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

Ten severely burned (greater than 50% BSA) pediatric and young adult patients developed 19 episodes of clinical sepsis of four or more days duration. During eight of the 19 septic episodes the patients received granulocyte transfusions (median, four; range, two to seven). Risk variables, types and prevalence of infections, mainly Pseudomonas aeruginosa and antibiotic regimens were similar for all the septic episodes studied. All eight episodes (100%) resolved in the transfused group while eight of 11 (72%) episodes resolved in the nontransfused group. Patients survived four episodes of ecthyma gangrenosum when granulocyte transfusions were used and the single episode in which they were not used was fatal. Granulocyte transfusions may be helpful in severely burned patients with sepsis.
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PMID:Granulocyte transfusions for patients with severe thermal burns. 41 32

A case of right-sided Pseudomonas cepacia endocarditis in a heroin addict is presented in which septic cutaneous vasculitis (ecthyma gangrenosum) is a prominent feature. Ecthyma gangrenosum, most commonly associated with sepsis due to P aeruginosa, has not been previously described with P cepacia septicemia.
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PMID:Pseudomonas cepacia endocarditis and ecthyma gangrenosum. 83 96

In parenteral drug abuse, cutaneous manifestations are very common. A variety of skin lesions are indicators of a possible drug addiction: obliteration of peripheral veins and hyperpigmentation of the overlying skin, punched-out scars due to subcutaneous injection, persistent edema following thrombophlebitis, and excoriations due to heroin pruritus. Infectious and non-infectious complications may be accompanied by typical skin alterations, such as ecthyma in sepsis caused by Pseudomonas aeruginosa, multiple ulcers due to embolic infarct, or hypersensitivity reactions mediated by an immunological process. A variety of serious complications may develop at the injection sites: abscesses, gangrene, necrosis, or necrotizing fasciitis. These examples show that the dermatologist is in many ways involved in the care for addicted patients. In addition, these patients frequently suffer from sexually transmitted diseases or blood-borne infections; HIV-infection is rapidly spreading in this group. We now face new problems of differential diagnosis, especially since constitutional symptoms of HIV-infection may mimic symptoms of drug abuse and vice versa. Moreover, immunological alterations similar to those in HIV patients may even occur in drug addicts who are not infected with the virus.
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PMID:[Skin changes in drug-dependent patients]. 219 89

In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial. In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage. Endotoxin probably plays a prominent role in producing these lesions. That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures. More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved. The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation. Lesions of symmetric peripheral gangrene characteristically do not have bacteria present. The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon. However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction. In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage. An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction. Favoring a role for other bacterial substances is the predisposition of V. vulnificus to cause cellulitis or of C. fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown. It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both. In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process. In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded. In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm. As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cutaneous manifestations of bacterial sepsis. 252 95

Although the first Aeromonas strain was described by Zimmermann as early as in 1890, it took 60 years until Caselitz established human pathogenicity of strains then called "Vibrio jamaicensis". Since then, and especially in the last 10 years, there have been increasing numbers of reports on different infections caused by members of the genus Aeromonas. These include sepsis; meningitis; cellulitis; necrotizing fasciitis; ecthyma gangrenosum; pneumonia; peritonitis; conjunctivitis; corneal ulcer; endophthalmitis; osteomyelitis; suppurative arthritis; myositis; subphrenic abscess; liver abscess; cholecystitis and/or ascending cholangitis; urinary tract infection; endocarditis; ear, nose, and throat infections; balanitis; etc. The role of Aeromonas in gastrointestinal disease is very controversial. Increasing epidemiological data suggest that these organisms play a major role in enteric infections, but so far enteropathogenicity has not been demonstrable in experiments where volunteers were given high numbers of Aeromonas possessing different virulence factors. Virulence factors include hemolysin(s), enterotoxin(s), hemagglutinins, invasivity, and others; but these are not found more frequently in strains isolated from patients with diarrhea than from healthy controls. Whether there is a correlation between species and disease remains to be elucidated and requires more information about the taxonomy of this genus.
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PMID:Aeromonas as a human pathogen. 264 16

We examined a patient with systemic lupus erythematosus and sepsis due to Pseudomonas aeruginosa. Early in the infection, she developed skin lesions that consisted of indurated tender nodules and hemorrhagic and nonhemorrhagic bullae. Blister fluid contained gram-negative rods, which were identified as P. aeruginosa on culture. Bullae and nodules, as well as ecthyma gangrenosum, can be early cutaneous signs of pseudomonal sepsis.
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PMID:Pseudomonas septicemia with nodules and bullae. 329 25

Bacteremia caused by Aeromonas species occurred in 24 hospitalized patients in a cancer institute during a 13-year period. All but one of these patients had a malignancy (88% had leukemia), and most were receiving chemotherapy for cancer. There was a striking numerical predominance of male patients (82%). Unlike some previously described patients with infections due to this organism, none of these 24 patients had recently been exposed to fresh or salt water or to fish. The source of the infecting organism was thought to be endogenous--i.e., from patients' own gastrointestinal tracts. The clinical presentation of sepsis caused by this organism was nonspecific, except that ecthyma gangrenosum occurred in several patients. The overall mortality rate was 28%. The combination of an aminoglycoside and a cephalosporin is appropriate therapy for bacteremia caused by Aeromonas species.
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PMID:Bacteremia caused by Aeromonas species in hospitalized cancer patients. 402 26

A simple, reproducible model of fatal Pseudomonas aeruginosa sepsis in mice during immunosuppression was developed. Mice were rendered leukopenic (less than or equal to 800 leukocytes per mm3 of blood) for a period of 5 days by multiple injections of cyclophosphamide. Mice were challenged at the onset of leukopenia by instilling the bacteria onto a 0.5-mm incision made into the back. The mean lethal dose (LD50) for P. aeruginosa PA220 and M-2 was less than 20 bacteria. The mean time to death for these strains ranged from 46 to 59 h. Leukopenic mice were comparatively resistant when challenged with Klebsiella pneumoniae (LD50 = 1.5 x 10(6)) or Staphylococcus aureus (LD50 greater than 10(6)). Infection with P. aeruginosa was characterized by rapid bacterial multiplication in the skin at the site of infection, producing ecthyma gangrenosum. Bacteremia and colonization of the liver were pronounced 21 h postinfection. This model should prove to be a useful tool for studying the pathogenesis of P. aeruginosa infections under immunosuppressed conditions.
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PMID:Simple model for the study of Pseudomonas aeruginosa infections in leukopenic mice. 640 16

Four patterns of tissue involvement can be distinguished in sepsis due to gram-negative enteric bacilli. When intense local inflammation predominates, cellulitis or thrombophlebitis results, often with venous or arterial obstruction. Bacteria are present in the affected tissues, but not in sufficient numbers to be seen microscopically. When bacterial proliferation is unchecked by an appropriate leukocyte response, ecthyma gangrenosum, erythema multiforme, or diffuse bullous lesions may occur with minimal clinical or histologic signs of inflammation. In symmetric peripheral gangrene associated with disseminated intravascular coagulation, bland fibrinous deposits are seen in small vessels but neither inflammatory cells nor bacteria are present. The fourth kind of lesion is that seen in bacterial endocarditis. In all four patterns a vascular component is prominent clinically and histologically. The pathogenesis of these lesions is multifactorial; in each individual case the interaction between bacterial and host factors probably determines which clinical picture will result. The appearance of symmetric soft tissue lesions of the extremities in the absence of predisposing local conditions suggests the possibility of sepsis due to gram-negative bacilli, especially if other clinical features indicate that sepsis might be present.
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PMID:Cutaneous and soft-tissue manifestations of sepsis due to gram-negative enteric bacilli. 701 88

Ecthyma gangrenosum caused by Escherichia coli (E. coli) occurred in a decompensated alcoholic cirrhotic patient with spontaneous bacterial peritonitis due to the same organism. Ecthyma is usually associated with systemic sepsis from Pseudomonas aeruginosa. Isolated instances due to other bacteria have been reported, but its occurrence in spontaneous bacterial peritonitis, of which the predominant causative organism is E. coli, is unique. The frequency, varied etiology, and pathogenesis of ecthyma are briefly reviewed.
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PMID:Spontaneous bacterial peritonitis with ecthyma gangrenosum due to Escherichia coli. 704 96


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