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

Herpesvirus infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We prospectively studied 52 patients with severe burn injuries in order to determine the prevalence of viral infections in this group of patients. Serologic testing was done each week to diagnose primary and reactivation infections. Twenty-seven of 52 patients (52%) became infected with either herpes simplex virus (HSV) or cytomegalovirus (CMV) or both. HSV infection was associated with older age, tracheal intubation, facial burn, inhalation injury, length of hospitalization, and the presence of full-thickness burn. CMV infection was associated with duration of hospitalization and full-thickness burn. Transfusion of blood products was not correlated with an increased incidence of primary or reactivation CMV infections. There was a significant correlation between the presence of these viral infections and bacterial sepsis (p less than 0.05). There was no significant association of HSV or CMV infections with mortality.
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PMID:Herpes simplex virus and cytomegalovirus infections in burned patients. 298 25

Six infants with disseminated HSV had no mucocutaneous lesions at any time during the course of the illness. These infants presented with lethargy, poor feeding, apnea, acidosis, and hepatomegaly. The diagnosis of HSV was made by culturing the infant's oropharynx and blood, and the maternal cervix. Eight infants with HSV encephalitis had no skin, eye, or mucous membrane lesions. These infants presented with lethargy and low-grade fever, followed within 24 hours by the onset of focal partial motor seizures. The seizures were refractory to anticonvulsant therapy. The mean CSF white cell count was 131 cells/mm3;the glucose and protein concentrations were in the normal range. Brain biopsy was required for the early diagnosis of HSV encephalitis. These 14 cases presented 70% (14/20) of all infants with neonatal HSV diagnosed during the study period. HSV infection should be considered in infants with no mucocutaneous lesions who have signs usually associated with bacterial sepsis or who develop focal seizures during the first three weeks of life.
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PMID:Neonatal herpes simplex infection in the absence of mucocutaneous lesions. 706 32

Herpes simplex virus (HSV) infections in the neonate can be acquired during pregnancy and during and following the birth process. The most common mode of transmission is from exposure to the virus in the birth canal at the time of delivery. HSV is among the less common infections in neonates. This often leads to delay in diagnosis and treatment, increasing the risk of a poor or fatal outcome. Clinically, HSV infection often presents in preterm or term infants with signs and symptoms similar to those of bacterial sepsis. Their immature immune systems puts preterm infants at higher risk for serious disease. A positive maternal history of HSV is not needed to support diagnosis; typically the mother is asymptomatic. Primary maternal infection usually leads to more serious disease in the neonate. It is important that caregivers recognize the subtle signs and symptoms of HSV infection so early diagnosis and prompt treatment can be instituted.
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PMID:Herpes simplex virus infection in the neonate: clinical presentation and management. 920 82

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.
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PMID:Disseminated herpes simplex virus infection in a neonate. 967 55

We report a case of viral laryngitis due to HSV in an adult. The patient was a 61-year-old female alcoholic. She presented with fever and stridor and developed sepsis and multiorgan failure. She was treated with antibiotics to no effect and died 14 days after hospitalisation. Post mortem histology of the larynx showed an acute pseudomembranous inflammation with the classical morphology of HSV infection. An immunohistochemical reaction for HSV was positive.
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PMID:[Pseudomembranous upper respiratory tract infection caused by herpes simplex virus in an adult]. 1255 20

Following thorascopic thymectomy performed because of myasthenia gravis, a 25-year-old man was affected by fulminant hepatic failure (FHF) of unknown etiology. He was then transferred to our department, where his clinical situation worsened with the onset of renal failure, shock, coagulopathy and coma. Given the young age of the patient, the immediate availability of a donor, and the absence of a definite diagnosis of sepsis at the time, it was decided to proceed with liver transplantation. The results of a polymerase chain reaction (PCR) test (a technique that was unavailable at the referring hospital), which arrived only a few hours later, indicated the presence of herpes simplex virus (HSV) DNA in several of the patient's samples; this led to the formulation of a diagnosis of FHF due to HSV. It is worth noting that HSV-IgM and HSV-IgG assays had always been negative in this patient. Despite acyclovir therapy with initially encouraging clinical results, the patient died several days later because the viral infection had spread to the graft, lungs, heart, spleen, stomach and kidneys. Since evaluating antibody response is not always useful in diagnosing HSV infection, and particularly if PCR methodology is unavailable, it is worth initiating early empiric antiviral therapy when the etiology of FHF is indeterminate This is because the timeliness of treatment while awaiting virological confirmation may be critical to survival. If a liver transplantation becomes mandatory, careful consideration should be given to the extent of the viral infection and its response to therapy because of the possibility of viral spread to the graft.
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PMID:Liver transplantation due to Herpes Simplex virus-related sepsis causing massive hepatic necrosis after thoracoscopic thymectomy. 1752 22

Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute liver failure is based on its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one of several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity is a major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because of its low incidence, however, and the lack of dermal manifestations, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted consensus to begin antiviral therapy pre-emptively with acyclovir in cases of acute liver failure of unknown origin, in which high urgency (HU) liver transplantation remains the only therapeutical option. Even in the case of early specific therapy, sepsis may prevail and the indication for HU transplantation must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of the risk of recurrence, lifelong prophylaxis with acyclovir is recommended.
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PMID:Herpes simplex virus sepsis and acute liver failure. 1993 Mar 15

Fever is defined as a rectal temperature greater than 38.0 degrees C (>100.4 degrees F). A recently documented fever at home should be considered the same as a fever in the ED and should be managed similarly. All febrile infants younger than 28 days should receive a "full sepsis workup" and be admitted for parenteral antibiotic therapy. Clinical and laboratory criteria can be used to identify a low-risk population of febrile infants aged 1 to 4 months who have not received 2 doses of conjugate vaccines for bacterial meningitis. Children with sickle cell disease are at high risk and require special evaluation. MRSA infections are now common and should be considered in all patients with pyoderma, severe pneumonia, and catheter-related sepsis. HSV infection of the CNS should be considered whenever a patient has altered mental status and CSF findings are not diagnostic of bacterial meningitis. Fever rarely represents life-threatening pathology; however, a handful of less common serious causes of pediatric fever exist with the potential for morbidity and mortality.
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PMID:Pediatric emergencies associated with fever. 1994 99

Herpes simplex virus (HSV) hepatitis has a fatal impact on the outcome of organ transplanted recipients. Here, we present a thought-provoking case of HSV hepatitis in a high-risk recipient after living-related liver transplantation (LRLT). A 1-month-old female newborn infant was affected by HSV encephalitis. Fulminant hepatic failure (FHF) of unknown etiology occurred suddenly at 4.4 years of age. Viral infections were ruled out as the cause of FHF. Intensive care including plasma exchange (PE) was started, and the preoperative treatments for ABO incompatibility were performed. Thereafter, LRLT was performed emergently. Although strong immunosuppression for ABO incompatibility was continued after LRLT, antibody-mediated rejection (AMR) occurred on postoperative day (POD) 4. PE was repeated and improvements were obtained. However, liver dysfunction appeared on POD 8. Histopathological findings of liver needle biopsy clearly revealed HSV hepatitis, although the results of HSV DNA and antibody titer in blood sample did not clearly indicate HSV infection. On POD 21, thrombotic microangiopathy (TMA) occurred and the plasma and immunoglobulin were replenished. Our pediatric recipient recovered successfully from AMR, HSV hepatitis, TMA, and repeated sepsis. We conclude that well considered therapy based on the real-time detection of HSV hepatitis is indispensable for the further improvements of outcome in HSV hepatitis after LRLT.
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PMID:Herpes simplex virus hepatitis after pediatric liver transplantation. 2003 Jul 95

A 5-day-old male presents to the emergency department septic and jaundiced, is resuscitated and started on broad spectrum intravenous antibiotics. However tragically in this case despite showing initial signs of stabilisation, he deteriorated with refractory metabolic acidosis and disseminated intravascular coagulation, and later passed away. At postmortem, disseminated herpes simplex virus-1 (HSV-1) was found. Paediatricians are well aware of the risk factors for bacterial neonatal sepsis and actively seek information from parents to identify those children at risk. When however should a viral aetiology be considered? Should all neonates receive empirical therapy until proven otherwise? The authors review the literature surrounding neonatal HSV infection and discuss the potential pitfalls of empirical treatment.
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PMID:Neonatal sepsis: A, B, C--don't ever forget herpes. 2267 98


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