scholarly journals A case of pneumonia and sepsis in cirrhosis as paradigm of the problems in the management of bacterial infections in cirrhosis and of the limitations of current knowledge

2013 ◽  
pp. 209-214
Author(s):  
Manuel Tufoni ◽  
Alessandra Tovoli ◽  
Caterina Maggioli ◽  
Lucia Napoli ◽  
Carmen Serena Ricci ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hepatitis C ◽  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Empirical Antibiotic Therapy ◽  
Increased Risk

Bacterial infections are a major problem in the management of liver cirrhosis. They represent the first precipitating cause of death since patients with cirrhosis carry an increased risk of sepsis, sepsis-induced organ failure and death. Although the clinical presentation is often misleading, the presence of bacterial infection should always be actively searched and ruled out with certainty whenever a cirrhotic patient is admitted to the hospital with an acute clinical deterioration. Major changes in the epidemiology of bacterial infections have also occurred in the last decade making the choice of empirical antibiotic therapy a challenge. We report a paradigmatic case of a 54-year old man with hepatitis C-related cirrhosis admitted to the hospital for worsening of his ascites and onset of hepatic encephalopathy, an excellent example for the difficulties of management of sepsis in cirrhosis and the limits of current knowledge.

scholarly journals Fever without a focus in children 0-36 months of age

2006 ◽  
Vol 59 (3-4) ◽  
pp. 187-191 ◽  
Author(s):  
Svetlana Kuzmanovic ◽  
Nevenka Roncevic ◽  
Aleksandra Stojadinovic
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Medical Care ◽  
Bacterial Infections ◽  
Clinical Presentation ◽  
Febrile Illness ◽  
Empirical Antibiotic Therapy ◽  
Focus Of Infection ◽  
Serious Bacterial Infections ◽  
Yale Observation Scale

Introduction. About 20% of fevers in childhood have no apparent cause. A small, but significant number of these children may have a seroius bacterial infection. Fever without a focus of infection is an acute febrile illness with rectal temperature of 38?C or higher in children younger than 36 months, without localizing signs or symptoms. Practice Guidelines for Medical Care. In this article, practical recommendations for medical care of febrile children 0-36 months of age are given, bearing in mind children's age, clinical presentation (toxic manifestations) and risk for serious bacterial infection (sepsis, meningitis, pneumonia, urinary tract infection...). Toxic appearance is a clinical presentation characterized by lethargy, poor perfusion, marked hypo/hyperventilation and cyanosis. All febrile children under 36 months of age, who are appearing toxic, require hospitalization, evaluation for sepsis and administration of empirical antibiotic therapy. All febrile neonates, however, must be hospitalized: cultures of blood, urine and spinal fluid should be taken and empirical antibiotic therapy administered immediately. Febrile infants, 28 to 90 days of age, need to be evaluated in order to determine whether they are in the low-risk group for serious bacterial infections (Rochester Criteria). Yale Observation Scale is recommended to assess febrile children aged 3-36 months, and the risk of occult bacteriemia. Febrile children, 3-36 months of age who appear well, with temperature of less than 39?C without focus, should be closely followed up without laboratory tests and antibiotics and 2-3 days later reexamined. In febrile children, 3-36 months old, with temperature of 39?C and above, without toxic manifestations, blood culture should be taken and ceftriaxone 50 mg/kg/in a single dose should be given, if leukocyte count is 15000/mm? or absolute neutrophil count is over 10.000/mm? .

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

scholarly journals Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity

2021 ◽  
Vol 10 (13) ◽  
pp. 2776
Author(s):  
Miren Altuna ◽  
Sandra Giménez ◽  
Juan Fortea
Keyword(s):  
Down Syndrome ◽  
Functional Outcomes ◽  
Clinical Presentation ◽  
Late Onset ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
Myoclonic Epilepsy ◽  
Increased Risk ◽  
Number Of Individuals

Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer’s disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.

scholarly journals The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections

Biology ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 192 ◽  
Author(s):  
Paulina Glowacka ◽  
Lidia Rudnicka ◽  
Olga Warszawik-Hendzel ◽  
Mariusz Sikora ◽  
Mohamad Goldust ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Influenza Virus ◽  
Hepatitis C ◽  
Beneficial Effect ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Skin Diseases ◽  
Current Knowledge ◽  
Immunosuppressive Treatment ◽  
Immunodeficiency Virus

This review updates current knowledge regarding the risk of viral infections, including COVID-19, in patients treated with cyclosporine. We also shortly refer to bacterial infections and parasitic infestations in patients treated with cyclosporin. Cyclosporine is an immunosuppressive drug, which is widely used in medicine, including in the treatment of autoimmune skin diseases in dermatology, rheumatology, ophthalmology and nephrology, and in organ transplantation. A usual concern associated with immunosuppressive treatment is the potential risk of infections. Interestingly, several data indicate a relatively low risk of infections, especially viral infections, in patients receiving cyclosporine. It was shown that cyclosporine exerts an inhibitory effect on the replication of some viruses, or may have a potentially beneficial effect on the disease course in infections. These include hepatitis C, influenza virus, rotavirus, human immunodeficiency virus and coronavirus infections. Available data indicate that cyclosporine may have a beneficial effect on COVID-19, which is caused by the coronavirus SARS-COV2.

Atypical Bacterial Infections Explained by a Concomitant Virus Infection

PEDIATRICS ◽  
1985 ◽  
Vol 76 (3) ◽  
pp. 411-414
Author(s):  
Ron Dagan ◽  
Caroline B. Hall ◽  
Marilyn A. Menegus
Keyword(s):  
Early Childhood ◽  
Virus Infection ◽  
Bacterial Infection ◽  
Clinical Manifestation ◽  
Bacterial Infections ◽  
Recent Progress ◽  
Clinical Presentation ◽  
Virus Detection ◽  
Dual Infection ◽  
Dual Infections

Because both viral and bacterial infections are common during early childhood, dual infections are not unexpected. However, the clinical manifestation of such combined infections may be, difficult to interpret, and they are often misdiagnosed as "atypical bacterial infection." Five patients with concomitant viral-bacterial infections are described. In all five cases, virus detection enabled the physicians to better understand an otherwise puzzling clinical presentation. In view of the recent progress in rapid viral diagnoses and the potential of antiviral drugs, the possibility of dual infection should be investigated more often.

scholarly journals Clinical Value of Soluble IgG Fc Receptor Type III in Plasma From Patients With Chronic Idiopathic Neutropenia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3962-3966
Author(s):  
Harry R. Koene ◽  
Masja de Haas ◽  
Marion Kleijer ◽  
Tom W.J. Huizinga ◽  
Dirk Roos ◽  
...  
Keyword(s):  
Plasma Level ◽  
Bacterial Infection ◽  
Neutrophil Count ◽  
Bacterial Infections ◽  
Fc Receptor ◽  
Receptor Type ◽  
Type Iii ◽  
Genotype Frequencies ◽  
Increased Risk ◽  
Chronic Idiopathic Neutropenia

Previous studies have shown that the plasma level of soluble IgG Fc receptor type III (sFcγRIII) is a measure of the total body neutrophil mass. The aim of this study was to determine whether the plasma level sFcγRIII is associated with the risk of contracting bacterial infections in patients with neutropenia. We collected blood from 66 patients suffering from acquired idiopathic neutropenia, whose blood was sent to our laboratory for diagnostic evaluation of neutropenia (neutrophil count <1,500 cells/μL). Soluble FcγRIII levels were measured in plasma. Genotype distibutions of FcγR polymorphisms were determined. Clinical data were obtained from the patient files. Patients were assessed as to whether or not they had suffered from a bacterial infection 3 months before to 3 months after a single sFcγRIII measurement. In addition, longitudinal data were obtained from 21 patients. Of the 66 neutropenic patients who were included, 15 had suffered from a bacterial infection in the period 3 months before to 3 months after sFcγRIII measurement. The age and sex distribution was equal among the groups with and without infections, as were the genotype frequencies of neutrophil FcγR polymorphisms. Both neutrophil count and plasma level sFcγRIII were significantly lower in the patient group with infections, compared with the noninfected group (P = .03 and P < .0001, respectively). No infections were reported for patients who had plasma sFcγRIII levels above 100 arbitrary units (AU; normal value, 30 to 200). After matching each infected patient with two noninfected patients having the same neutrophil count, sFcγRIII plasma levels remained significantly lower in the group with infections (P = .0001). For the patients who were followed in time, no infections were reported when sFcγRIII levels were above 100 AU. In conclusion, our population of patients with chronic idiopathic neutropenia with plasma sFcγRIII levels above 100 AU did not show an increased risk of contracting bacterial infections.

scholarly journals Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242533
Author(s):  
David Yu ◽  
Karolina Ininbergs ◽  
Karolina Hedman ◽  
Christian G. Giske ◽  
Kristoffer Strålin ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Control Group ◽  
Contamination Rate ◽  
Empirical Antibiotic Therapy ◽  
Cohort Study Design ◽  
Low Prevalence ◽  
Tertiary Care Hospitals

Purpose In the management of COVID-19, knowledge is lacking on the frequency of secondary bacterial infections and on how empirical antibiotic therapy should be used. In the present study, we aimed to compare blood culture (BC) results of a COVID-19 patient cohort with two cohorts of patients without detected COVID-19. Methods Using a retrospective cohort study design of patients subjected to BC in six tertiary care hospitals, SARS-CoV-2 positive patients from March 1 to April 30 in 2020 (COVID-19 group) were compared to patients without confirmed SARS-CoV-2 during the same period (control group-2020) and with patients sampled March 1 to April 30 in 2019 (control group-2019). The outcomes studied were proportion of BC positivity, clinically relevant growth, and contaminant growth. Results In total 15,103 patients and 17,865 BC episodes were studied. Clinically relevant growth was detected in 197/3,027 (6.5%) BC episodes in the COVID-19 group compared to 717/6,663 (10.8%) in control group-2020 (p<0.0001) and 850/8,175 (10.4%) in control group-2019 (p<0.0001). Contamination was present in 255/3,027 (8.4%) BC episodes in the COVID-19 group compared to 330/6,663 (5.0%) in control group-2020 (p<0.0001) and 354/8,175 (4.3%) in control group-2019 (p<0.0001). Conclusion In COVID-19 patients, the prevalence of bloodstream bacterial infection is low and the contamination rate of BC is high. This knowledge should influence guidelines regarding blood culture sampling and empirical antibiotic therapy in COVID-19 patients.

scholarly journals Liver Cirrhosis and Sarcopenia from the Viewpoint of Dysbiosis

2020 ◽  
Vol 21 (15) ◽  
pp. 5254 ◽  
Author(s):  
Hiroki Nishikawa ◽  
Hirayuki Enomoto ◽  
Shuhei Nishiguchi ◽  
Hiroko Iijima
Keyword(s):  
Liver Cirrhosis ◽  
Gut Microbiota ◽  
Bacterial Infections ◽  
Metabolic Disorders ◽  
Current Knowledge ◽  
Bacterial Species ◽  
Intestinal Barrier ◽  
Adverse Outcomes ◽  
The Relationship ◽  
Severe Disturbance

Sarcopenia in patients with liver cirrhosis (LC) has been attracting much attention these days because of the close linkage to adverse outcomes. LC can be related to secondary sarcopenia due to protein metabolic disorders and energy metabolic disorders. LC is associated with profound alterations in gut microbiota and injuries at the different levels of defensive mechanisms of the intestinal barrier. Dysbiosis refers to a state in which the diversity of gut microbiota is decreased by decreasing the bacterial species and the number of bacteria that compose the gut microbiota. The severe disturbance of intestinal barrier in LC can result in dysbiosis, several bacterial infections, LC-related complications, and sarcopenia. Here in this review, we will summarize the current knowledge of the relationship between sarcopenia and dysbiosis in patients with LC.

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