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)

An unusual case of sudden, fulminant pneumococcemia and disseminated intravascular coagulation occurred in a woman who had had incidental splenectomy 8 months previously, at the time of gastrectomy for duodenal ulcer. Similar cases in which there is constant relationship of splenectomy, pneumococcal sepsis, and Waterhouse-Friderichsen syndrome have been documented. Other similarities which are notable are a tendency for the disease to occur in women, lack of a nidus of infection, and proliferation of diplococci to numbers great enough to be seen easily on the peripheral blood smear.
 ...
PMID:Hyposplenic, coagulopathic, cryptogenetic pneumococcemia. 116 92

Twelve elderly patients without Waterhouse-Friderichsen syndrome or adrenal tumor who had spontaneous adrenal hemorrhage one to 33 days after operation are described. Seven of these patients had operations on the gastrointestinal tract, one on the biliary system, two on the genitourinary system and two on the central nervous system. Important factors relating to adrenal hemorrhage included: intra-abdominal sepsis in 5 patients, cancer in 4, pneumonia in 4, coagulation defects in 2, exogenous steroids in 2, and syphilis in one patient. Spontaneous adrenal hemorrhage should be considered in patients whose condition deteriorates rapidly after operation and in whom no other explanation is plausible. Its detection and appropriate therapy can be lifesaving.
 ...
PMID:Postoperative adrenal hemorrhage. 121 87

An otherwise healthy 36-year-old man had abdominal pain, vomiting, sepsis, and disseminated intravascular coagulation (DIC). Negative exploratory laparotomy was shortly followed by death. Autopsy showed Haemophilus influenzae (type B) meningitis, multiple organ involvement with DIC, and bilateral adrenal hemorrhagic necrosis (Waterhouse-Friderichsen syndrome). This patient is the fourth reported adult with H influenzae meningitis and hemorrhagic infarction of the adrenals, and the first such patient with an apparent abdominal catastrophe.
 ...
PMID:Haemophilus influenzae meningitis and Waterhouse-Friderichsen syndrome in an adult. 373 79

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (greater than 38 degrees C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P less than .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P less than .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 +/- 11.4 [SE] hours) was significantly shorter (P less than .05) than with meningococcal infection (120 +/- 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.
 ...
PMID:Apparent meningococcemia: clinical features of disease due to Haemophilus influenzae and Neisseria meningitidis. 641 7

Invasive meningococcal disease, caused mainly by Neisseria meningitidis B, occurred only sporadically in the Czech Republic for a long period, and the use of meningococcal polysaccharide vaccine was never indicated. This situation changed in 1993, when a new meningococcal clone appeared. By means of sero/subtyping (using Whole Cell ELISA) Neisseria meningitidis C:2a:P1.2(P1.5) was quickly revealed to be the causative agent of this unusual epidemiological situation. ET typing by multilocus enzyme electrophoresis showed the prevalence of the ET-15 electrophoretic type, which belongs to the ET-37 complex. This new clone had never been identified in the Czech Republic at least since 1973. The new clone caused an increase in the incidence of invasive meningococcal disease in the army campuses in the eastern part of the country and two local invasive meningococcal disease outbreaks in civilian population at the beginning of 1993. In May 1993, the highest age-specific incidence in the most affected district was found in the age group of 15-19 years (52.1 per 100,000), while the respective age specific incidence for the whole Czech Republic was 1.9 per 100,000. The vaccination campaign started in the most affected district at the beginning of June 1993 and was focused on the most affected age group, 15-19 years. After this targeted vaccination campaign the number of invasive meningococcal disease decreased in this district statistically significantly. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) is causing not only a new epidemiological situation, but also a new clinical situation, characterized by more serious and frequently atypical courses of invasive meningococcal disease with a high incidence of Waterhouse-Friderichsen syndrome and meningococcal sepsis. A high fatality rate was found for the clone Neisseria meningitidis C:2a:P1.2(P1.5) (20%) compared to the "normal" fatality rate of the "non C" invasive meningococcal disease (8.8%) in 1993. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) spread between 1993 and 1995 to the whole country, nevertheless, to date no similar epidemiological situation was identified, as was that in two districts in spring 1993. A more rapid increase in the age specific morbidity occurred recently in the age group of 1-4 years and in adult age groups as well.
 ...
PMID:Changing epidemiology of meningococcal invasive disease in the Czech republic caused by new clone Neisseria meningitidis C:2a:P1.2(P1.5), ET-15/37. 890 19

Two closely related boys from the same house hold (Home 1), aged two and three, were affected with fulminant meningococcal sepsis known as Waterhouse-Friderichsen syndrome. Neisseria meningitidis serogorup B was isolated from their blood and cerebrospinal fluid. The two-year-old boy died one day after the onset of the disease. Epidemiological examination of contacts and pharyngeal swabs were performed in 14 persons from the household, all of them relatives of the affected children, as well as in a number of other contacts. Chemoprophylaxis with cotrimoxazole was simultaneously administered to all contacts. Family histories revealed that two contacts from the household where the patients did not live (Home 2) were inadvertently omitted. Subsequent examinations, following a report of another contagious disease (salmonelosis), revealed that these two persons were Neisseria meningitidis carriers, together with another one in the same household. The carriers most probably caused the infection of a third, five-year-old boy, the deceased boy's brother (Home 1) who also developed fulminant meningococcal sepsis. The failure to take the appropriate prophylaxis led to a prolonged carrier state in the carrier from the second household. Repeated pharyngeal swab sampling revealed two more carriers from both households that had previously been negative. Control of the epidemic was achieved after 5 weeks by repeated and controlled chemoprophylaxis with ciprofloxacin, and by repeated epidemiological examinations, disinfection, and daily health surveillance by the Sanitary Inspectorate. This extremely rare instance of a familial epidemic with three infected persons emphasizes the need for consistent chemoprophylaxis in meningococcal disease contacts.
 ...
PMID:Familial epidemic of meningococcal disease. 947 10

Sudden unexpected death in childhood is rare. The commonest causes of such deaths are a result of fulminating infections of the respiratory or nervous systems. Other causes include unsuspected congenital abnormalities of the heart, acute metabolic disorders, and rarities such as internal hemorrhages and pulmonary thrombosis. Recognition of children with congenital asplenia who are otherwise normal but have an increased susceptibility to overwhelming sepsis is extremely difficult. We reviewed 1763 autopsy files from our institution over 5 years (1990-1995), of which 293 were classified as pediatric cases. The vast majority of the cases were stillbirths and deaths within the first year of life as a result of complex congenital anomalies. Four cases of asplenia were identified in our entire series, 3 of which were of the congenital syndromal variety and 1 of which was a case of isolated sporadic congenital asplenia. All 4 cases of asplenia were analyzed in detail with respect to autopsy findings and cause of death. Severe complex cardiac malformations were present in the congenital syndromal asplenia patients; these other malformations contributed significantly to their death. In this report, we discuss in detail the autopsy findings in a previously healthy 4-year-old girl who presented with a brief 8-hour history of being unwell and died within 4 hours of admission into the hospital. She had sporadic, isolated congenital asplenia complicated by high-grade type 6B pneumococcemia and acute bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). Previously healthy children who clinically deteriorate very rapidly should have a blood smear done as part of their clinical workup. The detection of Howell-Jolly bodies on a peripheral blood smear can be an indicator of asplenia, and this diagnosis can be confirmed by medical imaging of the abdomen. Such steps may aid in the aggressive management of isolated congenital asplenia and thereby avert untimely death.
 ...
PMID:Asplenia as a cause of sudden unexpected death in childhood. 1020 39

Waterhouse-Friderichsen syndrome and bilateral renal cortical necrosis (BRCN) are rare complications of meningococcal sepsis associated with high mortality rates. We describe a 20-year-old man who presented with a 1-day history of fever, chills, malaise, and vomiting. He collapsed in the emergency room, requiring mechanical ventilation and intravenous vasopressors for resuscitation. He was noted to be anuric, and computed tomography showed adrenal hemorrhage and BRCN. Blood cultures later confirmed Neisseria meningitidis sepsis, and a biopsy confirmed renal cortical infarction. The patient was treated aggressively with intravenous antibiotics, corticosteroids, and immunoglobulins, in addition to plasmapheresis, dialysis, and supportive measures. He recovered his adrenal function and was discharged from the hospital, but he remains dialysis dependent. To our knowledge, this is the first reported case of concomitant Waterhouse-Friderichsen syndrome and BRCN in a patient with meningococcal sepsis.
 ...
PMID:Waterhouse-Friderichsen syndrome and bilateral renal cortical necrosis in meningococcal sepsis. 1092 19

There have only been six deaths reported in the English literature due to disseminated intravascular coagulation and Waterhouse-Friderichsen syndrome complicating pneumococcemia in otherwise healthy persons with normal spleens. Four of these deaths occurred in children and two in adults. A case of fulminant pneumococcemia complicated by disseminated intravascular coagulation and Waterhouse-Friderichsen syndrome in an otherwise healthy adult with a normal spleen is presented. The case is typical of the course of fulminant pneumococcal sepsis and highlights some of the difficulties experienced by rural general practitioners and rural retrieval services. Mechanisms by which Pneumococcus can elicit fulminant sepsis are discussed, although there is no explanation as to why this may occur in the setting of normal splenic function.
 ...
PMID:Fatal pneumococcal Waterhouse-Friderichsen syndrome. 1148 65

Waterhouse-Friderichsen syndrome can cause acute death in the baboon without specific signs. Furthermore, this syndrome could result from stress-related intestinal permeability changes that allow macromolecules and/or microbiological entities to enter the systemic circulation. The resulting sepsis could cause adrenocortical insufficiency, hypotension and shock leading to death.
 ...
PMID:Spontaneous Waterhouse-Friderichsen syndrome in a gang-housed baboon. 1151 75


1 2 3 Next >>