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

Periorbital cellulitis is a condition primarily affecting young children. We present a 5-week-old boy who developed periorbital cellulitis and had a CT scan which identified acute ethmoiditis as the source of the sepsis. His clinical course is outlined, and the relevant literature is discussed. We believe this patient is the youngest case of periorbital cellulitis due to confirmed ethmoiditis reported. This emphasises the possibility of an underlying sinusitis in patients with periorbital cellulitis, even in this very young age group.
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PMID:Periorbital cellulitis secondary to ethmoiditis in a 5-week-old child. 1069 48

Nosocomial infection in the critically ill results from defects in the intrinsic barriers to microbial invasion. The diagnosis is complicated by an inability to perform an adequate physical examination in a patient with several compounding findings, usually necessitating sophisticated technologies to aid in the diagnosis. Pneumonia, line sepsis, urosepsis, sinusitis, endocarditis, peritonitis, and acalculous cholecystitis are the more common infections that challenge the care of the critically ill. Antibiotic therapy is adjunctive to efforts to preserve the barrier, but should be started early, should be targeted as specifically as possible to the offending organisms, and should be dosed adequately to ensure an effective concentration in the infected tissue.
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PMID:Contemporary issues with bacterial infection in the intensive care unit. 1089 68

Streptococcus pneumoniae is a common cause of meningitis, sepsis, pneumonia, acute otitis media, and sinusitis in children. Children younger than 24 months have the highest rates of invasive pneumococcal infections (Germany 1997-1999: 19.5/100,000/year). Pneumococcal infections cause in Germany 220-250 cases of meningitis, about 50,000 of pneumonia (children younger than 5 years) and more than 1 million cases of otitis media (children) annually. The case-fatality rate for invasive pneumococcal diseases is high (1997-1999 5.5%, meningitis 8.3%). 20-30% of survivors from meningitis suffer from CNS-related sequelea. In children up to 2 years vaccination with the heptavalent pneumococcal conjugate vaccine can reduce invasive pneumococcal diseases by about 80% and otitis media and recurrent otitis media by 6% and 9-16%, respectively. Due to the increased risk of pneumococcal infections in the first two years of live all children of this age group should be vaccinated. The high rate of resistance of pneumococci against macrolides in Germany, the high rate of non-licensed antibiotics in infants and the inefficacy of the 23-valent vaccine in children younger than 2 years makes the new vaccine to a necessary alternative.
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PMID:[Value of pneumococcal vaccination in infants and young children]. 1141 63

Because sinusitis is usually clinically silent in intubated patients, it is not widely appreciated as an important source of infection and fever in critically ill patients. Three such patients, two men aged 22 and 36 years, and a woman aged 50 years, suffered from respiratory insufficiency due to pneumonia. The course of the disease was determined by the sinusitis, which did not resolve during antibiotic therapy of the pneumonia, notwithstanding the fact that the causative micro-organism was susceptible to the antibiotics administered, and that both the tracheal and gastric tubes were led through the mouth instead of the nose. Flushing of the sinuses caused the fever to disappear and led to recovery of the patients. An aggressive approach to diagnose sinusitis in the intubated patient with fever in the intensive care unit is needed. A maxillary sinus lavage and culture, followed by treatment with specific antibiotics should be an integral part of the diagnosis and treatment in these patients. Surgery is indicated in the event of persistent sepsis.
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PMID:[Sinusitis as a major cause of fever in intubated patients]. 1157 67

Acute exacerbation of chronic bronchitis (AECB) is a very common condition, which presents with deteriorating sputum production and dyspnoea in a patient with pre-existing COPD or chronic bronchitis. As these symptoms are relatively non-specific and also the presenting feature of a wide range of other conditions, the physician should carefully consider the differential diagnosis before deciding on whether or not a patient indeed has AECB. The differential diagnosis can be summarised as pneumonia, pneumothorax, cardiac failure/cor pulmonale, bronchiectasis, asthma, tuberculosis, sinusitis and other forms of upper respiratory tract sepsis, diffuse panbronchiolitis, lung cancer, gastro-oesophageal reflux, the presence of a foreign body in the airway, melioidosis, and lung abscess. This article aims to discuss these conditions, with brief presentation of clinical cases, in the evaluation of differential diagnosis of AECB.
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PMID:Solutions for difficult diagnostic cases of acute exacerbations of chronic bronchitis. 1158 3

Invasive infection due to Streptococcus pneumoniae associated with rhabdomyolysis is rare. We report the case of a 31-year-old splenectomized man with pneumococcal bacteremia and paranasal sinusitis who presented with flu-like symptoms preceding a fulminant course of sepsis and rhabdomyolysis with acute renal failure and elevated creatinine phosphokinase. Although the possible mechanisms of rhabodomyolysis associated with pneumococcal infection remain unclear, this report may serve to alert clinicians of the need to prevent fulminant pneumococcal infection by vaccination and treatment with antibiotic prophylaxis in splenectomized patients.
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PMID:Rhabdomyolysis associated with Streptococcus pneumoniae bacteremia in a splenectomized patient. 1218 50

The purpose of this study was to assess the incidence of diagnosed sinusitis and the effect of diagnosis and treatment on the outcome in critically ill burn victims. Chart analysis of 84 consecutive burn victims requiring mechanical ventilation for greater than 7 days was performed. Sinusitis was diagnosed in 13/84 patients (15%). There was no difference in age or total body surface area burned, or the incidence of inhalation injury, ARDS, pneumonia and sepsis (P>0.05). Co-morbid disease was similar in both the groups. The number of ventilator-dependent days and hospital length of stay were higher in the sinusitis group (P<0.05). The hospital mortality in those diagnosed and treated for sinusitis was 23% (3/13) as opposed to 48% (34/71) in those not diagnosed with sinusitis (P<0.05). Increased number of ventilator-dependent days and longer hospital stay are associated with the diagnosis of sinusitis. Our findings suggest an improved survival in those diagnosed and treated for sinusitis.
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PMID:Effect of diagnosis and treatment of sinusitis in critically ill burn victims. 1254 50

Radiologic maxillary sinusitis is an important risk factor for development of bronchopneumonia in mechanically ventilated patients. Nitric oxide produced within the paranasal sinuses is considered to provide an antibacterial environment and to modulate mucociliary clearance function. We hypothesized that a reduced formation of nitric oxide might contribute to the compromised local host defense in radiologic maxillary sinusitis and measured nitric oxide levels directly within maxillary sinuses of septic patients with radiologic maxillary sinusitis (n = 11), whose sinuses were fenestrated to eliminate a possible septic focus. Data were compared with those of patients without airway inflammation (n = 11, control subjects). Despite local inflammation and infection, we found considerably lower maxillary nitric oxide levels than in control subjects (31 +/- 10 versus 2554 +/- 385 parts per billion, mean +/- standard error of the mean, p < 0.001). Consistently, immunohistochemical and in situ hybridization investigations revealed strongly reduced expression of inducible nitric oxide synthase. By applying ultrastructural immunolocalization, we identified cilia and microvilli of the maxillary sinus epithelium as the major nitric oxide production site in control subjects. Our findings provide evidence of markedly reduced nitric oxide production in maxillary sinuses of patients with radiologic maxillary sinusitis and sepsis, implicating impaired local host defense and an increased risk for secondary infections.
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PMID:Reduced nitric oxide in sinus epithelium of patients with radiologic maxillary sinusitis and sepsis. 1288 2

This paper presents the priority original methods (patent No. 2101046, Russia) for the treatment of inflammatory pyodestructive processes in the oral cavity, maxillofacial area, and neck (odontogenic abscesses and phlegmons including those complicated by mediastinitis and sepsis), sinusitis, carbuncles and furuncles of face and neck skin, parotitis, sialadenitis, adenophlegmons, lymphadenitis, periotitis, alveolitis, arthritis, arthrosis of the temporomandibular joint, odontogenic and traumatic osteomyelitis, infected purulent traumas (including gunshot ones), fractures of the jaws, etc. making use of Optodan laser (patent No. 2014107, Russia) for laser and magnetic-laser therapy.
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PMID:[Treatment of inflammatory pyodestructive processes of the oral cavity, maxillofacial area, and neck by laser and magnetic-laser exposure of the carotid sinus using the Optodan laser apparatus]. 1284 Nov 39

The X-linked hyper-IgM (XHIGM) syndrome is an uncommon primary immunodeficiency disease caused by mutations in the gene for CD40 ligand and characterized by normal or elevated serum IgM, reduced levels of IgG and IgA, and defective T-cell function. Because of its rarity, it has been difficult for any single investigator or institution to develop a comprehensive clinical picture of this disorder. Accordingly, a national registry was developed in the United States to provide demographic, genetic, immunologic, and clinical information on a relatively large number of patients with the XHIGM syndrome.A total of 79 patients from 60 unrelated families were registered between January 1997 and July 2002. The estimated minimal incidence was approximately 1/1,030,000 live births. All of the patients had significant IgG deficiency and most had IgA deficiency, but only one-half had elevated IgM levels. Most patients presented initially with a history of an increased susceptibility to infection including Pneumocystis carinii pneumonia. The average age of diagnosis was significantly earlier in patients born into a family with a previously affected individual. However, only one-third of the patients born into a family with a previously affected individual were diagnosed exclusively because of the presence of the positive family history before any clinical symptoms developed. Over half the patients developed symptoms of immunodeficiency and were diagnosed by 1 year of age, and over 90% by 4 years of age. The most prominent clinical infections were pneumonia (81% of patients), upper respiratory infections (49%) including sinusitis (43%) and recurrent otitis (43%), recurrent/protracted diarrhea (34%), central nervous system infections (14%), sepsis (13%), cellulitis (13%), hepatitis (9%), and osteomyelitis (1%). In addition to infections caused by encapsulated bacteria, opportunistic infections were relatively common and were caused by P. carinii, members of the herpes virus family (including cytomegalovirus), Cryptosporidium, Cryptococcus, Candida, Histoplasma, and Bartonella. Sclerosing cholangitis occurred in 5 patients and in 4 of these was associated with Cryptosporidium infection. Eight patients had died at the time of their entry into the Registry; 2 of pneumonia (1 P. carinii and 1 cytomegalovirus), 2 of encephalitis (1 ECHO virus and 1 cytomegalovirus), 2 of malignancy (both hepatocellular carcinoma), 1 of sclerosing cholangitis caused by Cryptosporidium, and 1 of hemolytic uremic syndrome.
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PMID:The X-linked hyper-IgM syndrome: clinical and immunologic features of 79 patients. 1466 87


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