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

Early discharge of suitable newborns is rapidly becoming a hospital standard. One concern is that truncated hospital observation of the infant during the first days of life, even with home visits or early clinical appointments, would allow early signs of a serious infection to go unnoticed, which could lead to a missed chance for early therapy and could imperil the child's favorable recovery. An analysis of available data for early onset neonatal bacterial sepsis and neonatal herpes virus infection shows that this new practice should not unduly place newborns at risk of treatable infections, however, so long as conventional risk factors are appreciated and reasonable, nationally sanctioned discharge criteria are followed.
 ...
PMID:The newborn at risk for serious infections. 964 96

The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, catheterized urinalysis with culture, blood cultures, cerebrospinal fluid analysis and culture, and possibly a chest radiograph. Admission for observation for neonates at high risk for sepsis is universal. Depending on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started. Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they cover the likely pathogens in this age group, ie, group B streptococci, Escherichia coli and other gram-negative enterics, and Listeria monocytogenes. Coverage for viral infection, most notably herpes simplex virus (HSV), is only rarely instituted in the ED and is usually considered if the patient has obvious ulcerative lesions or if the mother has known HSV infection. Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be effective. If antiviral therapy is started after viral entry into cells, morbidity is severe and mortality approaches 80%. Neonates who survive are usually severely disabled. Broadening the indications for initiating antiviral therapy to include the neonate whose mother has any history of a sexually transmitted disease may prevent the sequelae of untreated or inadequately treated HSV infection. A case is reported of an 8-day-old girl who developed disseminated HSV infection and died as a result of hepatic failure.
 ...
PMID:Disseminated herpes simplex virus infection in a neonate. 967 55

Diagnosis of perinatal infection in the newborn is difficult; there may be few clinical signs and current tests are slow or non-specific. Detection of organisms, antigen or specific antibody to common pathogens often requires repeat samples and does not give immediate results. Haematological parameters, although relied upon frequently to diagnose infection in the neonate prior to a positive bacterial isolation, are unreliable and insensitive. Indicators such as an increase in neutrophil band cell counts are highly variable between morphologists. Infection induces the expression of a number of T lymphocyte surface markers, including CD45RA/CD45RO and CD45RO. The use of changed expression of surface markers as a laboratory test for detection of infection in neonates was evaluated. We used multiparameter flow cytometry to detect expression of early (CD45RA/CD45RO) and late (CD45RO) activation markers. In the respective groups of 50 full term (including 25 normal vaginal deliveries and 25 caesarean deliveries) and 30 premature, i.e. < 36 weeks gestation (born by either normal vaginal delivery or caesarean delivery) the CD45RA isoform was brightly expressed on newborn 'naive' CD4+ T cells, whereas the CD45RO isoform (including both 'bright' and 'dim' populations) was present on < 19% of CD4+ T cells from these newborn infants. In a group of 37 infants, tested to evaluate possible effects of non-infective parameters such as respiratory distress and iso-immunization, no significant changes in surface marker expression were found and specificity of the test was confirmed. In 14 neonates with documented sepsis, up-regulation of dual staining CD45RA/CD45RO isoforms on CD4+ T cells was detected early in the infection. In addition, we found that CD45RO expression persisted for several weeks after bacterial infection, and up to several months in viral infection. In conclusion, detection of T cell activation by flow cytometry for the early diagnosis of neonatal infection is an easy test to carry out on small volumes of blood, is inexpensive, and may be a specific indicator of infection.
 ...
PMID:Surface activation markers of T lymphocytes: role in the detection of infection in neonates. 969 80

Streptococcus pneumoniae infection and disease have been modeled in several animal species including infant and adult mice, infant and adult rats, infant Rhesus monkeys, and adolescent and adult chinchillas. Most are models of sepsis arising from intravenous or intraperitoneal inoculation of bacteria, and a few were designed to study disease arising from intranasal infection. Chinchillas provide the only animal model of middle ear pneumococcal infection in which the disease can be produced by very small inocula injected into the middle ear (ME) or intranasally, and in which the disease remains localized to the ME in most cases. This model, developed at the University of Minnesota in 1975, has been used to study pneumococcal pathogenesis at a mucosal site, immunogenicity and efficacy of pneumococcal capsular polysaccharide (PS) vaccine antigens, and the kinetics and efficacy of antimicrobial drugs. Pathogenesis experiments in the chinchilla model have revealed variation in ME virulence among different pneumococcal serotypes, enhancement of ME infection during concurrent intranasal influenza A virus infections, and natural resolution of pneumococcal otitis media (OM) without intervention. Research has explored the relative contribution of pneumococcal and host products to ME inflammation. Pneumococcal cell wall components and pneumolysin have been studied in the model. Host inflammatory responses studied in the chinchilla ME include polymorphonuclear leukocyte oxidative products, hydrolytic enzymes, cytokine and eicosanoid metabolites, and ME epithelial cell adhesion and mucous glycoprotein production. Both clinical (tympanic membrane appearance) and histopathology (ME, Eustachian tube, inner ear) endpoints can be quantified. Immunologic and inflammatory studies have been facilitated by the production of affinity-purified antichinchilla immunoglobulin G (IgG), IgM, and secretory IgA polyclonal antibody reagents, and the identification of cross-reactivity between human and chinchilla cytokines, and between guinea pig and chinchilla C3. Alteration of ME mucosa by pneumococcal neuraminidase and alteration of ME epithelial cell (MEEC) surface carbohydrates during intranasal pneumococcal infection have been demonstrated. Pathogenesis studies have been aided by cultured chinchilla MEEC systems, in which the ability of platelet activating factor and interleukin (IL)-1 beta to stimulate epithelial mucous glycoprotein synthesis has recently been demonstrated. Because chronic OM with effusion is characterized by presence of large amounts of mucous glycoprotein in the ME, pneumococcus may have an important role in both acute and chronic ME disease. Both unconjugated PS and PS-protein-conjugated vaccines are immunogenic after intramuscular administration without adjuvant in chinchillas. Passive protection studies with human hyperimmune immunoglobulin demonstrated that anti-PS IgG alone is capable of protecting the chinchilla ME from direct ME challenge with pneumococci. Active PS immunization studies demonstrated protection following direct ME and intranasal pneumococcal challenge with and without concurrent influenza A virus infection. An attenuated influenza A virus vaccine also showed protection for pneumococcal OM. Antimicrobial treatment of acute OM has been based almost exclusively on empirical drug use and clinical trials without a foundation of ME pharmacokinetics. Studies in the chinchilla model have started to bring a rational basis to drug selection and dosing. Microassays have been developed using high-pressure liquid chromatography for many relevant drugs. Studies have explored the in vivo ME response in pneumococcal OM to antimicrobial drugs at supra- and sub-minimum inhibitory concentration (MIC), the effect of concurrent influenza A virus infection on ME drug penetration, and the effect of treatment on sensorineural hearing loss produced by pneumococcal OM.
 ...
PMID:Otitis media: the chinchilla model. 1033 23

A 5-year-old boy presented with primary varicella zoster virus infection, group A streptococcal sepsis, toxic shock, and multisite osteonecrosis. An association between osteonecrosis and group A streptococcal sepsis has not been previously reported. Clinical recognition with supportive radiologic and pathologic findings are presented. Therapeutic guidelines are suggested.
 ...
PMID:Varicella complicated by group A streptococcal sepsis and osteonecrosis. 1050 43

The CD14 molecule, which is known to be a receptor for endotoxin, is expressed on monocytes and neutrophils. It is found as a soluble CD14 (sCD14) in circulation, and the plasma level has been shown to be increased in some infectious diseases, including sepsis. To investigate the potential significance of circulating sCD14 in Kawasaki disease (KD), the plasma level of sCD14 was measured using ELISA in patients with KD, patients with a Gram-negative bacterial infection (GNBI) including sepsis, patients with viral infection (VI), and healthy controls. We also analysed CD14 receptor expression in monocytes and neutrophils using flow cytometry and a semiquantitative reverse transcription-polymerase chain reaction. Although KD patients had significantly lower counts of peripheral neutrophils and monocytes than GNBI patients, KD patients had significantly higher levels of sCD14 than GNBI. No significant correlations were observed between sCD14 levels and clinical laboratory values or the cytokine (interferon-gamma, tumour necrosis factor-alpha) levels in the acute phase. The mean intensity of CD14 receptor expression on neutrophils markedly increased in the acute phases of KD and GNBI compared with that in their convalescent phases, while that on monocytes decreased. The expression of CD14 mRNA in neutrophils increased in the acute phases of KD and GNBI, while that in monocytes did not decrease but instead remained quite abundant. The present findings suggest that the elevated level of circulating sCD14 appears to be an important parameter for KD and that sCD14 shedding is accompanied by different kinetics regarding the expression of CD14 antigen and CD14 gene between monocytes and neutrophils.
 ...
PMID:Increased levels of circulating soluble CD14 in Kawasaki disease. 1063 78

Graft-versus-host disease (GVHD) after liver transplantation is uncommon and the outcome is often fatal. A firm diagnosis of GVHD is difficult because the clinical triad of skin rash, marrow failure and diarrhoea can be indistinguishable from drug reaction or viral infection, and the presence of donor lymphocyte chimerism is not specific. We describe a case of severe GVHD in a female patient after liver transplantation from a male cadaveric donor. Skin biopsy showed characteristic changes of GVHD. Using Y-chromosome-specific fluorescent in situ hybridisation (FISH), male lymphocytes were demonstrated in 10% of marrow cells and in 90% of lymphocytes infiltrating the dermal epidermal junction. Donor human leucocyte antigens (HLAs) were detected in the peripheral blood, buccal mucosa and skin by polymerase chain reaction. The GVHD subsided with steroid and anti-thymocyte globulin, but recurred on tailing off of treatment. Despite maximum supportive therapy, including random donor leucocyte infusion, and marrow infusion from a HLA-identical sibling, the patient succumbed to sepsis. Our results showed the utility of combining morphological features with molecular techniques using FISH and HLA typing in confirming a diagnosis of GVHD.
 ...
PMID:Graft-versus-host disease after liver transplantation: documentation by fluorescent in situ hybridisation and human leucocyte antigen typing. 1077 Apr 25

The safety and efficacy of the needle catheter jejunostomy (NCJJ) is evaluated in 200 consecutive, prospectively studied gastric bypass procedure patients with a follow-up of 6 months to 9.5 years. The NCJJ was used in place of intravenous fluid administration from the first postoperative day to supplement oral fluids for 6 weeks postoperatively and for complete temporary supplementation in 16 patients with viral illness or pouch outlet obstruction, thus avoiding re-hospitalization for rehydration. We did not use X-ray confirmation of the catheter placement. Analysis revealed no major complications with no catheter dislodgment, associated intra-abdominal sepsis or late bowel obstruction. There were 24 (12%) subcutaneous infections, only four (2%) of which required minor incisions and drainage under local anesthesia. Risk factors for the infections were insulin-dependent diabetes mellitus and the actual withdrawal of the NCJJ (50% of the infections occurred at this time). The NCJJ has been a safe, useful and cost-effective adjunct in the operative management of the morbidly obese patient.
 ...
PMID:The Needle Catheter Jejunostomy: a useful and cost-effective adjunct in bariatric surgery. 1077 29

Urologic emergencies are common in the cancer patient and relate mainly to complications of bladder hemorrhage, upper or lower urinary tract obstruction, urinary tract infection, and priapism. Hemorrhagic cystitis is commonly due to bladder injury from radiation therapy, viral infection, or metabolites of chemotherapeutic agents. Treatments aimed at ameliorating the effects of theses metabolites, such as mesna and intravenous (IV) hydration, coupled with cystoscopy, evacuation of clots, and formalin instillation, have given clinicians an effective means of avoiding exsanguinating hemorrhage from the bladder. Malignant ureteral obstruction is an ominous sign in the cancer patient and may be due to tumor compression, retroperitoneal adenopathy, or direct tumor invasion. The endourologic procedures of ureteral stenting and percutaneous nephrostomy are effective means of palliation; however, complications of infection, stent obstruction, and stent migration can result in hospital admission and a decline in quality of life. Median survival for patients with malignant ureteral obstruction is less than 7 months, regardless of the tumor of origin. Bladder outlet obstruction leading to urinary retention can be due to mechanical factors involving the bladder neck or prostate, or to a breakdown in the neurophysiologic function of the bladder. Every attempt is made to avoid surgical intervention or the placement of chronic in-dwelling catheter in these often debilitated patients. Patients are often effectively treated with a variety of pharmacologic agents, such as alpha-adrenergic receptor blockers or by the initiation of chronic intermittent catheterization. Urinary tract infections are particularly dangerous in neutropenic and bone marrow transplant patients, with bladder catheters the most common portal entry. The colonization and later infection by resistant nosocomial organisms, such as Pseudomonas aeruginosa and Candida albicans, can rapidly lead to life-threatening sepsis. On rare occasions, emergency surgical intervention with adequate open drainage or nephrectomy is required to control such infections. Priapism can be caused by hematologic malignancy with hypercoagulation, metastatic disease involving the corpora cavernosa with thrombosis of the venous outflow from the penis, or rarely from intracavernous injections used for the treatment of impotence. If effective treatment exists for the primary tumor, improvement or resolution of the state of priapism may occur. Radiation therapy may be required to decrease the pain associated with malignant priapism, but surgical shunting procedures are rarely effective.
 ...
PMID:Urologic emergencies in the cancer patient. 1086 17

We present two premature infants with disseminated neonatal adenovirus infection, whose epidemiology, clinical course and outcome differ to a great extent. The first infant, born vaginally at 35 weeks gestational age after premature rupture of membranes and maternal illness, developed pneumonia, hepatitis and coagulopathy and died of circulatory failure at the age of 17 days. The other infant, delivered by cesarean section at 36 weeks gestational age, did - in contrast to all documented cases in the literature - not show any signs of pneumonia and survived meningitis without sequelae. The mode of transmission of the viral infection may have been via the maternal birth canal in the first infant and transplacental in the second one. Diagnosis was obtained by direct immunofluorescent test and serology in the first patient and by maternal serology and the detection of viral antigen in tracheal aspirates (ELISA) in the second patient. Disseminated neonatal adenovirus infection has a high mortality and should be considered in the differential diagnosis of neonatal sepsis, especially when pneumonia, hepatitis and neurologic symptoms develop together with thrombocytopenia or disseminated intravascular coagulopathy.
 ...
PMID:Disseminated adenovirus infection in two premature infants. 1096 32


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>