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

Candida sepsis has become one of the most common and dangerous forms of hospital acquired infection. The recommended drug for parenteral treatment of Candida sepsis is amphotericin B, however, its toxic effects preclude its usage in many patients, particularly in the presence of renal failure. A less toxic antifungal agent is 5-fluorocytosine. A patient with Candida albicans sepsis was treated successfully with 5-fluorocytosine by intravenous administration. The fungal infection developed during the course of acute renal failure, repeated surgical intervention, intravenous hyperalimentation, gastrointestinal bleeding and five months of antibiotic therapy. The clinical symptoms receded rapidly and cultures became sterile after one week of intravenous treatment. The predisposing factors, difficulties in prevention and diagnosis of fungal infection are discussed.
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PMID:Candida sepsis successfully treated by parenteral administration of 5-fluorocytosine. 96 77

A 30-year-old woman receiving total parenteral nutrition via an indwelling central venous catheter for an intestinal motility disorder developed fever, tachycardia, tachypnea, and hypotension. Multiple blood cultures drawn through the catheter prior to these events, as well as a peripheral blood culture obtained earlier, grew the red yeast Rhodotorula rubra. The patient was critically ill for over one month but eventually recovered with therapy including the systemic antifungal agents amphotericin B and flucytosine and removal of the catheter. Although Rhodotorula has generally been regarded as having low pathogenicity, this case emphasizes the serious nature of Rhodotorula sepsis and suggests the need for both systemic antifungal therapy and removal of a colonized indwelling catheter.
Mycoses
PMID:Rhodotorula fungaemia: a life-threatening complication of indwelling central venous catheters. 130 3

A case of a severe Candida sepsis is reported, which was treated successfully by a combination therapy of flucytosine with fluconazole. After an extensive abdominal operation, a 70-year-old man developed a syndrome of fulminant sepsis due to Candida albicans with the beginnings of renal failure. The latter fact forced us to search for a therapeutic alternative to the classical amphotericin B plus flucytosine combination therapy.
Mycoses
PMID:Successful treatment of a Candida albicans sepsis with a combination of flucytosine and fluconazole. 130 6

Gastrointestinal mucormycosis, an opportunistic fungal infection, is a rare complication of trauma. We report on four patients who developed this frequently fatal condition after delayed treatment of intra-abdominal sepsis and discuss the aetiology, diagnosis and management of the disease.
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PMID:Post-traumatic abdominal mucormycosis. 142 65

Fungal infections are assuming a more prominent role in the sepsis of patients with burns. Torula glabrata (Candida glabrata) is a fungus increasingly found in immunosuppressed patients. This report describes a seriously burned patient who developed a torula infection in the lungs.
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PMID:Torula glabrata: a severe and rare complication in patients suffering from burns. 155 84

Multiple benefits of intravenous immunoglobulin (IVIG) therapy after marrow transplantation have been reported, including decreased incidence of acute graft-versus-host disease (GVHD), infection, sepsis, cytomegalovirus (CMV) pneumonitis and platelet use. To test the hypothesis that the observed beneficial effects of IVIG are related to the serum IgG levels achieved, we followed IgG levels (pre-infusion, 1 h and 24 h post-infusion) in 45 consecutive marrow transplant recipients. IVIG 500 mg/kg was given weekly for six doses starting day -8 pre-transplant, then every other week for a total of 11 doses. Forty-one patients (22 allogeneic, 17 autologous, two syngeneic) were evaluable. Patients with acute GVHD had significantly lower serum IgG trough levels (less than 1200 mg/dl) noted at day +20 post-transplant and afterwards than patients without GVHD (greater than or equal to 1200 mg/dl). Pharmacokinetic modeling of the data indicates that IgG half-life between day -8 and day +6 may predict which recipients are at increased risk of acute GVHD. Allogeneic recipients in the group with trough levels less than 1200 mg/dl required more platelet transfusions. Although there was no significant difference in fungal infection rates or bacteremia, sepsis was noted in only two recipients (one allogeneic, one autologous), both with serum IgG trough levels less than 1200 mg/dl. In addition, three allogeneic recipients had cytomegalovirus pneumonitis, all in the group with lower IgG trough levels. Thus, while serum IgG trough levels less than 1200 mg/dl appear to be strongly associated with acute GVHD, low levels may also be associated with increased platelet utilization, with cytomegalovirus pneumonitis, and sepsis, but not with the overall incidence of infection.
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PMID:Some but not all benefits of intravenous immunoglobulin therapy after marrow transplantation appear to correlate with IgG trough levels. 165 38

Sepsis is a major cause of morbidity and mortality in infants with cholestatic jaundice. This may be attributed to altered host defense mechanisms. Fungal infection frequently occurs in immunocompromised patients. This study evaluates the effect of biliary obstruction on blood clearance and organ localization of radiolabeled viable Candida albicans. Male Sprague-Dawley rats (140 to 150 g) were placed in 2 groups. Group I (n = 30) were sham-operated controls. Group II (n = 90) underwent ligation and division of the distal common bile duct (CDL). At 1, 2, and 3 weeks following CDL, 10(7) cells/mL radiolabeled viable C albicans were injected via the tail vein. The final distribution of the organisms was calculated and expressed as the mean percent of radiolabeled organisms per gram and per total organ. Blood clearance of C albicans was similarly rapid in both groups. However, there was a significant decrease in the trapping of fungi by the rat liver Kupffer cells (20.3% +/- 7.9% v control 42.5% +/- 15%; P greater than .001), and increased pulmonary localization of bacteria 3 weeks following CDL (53.6% +/- 13.2% v control 41.4% +/- 6.4%). The significant decrease in liver trapping and increased lung localization of C albicans in CDL rats, may result in systemic reemergence of fungi and play a role in the susceptibility to fungal infection in jaundiced subjects.
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PMID:Impaired clearance and organ localization of Candida albicans in obstructive jaundice. 191 81

Seventy three adults underwent orthotopic liver transplantations between February 1987 and November 1989 and were followed (54 retrospectively and 19 in a prospective study) with the aim of establishing the incidence of deep mycoses (3 disseminated candidiasis due to C. albicans, 1 invasive aspergillosis due to A. fumigatus and 1 invasive pulmonary aspergillosis due to A. niger and A. fumigatus). 4/5 of these infections occurred in the first month after transplantation. All the patients were associated with the following clinical risk factors: previous use of wide spectrum antibiotics (5/5); more than 1 abdominal laparotomy (4/5), due to primary failure of the graft (3/4) and thrombosis of the hepatic artery (1/4). Two of the three patients [corrected] with invasive candidiasis had previous episodes of documented fungemia. 24 patients of the group who didn't show MIP had some risk factor which in all of them was the previous use of high dose steroids and/or of wide spectrum antibiotics, in addition to the used in surgical prophylaxis. In our series, the one risk factor associated with MIP was more than one previous laparotomy (p less than 0.001). Other significant associated infections were 3 bacterial sepsis (2 due to Enterococcus faecalis and 1 due to Staphylococcus epidermidis) and one viral (Cytomegalovirus viremia). The mortality rate was 100%, however the cause of death was multifactorial.
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PMID:[Invasive mycoses in liver transplantation]. 193 38

This report reviews the cases of 43 patients with 48 episodes of fungemia, and examines the clinical significance of fungemia and the results of treatment. All episodes were nosocomial infections. Candida albicans (60.4%), Candida parapsilosis (16.7%), and Candida tropicals (14.6%) were the most common fungal pathogens isolated from blood cultures. Patients with Candida albicans had a better survival rate than those with other species (p = 0.011). Polymicrobial fungemia was noted in 5 patients (11.6%). Most patients had underlying diseases and predisposing factors. Intravascular catheters (100%), broad-spectrum antibiotics administration (100%), surgical procedures (46.5%) and total parental alimentation (41.9%) were the most common predisposing factors. The clinical manifestations were not characteristic and consisted of nonspecific signs of sepsis. The overall mortality rate was 79%. We did not find any improvement in the mortality rate of our patients treated with amphotericin B. Early recognization, immediate removal of predisposing factors, and correction of underlying conditions is most important for patients with fungemia. We also suggest that fungal infection should be considered early when a febrile patient at high risk dose not improve with broad-spectrum antibacterial therapy.
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PMID:Fungemia: analysis of 43 cases. 198 73

Since 1984, 47 patients with untreated acute myeloid leukemia (AML) were hospitalized in a special hematology unit for aggressive chemotherapy. Complete remission was obtained in 68%, 15% died of complications of treatment (infections and bleeding) and 15% had refractory leukemia. The actuarial survival after 3 years for patients in remission was 43%. No patients with refractory leukemia lived more than 1 year. The actuarial remission at 3 years of 21 patients who received additional courses of aggressive chemotherapy (consolidation treatment) was 42%, as opposed to 11% in 11 patients who received maintenance treatment. The 47 patients received 108 courses of aggressive chemotherapy including 47 for induction of remission. During 86 courses (80%) the patients developed fever and in 33 blood cultures were positive; during 16 courses a fungal infection developed. The most common bacterial infection was by E. coli. During the first induction treatment 5 patients died of sepsis and 1 of cerebral hemorrhage. None died during consolidation therapy. During the year preceding the opening of the unit, 12 AML patients were treated on regular medical wards, and five (42%) achieved a complete remission, while 6 died of complications during the first course of induction chemotherapy. Our findings are in line with those of similar units, which indicates the importance of special nursing units for the treatment of acute leukemia.
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PMID:[Treatment of acute myeloid leukemia in a special hematology unit]. 231 3


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