Articles: sepsis.
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Rev. Soc. Bras. Med. Trop. · May 2007
Comparative Study[Meningococcal disease: comparison between clinical forms].
In order to asses the clinical forms of meningococcal disease, we reviewed 201 cases diagnosed as meningococcal disease in the University Hospital of the Fluminense Federal University in Rio de Janeiro, 185 of which met the inclusion criteria. Clinical and laboratorial characterization allowed for grouping of the cases as follows: meningococcal meningitis, 18%; meningitis with septicemia, 62%; and septicemia, 20%. Available epidemiological data did not differentiate clinical forms. ⋯ The following were significantly predominant in septicemia: shock; fatal outcome and higher partial thromboplastin time. Septicemia and meningitis with septicemia were differentiated from meningococcal meningitis in the following: duration of clinical history; occurrence of focal neurological signs; disseminated intravascular coagulation; and arthritis. Clinical and laboratory data lead us to admit meningococcal meningitis as a localized form of Meningococcal disease, and meningitis with septicemia and septicemia as variations in severity of the systemic form of the disease.
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Lemierre's syndrome or postanginal septicaemia is described in the literature as an unusual complication of oropharyngeal infection. In most cases the syndrome is caused by Fusobacterium necrophorum. This disease usually occurs in young healthy individuals with an oropharyngeal infection, implying high fever, cervical tumefaction, and cervical pain, frequently associated with septic lung embolization. This case report is an unusual variant of this disease in a 12-year-old patient whose site of primary infection was the middle ear.
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Severe sepsis represents the leading cause of mortality and morbidity in critically ill patients. Although the authors' understanding of the complex pathophysiological alterations that occur in severe sepsis and septic shock has increased greatly, mortality associated with the disorder remains unacceptably high. Recent treatment guidelines have reinforced the importance of early goal directed therapy. ⋯ Extra-corporeal blood purification techniques offer a variety of techniques that can efficiently eliminate septic mediators. The rationale for its use in sepsis is sound Animal and human studies show promise with improvements in hemodynamics and mortality, but are limited by number and design. These techniques require large-scale well-conducted studies to demonstrate the validity in sepsis.