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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Effective host defense against bacterial infection is dependent upon the vigorous recruitment and activation of neutrophils and macrophages. We hypothesized that IL-10 is produced in the setting of bacterial pneumonia, and this cytokine may attenuate host defense by inhibiting the expression of important activating and chemotactic cytokines. CD-1 mice were challenged with either 30 microliters of saline or saline containing 10(3) CFUs of Klebsiella pneumoniae intratracheally (i.t.) and lungs were harvested at 8, 24, and 48 h. The i.t. inoculation with K. pneumoniae resulted in a 13-, 14-, and 8-fold increase in lung homogenate TNF, macrophage inflammatory protein-2 (MIP-2), and macrophage inflammatory protein-1 alpha (MIP-1 alpha) levels, respectively, as compared with control animals. In addition, we observed an increase in IL-10 mRNA and protein levels in lung homogenates, maximal at 48 h postinoculation. To establish the biologic relevance of IL-10 in Klebsiella pneumonia, we passively immunized CD-1 mice with 0.5 ml of rabbit anti-murine IL-10 serum or preimmune serum i.p. 2 h before i.t. administration of K. pneumoniae. Treatment of animals with anti-IL-10 serum resulted in increased levels of TNF, MIP-2, and MIP-1 alpha, respectively, within lung homogenates at 24 and 48 h, as compared with preimmune-treated animals. Furthermore, neutralization of IL-10 resulted in a significant decrease in K. pneumoniae CFU in both lung homogenates and plasma harvested at 48 h, as well as a significant increase in survival in these animals. Our studies indicate that 1) IL-10 is produced during Klebsiella pneumonia; and 2) inhibition of IL-10 bioactivity in vivo results in enhanced bacterial clearance, increased expression of proinflammatory cytokines, and prolonged survival.
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PMID:Neutralization of IL-10 increases survival in a murine model of Klebsiella pneumonia. 760 50

We studied the usefulness of bronchoscopy in the diagnosis of pulmonary complications in elderly patients with non-Hodgkin's lymphoma (NHL). The subjects were 12 patients 65 or older with NHL. Two of these patients underwent transbronchial lung biopsies (TBLB), all of them underwent bronchiolavage (BAL) and 2 with tumors underwent transbronchial biopsies of the tumors. Diagnosis was obtained in 8 out of 12 patients (66.7%). Two patients showed infiltration of lymphoma cells, 2 had cytomegalovirus (CMV) infection, 1 had pneumocystosis (P. carinii), 2 had fungal infections and 1 had a bacterial infection. TBLB was performed in 2 patients with platelet counts of over 5 x 10(4)/microliters. Lymphoma cell infiltration was diagnosed in one of these patients and a fungal infection in the other. BAL was performed on all patients. CMV was detected in 2 cases by the PCR method, P. carinii was detected in 1 case and aspergillus in 1 case. Klebsiella pneumonia was diagnosed in 1 patient. Since respiratory tract complications are often serious in NHL and the prognosis depends on early diagnosis and treatment, it is important to perform bronchoscopy on elderly patients and obtain a definitive diagnosis.
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PMID:[Evaluation of respiratory tract disease accompanying malignant lymphoma in the elderly]. 761 78

Struvite renal stones are caused by infection of the urine with bacteria that synthesize the enzyme urease. Ammonium is released by the breakdown of urea by urease, the urine becomes highly alkaline, and magnesium ammonium phosphate (struvite) and carbonate apatite crystallize. Incorporation of the infecting bacteria within the developing stone, results in a focus of infection that is resistant to conventional antimicrobial therapy, and which is manifested clinically by repeated urinary tract infection caused by persistent bacteriuria. Extracorporeal shock wave lithotripsy (ESWL) currently is accepted as the election treatment for most renal calculi. This trial examines the bacteriologic aspects pre and post-ESWL. Eighty adult patients, 47 females and 33 males, without clinical signs of urinary tract infections (UTI) were submitted to urine cultures pre and post-ESWL. The first 50 patients underwent during and post-ESWL, 150 blood cultures, which all proved to be negative, confirming very low risk of generalized sepsis. No patient presented fever, chills or rigors pre or postprocedures. With respect to urine cultures 43 patients (52.5%) had a pre-ESWL UTI, in comparison to 49 (60%) who had a UTI post-ESWL. The distribution of organisms pre and post-ESWL was as follows: Proteus mirabilis (22/22), Escherichia coli (11/11), Pseudomonas aeruginosa (4/5), Klebsiella pneumoniae (2/2), Enterobacter cloacae (0/1), Alcaligenes odorans (1/2) Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) and Candida albicans (1/1). In this study 6 patients presented bacteriuria post-ESWL probably due to bacteria from inside the calculi. According to these results, the risk of bacteremia seems to be very low. In 60% of staghorn renal stones we could demonstrate a bacterial infection.
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PMID:[Staghorn renal lithiasis treated with shock waves. Bacteriologic aspects]. 765 75

A detailed analysis of bacteriuria in 148 aged patients with burns was made for a period of 2 years (1991-92), in order to determine the incidence of the urine infections they sustained, the sources and mechanisms of the infections and the impact on the course and outcome of the primary disease. Urine infection was found in 7.6 per cent (46 patients) of all patients treated for burns during the study period; 39.1 per cent were community acquired uroinfection (CAU) and 60.9 per cent were hospital acquired (HAU). In addition there were eight patients with bacteriuria, secondary to a generalized bacterial infection (GBI), and 11 with candiduria associated with massive antibacterial therapy. Leading causes of CAU were the common uropathogens: E. coli, Citrobacter and Proteus sp.; those of HAU were multiresistant hospital strains, characteristic of the Burns Clinic: Pseud. aeruginosa, Klebsiella sp., Acinetobacter sp. and Serratia sp. This study confirmed the role of transurethral catheterizations as factors associated with the development or exacerbation of chronic uroinfections, which increased the chances of non-survival, especially in aged people with concomitant chronic urological, nephrological or other underlying diseases. The causes of death in 20 patients with HAU, CAU, GBI and candiduria were analysed. The need for strict monitoring of burned patients at risk for uroinfection development and the need to take urgent preventive measures is emphasized.
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PMID:Analysis of bacteriuria in patients with burns. 771 15

To evaluate the cause of the vulnerability to infections in the elderly, the ability of neutrophil to generate reactive oxygen species was assessed by a luminol-dependent chemiluminescence (CL) assay after stimulation with non-opsonized zymosan, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Candida albicans and lumispheres in elderly patients aged 70 to 93 years. The integrated CL for 20 minutes of whole blood and neutrophils induced by zymosan in the elderly was significantly lower than that in healthy young adults, and the integrated CL of neutrophils induced by lumispheres was also significantly lower in the elderly aged 80 years and over. When bacterial infection occurred in the elderly, the levels of CL were elevated and decreased in the convalescence. This response is proper for host-defense mechanism against infection. However, whole blood CL response was not fully activated in any patients of the elderly during bacterial infection. In these cases lower white blood cell counts, lower neutrophil counts, or the decreased level of the serum total protein, albumin, total cholesterol or cholinesterase were observed. Relationship between malnutrition and the ability of neutrophil to generate reactive oxygen species was suggested. Furthermore, I evaluated the priming effect of lipopolysaccharide (LPS) and tumor necrosis factor-alpha (TNF-alpha) on whole blood CL. The CL responses stimulated with non-opsonized zymosan or P. aeruginosa were enhanced by pretreatment with TNF-alpha and LPS in healthy young adults. On the other hand, no significant priming effect was observed when blood from elderly patients were incubated with each primer. These findings suggest that the impairment in the generation of reactive oxygen species of the neutrophils and the decrease in reactivity to LPS and TNF-alpha that activate neutrophils at the site of infection and potentiate host defense against invading bacteria, may contribute to susceptibility to infection in the elderly.
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PMID:[Study of neutrophil dysfunctions in the elderly using a chemiluminescence method]. 782 5

Neonates and leukopenic, immunosuppressed patients are at high risk for severe infection of opportunistic pathogens despite of the availability of potent antimicrobial agents. In this study, antibody titers of immunoglobulin preparations (IVIG) were contrasted with the protective effect in mice against each of bacterial infection. Antibody titers were determined by ELISA. The antigens were 70-80 clinical isolates of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus, respectively. Antibody titers of IVIG against these three gram-negative bacteria ranged 3200 to 102,400. ICR mice were inoculated intraperitoneally with each of several strains against which IVIG showed various titers. IVIG showed rather high protective activities against well-reactive strains, while it showed little protective activities against poor-reactive strains. In the case of P. aeruginosa, statistical analysis of the results obtained with the antibody titer and efficacy showed a good correlation (p < 0.01). On the other hand, IVIG showed a high and complicate antibody titer against S. aureus IVIG ranging 400,000 to 12,800,000, since apparent titers contained non-specific binding of Fc portion of IgG with protein A on the cell wall. IVIG was active in mice, where protein A was less and specific binding was stronger. Bacterial cells have various components; lipopolysaccharide, lipid A, capsule, flagella, pill, etc. that are responsive to specific antibodies. This study indicates that IVIG have such antibodies and that is associated with protective activity against bacterial infection in proportion to antibody titer.
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PMID:[Protective effect and antibody titer of intravenous immunoglobulin (IVIG) against clinical isolates of opportunistic bacteria]. 786 37

An experimental disseminated intravascular coagulation (DIC) was induced in female CD rats by the intravenous administration of living bacteria (9.5 x 10(7) cfu Klebsiella pneumoniae), sublethal (5 mg/kg) or lethal (50 mg/kg) lipopolysaccharide (LPS), or tissue factor (1.5 micrograms/kg i.v. bolus or 0.4 micrograms/kg x hr i.v. infusion). We used a new fibrin monomer (FM) assay to follow the course of DIC. FM were detected by their ability to stimulate the tissue-type (t-PA) plasminogen activator dependent conversion of plasminogen to plasmin by a chromogenic assay. Miniplasminogen was used instead of plasminogen to avoid interference of the assay by alpha 2-antiplasmin. As a marker of DIC, elevated levels of FM were observed with all DIC-inducing agents (plasma levels were up to 90 micrograms/ml). The kinetics of FM formation were similar to the course of thrombin-antithrombin III (TAT) levels (maximal plasma levels 70 ng/ml); however, in the bacterial infection group, both parameters rose after a lag phase of about 1 hr. A 4 hr infusion of the highly specific thrombin inhibitor recombinant (rec.) hirudin (0.125 mg/kg x hr) resulted in a decrease of FM levels from 89.2 +/- 14.4 micrograms/ml in the LPS group (n = 10) to 27.4 +/- 11.2 micrograms/ml in the rec. hirudin group (n = 10; P < 0.001). The respective values for TAT levels were 73.1 +/- 19.7 micrograms/ml in the LPS group and 52.7 +/- 15.7 ng/ml in the rec. hirudin group (P < 0.001). Other coagulation parameters, such as platelets, fibrinogen, and fibrin(ogen) degradation products, were ameliorated accordingly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Formation of fibrin monomers in experimental disseminated intravascular coagulation and its inhibition by recombinant hirudin. 805 64

Patients in intensive care units (ICUs) are at increased risk of developing nosocomial infections. This is of special concern in the immunocompromised patient, particularly with regard to multiresistant pathogens. We evaluated the effectiveness of cefepime 2 g bd in combination with amikacin 7.5 mg/kg bd for the treatment of severe bacterial infection in 118 ICU patients, including 113 patients with nosocomial lower respiratory tract infections (LRTI) (mean age, 51 years). Ninety-six per cent (108/113) of the LRTI patients required respiratory assistance and 12% (14/113) had associated septicaemia/bacteraemia. Eighty-four per cent (95/113) had clinical signs of sepsis and 35% (39/113) had features of septic shock. The mean Simplified Acute Physiologic Score (SAPS) was 12 at inclusion. Seventy-nine patients with LRTI were clinically and bacteriologically evaluable. The causative pathogens were representative of those usually isolated in ICUs: Staphylococcus aureus (19%); Pseudomonas aeruginosa (14%); and Klebsiella, Enterobacter and Serratia spp. (17%). The clinical cure rate was 86% (68/79) while the pathogen eradication rate was 91% (107/117). Of the patients with associated septicaemia/bacteraemia, 89% (8/9) of the pathogens were eliminated. Cefepime-amikacin combination therapy was well tolerated; two patients discontinued treatment due to rashes. Combination therapy with cefepime 2 g bd and amikacin 7.5 mg/kg bd appears safe and effective for the treatment of nosocomial pneumonia in patients hospitalized in ICUs. Further comparative controlled studies are justified.
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PMID:A non-comparative study of the efficacy and tolerance of cefepime in combination with amikacin in the treatment of severe infections in patients in intensive care. 815 Jul 64

We describe a case of spontaneous bacterial peritonitis in a 53 year old man affected by cryptogenic micro-macronodular cirrhosis, portal hypertention, splenomegaly and hypersplenism, who was admitted with hepatic failure and septic shock and successfully treated with antibiotics (combination of clindamycin and netilmycin), surgical abdominal drainage and splenectomy. This case gave reason for a literature review and an update on the therapeutic options in these high risk patients, especially concerning the role of surgery. Spontaneous Bacterial Peritonitis (SBP) is defined as a bacterial infection of ascitic fluid in the absence of any septic focus. It is a typical life-threatening complication of hepatic cirrhosis with ascites. Mortality is very high and ranges from 75% to 97% of patients, due to septic shock and hepatic failure (hepatorenal syndrome, hepatic encephalopathy, gastrointestinal bleeding). Infection with a single organism is found in most cases. Gram negative bacilli are present in about 70% of cases and E. coli (less frequently Klebsiella, Serratia, Pseudomonas) is principally found. Gram positive cocchi comprise an additional 30% of cases. Anaerobic and microaerophilic organisms seem to be rare causes of SBP (2.7-6%); this finding is probably due to the intrinsic bacteriostatic activity of ascites, which contains high oxygen tension (70 mmHg) and is an inhospitable environment for bacteroides and Clostridia. The prevalent isolation of enteric organism suggest that the gut is the most frequent source of infection, even if the pathogenetic mechanism is not yet well known. The right treatment depends on differentiating primary (SBP) from secondary peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Is the surgical treatment of spontaneous bacterial peritonitis still up-to-date?]. 824 98

Cholestatic jaundice is a well-known complication of gram-negative bacterial infections in the neonates. Newborn and premature infants are particularly vulnerable to cholestasis because of immaturities in bile forming mechanisms. The Authors describe two premature infants who developed cholestasis in the course of a proved bacterial infection by Klebsiella pneumoniae. The main clinical aspects of this association are illustrated and the recent concepts of pathogenetic mechanism of intrahepatic cholestasis is discussed.
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PMID:[Cholestasis associated with sepsis in newborns]. 848 27


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