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

Pylephlebitis or septic portal thrombophlebitis is a rare but serious condition which may occur following intra-abdominal sepsis from any source. Sigmoid diverticulitis is one of the most common sources. Modern imaging modalities, particularly CT, have increased the recognition of this condition. Standard treatment consists of anticoagulation plus antibiotic therapy to cover anaerobic and gram negative organisms. The duration of anticoagulation therapy remains controversial. Sigmoid colectomy may be required in cases of perforated diverticulitis or failure of medical therapy.
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PMID:[Pylephlebitis in the course of diverticulitis]. 1877 40

Deep infections of the neck are potentially life-threatening for their descending spread along cervical fascia planes towards the mediastinum and development of sepsis after thrombophlebitis of the internal jugular vein. The aim of the present report is to review the complications of the deep neck infections and their surgical treatment for the period of the last 5 years. From 1999 to 2003 29 patients with deep cervical infections were treated surgically. Twelve of the patients had submandibular abscess, 10 cases were with parapharyngeal abscess, 3 with Ludwig's angina, 1 with mastoiditis with exteriorization in the neck and 3 with neck phlegmonas. The infections were most frequently of tonsillar and dental origin. The following complications were observed: 6 cases with acute obstruction of the upper airways treated with tracheostomy; 2 cases with sepsis; 2 with descending mediastinitis; and 1 with acute hemorrhage of stress ulcer of the stomach treated with laparotomy and laparostomy. Combined surgical and massive antibiotic treatment according to the bacteriological findings was carried out. Cervical incisions, jugulotomy and thoracotomy were performed in cases with descending mrdiastinitis. Permanent suction drainage and lavage of the abscess cavities were used. In cervical phlegmonas the surgical wounds were left open against anaerobic infection. Three cases of deep cervical infections, complicated with mediastinitis, sepsis, VII and XI cranial nerves paresis, hemorrhages from the gastrointestinal tract are cited. The third case is interesting with the multiple complications of the deep neck infection--stress ulcer of the stomach, which could not be managed endoscopically because of the compression due to hypopharingeal edema, sepsis, tracheal stenosis. All the patients but one recovered after the treatment. One of them with cervical phlegmona died out of heart arrest in the operating theater after urgent intubation and tracheotomy for airway obstruction. The great importance of the early surgical treatment of neck infections, the use of antibiotics covering both aerobic and anaerobic bacterial spectrum and the good coordination between otolaryngologists, surgeons, reanimators and microbiologists is stressed in conclusion.
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PMID:[Complications of the deep infections of the neck]. 1878 14

Pylephlebitis or septic thrombophlebitis of the portal vein is a rare entity with a high mortality rate. It is often a complication of intra-abdominal infection most commonly caused by diverticulitis and appendicitis. Diagnosis is often delayed since clinical signs and symptoms are nonspecific. Pylephlebitis should be considered in patients with sepsis due to gut-associated organisms without a clear focus of infection. We describe a patient with metastastatic colon carcinoma treated with chemotherapy and bevacizumab who was diagnosed with pylephlebitis after a duodenal ulcer and responded well to antibiotic treatment.
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PMID:Pylephlebitis after a duodenal ulcer in a patient with metastasised colon carcinoma treated with chemotherapy and bevacizumab: a case report. 1929 49

Sepsis is a common problem in patients who have cuffed catheters for hemodialysis. Line sepsis, however, has not often been associated with septic thrombophlebitis as seen in Lemierre syndrome. Thrombophlebitis of a central vein associated with catheter placement is extremely rare and when encountered is known to affect the femoral or the subclavian vein. Thrombophlebitis of the internal jugular vein after hemodialysis catheter placement has not been reported. We present the case of a woman with line sepsis who developed Lemierre syndrome, a serious complication of which the medical community should be aware. Lemierre syndrome requires a high index of suspicion for diagnosis and can have a fatal outcome if not treated with appropriate antibiotics.
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PMID:Cuffed-catheter-related Lemierre syndrome. 1937 48

Despite implementation of CDC recommendations and bundled interventions for preventing catheter-associated blood stream infection, ventilator-associated pneumonia, or urinary catheter-associated infections, nosocomial infections and sepsis remain a significant cause of morbidity and mortality in critically ill children. Recent studies suggest that acquired critical illness stress-induced immune suppression (CRISIS) plays a role in the development of nosocomial infection and sepsis. This condition can be related to inadequate zinc, selenium, and glutamine levels, as well as hypoprolactinemia, leading to stress-induced lymphopenia, a predominant T(H)2 monocyte/macrophage state, and subsequent immune suppression. Prolonged immune dysfunction increases the likelihood of nosocomial infections associated with invasive devices. Although strategies to prevent common complications of critical illness are routinely employed (eg, prophylaxis for gastrointestinal bleeding, thrombophlebitis), no prophylactic strategy is used to prevent stress-induced immune suppression. This is the authors' rationale for the pediatric CRISIS prevention trial (NCT00395161), designed as a randomized, double-blind, controlled clinical investigation to determine if daily enteral supplementation with zinc, selenium, and glutamine as well as parenteral metoclopramide (a dopamine 2 receptor antagonist that reverses hypoprolactinemia) prolongs the time until onset of nosocomial infection or sepsis in critically ill children compared to enteral supplementation with whey protein. If effective, this combined nutritional and pharmacologic approach may lessen the excess morbidity and mortality as well as resource utilization associated with nosocomial infections and sepsis in this population. The authors present the design and analytic plan for the CRISIS prevention trial.
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PMID:Rationale and design of the pediatric critical illness stress-induced immune suppression (CRISIS) prevention trial. 1940 4

Lemierre's syndrome is a rare but a life threatening condition which affects young healthy individuals, was first described by Dr.Andre Lemierre in 1936. Incidence rates are between 0.6 and 2.3 per million population. It is found more commonly in males, with a male to female ratio of approximately 2:1. Its pathogenesis consists of the development of infectious thrombophlebitis in the internal jugular vein or one of its branches caused by a focal sepsis, mostly localized in the oropharynx, leading to generalized multiorgan metastatic infections, generally to the lung. This computerized tomography (CT) neck with intravenous contrast is from a 24 year old female who presented with a two day history of fever, hypotension and respiratory failure. The physical exam was positive for diminished breath sounds bilaterally on lung exam. Complete blood count revealed a leukocytosis of 16,200 u/L with 70% neutrophils and 9% bands, hemoglobin of 13.4mg/dl and severe thrombocytopenia with a platelet count of 34,000 u/L; comprehensive metabolic panel revealed sodium 140mmol/L, potassium 2.9mmol/L, bicarbonate 26mmol/L, blood urea nitrogen (BUN) 16mg/dl, creatinine 0.8mg/dl, calcium 7.2 mg/dl, albumin 2.4g/dl, total bilurubin 3.1mg/dl, AST 81 U/L, ALK 101 U/L, ALT 35U/L. CT chest revealed multiple cavitary opacities in both lungs. Blood cultures were positive for Fusobacterium necrophorum. CT scan neck showed a filling defect of the right internal jugular vein consistent with a thrombus and multiple enlarged cervical lymph nodes. Treatment is medical with intravenous antibiotics and anticoagulation. References: 1. Carlson ER, Bergamo DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994; 52:74-78. 2. Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: a forgotten disease. BMJ 1984;288:1526-1527. 3. Jones C, Siva TM, Seymour FK, O'Reilly BJ. Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol 2006;120:502-504 4. Mohammed Iqbal Syed et al. Lemierre Syndrome: Two Cases and a Review. Laryngoscope, 117:1605-1610, 2007 5. Vohra A, Saiz E, Ratzan KR. A young woman with a sore throat, septicaemia, and respiratory failure. Lancet 1997; 350:928.
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PMID:"A forgotten disease": a case of Lemierre syndrome. 1946 52

Lemierre's syndrome is a potentially fatal disease that usually presents with oropharyngeal infection, followed by sepsis, thrombosis of the internal jugular vein and septic emboli. Most cases are caused by the Gram-negative, anaerobic Fusobacterium necrophorum. We present two patients with an atypical presentation of Lemierre's syndrome and a review. These cases illustrate that a positive blood culture for F. necrophorum, even without the presence of clinical symptoms pointing towards thrombosis of the internal jugular vein, justifies further radiological testing for thrombophlebitis of the internal jugular vein.
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PMID:Unusual presentation of Lemierre's syndrome: two cases and a review. 1949 63

Lemierre syndrome refers to necrotizing infections of the head due to Fusobacterium necrophorum and has been called the 'forgotten disease' due to its rarity in the antibiotic era. Recently, however, more cases have been documented in the literature suggesting that there has been an increase in incidence. A 10-year-old boy is reported who had a five-day history of ear infection, with the development of fever, drowsiness and ipsilateral neck swelling. Unexpected cardiac arrest occurred soon after medical assessment. At autopsy, right otitis media was demonstrated with extension of suppurative infection into subcutaneous tissues behind the ear and also into the extradural space at the lateral end of the petrous temporal bone. There was also septic thrombophlebitis of the adjacent sigmoid sinus, but no evidence of meningitis. This case demonstrates yet another infectious condition that may be associated with rapid deterioration and unexpected death in childhood. An autopsy approach to suspected sepsis in childhood is outlined.
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PMID:Lemierre syndrome and unexpected death in childhood. 1978 21

Portal vein thrombosis is a fairly common clinical condition that is usually not fatal but may give rise to serious complications. We report the case of a woman who was always in good health until the age of 50, when she developed acute gastroenterocolitis with inflammation of the portal vein (pylephlebitis or septic portal thrombophlebitis), resulting in thrombus formation, rupture of the vascular wall and exsanguination. At autopsy, no signs of thrombosis or inflammation were found elsewhere in the body and there was no evidence of any other disease or abnormality. Pylephlebitis may occur following intra-abdominal sepsis from any source. It is a rare condition that carries a high mortality. Rupture of the inflamed portal vein and possibly the adjacent artery is an extremely rare complication.
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PMID:Fatal hemorrhage due to thrombosis and rupture of the portal vein and hepatic artery. 1978 25

This report of a recreational athlete who had arm discomfort, fever, headache, and emesis frames a discussion of the diagnosis and treatment for primary upper-extremity deep vein thrombosis (PUEDVT). An unusual aspect of the case was sepsis without typical risk factors. Treatment of PUEDVT usually involves immediate anticoagulation and local thrombolysis followed by evaluation for postthrombosis management; septic thrombophlebitis usually responds to intravenous antibiotics. Postthrombosis management is somewhat controversial, but first-rib resection is frequently recommended for patients who have thoracic outlet compression. This patient returned to unrestricted athletics without surgical intervention.
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PMID:Effort thrombosis with sepsis. 2008 20


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