Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The patient who has clinical jaundice, abnormal results on liver function tests, or both presents a difficult diagnostic challenge. Many infectious diseases affect the liver, and the extent of involvement determines the degree of clinically apparent jaundice. Some diseases that affect the liver minimally cause no jaundice at all. An important clue to the cause of the disorder is the pattern of abnormal results on liver function tests. Increased alkaline phosphatase predominates with Q fever, secondary or tertiary syphilis, clonorchiasis, and hepatic candidiasis, while elevated levels of serum transaminases characterize viral hepatitis, leptospirosis, mononucleosis syndromes, legionnaires' disease, typhoid fever, toxic shock syndrome, and yellow fever. Increases in serum bilirubin are typical with jaundice caused by clostridial myelonecrosis, severe bacterial sepsis, and relapsing fever (borreliosis). These findings together with the patient's history, physical findings, and basic laboratory tests provide a presumptive diagnosis in most cases.
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PMID:Systemic infections affecting the liver. Some cause jaundice, some do not. 305 Sep 27

About 2% of patients with a prosthetic valve will develop endocarditis. This may occur within a few weeks of the valve replacement operation (early) or many months or years later (late). The infecting organisms, pathogenicity and prognosis differ in the two groups. The incidence of early prosthetic valve endocarditis (PVE) is under 1%; the predominant organisms are staphylococci that are acquired in the operating theatre or in the intensive therapy unit. Early PVE usually follows wound sepsis that may initially appear trivial. The mortality rate is around 70%, but such infections should be preventable by stringent antisepsis, good surgical technique and (perhaps) perioperative antistaphylococcal antibiotics. The incidence of late PVE is about 1% per annum. The infecting organisms are similar to those causing native valve endocarditis, predominantly streptococci. The commonest source of these organisms is the mouth and regular dental care and appropriate prophylactic antibiotics should help to prevent infection. The mortality rate of late PVE is around 10%. Failure of medical treatment in PVE is an indication for surgery to remove the infected valve(s) and this should not be delayed. The optimum length of treatment for PVE is unknown but it is seldom necessary to give antibiotics for more than 6 weeks except in Coxiella burnetii infection.
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PMID:Prosthetic valve endocarditis. 331 60

Since the introduction of effective antimicrobial therapy, the leading cause of death in patients with infective endocarditis is no longer sepsis but, rather, congestive heart failure. The mortality is higher in patients with severe heart failure due to infective endocarditis who are treated with medical therapy only than in those who additionally undergo cardiac valve replacement. The mortality is also higher in patients with severe heart failure due to aortic infective endocarditis (40 to 93%) than in those with heart failure due to mitral infective endocarditis (17 to 66%). In patients with and in those without infective endocarditis, surgical intervention can be carried out with comparable mortality not only for aortic valve replacement (9 vs 8.4%) but also overall for valve replacement (10 vs 12%). In patients with class IV heart failure, overall mortality of valve replacement was higher (17%) than in patients with class II (8%) or class III heart failure (7%) and, similarly, comparable with that of matched groups of patients without infective endocarditis. In patients with class IV disability, the mortality of valve replacement was higher in those with active infective endocarditis (19%) than in those with inactive infective endocarditis, possibly due to a higher incidence of sudden onset of severe aortic regurgitation and myocardial abscess. No patient with valve replacement for inactive infective endocarditis developed prosthetic valve endocarditis; a single case of prosthetic valve endocarditis occurred in a patient with active infective endocarditis. In general, early surgical intervention is preferable to procrastination in the management of patients with progressive or severe heart failure due to infective endocarditis. Although, in at least 70% of patients, blood cultures may be rendered sterile within one week of initiation of appropriate antimicrobial therapy, patients with infective endocarditis due to staphylococci, multiply-resistant gram-negative bacilli, fungi, Q-fever or those with myocardial abscess or multiple relapses may require surgical intervention. While the overall incidence of clinically apparent emboli has been reported to be as high as 30%, in a ten-year observation period at the Mayo Clinic, the rate was 5.6%. Patients with echocardiographic evidence of large or mobile vegetations and those with infective endocarditis cause by microorganisms associated with a high risk of embolization such as slow-growing fastidious gram-negative bacilli, fungi (especially Aspergillus) and nutritionally-variant viridans streptococci should be considered candidates for surgery irrespective of a history of emboli.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cardiac valve replacement in patients with active infective endocarditis. 666 78

Ten male patients with a mean age of 57.5 years (range 27-75 years) underwent homograft aortic valve or root replacement for destructive aortic valve endocarditis. Six patients had native valve endocarditis (one with associated native mitral valve endocarditis) and four had prosthetic valve endocarditis (one with associated prosthetic mitral endocarditis). Causative organisms were Streptococci in six patients, Staphylococci in one, Q fever in one and no organisms were isolated in the remaining two patients. All the patients were operated while on antibiotics (mean lengths of treatment 13 days; range 2-42). The main indication for surgery was cardiogenic shock in five patients, progressive cardiac failure in four patients and uncontrolled sepsis in one patient. Operative procedures involved homograft aortic root replacement with coronary reimplantation (seven patients; associated prosthetic mitral valve replacement in one patient), infracoronary homograft aortic valve replacement (three patients) and a number of other procedures were performed to reconstruct the disrupted cardiac anatomy. Patients were followed up for a mean of 13.2 months (range 2-21). One patient died 4 months postoperatively of an unrelated cause; all the others are asymptomatic with no evidence of recurrent endocarditis. We conclude that homograft aortic valve or root replacement is an effective method of managing destructive aortic valve endocarditis.
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PMID:Homograft aortic valve and root replacement for severe destructive native or prosthetic endocarditis. 803 58

Coxiella burnetii is a macrophage-tropic, Gram-negative organism, which causes acute Q fever infection in humans. This zoonotic infection causes illness ranging from asymptomatic seroconversion to severe and protracted disease featuring hepatitis and pneumonia. Interactions between C. burnetii lipopolysaccharide (LPS) and host Toll-like receptors (TLR)-2 and -4 have been implicated in pathogen recognition, phagocytosis and signaling responses. Nonconservative single nucleotide polymorphisms in the coding regions of TLR-2 (Arg677Trp and Arg753Gln) and TLR-4 (Asp299Gly) have been found to correlate with mycobacterial infections and Gram-negative sepsis respectively. Associations between the TLR-2 and -4 polymorphisms, illness characteristics and immune response parameters were examined in subjects with acute Q fever (n=85) and comparison subjects with viral infections (n=162). No correlation was demonstrated between these polymorphisms and susceptibility to Q fever, illness severity or illness course.
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PMID:Polymorphisms in Toll-like receptors-2 and -4 are not associated with disease manifestations in acute Q fever. 1785 3

A 50-year-old patient underwent a routine primary total hip replacement. Soon after surgery, he developed acute respiratory failure from post-operative sepsis. His condition deteriorated rapidly despite supportive management and he required admission into intensive care unit for assisted ventilation. It took almost one week before the underlying cause of the deterioration was determined to be unrelated to complications of surgery. A diagnosis of Q-fever was made following detailed attention to the clinical history. Appropriate treatment was started and the patient made a full recovery. The diagnosis was confirmed later following discharge from hospital.
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PMID:Acute Q-fever and history taking--a lesson learned. 1909 13

Tigecycline belong to glycylcycline antibiotics. This new group of antibiotics was derived from lipophilic tetracyclines but differs from them by higher effectivity, lower affinity to bacterial resistance mechanisms, and very long half-time. Tigecycline is registered for treatment two groups of infections: skin and soft tissue infections and complicated intra-abdominal infections. Nevertheless, its therapeutic use probably can be enlarged to pneumonia, STD, infections caused by multi-resistant Helicobacter pylori, subacute and chronic infections associated with biofilm formation, and serious infections caused by intracellular pathogens (serious brucellosis, Q-fever, rickettsial infections). By contrast, tigecycline seems not appropriate for treatment sepsis and similar acute life-threatening bacterial diseases.
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PMID:[Tigecycline: Its position between other antibiotics, features, clinical usage]. 1939 24

A 28-year-old woman, a park ranger, developed acute Q fever with associated sepsis, profound jaundice, disseminated intravascular coagulation and multiorgan failure necessitating prolonged admission to the intensive care unit for ventilatory support. She recovered fully and remains well 4 years later.
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PMID:Life-threatening Q fever infection following exposure to kangaroos and wallabies. 2638 15

Granulomas are a collection of immune cells considered to be protective in infectious diseases. The in vitro generation of granulomas is an interesting substitution to invasive approaches of granuloma study. The monitoring of immune response through the determination of in vitro granuloma formation in patients with severe sepsis may be critical to individualize treatments. We compared the in vitro generation of granulomas by co-culturing circulating mononuclear cells from 19 patients with severe sepsis, 9 patients cured from Q fever and 12 healthy subjects as controls, and Sepharose beads coated either with BCG or Coxiella burnetii extracts to analyze both immune and innate granulomas, respectively. We showed that the great majority of patients with severe sepsis were unable to form granulomas in response to BCG and C. burnetii extracts whereas more than 80% of healthy controls and patients cured from Q fever formed granulomas. We also found that monocytopenia and defective production of tumor necrosis factor were associated with reduced formation of granulomas in patients with severe sepsis even if TNF did not seem to be involved in the defective granuloma formation. Taken together, these results suggest that the deficiency of granuloma formation may be a measurement of altered recruitment and activation of monocytes and lymphocytes in patients with severe sepsis.
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PMID:Impaired Granuloma Formation in Sepsis: Impact of Monocytopenia. 2744 46

We present the case of a 48-year-old man admitted to the critical care unit with atrial fibrillation, and acute heart and kidney failure accompanied by coagulopathy and an abnormal liver test. Initially diagnosed as a non-ST elevation myocardial infarction, re-evaluation of the case led to the consideration of severe sepsis. Q fever and leptospirosis were the most probable causes and empiric treatment was initiated. A complete recovery was achieved following treatment.
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PMID:Acute Q Fever Presenting with Multi-Organ Failure: Re-Evaluation of the Initial Diagnosis. 3075 76


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