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

When the late Dr. John F. Fulton contracted severe pulmonary coccidioidomycosis in January, 1942, a metastatic lesion posed the threat of further progression and fatal dissemination. The possibility that an untested and generally unavailable antibiotic, penicillin, might be of value in Fulton's illness led his physician, Dr. John Bumstead, to appeal directly to Fulton to obtain this antibiotic, but ostensibly for the benefit of another patient succumbing to hemolytic streptococcal infection. While of no value for Fulton, penicillin was highly successful in the treatment of his other patient and soon of a second one with staphylococcal sepsis and pneumonia. This penicillin, administered in March, 1942, was the first clinical trial of penicillin under the control of the Office of Scientific Research and Development. The unique contribution of Dr. Fulton and of his illness to this event is described.
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PMID:John F. Fulton, coccidioidomycosis, and penicillin. 79 4

Histoplasma capsulatum and Coccidioides immitis are two fungi that are regional in occurrence and cause opportunistic fungal infections in patients with AIDS. Many cases of histoplasmosis have been reported in patients months or years after they have been in an endemic area. These are obviously cases of reactivation of latent infections. With coccidioidomycosis, the cases have been reported from endemic areas, but some also appear to be reactivation infections, and we should anticipate such cases in nonendemic areas just as with histoplasmosis. The clinical presentations may be atypical, even mimicking acute bacterial sepsis. The diagnosis should be sought in any HIV-infected patient with an unexplained infection and residence or travel in an endemic area even in the remote past. Studies should include bone marrow examinations for histoplasmosis as well as skin biopsies with special strains and cultures for fungi for both infections. Sputum or bronchoscopy specimens have often been the source of a diagnosis in coccidioidomycosis. Serologic tests for antibody in both diseases yield inconsistently positive results in AIDS patients. Treatment of the acute infection should be with amphotericin B followed by maintenance suppressive therapy with ketoconazole or Amphotericin B.
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PMID:Fungal infections in AIDS. Histoplasmosis and coccidioidomycosis. 306 May 28

Two patients with acute pulmonary coccidioidomycosis presenting as acute bacterial pneumonia and sepsis are described. One patient died despite appropriate antifungal therapy, whereas the diagnosis in the other patient was only established after postmortem examination. In both cases, coccidioidomycosis had disseminated beyond the lungs. Factors leading to overwhelming coccidioidomycosis are discussed, and the relation of the sepsis syndrome to coccidioidomycosis is reviewed.
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PMID:Acute pulmonary coccidioidomycosis mimicking bacterial pneumonia and septic shock: a report of two cases. 835 90

Four cases of coccidioidomycosis, diagnosed in New Orleans, are described to illustrate the varied clinical presentation of this infection. The first is an immunocompromised elderly patient presenting with a cavitary lung lesion after travel to Utah. The second, a young immunocompetent patient presenting with acute respiratory distress syndrome after moving from Arizona. The third and fourth, young Hispanic immigrants with acquired immunodeficiency syndrome presenting with respiratory distress and sepsis. These are examples of different presentations, depending on immune competency, and illustrate the challenges in making this diagnosis in non-endemic areas. For two of the three patients who died an autopsy was obtained. We present the cases, show radiographic and pathological findings, and review the current literature on coccidioidomyocosis.
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PMID:Coccidioidomycosis in nonendemic area: case series and review of literature. 2052 40

Coccidioidomycosis is a fungal disease with a wide variety of manifestations. The systemic infection is a product of airborne spore inhalation released from the soil. This once-endemic disease is steadily increasing in incidence, geographic location, and severity. The rare coccidioidomycosis cases requiring surgical intervention present unique challenges to anesthesia providers. This case report describes a 45-year-old woman with no relevant medical history admitted for lobec-occidi tomy with decortication because of aggressive coccidioidomycosis. Anesthetic considerations included attention to fungal sepsis, acute tubular necrosis related to amphotericin B therapy, and airway challenges. Careful attention to perioperative fungal therapies, invasive monitoring, and electrolyte stabilization remain pivotal concerns offering the best outcomes for patients with coccidioidomycosis.
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PMID:Anesthetic management for lobectomy in a patient with coccidioidomycosis: a case report. 2087 33

Coccidioidomycosis refers to the spectrum of disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Clinical manifestations vary depending upon both the extent of infection and the immune status of the host. Coccidioidomycosis has been reported to involve almost all organ systems; however, pulmonary disease is the most common clinical manifestation. The incidence of coccidioidomycosis continues to rise, and primary coccidioidal pneumonia accounts for 17 to 29% of all cases of community-acquired pneumonia in endemic regions. The majority of patients with coccidioidomycosis resolve their initial infection without sequelae; however, several patients develop complications of disease ranging in severity from complicated pulmonary coccidioidomycosis to widely disseminated disease with immediately life-threatening manifestations. This review focuses on complications of pulmonary coccidioidomycosis with an emphasis on the management of primary coccidioidal infection, solitary pulmonary nodules, pleural effusions, cavitary disease, acute respiratory distress syndrome (ARDS), miliary disease, and sepsis.
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PMID:Pulmonary coccidioidomycosis. 2216 3

Severe pulmonary or disseminated histoplasmosis often necessitates presumptive antifungal treatment while awaiting definitive diagnosis. Histoplasma antigen assays have improved sensitivity but results may lag up to 7 days. In order to increase diagnostic certainty, "soft clues" may be looked for in laboratory and radiologic data, such as elevated alkaline phosphatase or ferritin levels and findings of mediastinal adenopathy or hepatosplenomegaly. To determine if elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is specific to histoplasmosis or a non-specific marker for disseminated fungal infection or sepsis in general, we retrospectively examined records of all patients diagnosed with an endemic fungal infection (EFI) at Rush University Medical Center from January of 1997 to October of 2012, and a cohort of septic patients with elevated liver enzymes. We identified 90 cases of EFIs during the study period that met all inclusion criteria (Histoplasma 21, Blastomyces 56, Coccidioides 12, Paracoccidioides 1). We also evaluated 10 control patients with bacterial sepsis. The mean ratio of AST to ALT in patients with disseminated histoplasmosis was 2.69 (95% CI:1.22, 4.16) while for other EFIs, the mean ratio ranged from 0.38 to 1.14 with disseminated coccidioidomycosis and blastomycosis respectively (P < 0.0001). The ratio in patients with bacterial sepsis was 0.84. We propose the use of the AST/ALT ratio as a clinical "soft clue" suggestive of disseminated histoplasmosis in the appropriate host, and to possibly distinguish cross reactivity of the Histoplasma antigen assay with other EFIs.
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PMID:AST to ALT Ratio is elevated in disseminated histoplasmosis as compared to localized pulmonary disease and other endemic mycoses. 2774 8

Hypercalcaemia occurs in many granulomatous diseases. Among them, sarcoidosis and tuberculosis are the most common causes. Other causes include berylliosis, coccidioidomycosis, histoplasmosis, Crohn's disease, silicone-induced granulomas, cat-scratch disease, Wegener's granulomatosis and Pneumocystis carinii pneumonia. Hypercalcaemia in granulomatous disease occurs as a consequence of dysregulated production of 1,25-(OH)2 D3 (calcitriol) by activated macrophages in granulomas. Hypercalcaemia in patients with Mycobacterium tuberculosis infection has been reported in 0%-28% of cases. Uncultured bronchoalveolar lavage cells from patients with M. tuberculosis produce greater amounts of calcitriol compared with controls. Although Nayar et al described hypercalcaemia in a case of sepsis associated with intravesical Bacille Calmette Guerin therapy, there are no published reports describing hypercalcaemia in patients with pulmonary M. bovis infection. We describe a patient with M. bovis cavitary pulmonary infection with sustained hypercalcaemia that fluctuated and recurred repeatedly over the course of therapy, ultimately culminating in normalisation of serum calcium when therapy had led to cure. Treatment consisted of antituberculous therapy, oral corticosteroids and intravenous bisphosphonates with a favourable outcome.
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PMID:Fluctuating hypercalcaemia caused by cavitary Mycobacterium bovis pulmonary infection. 2937 38

Coccidioidomycosis is a predominantly pulmonary disease caused by species of Coccidioides, a fungus endemic to the American Southwest. Most cases involve exclusively pulmonary manifestations while less than one percent present with disseminated infection, usually with meningeal or skin involvement. In this case, a patient with a history of odynophagia, sore throat, productive cough, weight loss, and abnormalities on chest radiograph presented with sepsis and diabetic ketoacidosis. During admission, the patient underwent bronchoscopy with resulting tissue and bronchoalveolar lavage samples positive for Coccidioides immitis, later supported by confirmatory serum studies. This case illustrates a rare presentation of vocal fold involvement without direct invasion from a continuous site and highlights the importance of a high index of suspicion for disseminated coccidioidomycosis with prompt antifungal treatment in order to avoid the very high morbidity and mortality in such cases.
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PMID:Coccidioidomycosis of the Vocal Cords Presenting in Sepsis: A Case Report and Literature Review. 3237 71