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

Isolated endocarditis of the native pulmonary valve is a rare clinical condition. It usually appears in association with certain predisposing factors, particularly intravenous drug abuse, alcohol abuse, sepsis, endovascular infections or congenital heart disease. The authors describe the case of isolated pulmonary valve endocarditis due to Pseudomonas aeruginosa of possible nosocomial origin in the absence of the predisposing factors mentioned above. Native pulmonary valve infection due to Pseudomnzonas aeruginosa in the absence of predisposing factors has not been described in the literature. The authors stress the importance of diagnosing this entity as early as possible as it is associated with high mortality and is on the increase due to the growing number of invasive procedures applied to patients in the hospital environment.
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PMID:Isolated pulmonary valve endocarditis due to Pseudomonas aeruginosa. 1742 35

The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).
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PMID:Predictors of inferior outcome in community acquired bacterial meningitis. 1803 Feb 61

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk factors such as underlying disease, cancer, diabetes alcoholism, surgery, VLBW, ENT infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared in both groups. Significant differences in etiology and risk factors between both groups were reported. Those after neurosurgery had more frequently Coagulase negative staphylococci (p<0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p<0.001), Neisseria meningitis (p<0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p<0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p<0.001) as well as otitis/sinusitis (p<0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p<0.001) but cure after modification was more common in PM (p=0.002). Therefore outcome in both groups was similar (14.6% vs. 12.4%, p=NS).
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PMID:Comparison of postsurgical and community acquired bacterial meningitis--analysis of 372 cases within a nationwide survey. 1803 Feb 63

Within last 17 years we went through all charts of bacterial meningitis within our nationwide survey and among 372 cases we found 62 cases of MM, in 12 cases with meningococcal disease (with shock, petechial effusions or disseminated intravascular coagulation or digital gangrenes). MM was usually observed in young adults without any of investigated risk factors like neoplasia, ENT (ear, nose, throat) focuses, elderly age, sepsis, diabetes, alcoholism, trauma, neonatal VLBW etc. Trauma, diabetes mellitus, alcohol abuse and chronic sinusitis/otitis were significantly less frequently found as a risk factor for MM. Mortality was very low, only 4.8% and was lower than overall mortality in CBM (12.4%, NS). Also the proportion of neurologic sequellae (9.7%) and initial treatment failure (8.1%) were comparable or even lower. This positive outcome results are probably because all N. meningitis strains were susceptible to penicillin, chloramphenicol, cefotaxim, cotrimoxazol or ciprofloxacin. Other reason for low mortality was that most cases received oral antibiotic immediately, even before admission (50 of 62). 95.2% of cases survived, 90.3% without any transient neurological residual symptoms.
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PMID:Meningococcal meningitis is still the commonest neuroinfection in the community in tropics: overview of 62 cases. 1803 Feb 71

Sepsis is a common and devastating syndrome that represents a significant healthcare burden worldwide. The average annual cost to care for patients with sepsis has been estimated to being $16.7 billion. Uniform definitions have been developed for the spectrum of sepsis syndrome, including the systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. SIRS describes the clinical manifestations derived from an acute yet nonspecific illness, whereas an infectious etiology is required for the diagnosis of sepsis. As sepsis progresses, organ system dysfunction becomes apparent (severe sepsis) with the final development of fluid refractory cardiovascular dysfunction (septic shock). Pulmonary, gastrointestinal, genitourinary, and primary bloodstream infections account for the majority of infectious sources in septic patients. Since 1987, gram positive bacteria have become the most common organisms responsible for the development of sepsis. Several risk factors for the development of sepsis have been identified including male sex, race, age, comorbid medical conditions, alcohol abuse, and a lower socioeconomic status. Seasonal variations also exist, with sepsis being more common in the winter months. Fortunately, the case fatality rates for both sepsis and severe sepsis have diminished over the last two decades. However, patients who survive their episode of sepsis continue to have increased morbidity and mortality up to five years after their initial illness.
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PMID:The epidemiology of sepsis. 1869 Oct 94

A healthy 54-year-old man presented at the emergency department with signs of sepsis. Four days prior he was bitten and scratched by his dog. Microscopy of the blood smear showed intracellular Gram-negative rods. Despite maximal treatment the patient died a day and a half after admission due to septic shock with multi-organ failure and disseminated intravascular coagulopathy. After extended incubation of the spleen culture a Gram-negative rod was isolated and identified as Capnocytophaga canimorsus based on 16s RNA analysis. This is a commensal microorganism found in the oropharynx of dogs and cats. Infection occurs 2-3 days after contamination. The clinical presentation is heterogeneous, and contamination can sometimes proceed to fulminant infection. The lethality of infection is 30%. A risk factor is often present, such assplenectomy, alcohol abuse or immunosuppression. Immediate antibiotic treatment may influence the course of infection. Antibiotic prophylaxis has also been proposed for high-risk patients with dog bites.
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PMID:[Fatal case of sepsis with Capnocytophaga canimorsus after a minor dog bite]. 1878 80

With improved survival, more AIDS patients, especially heavy smokers and alcohol abusers, may be confronted with laryngeal squamous cell carcinoma. Since curative treatment may require aggressive combined therapy, these patients, often suffering from immunosupression and poor general condition, present unique therapeutic challenges. The objective of the study was to describe treatment dilemmas. This case report presents a detailed description of an AIDS patient with carcinoma of the larynx. A patient with T3N0M0 laryngeal carcinoma and AIDS underwent tracheotomy and biopsy, followed by severe neck and pulmonary infection. After convalescence, radiotherapy was administered, with no evidence of a disease during a 3.5-year follow-up. During his remaining life, the patient developed severe psychoaffective disorder, his immune state deteriorated until he demised from sepsis. In conclusion, patients with HIV infection, especially having a history of tobacco or alcohol abuse, should be carefully examined for head and neck carcinoma that is likely to be more aggressive. Following surgery, AIDS patients may have worse wound healing and a greater tendency to contract infections. Radiotherapy and especially chemotherapy may cause life-threatening complications. Although early detection may increase survival, curative treatment should involve many disciplines and extra caution.
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PMID:Laryngeal cancer in acquired immunodeficiency syndrome. 1962 96

Central pontine myelinolysis (CPM) has been described in alcoholic patients and in the aftermath of rapid correction of chronic hyponatraemia. We describe a case of CPM occurring secondary to nephrogenic diabetes insipidus (DI), which developed as a consequence of severe hypokalaemia. A 63-year-old man with alcohol dependence was admitted to hospital with severe pulmonary sepsis and type 1 respiratory failure. On admission, he had euvolaemic hyponatraemia of 127 mmol/L, consistent with a syndrome of inappropriate antidiuretic hormone secondary to his pneumonia. Following admission, his plasma potassium dropped from 3.2 to a nadir of 2.3 mmol/L. Mineralocorticoid excess, ectopic adrenocorticotrophic hormone production and other causes of hypokalaemia were excluded. The hypokalaemia provoked significant hypotonic polyuria and a slow rise in plasma sodium to 161 mmol/L over several days. Plasma glucose, calcium and creatinine were normal. The polyuria did not respond to desmopressin, and subsequent correction of his polyuria and hypernatraemia after normalization of plasma potassium confirmed the diagnosis of nephrogenic DI due to hypokalaemia. The patient remained obtunded, and the clinical suspicion of osmotic demyelination was confirmed on magnetic resonance imaging. The patient remained comatose and passed away 10 days later. This is the first reported case of nephrogenic DI resulting in the development of CPM, despite a relatively slow rise in plasma sodium of less than 12 mmol/L/24 h. Coexisting alcohol abuse, hypoxaemia and hypokalaemia may have contributed significantly to the development of CPM in this patient.
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PMID:Central pontine myelinolysis secondary to hypokalaemic nephrogenic diabetes insipidus. 1994 Feb 3

Recent studies have revealed an important but previously unrecognized association between alcohol abuse and the risk of acute respiratory distress syndrome (ARDS). This devastating form of lung injury strikes individuals of any age following insults, such as major trauma or sepsis, and even with state-of-the-art medical care it has a mortality as high as 50%. Although the precise incidence is unknown, it is estimated that 200,000 individuals develop ARDS each year in the USA alone. Alcohol abuse independently increases the risk approximately two- to fourfold and, therefore, causes tens of thousands of excess deaths annually. When one couples these grim estimates with the well-recognized association between alcohol abuse and severe lung infections, such as bacterial pneumonia and tuberculosis, it is apparent that alcohol-related lung diseases are a major public health problem. Exciting new studies reveal that the alcoholic lung is characterized by discrete changes in cellular function within the lower airways, mediated via oxidant stress and altered signaling pathways and, in experimental models, is highly amenable to targeted therapies. Furthermore, these therapies are already used clinically for other conditions and could readily be tested in clinical studies of alcoholics at high risk for ARDS and/or with severe lung infections. This article focuses on the epidemiology and pathophysiology of alcohol-induced lung dysfunction and discusses potential new treatments that are suggested by recent experimental findings.
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PMID:Alcohol abuse and acute lung injury: can we target therapy? 2047 84

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.
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PMID:Necrotizing fasciitis. 2055 17


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