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

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.
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PMID:Clinical characteristics of nosocomial sinusitis. 368 59

Two cases of pituitary abscesses are reported. The first case was a 22-year-old female who was admitted with 14 months history of intermittent fever and headache followed by amenorrhea and polyuria. Plain craniograms showed no remarkable changes on the sella turcica. Direct coronal CT demonstrated a cystic lesion with a ring-like enhanced capsule in the pituitary complex with the apparent bulging of the pituitary top surface. On dynamic CT, the cystic lesion showed no remarkable increase in density. Transsphenoidal surgery was performed and a purulent materials was drained by cutting the underlying fibrous pituitary tissue. Pathological specimen revealed a marked inflammatory reaction around the degenerative pituitary gland. The second case was a 27-year-old female who underwent transsphenoidal excision of craniopharyngioma on May 12, 1983. Postoperatively she did well with the hormonal replacement therapy until 9 months after surgery when a follow up direct coronal CT revealed a cystic lesion with ring-like enhancement in the pituitary fossa. Purulent material was found at transsphenoidal surgery. Pathological specimen from the hard capsule was a chronic inflammatory fibrous tissue without tumorous component. Over seventy cases of pituitary abscesses have been reported previously, but the majority of them were secondary infections associated with systemic sepsis, chronic sphenoid sinusitis or pituitary tumors. Primary pituitary abscesses were rare and would be difficult to be diagnosed preoperatively without an aid of recent CT technology. Thirty cases in the literature since 1970 are reviewed and its clinical pictures and radiological findings are discussed.
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PMID:[Pituitary abscess: report of two cases and a review]. 380

Paranasal sinusitis secondary to prolonged nasotracheal intubation represents an infrequently reported source of sepsis. Of 27 nasally intubated patients who developed paranasal sinusitis over a 1-yr period, 17 patients underwent emergency blind nasotracheal intubation post-trauma or shock (group 1) and the remaining ten were intubated electively under operating room or ICU conditions (group 2). Group 1 patients were younger (mean age 33 +/- 6 vs. 57 +/- 5 yr) than those in group 2; they also developed sinusitis more quickly after intubation (mean time 8 +/- 1 vs. 15 +/- 2 days). Diagnosis was confirmed via sinus x-rays (14 cases), computed tomography (five cases), indium scan (two cases), or clinical picture. Cultures were obtained in 14 cases. Staphylococci predominated in group 1, while nosocomial Gram-negative organisms predominated in group 2. Seven patients developed pulmonary infections and two developed systemic sepsis with an organism present on sinus culture. In all cases treatment was successful with antibiotics and tracheostomy or movement of the tube to the oral route. These data indicate that patients nasally intubated are at risk for development of paranasal sinusitis; this diagnosis should be suspected in sepsis of undetermined etiology.
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PMID:Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. 394 15

The ultimate source of sepsis may be difficult to pinpoint in critically ill patients with multiple possible sources of iatrogenic infection. In the last year, we have been consulted with regard to several febrile intensive care unit patients in whom sinusitis was initially identified by computerized axial tomography done for other reasons. The questions are: 1. are the x-ray findings significant; 2. is this the cause of fever and sepsis; 3. how should the patient be treated for this problem; and 4. can this be prevented. In five patients, sepsis was clearly related to sinusitis. Treatment had included nasal tubes in all six patients, and in addition, five patients had received high doses of corticosteroids while intubated. The sixth patient was a diabetic. Etiology, diagnosis, and management are discussed in detail. We believe that prolonged nasal intubation should be avoided, particularly in patients with decreased resistance to infection. Initial treatment consists of removing intranasal tubes and the administration of broad spectrum or culture specific antibiotics. Surgery is indicated in the event of persistent sepsis or secondary complications. Computerized tomography is an excellent tool for diagnosis and following response to therapy.
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PMID:Sinusitis in intensive care unit patients. 402 87

The cause of sepsis in the intensive care unit patient can be a perplexing diagnostic problem. We have recently encountered seven patients who had sepsis associated with sinusitis of the paranasal sinuses. They represented 26 percent of all patients who had nasotracheal intubation for 5 days or more. Sinusitis as a complication of nasotracheal intubation has been previously reported, but its frequency has not been appreciated. Three case reports are presented to emphasize the importance of making this diagnosis. Standard x-ray studies will not adequately demonstrate all the paranasal sinuses. We have utilized computerized tomography to study these patients and found it to clearly demonstrate all the paranasal sinuses. We suggest a plan to help prevent sinusitis from nasotracheal intubation. Should this complication occur, however, the nasotracheal tube should be removed and the sinuses surgically drained or treated aggressively with topical agents.
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PMID:Sepsis from sinusitis in nasotracheally intubated patients. A diagnostic dilemma. 672 Oct 35

Neisseriae other than N. meningitidis and N. gonorrhoeae are common upper respiratory commensals, but rarely cause disease. A case of N. sicca bacteremia in an immunocompromised patient is reported, and the literature dealing with infections attributed to these usually nonpathogenic organisms is reviewed. These neisseriae have been shown to cause meningitis, endocarditis, sepsis, and some cases of pneumonia, otitis media, and sinusitis; however, their pathogenicity is doubtful in many of the reported cases of urethritis, cervicitis, and upper respiratory infection. They are not uniformly sensitive to the penicillins, so therapy should be guided by the results of antimicrobial susceptibility testing.
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PMID:Are the "nonpathogenic" Neisseriae pathogenic? 701 24

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient's illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient's illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient's illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.
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PMID:Bacteremia caused by viridans streptococci in 71 children. 733 84

A frequently overlooked source of sepsis in the critical care patient is the paranasal sinuses. These patients are typically unable to communicate and, therefore, the usual findings of sinus infection, such as facial pain and complaints of purulent drainage, will be absent. Sepsis may be the first manifestation of such infection. Nasotracheal intubation is the most important predisposing factor to developing sinusitis in these patients. The clinician, therefore, must maintain a high index of suspicion in any patient with fever of unknown origin. Radiologic studies, including plain sinus radiographs, or preferably, a computed tomography scan, will usually show the presence of fluid or inflammation. Lavage of the maxillary sinus is helpful both to verify the presence of infection and to obtain culture material. These infections tend to be polymicrobial, and often display a predominance of Gram-negative organisms, particularly Pseudomonas aeruginosa. Treatment includes removal of all nasal tubes and institution of appropriate antibiotics, along with decongestant therapy. In some cases, surgical drainage will be necessary. For patients who are immunocompromised, or requiring intubation for > 7 days, the nasotracheal route is best avoided.
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PMID:Sinusitis in the critical care patient. 752 19

Twenty-four isolated double lung transplants (LTXs) have been performed in 22 patients with cystic fibrosis, with a follow-up of 4 to 47 months. Prior to LTX, all patients were colonized with Pseudomonas aeruginosa, and ten patients were also colonized with Pseudomonas cepacia. Both organisms were specifically sought before LTX. All patients who grew P cepacia before LTX did so after LTX. Five additional patients only grew this bacterium after LTX. There was no difference between those who grew P cepacia and those who did not in terms of data before LTX for age, weight, pulmonary function, and 6-min walk. After LTX, 7 of the 15 patients who had ever grown P cepacia died. No patient who grew only P aeruginosa died. The median survival in the subgroup with P cepacia was 28 days. Five of the seven died as a direct result of P cepacia pneumonia and sepsis. One died of cyclosporin A (cyclosporine) neurotoxicity with concurrent P cepacia pneumonia, and one died at the time of a retransplant for graft failure (associated with three bouts of P cepacia pneumonia and cytomegalovirus). Four of seven had not grown this bacterium before LTX. There were no perioperative factors, including antibiotic choices, that distinguished survivors and nonsurvivors. Overall 1-year survival is about 70 percent (15/22). Fourteen bouts of P cepacia pneumonia occurred in 12 patients. Four empyemas, one lung abscess, one suppurative pericarditis, and five cases of sinusitis were also due to this bacterium. In conclusion, P cepacia is responsible for excess morbidity and mortality after LTX. This organism is particularly lethal if isolated for the first time after LTX. Factors predicting its acquisition in this setting are unknown. While it is possible that the facial sinuses may act as an unrecognized reservoir or that patients or equipment provide a source, further study into the epidemiology of this organism is necessary to improve the survival of colonized patients undergoing LTX.
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PMID:Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. 751 20

The occurrence of sinusitis and middle ear effusions has frequently been attributed to the obstruction of the sinus ostia and/or eustachian tube. In the intensive care unit setting, edema caused by the irritation from nasogastric, nasotracheal and orotracheal tubes has been associated with this pathology and has been responsible for occult sepsis in this population. Our investigation was performed to determine the risk of chronic otitis media with effusion necessitating myringotomy with tympanostomy tubes among tracheotomized, ventilator dependent children in a consecutive series of children admitted to our recently created stable ventilator unit. We retrospectively reviewed the medical records of all tracheotomized, chronically ventilator dependent children < 48 months of age who had been hospitalized in this unit from the initial opening in September 1990 to January 1993. Data collected consisted of patient demographics, gestational age, cognitive abilities, age at onset of mechanical ventilation, age at tracheostomy, age at myringotomy, presence of nasogastric and gastroenterostomy tubes and evidence of gastric-esophageal reflux. All children underwent a tracheostomy procedure subsequent to the onset of mechanical ventilation. Of these patients, 9/12 (75%) later required myringotomy with tympanostomy tube placement following the occurrence of chronic otitis media with effusion. Ventilation tubes for chronic otitis media with effusion were not required in 3 patients. Using a case control study design, we examined the need of myringotomy tubes for children requiring continuous mechanical ventilation versus those requiring night-time only ventilation. The risk of myringotomy tubes in the continuously ventilated group (9/9) was significantly greater than the risk in the intermittently ventilated group (0/3) P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic otitis media requiring ventilation tubes in tracheotomized ventilator dependent children. 783 30


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