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

Because gram-positive infections cause morbidity following intensive antileukemic chemotherapy, the effects of vancomycin versus placebo were evaluated in a randomized, double-blind, placebo-controlled trial in 60 adult patients with acute leukemia and first infectious fever during prolonged (mean of 32 days) granulocytopenia. Gram-positive sepsis was associated with first fever in 17 (28 percent) of the 60 patients. None of 31 patients randomly assigned to receive vancomycin demonstrated gram-positive infection, whereas 16 of 22 patients randomly assigned to receive placebo subsequently had gram-positive infection (seven had sepsis, and nine had local infections; p less than 0.005). All patients with gram-positive infection were then given vancomycin, and all showed prompt clinical responses. The predominant gram-positive organism causing infection was beta-lactam-resistant Staphylococcus epidermis (19 of 44 isolates). Patients randomly assigned to receive vancomycin had more rapid resolution of first infectious fever and fewer total febrile days during the granulocytopenic course than did patients randomly assigned to receive placebo. Although vancomycin had no effect on the presence or absence of documented fungal infection, patients treated with vancomycin received empiric amphotericin B for recurrent or persistent fever later (mean of 14 days after initial antibiotic coverage was begun) than did patients receiving placebo (mean of 9.9 days; p less than 0.005), and thus received fewer total days of empiric amphotericin B therapy (mean of 16.3 days) than did patients given placebo (mean of 24.6 days; p less than 0.01). These data demonstrate that empiric use of vancomycin reduces the morbidity of gram-positive infections following intensive antileukemic therapy and decreases the need for empiric use of toxic amphotericin B.
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PMID:Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Randomized, double-blind, placebo-controlled clinical trial in patients with acute leukemia. 352 84

Thirty-one immunocompromised patients (22 renal allograft recipients, 5 patients receiving chronic corticosteroid therapy, and 4 patients undergoing chemotherapy for acute leukemia) with significant dermatologic infection, excluding typical cellulitis and herpesvirus infections, were retrospectively identified over a 12-year period. Of these 31 patients, 15 (48%) had infection restricted to their skin, 6 (19%) appeared to have primary cutaneous infection that spread hematogenously to other parts of the body, 2 (6%) had infections of adjoining nasal tissue that spread to contiguous skin, and 8 (26%) appeared to have disseminated systemic infection that spread to the skin. In six of the eight patients with apparent secondary skin involvement, the development of the cutaneous lesion was the first clinical indication of disseminated infection. Eleven immunocompromised patients (35%) with bacterial infection of the skin or subcutaneous tissue were identified. These patients could be divided into three categories: leukemic patients with bacteremic gram-negative infection metastasizing to the skin (3 cases), renal transplant recipients with recurrent staphylococcal infection on and around the elbow ("transplant elbow") or streptococcal sepsis from a site of cellulitis (5 cases), and immunocompromised patients with opportunistic bacterial infection due to Nocardia asteroides or atypical mycobacteria (3 cases). Seventeen immunocompromised patients (55%) with fungal infection of the skin or subcutaneous tissue were identified. These included 12 patients with opportunistic fungal infection (Cryptococcus neoformans, 4 cases; Aspergillus species, 3 cases; Paecilomyces, 2 cases; Rhizopus species, 2 cases; and Candida tropicalis, 1 case) and 5 patients with extensive, confluent cutaneous dermatophyte infections. One patient with protothecosis and two patients with extensive papillomavirus infection were identified. Of these latter two cases, one had his immunosuppression discontinued, with clearing of his extensive warts; the other had confluent warts of the face and neck that subsequently underwent malignant degeneration to squamous cell carcinoma while chronic immunosuppressive therapy was continued.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Dermatologic manifestations of infections in immunocompromised patients. 397 41

A 56-year-old immunocompromised man had an acute decrease in vision that led to the detection of Actinobacillus actinomycetemcomitans endocarditis complicated by septic emboli to his eye and other organs. This case demonstrates that bacterial sepsis can mimic a fungal infection. To our knowledge, this is the first report of endophthalmitis resulting from infection with A actinomycetemcomitans.
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PMID:Endogenous Actinobacillus actinomycetemcomitans endophthalmitis. 633 67

Fifty febrile, granulocytopenic allogeneic bone marrow transplant patients receiving prophylactic trimethoprim-sulfamethoxazole were randomized to one of two empirical antibiotic regimens to determine whether a shortened course of empirical therapy was beneficial. Of the 50 patients, 25 received empirical tobramycin and ticarcillin for only 3 days, and 25 were maintained on empirical tobramycin and ticarcillin until they were afebrile and no longer granulocytopenic. Although the incidence of bacterial infections in the two groups was not statistically significantly different, almost twice as many bacterial infections were observed in the group that received the short course of empirical therapy. Furthermore, because of the high incidence of bacterial infection and clinical concerns about occult bacterial sepsis, within 2 weeks of the randomization the overall use of parenteral antibacterial agents was similar in both groups. The incidence of invasive fungal disease and the use of amphotericin B therapy were similar in both groups. The results of this study suggest that little clinical benefit is likely to be seen in bone marrow transplant patients treated with short-course empirical tobramycin and ticarcillin, despite the administration of prophylactic trimethoprim-sulfamethoxazole, and emphasize the need for new strategies to prevent infections with gram-positive and trimethoprim-sulfamethoxazole-resistant gram-negative bacteria in these patients.
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PMID:Empirical antibacterial therapy in febrile, granulocytopenic bone marrow transplant patients. 638 35

Antibodies against the major capsular polysaccharide of Cryptococcus neoformans, glucuronoxylomannan (GXM), and a minor secreted polysaccharide, galactoxylomannan (GalXM), were surveyed by indirect enzyme immunoassay (EIA) in patients with cryptococcosis, with other mycoses, and in normal controls. Measurement of IgG levels against GalXM revealed cross reactions in candidiasis patients that were reduced by adsorption with Candida albicans cell walls. Measurement of IgM levels were subject to fewer cross reactions. The combination of adsorption with C albicans cell walls and measurement of IgM detected antibodies in 12 of 55 cryptococcosis patients. An end point equal to or greater than a titer of 1/16 excluded reactions in normals and limited cross reactivity in candidiasis patients to below 7%. This test has potential diagnostic significance in cryptococcosis patients who show no evidence of cryptococcal antigen circulating in the cerebrospinal fluid or serum. Reactions in this IgM assay were not spuriously due to rheumatoid factor. The major capsular GXM was much less serologically active and was subject to cross reactions with agents of bacterial sepsis. The specificity of the GalXM is directed mainly by the mannose and to a lesser extent by galactosyl residues.
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PMID:Enzyme immunoassay detection of IgM to galactoxylomannan of Cryptococcus neoformans. 638 77

In 1979 and 1980, an apparent increase in the occurrence of disseminated fungal infections was observed. The clinical features of such infections in very low-birth weight infants are poorly described, and diagnosis is often delayed. Over a 24-month period, a discrete group of ten clinically diagnosed and four autopsy-diagnosed cases of systemic fungal infections in very low-birth-weight infants was observed. Prior to developing systemic fungal illness, these infants required prolonged total parenteral nutrition, central arterial or venous catheters, and multiple courses of broad-spectrum antibiotics for documented or suspected bacterial sepsis. The clinically diagnosed disseminated fungal infection (ten infants) was noted at a mean age of 33 days with one or more of the following: respiratory deterioration, abdominal distension, guaiac positive stools, carbohydrate intolerance, candiduria, endophthalmitis, meningitis, abscesses, erythematous rash, temperature instability, and hypotension. These signs and symptoms were seen as chronic or were intermittent in clinical course. In contrast, the autopsy-diagnosed disseminated fungal infection (four infants) was present at an earlier age with fewer recognizable predisposing factors and a more acute onset of infection. Nevertheless, in both groups the diagnosis of systemic candidal infection was delayed, due to an inability to consistently recover the organism from blood, CSF, or urine. The neonatologist caring for the very low-birth-weight infant needs to become more aware of these clinical entities. A high index of suspicion and ancillary diagnostic evaluation, such as retinoscopy or tissue biopsy, may be indicated in the critically ill, culture-negative patient.
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PMID:Disseminated fungal infections in very low-birth-weight infants: clinical manifestations and epidemiology. 642 Jul 64

The effectiveness of miconazole was evaluated in 9 documented fungal infections, 4 of which were candidal sepsis. All patients were receiving therapy for hematological malignancies. Miconazole revealed the excellent effect in 3 patients with candidal esophagitis and 1 patient with candidal sepsis and esophagitis. Twelve patients who received miconazole for presumed or documented fungal infection were evaluated for toxicity. No particular side effects, except for only 1 case of mild hepatic dysfunction, were observed. Miconazole is apparently an effective antifungal agents for treatment of systemic fungal infection in patients with hematological malignancies.
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PMID:[Therapeutic effect of miconazole on fungal infection in patients with hematological malignancies]. 673 93

Candidosis was recognized retrospectively in the hearts of 20 of 8,975 patients (0.2%) who had complete postmortem examinations done in Central Kentucky and South Florida. This mycosis, characterized by myocardial micro-abscesses with yeasts and pseudohyphal elements in 18 patients, was the most common fungal cardiac infection. Noncaseating granulomas were seen in only one patient. Infective endocarditis due to Candida species was found in seven individuals and involved the mitral valve most frequently. The 20 infected persons varied in age from 20 days to 65 years, with a mean age of 37 years, and included 11 males and nine females. All had compromising, usually benign, underlying diseases complicated by antibiotic therapy for suspected or proven Gram-negative sepsis. Typically, these patients were extremely ill, and eight had recognized conduction disturbances including altered heart rates and rhythms. Deep candidosis was considered a major factor in every patient's death. Experimental deep candidosis in 12 infected, adult laboratory rats was characterized by similar haphazardly scattered myocardial microabscesses with fungal elements in eight (67%). Endocarditis in the rats was not seen in this intracardiac injection model. Widespread antibiotic exposure in patients who have compromising underlying diseases portends an increasing incidence of deep candidosis, which as the potential to infect any tissue, particularly the heart, and to create cardiac arrhythmias and death.
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PMID:The potentially lethal problem of cardiac candidosis. 698 62

A 62-year-old woman with chronic active hepatitis receiving immunosuppressive drugs was initially admitted with sepsis secondary to an intra-abdominal abscess caused by Klebsiella pneumoniae. She had a stormy course despite adequate antimicrobial therapy. Her postoperative course was further complicated by a fungal infection. Blood, urine, and sputum cultures were positive for Trichosporon. Antifungal therapy was given but her condition deteriorated and she died. At autopsy, a disseminated fungal infection was found. Diagnosis and management of such infections in the immunosuppressed host are difficult.
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PMID:Disseminated Trichosporon infection. Occurrence in an immunosuppressed patient with chronic active hepatitis. 718 29

Candidosis is the most common postmortem cerebral mycosis, yet is rarely appreciated clinically. From 8975 complete autopsies, 41 patients were identified with tissue verified deep candidosis. Nineteen of them (46 per cent) had cerebral candidal infections. There were eight males and 11 females, and 15 whites and four blacks. The age varied from 17 days to 82 years, with a mean age of 40 years. Cancer was observed in four (21 per cent). All 19 individuals had proven or suspected gram negative sepsis and had been treated with appropriate antibiotic therapy. Other predisposing factors included major surgery (63 per cent), steroid therapy (53 per cent), and deep venous lines (42 percent). Candida species was identified outside the brain in every patient and included the kidneys (90 per cent), heart (80 per cent), and other organs. Portals of entry appeared to be the gastrointestinal tract, deep venous lines, or both. In this autopsy population, candidosis occurred only in compromised patients and produced intracerebral microabscesses and noncaseating granulomas without diffuse leptomeningitis. Cerebral lesions occurred late in the disease, and were complicated by cardiac and renal candidosis, which contributed to the patient's death. With an increased awareness of the appropriate clinical setting, this iatrogenic mycosis can be handled properly and prevented from jeopardizing the patient.
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PMID:Human cerebral candidosis--a postmortem evaluation of 19 patients. 720 51


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