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Query: UMLS:C0243026 (sepsis)
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The etiology of invasive bacterial infections was studied among 956 Filipino children less than five years old who fulfilled the World Health Organization criteria for severe or very severe pneumonia or had suspected meningitis or sepsis. The most common invasive infections were due to Streptococcus pneumoniae (12 [1.3%]) and Haemophilus influenzae (12 [1.3%]); including four cases of pneumococcal meningitis and 11 cases of H. influenzae meningitis. Type 1 was the most common (six of the 12 isolates) of the pneumococcal serotypes. Serotypes/groups 1, 6, 14, and 23 accounted for 91.7% of the invasive isolates. The majority of the H. influenzae strains from blood (10 out of 10) and cerebrospinal fluid (6 out of 7) were type b. Almost all of the invasive S. pneumoniae (9 out of 12) and H. influenzae (11 out of 12) infections were seen before one year of age, which stresses the need to investigate early immunization of children for H. influenzae type b and S. pneumoniae, as well as maternal immunization to maximize the potential of immunoprophylaxis.
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PMID:Invasive bacterial infections of children in a rural province in the central Philippines. 1103 75

Absence of the spleen or splenic function predisposes individuals to risk of overwhelming infection. These infections are most often due to encapsulated organisms, especially pneumococcus, Haemophilus influenzae type b, and meningococcus, but any bacterial agent may cause the rapid onset of septicemia, meningitis, pneumonia, and shock characteristic of the asplenic-hyposplenic condition. The risk is greatest in infants and young children, but asplenic-hyposplenic adults also have an increased risk of infection. Prophylactic antibiotics and immunization with polyvalent pneumococcal, H. influenzae type b, and meningococcal vaccines have reduced the incidence of infections in asplenic-hyposplenic individuals, but even these measures have not eliminated the risk. Surgeons have adopted techniques to save as much splenic tissue as possible and some splenic functions, such as pitting red cells, have been preserved, but conservative surgery has not provided total protection against overwhelming infection. Therapies designed to interrupt the cascade of overwhelming sepsis have not yet been successful. In those cases in which the spleen is surgically removed, the underlying disease or condition leading to splenectomy influences the risk of sepsis. Splenectomy incidental to other operations, such as gastrectomy, results in the lowest risk for overwhelming infection, but this is still some 35-fold greater than the risk for overwhelming infections in the general population. In increasing order of risk, the other main indications for surgical removal of the spleen are idiopathic thrombocytopenia purpura, trauma, transplantation procedures, hereditary spherocytosis, staging Hodgkin's disease, portal hypertension with hypersplenism, and thalassemia. Pathologists should comment on the risk of overwhelming sepsis when spleens are processed as surgical specimens, and should carefully weigh all splenic tissue, including accessory spleens and splenic implants (splenosis), in autopsy cases with and without overwhelming sepsis.
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PMID:Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. 1117 26

Over the last decade or so there has been a growing interest in routes of antimicrobial administration other than by the conventional intravenous route for institutionalized patients and for some outpatients. Both oral (PO) and intramuscular (IM) routes of administration are less costly than giving antimicrobial agents by vein (IV). In addition, fewer complications such as catheter-related sepsis and phlebitis are associated with non-IV routes of administration. Furthermore, a reduced-dosage, reduced-volume IM administration of ceftriaxone may provide a tolerable route of administration and equivalent bactericidal activities compared with higher dose IV ceftriaxone. The purpose of this study was to determine the time that the drug concentration remained in excess of the minimum inhibitory concentration (MIC) (T > MIC) and the duration of bactericidal activities of ceftriaxone one gram administered IV, ceftriaxone 250 mg given IM and cefixime 400 mg given orally against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in adult volunteers. Single doses of each agent were administered and serum concentrations were collected over the standard dosing period of 24 h for all study regimens. Ceftriaxone, regardless of route of administration and dose, resulted in bactericidal activities and T > MIC for 100% of the dosing period for S. pneumoniae, H. influenzae, and M. catarrhalis. Cefixime maintained at least 50% T > MIC and bactericidal activity against both isolates each of H. influenzae and M. catarrhalis. Against both isolates of S. pneumoniae, cefixime achieved T > MIC for at least 50% of the dosing period, but did not maintain bactericidal activity. Reduced dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility and infection site are known. Based on T > MIC exceeding 50% of the dosing interval, cefixime would be considered an effective alternative to IV therapy against common respiratory tract pathogens. Clinical studies need to be conducted to confirm these findings.
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PMID:Pharmacodynamics of ceftriaxone and cefixime against community-acquired respiratory tract pathogens. 1139 19

Acute otitis media (AOM) is the most common disease for which pediatricians prescribe antimicrobial agents. Middle ear fluid were collected from 243 children with AOM that failed to respond to a previous course of antimicrobial therapy and who had then received myringotomy from September 1997 through August 1999. Bacterial cultures were done and antimicrobial susceptibilities were analyzed. Streptococcus pneumoniae (21.8%) was the most common causative organism, followed by Haemophilus influenzae (10.2%), Staphylococcus aureus (7%), and Pseudomonas aeruginosa (1.8%), while Moraxella catarrhalis (0.7%) and group A beta-hemolytic streptococcus (0.2%) were rarely isolated. In patients whose condition failed to improve after a course of antibiotic treatment, drug resistance became a serious problem. Fourteen percent of the patients in this series had complications, which included recurrent AOM, persistent middle ear effusion necessitating ventilation tube insertion, hearing impairment, mastoiditis, meningitis, chronic otitis media, brain abscess, and sepsis. Possible risk factors such as young age, male sex, underlying diseases, and a culture of S. pneumoniae or H. influenzae were not significantly associated with an increased incidence of complications. More stringent diagnosis and the correct choice of antibiotic treatment combined with the introduction of potential virus and bacterial vaccines are promising ways to reduce the morbidity of AOM in children.
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PMID:Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications. 1160 10

95 strains of Haemophilus influenzae (H. influenzae) isolated from blood of the patients with systemic infections were serotyped by staphylococcal coagglutination during the ten years from 1992 through 2001. As a result, 92 (96.8%) cases were caused by type b strains and 3 (3.2%) cases were caused by non-typeable strains. Three cases with systemic infection due to non-typeable H. influenzae were reported. One patient was a premature neonate with sepsis and respiratory failure who had a fulminant course and died. The other two patients were a 3-year-old girl and a 1-month-old boy both with pneumonia. About their underlying conditions, one received intravenous steroid therapy and the other suffered from respiratory syncytial virus infection. They were treated with appropriate antibiotics and their clinical courses were satisfactory and uncomplicated. Non-typeable H. influenzae was isolated from not only blood but also the lower respiratory tract in all three cases. Systemic infection due to non-typeable strain is rare. But, it should be recognized as a substantial proportion of the serious infections caused by H. influenzae.
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PMID:[The frequency of non-typeable Haemophilus influenzae systemic disease in children]. 1263 54

A previously healthy 4-year-old child became acutely ill with vomiting and low-grade fever. The following day she suddenly became limp and unresponsive. She experienced acute septic shock and despite aggressive treatment died. Blood cultures grew ampicillin-resistant Haemophilus influenzae type f. There was no evidence of bacterial pneumonia or meningitis. To our knowledge, this represents the first case of fatal H. influenzae type f sepsis in a child without an identifiable focus or underlying predisposing condition. Despite the overwhelming success of the H. influenzae type b vaccine, physicians need to be aware of the potential for severe and fatal H. influenzae infections other than type b.
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PMID:Rapidly fatal Haemophilus influenzae serotype f sepsis in a healthy child. 1264 72

Surveillance after introduction of Haemophilus influenzae serotype b vaccination in Spain identified 26 H. influenzae serotype e (HiE) isolates. Of these, 16 (61.5%) were recovered from patients aged >16 years and 10 (38.5%) from children <16 years of age. HiE caused respiratory infections in 14 patients (9 with pneumonia), conjunctivitis in 4, vaginitis in 2, abscess in 2, and cellulitis, peritoneal infection, sepsis and meningitis in 1 patient each. HiE was strongly clonal and highly resistant to ampicillin and cotrimoxazole, and the incidence of HiE infection did not increase over time.
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PMID:Infections due to Haemophilus influenzae serotype E: microbiological, clinical, and epidemiological features. 1503 42

Nine premature infants developed early onset sepsis and/or pneumonia with Haemophilus influenzae during a period of 53 months (January 2000 -May 2004). Their respiratory problems were pneumonia-like rather than classic respiratory distress syndrome. In 8 of the cases, the pathogen was a beta-lactamase-negative, nontypable H. influenzae. In the remaining case, the Haemophilus identified was type d. Before January 2000, no case of beta-lactamase-negative, nontypable H. influenzae sepsis or pneumonia had been recorded.
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PMID:A cluster of early neonatal sepsis and pneumonia caused by nontypable Haemophilus influenzae. 1554 67

A previously healthy 31-month-old male child became acutely ill with dyspnea and high fever 48 h after admission for acute bronchitis. He experienced sepsis and acute respiratory distress syndrome throughout the subsequent hospitalization, eventually expiring despite aggressive treatment with antibiotics and extracorporeal membrane oxygenation. Blood cultures yielded ampicillin-resistant non-typeable Haemophilus influenzae. To the best of our knowledge, this is the first reported case of fatal non-typeable H. influenzae sepsis and ARDS in a child without an underlying predisposing condition.
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PMID:Fatal non-typeable Haemophilus influenzae sepsis complicated with acute respiratory distress syndrome: case report and literature review. 1630 33

Children born without a spleen or who have impaired splenic function, due to disease or splenectomy, are at significantly increased risk of life-threatening bacterial sepsis. The mainstays of prevention are education, immunization, and prophylactic antibiotics. The availability of conjugate 7-valent pneumococcal vaccines for use in children to age 9 years at least, as well as conjugate meningococcal C vaccine in some countries, for use beginning in infancy, appear to represent beneficial additions, but not substitutions, to previous recommendations for the use of polysaccharide 23-valent pneumococcal and quadrivalent A, C, Y, W-135 vaccines. Routine immunization against H. influenzae type b should continue with non-immunized children older than age 5 years receiving two doses 2 months apart, similar to children who have not previously received conjugate pneumococcal vaccine in infancy. Annual influenza immunization, which reduces the risk of secondary bacterial infection, is also recommended for asplenic children and their household contacts. Many experts continue prophylaxis indefinitely although prophylaxis of the penicillin allergic child remains suboptimal.
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PMID:The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: practice considerations at the Hospital for Sick Children, Toronto. 1633 16


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