11/30. Epithelioid germinal centers in overwhelming childhood infections. The aftermath of nonspecific destruction of follicular B cells by natural killer cells.The destruction of proliferating lymphoid cells within germinal centers with subsequent replacement by histiocytoid cells has been described in infants and children dying of viral and bacterial infections. The etiology and significance of "epithelioid germinal centers" (EGCs) are unknown. The cells implicated in forming EGCs have included histiocytes and dendritic reticulum cells. We have studied four children at autopsy who died at ages ranging from 10 months to 7 years. Three contracted fatal infections, one with fulminant meningococcemia, one with bacterial sepsis, and one with viral hepatitis. The fourth child contracted viral pneumonitis and died of acetaminophen toxicity. Epithelioid germinal centers were found in numerous lymphoid organs (spleen, lymph nodes, and Peyer's patches) in all four cases. avidin-biotin complex immunohistochemical analysis performed on formalin-fixed splenic tissue from the first three cases and snap-frozen splenic tissue from the second case revealed an absence of B cells in the follicular centers. The mantle zones surrounding follicles were thin but intact. The histiocytoid cells expanding the germinal centers were positive for S100 and R4/23 (dendritic reticulum cells) and negative for numerous histiocyte markers (alpha 1-antitrypsin, alpha 1-antichymotrypsin, and lysozyme). Increased numbers of killer cells (Leu-7) were present within the affected germinal centers in the three cases in which material was available for immunohistochemical studies. Overwhelming infections in these patients seem to result in anomalous natural killer cell activation resulting in localized nonselective destruction of follicular centers similar to anomalous natural killer cell activity reported to occur in fatal infectious mononucleosis. This may lead to an acquired immunodeficiency that precludes long-term survival in affected patients.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
12/30. Serious bacterial infections. c-reactive protein as a serial index of severity.The clinical course of 72 septicemic episodes or focal severe bacterial infections was monitored by daily measurements of serum c-reactive protein (CRP) in 59 children beyond the neonatal period, 19 of whom were immunocompromised. CRP was determined quantitatively by an immunoturbidimetric method from a finger prick sample until either clinical recovery occurred and antimicrobial therapy was discontinued or until the death of the patient. The primarily elevated CRP levels (greater than or equal to 20 mg/l) usually increased about for a day but then decreased rapidly, provided the patient recovered uneventfully. If not, CRP remained at a high level or reincreased after transient decrease. Behaviour of CRP was not affected by the immunologic status of the patient. This property makes CRP especially useful in immunocompromised patients in whom other commonly used laboratory parameters may fail.- - - - - - - - - - ranking = 5keywords = bacterial infection (Clic here for more details about this article) |
13/30. Unexplained neonatal jaundice as an early diagnostic sign of septicemia in the newborn.This prospective study was performed to determine the frequency of unexplained unconjugated hyperbilirubinemia associated with bacterial infection during the first week of life. Of 5805 infants delivered between September 1984 and December 1986, 93 jaundiced newborns without evidence of septicemia fulfilled the following criteria to be enrolled in the study: weight greater than 2500 g, gestational age greater than 38 weeks, age less than 7 days, and unexplained unconjugated bilirubin greater than 170 mumol/L (greater than 10 mg/dL) during the first 48 hours of life and/or greater than 255 mumol/L (greater than 15 mg/dL) thereafter. Evaluation for septicemia included blood and urine cultures, and white cell and thrombocyte counts. The study disclosed three (3.2%) infants who developed septicemia before any clinical suspicion had been aroused. It is concluded that bacterial infections should be considered a possible cause of neonatal unconjugated hyperbilirubinemia during the first week of life, regardless of the clinical condition of the infant.- - - - - - - - - - ranking = 2keywords = bacterial infection (Clic here for more details about this article) |
14/30. adult respiratory distress syndrome (ARDS), sepsis, and extracorporeal membrane oxygenation (ECMO).This report presents data obtained in the care of 830 patients requiring assisted ventilation. When these patients were divided into groups by the severity of their respiratory failure as defined by the duration of ventilatory assistance (greater than 48 hours, less than 48 hours) and level of positive end expiratory pressure (PEEP) required (greater than 5 cm HoH, less than 5 cm HoH), it was found that evidence of concurrent bacterial infection was present in the majority of patients with severe respiratory failure. This finding could not be explained by infection acquired after the onset of respiratory failure. In addition, this analysis demonstrated the important association of active pulmonary infection with the occurrence of barotrauma in these patients. Case analysis of patients subjected to extracorporeal membrane oxygenation has led to the suggestion that underlying sepsis in patients failing to respond to conventional ventilatory assistance similarly limits the usefulness of membrane oxygenator support.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
15/30. Community-acquired bloodstream infection caused by pseudomonas paucimobilis: case report and review of the literature.Various sources of pseudomonas paucimobilis bacterial infections have been documented. We report the third human case of bloodstream infection due to P. paucimobilis and review the literature in English regarding community-acquired and nosocomial infection due to this bacterium. Biochemical and genetic characteristics supporting the pathogenic potential of P. paucimobilis are presented, and the antibiotic susceptibility profile of the organism is summarized.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
16/30. Inherited deficiency of properdin and C2 in a patient with recurrent bacteremia.A nine-year-old white boy with recurrent pneumococcal bacteremia is described. His serum had no hemolytic activity in either the classic or alternative complement pathways. Absence of classic pathway activity was secondary to a homozygous deficiency of C2. The parents had half-normal levels of C2, compatible with an autosomal recessive mode of inheritance. Measurement of serum properdin levels by radial immunodiffusion and enzyme-linked immunoabsorbent assay revealed a profound deficiency in the patient, normal levels in the father, and half-normal levels in the mother, suggesting X-linked inheritance of the deficiency. Addition of purified properdin to the patient's serum fully reconstituted the alternative pathway function. This patient's unique combination of inherited deficiencies of properdin and C2 is a likely explanation for his susceptibility to bacterial infection.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
17/30. Clues to the early diagnosis of mycobacterium avium-intracellulare infection in patients with acquired immunodeficiency syndrome.Four patients with acquired immunodeficiency syndrome with bacillemia from Mycobacterium avium-intracellulare presented with early pathologic clues of a disseminated mycobacterial infection. All had persistent fevers with negative diagnostic workups for other usual pathogens seen in patients with acquired immunodeficiency syndrome. Two patients had prolonged clearance of the bacillemia on a drug regimen of ansamycin, clofazimine, and amikacin sulfate.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
18/30. Spontaneous bacterial peritonitis.Spontaneous bacterial peritonitis is an infection of the ascitic fluid of patients who, in general, have severe chronic liver disease. Several variants of this disease exist including bacterascites, culture-negative neutrocytic ascites, and secondary bacterial peritonitis. Spontaneous bacterial peritonitis is frequently manifested by signs and symptoms of peritonitis although the findings may be subtle; however, occasionally it may be completely without clinical manifestation. The clinician must have a high index of suspicion in order to make this diagnosis at a relatively earlier stage of infection. An abdominal paracentesis is required to make the diagnosis of spontaneous bacterial peritonitis. This paracentesis should be performed on all patients who are admitted to the hospital for ascites and should be repeated if there is any manifestation of bacterial infection during the hospitalization. patients with severe intrahepatic shunting--as manifested by marked redistribution of activity from the liver to the spleen and to the bone marrow on liver-spleen scan as well as patients with an ascitic fluid total protein concentration of less than 1 g/dl--appear to be particularly susceptible to bacterial infection of their ascites. In order to optimize the yield of ascitic fluid culture, it is probably appropriate to inject blood culture bottles with ascites at the bedside immediately after the abdominal paracentesis. The mortality of spontaneous bacterial peritonitis continues to be very high. Perhaps routine admission paracentesis and prompt empiric antibiotic therapy with a third-generation cephalosporin will decrease the mortality of this infection if the Gram stain of the ascitic fluid demonstrates bacteria or the ascitic fluid neutrophil count is greater than 250 cells/cu mm. Repeating the paracentesis after 48 hours of treatment to reculture the fluid and reassess the ascitic fluid neutrophil count appears to be the best way to assess efficacy of treatment. After 48 hours of treatment the ascitic fluid neutrophil count should be less than 50% of the original value if the antimicrobial therapy is appropriate. The optimal duration of antibiotic treatment is unknown; however, until controlled trials provide data regarding duration of treatment it is appropriate to treat with parenteral antibiotics for 10 to 14 days. research is also needed to determine if there are measures which can be taken to prevent the development of spontaneous peritonitis.- - - - - - - - - - ranking = 2keywords = bacterial infection (Clic here for more details about this article) |
19/30. rhabdomyolysis associated with pneumococcal sepsis.A case of pneumococcal sepsis associated with rhabdomyolysis is reported. rhabdomyolysis is a rare complication of bacterial infections not directly involving muscle. Eleven cases of rhabdomyolysis associated with bacteremic infections were found in the literature and clinical data are summarized. The pathogenesis and frequency of this association remains unknown.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
20/30. Infection with CDC group DF-2 gram-negative rod: report of two cases.Two patients had bacteremia with Center for disease Control group DF-2 Gram-negative rods. Previously described patients infected with this organism had clinical syndromes including cellulitis, meningitis, and endocarditis, and generally were severely ill. One of our patients had acute oligoarticular arthritis. The other had fever, headache, malaise, and a generalized rash. In neither case was bacterial infection considered likely at onset, and neither patient received antibiotic therapy. Both patients recovered completely. The organism is a fastidious Gram-negative rod that only recently has been characterized. methods for isolating and identifying the organism are reviewed. The spectrum and frequency of illnesses caused by this organism are probably greater than previously recognized.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
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