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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial infections with local inflammation or hematogenous spreading may occur after joint punctures and intra- or periarticular injections. The risk of severe infections increases in patients with diseases accompanied by low immunity, e.g., gout, alcoholism, rheumatoid arthritis, and diabetes mellitus. Cases of septic omarthritis after intra-articular injection with fatal outcome after delayed onset of therapy are known. In our clinic we treated a female patient who previously received an injection in the shoulder region in a different facility. On admission she was suffering from an abscess of the surrounding soft tissues, systemic inflammatory response syndrome (SIRS), and adult respiratory distress syndrome (ARDS). Because the clinical picture was recognized early, we were able to prevent severe progression with organ failure. Another female patient developed a postinjection bacterial acromioclavicular arthritis followed by septic inflammatory response syndrome (SIRS) and eventually multiple organ failure (MOF). With inconspicuous clinical findings in the initial shoulder examination the bacterial arthritis was detected as the cause of sepsis only after intensive investigations.
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PMID:[SIRS and ARDS as a result of drug injection in the shoulder region]. 1804 2

Melioidosis is sporadically reported from various parts of India. We present a case series from south India, highlighting the varied manifestations of the disease. Seven cases of culture-proven melioidosis are presented in whom Burkholderia pseudomallei were isolated from aspirate or blood. Melioidosis had a varied presentation involving multiple abscesses in the soft tissues, liver, spleen, mediastinum and the subdural space. It presented as either acute fulminant sepsis or followed a chronic indolent course, mimicking tuberculosis. Most cases had predisposing risk factors such as diabetes and chronic alcoholism.
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PMID:Melioidosis--a case series from south India. 1912 79

The first point of a good diagnostic strategy for healthcare-associated pneumonia (HCAP) is correct classification of patients with specific criteria, as suggested by the last American Thoracic Society/ Infectious Diseases Society of America (ATS/IDSA) guidelines. However, clinical practice and recent literature have suggested new risk factors for multidrug-resistant infection (MRI): the presence of permanent indwelling devices, prior antibiotic use in the last 3 months, chronic and advanced pulmonary diseases (chronic obstructive pulmonary disease, bronchiectasis, etc.), history of alcoholism, and immunosuppression. The clinical presentation in HCAP patients is often unusual (mild respiratory symptoms and frequent extrapulmonary manifestations) due to different factors: advanced age, neurological disorders, and multiple chronic comorbidities. Moreover, HCAP commonly presents a worse clinical course than community-acquired pneumonia, a prolonged length of stay, and a mortality rate close to hospital-acquired pneumonia. Chest radiography and routine laboratory markers (including C-reactive protein) are always needed for clinical evaluation and severity assessment. The clinical use of new biomarkers of infection and sepsis (procalcitonin, etc.) is currently being investigated. Extensive microbiological testing to overcome the high prevalence of MRI in HCAP, including urinary antigens for Legionella and Streptococcus pneumoniae; blood cultures; Gram staining and low respiratory tract secretions (sputum, tracheobronchial aspirate, fibrobronchial aspirate, protected specimen brush, bronchoalveolar lavage); and cultures for aerobic, anaerobic, mycobacterial, and fungal pathogens are recommended, whereas the indication for serology tests for respiratory viruses and atypical pathogens is low. By contrast, the new polymerase chain reaction-based techniques for the rapid identification (2 to 4 hours) of microbial pathogens in respiratory samples (nasopharyngeal swab, bronchoalveolar lavage) seem to be the most innovative future perspective in the diagnostics of HCAP.
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PMID:Diagnostic strategies for healthcare-associated pneumonia. 1919 85

Thousands of patients are awaiting liver transplantation, mainly owing to the lack of donors. The aim of this study was to analyze the characteristics of discarded livers from donors seeking to understand how to increase the number of grafts. A retrospective analysis of 1432 discarded donor livers was performed in the period between 1994 and 2007. Data were stored in a standardized database in accordance with expanded donor criteria. The average donor age was 35.2 years with; 67.7% male subjects and 20.9% over age 50 years. The main cause of donor discard was family refusal (46.6%), followed by cardiorespiratory arrest (CRA) in 28.3%, and surgeon discard (16.9%), principally owing to sepsis (24.5%). Vasopressor drugs were used in 97.2%. Alcoholism was detected in 44.56% and drug addiction in 12.4%. There was infections documented in 23.9% of records, mainly of the respiratory type (75%). Intensive care time was over 120 hours in 11.0%. Hepatitis B infection was detected in 22.5%, (n = 338), and hepatitis C in 3.5% (n = 593). Finally, there were losses due to hypotension in 45.7% (516/1130) and also loss due to CRA. As family refusal was the principal cause for discarding a donor, it is necessary to investigate the role of information about organ transplantation to increase acceptance.
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PMID:Reviewing the causes for 1432 discharged liver donors: can donations be increased? 1937 55

Spinal sepsis (spinal epidural or subdural abscess) is a rare condition, which, if not diagnosed rapidly, can lead to paralysis or death. It is difficult to diagnose in its early stages as the symptoms are as yet non-specific. We aimed to identify predisposing factors and presenting symptoms that might aid in the early diagnosis of spinal sepsis. A case-control study was performed with non-pediatric patients who had been diagnosed with spinal sepsis from 1998 to 2007. Our control group comprised 80 randomly selected patients who had presented to the emergency department with back pain. We identified 72 patients with spinal sepsis. A multivariate analysis revealed that obesity (adjusted odds ratio [aOR] 21.4; 95% confidence interval [CI] 1.8-257.5) and alcoholism (aOR 6.5; 95% CI 1.3-32.8) were important predictive factors for spinal sepsis. To our knowledge, this is the first report that associates obesity and alcoholism with spinal sepsis.
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PMID:Early detection of spinal sepsis. 1963 47

A male patient who had suffered from alcohol dependence for several years was transferred to the Magdeburg University Hospital with signs of sepsis. The main cause for this was a previously unsuccessfully treated acute episode of chronic pancreatitis. Diagnostic imaging showed a distended ascending abscess extending above the larynx. During interdisciplinary emergency surgery, the neck, mediastinum and abdomen were drained and the pancreatic abscess removed. Under drainage, antibiotic therapy and parenteral nutrition the patient made a full recovery.
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PMID:[Ascending pancreatitis with mediastinal and parapharyngeal involvement]. 1969 Aug 15

Central pontine myelinolysis (CPM) has been described in alcoholic patients and in the aftermath of rapid correction of chronic hyponatraemia. We describe a case of CPM occurring secondary to nephrogenic diabetes insipidus (DI), which developed as a consequence of severe hypokalaemia. A 63-year-old man with alcohol dependence was admitted to hospital with severe pulmonary sepsis and type 1 respiratory failure. On admission, he had euvolaemic hyponatraemia of 127 mmol/L, consistent with a syndrome of inappropriate antidiuretic hormone secondary to his pneumonia. Following admission, his plasma potassium dropped from 3.2 to a nadir of 2.3 mmol/L. Mineralocorticoid excess, ectopic adrenocorticotrophic hormone production and other causes of hypokalaemia were excluded. The hypokalaemia provoked significant hypotonic polyuria and a slow rise in plasma sodium to 161 mmol/L over several days. Plasma glucose, calcium and creatinine were normal. The polyuria did not respond to desmopressin, and subsequent correction of his polyuria and hypernatraemia after normalization of plasma potassium confirmed the diagnosis of nephrogenic DI due to hypokalaemia. The patient remained obtunded, and the clinical suspicion of osmotic demyelination was confirmed on magnetic resonance imaging. The patient remained comatose and passed away 10 days later. This is the first reported case of nephrogenic DI resulting in the development of CPM, despite a relatively slow rise in plasma sodium of less than 12 mmol/L/24 h. Coexisting alcohol abuse, hypoxaemia and hypokalaemia may have contributed significantly to the development of CPM in this patient.
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PMID:Central pontine myelinolysis secondary to hypokalaemic nephrogenic diabetes insipidus. 1994 Feb 3

Acute poisonings with corrosive substances may cause serious chemical injuries to upper gastrointestinal tract, the most common location being the esophagus and the stomach. If the patient survives the acute phase of the poisoning, regenerative response may result in esophageal and/or gastric stenosis and increased risk for esophageal cancer. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. In establishing the diagnosis of acute corrosive poisonings, the severity of the post-corrosive endoscopic changes of the esophagus, stomach and duodenum is of major importance. According to Holinder and Fridman classification, post-corrosive endoscopic changes are classified in three degrees: First degree--superficial damage associated with hyperthermia, epithelial desquamation and mucous edema. Second degree--transmucous damage affecting all of the mucosal layers, followed by exudation, erosions and ulcerations. Third degree--transmural damage associated with ulcer's penetration in the deep layers of the tissue and neighboring organs. Severity of the lesions depends on the nature, quantity and concentration of the corrosive substance, the duration of exposure and current state of the exposed organs. Most often caustic injuries occur to the esophagus and stomach since the corrosive substance remains there for a longer period of time. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, corticosteroids, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery. The most common complications that may appear are: perforation, gastrointestinal bleeding, sepsis, esophageal strictures and stenosis, stenosis of gastric antrum and pylorus, cancer of the esophagus and the stomach. Today, owing to the substantially enhanced diagnostic and therapeutic approach, the mortality percentage has been reduced from 20% to 1-5%. Women more often than men are intoxicated with corrosive substances; suicidal poisonings prevail; the most abused agents are hydrochloric acid (HCl) and sodium hydroxide; intoxications are more common in children (80% out of the total number of intoxications). In spite of the preventive measures for restriction of the trade with corrosive substances, standardization of their concentration and protective safety bottle caps, still the number of corrosive intoxications, the percentage of post-corrosive complications and the handicap are high. Acute corrosive intoxications are the leading cause of death in clinical toxicology.
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PMID:Post-corrosive injuries of upper gastrointestinal tract. 2069 48

Alcohol abuse and dependence, referred to as alcohol-use disorders (AUDs), affect 76.3 million people worldwide and account for 1.8 million deaths per year. AUDs affect 18.3 million Americans (7.3% of the population), and up to 40% of hospitalized patients have AUDs. This review discusses the development and progression of critical illness in patients with AUDs. In contrast to acute intoxication, AUDs have been linked to increased severity of illness in a number of studies. In particular, surgical patients with AUDs experience higher rates of postoperative hemorrhage, cardiac complications, sepsis, and need for repeat surgery. Outcomes from trauma are worse for patients with chronic alcohol abuse, whereas burn patients who are acutely intoxicated may not have worse outcomes. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs. Despite studies showing that up to 40% of hospitalized patients have AUDs, relatively few guidelines exist on the specific management of the critically ill patient with AUDs. AUDs are underdiagnosed, and a first step to improving patient outcomes may lie in systematically and accurately identifying AUDs.
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PMID:Alcohol-use disorders in the critically ill patient. 2092 4

Thrombocytopenia is usually acquired. The laboratory artefact of pseudothrombocytopenia should always be excluded. Bone marrow insufficiency with impaired platelet production results from infiltrating tumor cells or from a myelodsplastic syndrome. In patients with splenomegaly, platelets are trapped by the spleen. An increased platelet turnover is caused by activation of the clotting cascade, e.g. due to sepsis or malignancy. Platelet binding antibodies cause thrombocytopenia by increased platelet clearance. Important differential diagnoses in patients with severe thrombocytopenia are: acute leukemia, thrombotic thrombocytopenic purpura, autoimmune thrombocytopenia and drug-dependent thrombocytopenia. Multifactorial causes are thrombocytopenia associated with pregnancy, chronic alcohol abuse, and liver cirrhosis. Treatment should focus on the underlying disease. In regard to low platelet counts only clinical bleeding and not platelet count numbers should be treated.
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PMID:[Differential diagnosis and treatment of thrombocytopenia]. 2094 73


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