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

Necrotizing cellulitis and fasciitis may be difficult to recognize. When skin necrosis is not obvious, the diagnosis must be suspected if there are signs of severe sepsis (accelerated heart or respiratory rates, oliguria, mental confusion.) and/or some of the following local symptoms or signs: severe spontaneous pain, indurated edema, bullae, cyanosis, skin pallor, absence of lymphangitis, skin hypoesthesia, crepitation, muscle weakness, foul smell of exudates. Many risk factors are suspected. A recent case-control study demonstrated that using ibuprofen increased the risk of cellulitis complicating chickenpox in children. Evidence is lower for other risk factors that are present with a high prevalence in most series: local lesion of skin or mucous membranes (acute or chronic disease, traumatism, surgery.), diabetes, arteriopathy, alcoholism, obesity, immunosuppression, NSAIDs. The risk of streptococcal necrotizing fasciitis is increased when in contact with patients infected by the same streptococcus.
Ann Dermatol Venereol 2001 Mar
PMID:[Necrotizing fasciitis. Clinical criteria and risk factors]. 1131 68

Necrotizing fasciitis are characterized by the necrosis of fascias, and their severe consequences in terms of morbidity and mortality. An early diagnosis, based on sometimes subtle cutaneous lesions (associated to a sepsis syndrome) allows to start resuscitation and decide on a probable surgery. 3 major forms can be distinguished: streptococcal fasciitis, due to beta-hemolytic streptococci, often following minor trauma, and increasingly associated to a streptococcal toxic shock syndrome (STTS); clostridial gangrene (often polymicrobial when developed on a open wound or after surgery); and synergistic gangrene due to a mixed aerobic-anaerobic flora. Other apparently "primitive" necrotizing fasciitis, caused by specific organisms, may occur in debilitated patients. The prognosis depends on age, comorbidity, and above all on the severity of the sepsis syndrome. Initial resuscitation involves controlling the hypotension and organ dysfunction associated with severe sepsis, and is usually dominated by a severe hypovolemia. Penicillin G remains the key antibiotic for streptococcal and clostridial fasciitis, with a broad spectrum including enterobacteriaceae, streptococci and enterococci, and anaerobes (including Bacteroides spp.) in other types or when the etiology is unknown. In patients presenting with STSS, a combination of clindamycin (or rifampin) to penicillin is recommended, because of their effect on exotoxin production; administration of non-specific immunoglobulins also appears to improve the outcome of patients affected. Hyperbaric oxygen therapy has not proved effective. Early surgical debridement largely influences the prognosis. The prevention of complications associated with long-term intensive care, including early nutritional support and prevention of a thromboembolic disease, is also important.
Ann Dermatol Venereol 2001 Mar
PMID:[The therapeutic approach to necrotizing fasciitis]. 1131 71

Calciphylaxis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to small and medium-sized vessel calcification. It is seen almost exclusively in patients with end-stage renal disease and secondary hyperparathyroidism. We experienced a case of 67-year-old man with calciphylaxis that manifested with characteristic skin lesions, pathologic findings, and laboratory changes. His skin lesions began as painful erythematous patches and subsequently progressed to necrotic ulcers with eschars on the distal aspect of the extremities. Pathologically, calcification was found in small and medium-sized blood vessels in the deep dermis and subcutaneous tissue. His serum calcium was 9.5 mg/dL, phosphorus was 7.8 mg/dL, and nPTH was 99.9 pg/mL. The patient had been treated with surgical debridement and other supportive treatment. However, he eventually underwent an amputation below the right knee and died from sepsis.
J Dermatol 2001 May
PMID:Calciphylaxis in a patient with end-stage renal disease. 1143 66

A 15-day-old Yemeni boy presented with anonychia and granulomatous nail beds and white patches in the mouth. Biopsy specimens from the nail beds were nondiagnostic. Shortly thereafter the child developed multiple tense bullae, a hoarse voice, and poor appetite. Hematoxylin and eosin staining along with monoclonal antibody studies of a skin biopsy specimen revealed subepidermal bullae through the lamina lucida and a marked decrease in laminin 5. A diagnosis of junctional epidermolysis bullosa Herlitz variant was made. His course was complicated by multiple nonhealing wounds, oral pharyngeal involvement, sepsis, anemia, and poor nutrition, leading to his eventual death. This report emphasizes the unusual presentation of Herlitz junctional epidermolysis bullosa with anonychia as the initial finding and a relatively prolonged period before cutaneous blister formation, resulting in delay of diagnosis.
Pediatr Dermatol
PMID:Herlitz junctional epidermolysis bullosa presenting at birth with anonychia: a case report and review of H-JEB. 1143 2

Epidermolysis bullosa dystropicans of the Hallopeau-Siemens type (HS-EBD) is an autosomal-recessive blistering disease. Skin fragility due to mutations in structural proteins is responsible for further development of chronic and painful wounds, skin infections and sepsis. There is no causative treatment available. We present a case report with HS-EBD and longstanding painful wounds treated with autologous keratinocytes on an esterified hyaluronic acid membrane. Two out of three wounds treated showed a complete take of the graft. They improved markedly with a stable result over 12 months until now. Even autologous keratinocyte grafting may have a beneficial effect on chronic wounds in HS-EBD despite the fact that the genetic defects are unchanged.
J Dermatol 2001 Apr
PMID:Recessive epidermolysis bullosa dystrophicans (Hallopeau-Siemens)--improvement of wound healing by autologous epidermal grafts on an esterified hyaluronic acid membrane. 1144 73

The disease of Epstein-Barr virus (EBV) -associated recurrent necrotic papulovesicles is a distinct clinicopathologic entity different from classic hydroa vacciniforme (HV). A few patients have been reported as atypical HV with systemic involvement, development of lymphoma, and poor prognosis. We describe a patient with recurrent necrotic papulovesicles and multiple varioliform scars in both sun-exposed and covered areas. In contrast to cases of previously reported atypical HV, our patient suffered from repeated bacterial infections on various sites ending in sepsis and death, but without malignant transformation. EBV was detected in the lymphoid cells from the skin lesions by anti-latent membrane protein (LMP) antibody and in situ hybridization. We suggest that the repeated bacterial infections in this case raise the possibility of an association of EBV infection with increased susceptibility to bacterial infections.
J Dermatol 2001 Aug
PMID:Epstein-Barr virus-associated recurrent necrotic papulovesicles with repeated bacterial infections ending in sepsis and death: consideration of the relationship between Epstein-Barr virus infection and immune defect. 1156 Jan 62

Wound infection with antimicrobial-resistant bacteria may result in prolonged debility of the patient and increased healthcare costs. Avoidance of the development of resistance therefore needs increasing attention in the management of patients with wound infections. Antimicrobial use is the major determinant in the development of resistance. Knowledge of the criteria for wound infections, the causative pathogens, and their prevailing susceptibility patterns is a prerequisite for the rational prescribing of antimicrobials. Since the benefits of wound debridement and wound irrigation have been proven, prescribing antibacterials should not usually be the initial treatment strategy in the management of infected wounds. The use of systemic antibacterials is only indicated when infection appears to be spreading through the subcutaneous soft tissues and in cases of ascending limb infection or severe sepsis. To minimize the selection pressure of individual antibacterials on the normal flora of the skin and gut, narrow-spectrum agents are to be preferred. Empirical treatment with systemic antibacterials should be adapted, based on the results of wound cultures. Topical antibacterials have also been successfully used in the management of patients with infected wounds. Defining guidelines for the rational use of systemic and topical antimicrobials is an important tool to limit and control the development of resistance. Because of geographical differences in resistance rates and methodological differences in published reports, local surveillance data should be available to assist clinicians in the development of these guidelines. New systemic and topical agents should be assessed at an early stage of development for their potential for selection of resistance. Research is needed on the applicability of alternatives to antimicrobials in the management of patients with wound infections in order to reduce the future risk of antimicrobial resistance.
Am J Clin Dermatol 2002
PMID:Impact of increasing antimicrobial resistance on wound management. 1181 64

Calciphylaxis is a rare, painful, necrotizing skin condition that occurs most frequently in patients with chronic renal failure who are receiving dialysis. These patients commonly have secondary hyperparathyroidism. Treatment involves a multidisciplinary approach. Surgical wound debridement, local wound care, pain control, and nutritional support are the primary care issues that must be addressed. The outcome is often poor, with the fatal outcome often resulting from sepsis.
Dermatol Nurs 2001 Dec
PMID:Calciphylaxis in the patient with chronic renal failure. 1183 81

In this article, the clinical and laboratory findings of six (15%) cases of cutaneous manifestations of 39 patients with sepsis caused by Staphylococcus aureus (S. aureus) were reviewed retrospectively. Our purpose was to determine the cutaneous manifestations in patients with sepsis caused by S. aureus. In our study, four patients had maculopapular and/or petechial/purpuric rashes, and two had erythematous lesions (one of them also had pustular lesions, and the other had furuncles). Aside from these, all patients had one or more systemic involvement such as bronchopneumonia, arthritis, osteomyelitis, or cardiac involvement. In conclusion, our findings suggest that there are no skin findings specific to staphylococcal sepsis and that pulmonary infections appear to have a high correlation with cutaneous findings, because all of our patients had evidence of bronchopneumonia. The mortality of staphylococcal sepsis associated with cutaneous findings appears to be high.
J Dermatol 2002 Jan
PMID:Cutaneous manifestations in childhood staphylococcal sepsis. 1183 74

In the past 5 y, the 28 d mortality in patients with sepsis syndrome has decreased somewhat but still ranges from 30% to 40%; mortality in those patients with septic shock and multiple organ failure is higher. This high mortality is observed despite intensive care units that deliver hemodynamic, metabolic, ventilatory, and renal support. Clearly some patients survive the ordeal but it remains frustrating not being able to stop the downhill course leading to multiple organ failure and death in these patients. New therapies have been sought and tested, including those preventing the biologic activity of two pro-inflammatory cytokines, interleukin-1 (IL-1) and tumor necrosis factor (TNF). Based on animal studies, anti-TNF and IL-1 therapy has been used to "rescue" the patient who continues to deteriorate in the face of considerable support efforts. Unfortunately, these anticytokine therapies have not dramatically reduced 28 d mortality in double-blind, placebo-controlled trials involving nearly 10000 patients, although there is a consistent but statistically nonsignificant decrease in mortality associated with anticytokine therapies. On the other hand, the same anti-TNF and IL-1-based therapies have made a dramatic improvement in the local inflammation and progression of rheumatoid arthritis. It appears that systemic inflammation of sepsis requires more than anticytokine monotherapy to significantly reduce mortality.
J Investig Dermatol Symp Proc 2001 Dec
PMID:Anti-cytokine therapies in response to systemic infection. 1192 36


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