Articles: sepsis.
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Sepsis is a serious situation in patients with chronic central venous access. The infections complications presented with totally implanted reservoirs are studied in this paper. Twenty five venous systems for chemotherapy, total parenteral nutrition, specific drugs and blood drawing, were placed in 24 patients ranging in age from three months to sixteen years. ⋯ Four systems was removed after unsuccessful antimicrobial therapy. Three symptomatic patients were studied by echocardiography, one of them showed thrombosis in superior vena cava and right atrium, this child underwent an open atriotomy. These data suggest that removal of implantable venous system is required for successful treatment in patients with catheter related sepsis.
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Awareness of the role of anaerobic bacteria in neonatal bacteremia has increased in recent years. The incidence of recovery of anaerobes in neonatal bacteremia varies, according to different studies, between 1.8% and 12.5%. Of the 178 cases reported in the literature, 73 were due to Bacteroides species (69 were the Bacteroides fragilis group), 57 Clostridium species (mostly Clostridium perfringens), 35 Peptostreptococci, 5 Propionibacterium acnes, 3 Veillonella species, 3 Fusobacterium species, and 2 Eubacterium species. ⋯ Correction of underlying pathology, surgical drainage, and the use of proper antimicrobials are critical to successful resolution of the infection. Penicillin G is the drug of choice for anaerobic infection other than beta-lactamase-producing Bacteroides. Antimicrobials useful for therapy of beta-lactamase-producing Bacteroides include clindamycin, metronidazole, chloramphenicol, imipenem-cilastatin, and the combination of a penicillin plus a beta-lactamase inhibitor.
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Physicians and surgeons have long recognized that septic illness may be accompanied by abnormal brain functions; however, no systematic, comprehensive study has been done to define the clinical and laboratory features of the syndrome of sepsis-associated encephalopathy. We undertook such a prospective study in a tertiary care hospital and found that of 69 patients with fever and microbial cultures, 32 had marked brain dysfunction, 17 showed mild encephalopathy, and 20 were clinically nonencephalopathic. Severe cases showed obtundation and paratonic rigidity while milder cases showed confusion, inappropriate behavior, inattention, disorientation, and writing errors. ⋯ Pathogenetic mechanisms are discussed. The brain dysfunction should be regarded as potentially reversible, even in severely encephalopathic cases. Prompt control of the infection is the most important measure in controlling the encephalopathy and in preventing the increased mortality found with severely encephalopathic patients.
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Bacteremia is a recognized complication in patients with indwelling central venous catheters. More recently pulmonary embolism in such patients has also been described. Despite abundant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients. This case illustrates such a complication.
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Annales de pédiatrie · Dec 1990
Case Reports[Capnocytophaga septicemia during bone marrow transplantation. Apropos of 2 cases].
Two cases of septicemia due to Capnocytophaga in pediatric bone marrow recipients are reported. These gram negative rods, which are part of the normal buccal flora, cause periodontitis and localized or systemic infections, usually in immunocompromised hosts. Severe, prolonged neutropenia and mucitis due to chemotherapy and/or radiotherapy are risk factors for this opportunistic infection. Recovery can be achieved with most of the drug combinations including a beta-lactam used in hematology.