogenic role for some of them. These bacteria comprise well-known pathogens such as C. diphtheriae responsible for diphtheria, Actinomyces spp. responsible for actinomycosis and Arcanobacterium haemolyticum recovered from pharyngitis, but other corynebacteria were related to particular infections. For example, the lipophilic and antibiotics multiresistant species Corynebacterium urealyticum and C. jeikeium were found to be responsible for urinary tract infections and septicemias, respectively. The recently described species Turicella otitidis was found to be implicated in otitis media and C. seminale were recovered from genital specimens of male patients. Implantation of material devices, use of broad-spectrum antibiotics led to an increase of sepsis due to the species C. jeikeium and C. amycolatum. Many of the new Actinomyces species grow well under aerobic conditions and are often implicated in various abscesses. Moreover an increase of immunocompromised patients led to the development of infections due to the aerobic actinomycete Rhodococcus equi. The association of some corynebacteria with particular diseases should prompt the microbiologist to identify these bacteria when they are encountered in a pathogenic situation. Identification of the major part of corynebacteria isolated from clinical specimens can now be achieved by using recent schemes.
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PMID:[Bacteriological and clinical aspects of corynebacterium]. 975 61

Bone infections are usually due to haematogenous spread from distant infected organs. Spread of local sepsis or contamination of open wounds are less frequent routes of infection. The commonest cause of osteomyelitis is Staphylococcus aureus. The term rare bone infections refers to diseases where only a few percent affect bone or diseases which are essentially rare; these include bacteria, fungi, parasites and non-specific conditions. Common examples are tuberculosis, salmonellosis, brucellosis, hydatidosis, madura, actinomycosis, aspergillosis and American fungal infections. Certain bone infections have become exceedingly rare, particularly atypical mycobacteria, viral embryopathies and spirochaetes. Rare bone infections are encountered in many parts of the world commonly in the tropics and in the U. S. Immunocompromise and ease of travel can lead to increased incidence. A high index of clinical suspicion is necessary for diagnosis. Specific laboratory diagnosis is not always possible. Radiographs, computed tomography, isotope studies and magnetic resonance are useful but may not make the diagnosis. Aspiration or biopsy is necessary. Rare bone infections may simulate non-infective bone lesions.
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PMID:Rare bone infections "excluding the spine". 1041 38

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. Risk factors for epidural abscess include immunocompromised states such as diabetes mellitus, alcoholism, cancer, and acquired immunodeficiency syndrome, as well as spinal procedures including epidural anesthesia and spinal surgery. The signs and symptoms of epidural abscess are nonspecific and can range from low back pain to sepsis. The treatment of choice in most patients is surgical decompression followed by four to six weeks of antibiotic therapy. Nonsurgical treatment may be appropriate in selected patients. The most common causative organism in spinal epidural abscess is Staphylococcus aureus. Spinal epidural abscess involving actinomycosis is rare.
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PMID:Spinal epidural abscess: a diagnostic challenge. 1199 16

The Dalkon Shield IUD was introduced to the list of contraceptives being distributed to developing countries by IPPF (International Planned Parenthood Federation) in 1973. By 1974, doubts had arisen about the safety of the Dalkon Shield and several cases of maternal mortality and sepsis in Dalkon Shield users had been reported. In 1974, IPPF stopped supplying Dalkon Shields to its affiliates. During the 1973-74 period of distribution, IPPF had distributed approximately 300,000 of the Shields in 41 countries. Almost 1/2 that amount had already been inserted. The position of IPPF's IMAP (International Medical Advisory Panel) on any relationship existing between use of IUDs and pelvic inflammatory disease is as follows as of 1980: 1) infection with actinomycosis makes up only a small component of all the incidents of pelvic inflammatory disease connected with IUDs; 2) the occurrence of pelvic inflammatory disease is not related to the length of use of an IUD; 3) data do not now support the recommendation that inert devices free from major side effects should be removed; and 4) any woman still wearing a Dalkon Shield should have it removed.
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PMID:The Dalkon Shield IUD. 1231 88

Abdominal actinomycosis is a rare condition caused by actinomyces species found in the normal flora of the oral cavity, gastrointestinal and genital tract. All cases reported describe localized forms demonstrating masses, pseudotumors or abscess during surgery or radiology studies and there are no reports about spontaneous peritonitis caused by actinomycetes. We report a case in which this disease present as symptomatic ascitic fluid infection refractory to antimicrobial therapy for intra- abdominal sepsis and detected during unsuspected cytology test. The case was successfully treated with a penicillin regimen. As a spontaneous peritonitis variety, the microbiology diagnosis remains difficult as we don't think in this form of abdominal actinomycosis not described previously in the literature. The present illustrative case strength the usefulness of cytology test in patients with suspected ascitic fluid infection refractory to a medical therapy.
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PMID:Spontaneous peritonitis attributed to actinomyces species. 1800 61

We describe a patient who presented with neurological symptoms and radiological findings consistent with metastatic malignancy in several sites. However, no obvious primary site of tumour was identified and the patient later went on to develop clinical features of sepsis whilst using palliative dexamethasone therapy. A diagnosis of actinomycosis was eventually made on open lung biopsy and the patient recovered completely on penicillin V. This case serves to illustrate the need to obtain a formal tissue diagnosis whenever possible in all cases of suspected malignancy, in addition to exposing the weaknesses inherent in empiric diagnoses.
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PMID:Actinomycosis masquerading as malignancy. 2268 98


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