Sepsis clinical presentation

The clinical presentation of sepsis varies and the rate of development of clinical manifestations may differ from patient to... 

The clinical presentation of these 7 cases was that of a spectrum involving the kidneys with GIT manifestations in all, as well as hepatic failure in two. Sepsis and hemorrhage were secondary manifestation of mucosal damage and in one case, rectal perforation (probably traumatic enema) was an additional finding. 

Infectious diseases are common and result in significant morbidity and mortality in patients with ESKD. Although multiple abnormalities in host defenses and an increased susceptibility to infection have been described, the causal link between these observations remains speculative. Absolute lymphopenia and impaired cell-mediated immunity are common in ESKD patients and may be caused by uremic toxins or protein-calorie malnutrition. Although plasma concentrations of IgG, IgM, and IgA are usually normal, antibody responses appear to be significantly depressed. Patients requiring dialysis have many problems with vascular access which puts them at higher risk for exposure to infectious sources. The risk of infections in patients with CKD, and particularly ESKD, is an important consideration when reviewing the clinical presentation of a patient, as hospitalization rates for infection and sepsis have increased dramatically in the last 10 years. ... 

Patients present with the acute onset of fever, tachycardia, tachypnea, and occasionally, chills or hypotension. The clinical presentation generally is indistinguishable from that seen with sepsis of bacterial origin. 

In patients with clinical signs and symptoms of (severe) sepsis the diagnosis is based on microbiological analysis of blood and material from the original site of infection and, if present, on signs and... 

Infants with SCID have profound immunodehciency and present with frequent episodes of diarrhea, pneumonia, otitis, sepsis, and cutaneous infections. Persistent infections with opportunistic organisms such as Pneumocystis carinii, Epstein-Barr virus, Candida albicans, cytomegalovirus, parainhuenzae 3 virus, respiratory syncitial virus, adenovirus, varicella, and bacille Calmette-Guerin (BCG) lead to death within the hrst or second year of life. ADA dehciency also occurs in adults, but with a much later onset and nhlder, but clinically discernible, immunodehciency [3,5]. 

Intraabdominal infections have a wide spectrum of clinical features often depending on the specific disease process, the location and the magnitude of bacterial contamination, and concurrent host factors. Patients with primary and secondary peritonitis present quite differently (Table 42-3). If peritonitis continues untreated, the patient may experience hypovolemic shock from fluid loss into the peritoneum, bowel wall, and lumen. This may be accompanied by generalized sepsis. Intraabdominal abscess may pose a diagnostic challenge as the symptoms are neither specific nor dramatic. 

Adsorbents are used in medicine mainly for the treatment of acute poisoning, whereas other extracorporeal techniques based on physico-chemical principles, such as dialysis and ultrafiltration, currently have much wider clinical applications [1]. Nevertheless, there are medical conditions, such as acute inflammation, hepatic and multi-organ failure and sepsis, for which mortality rates have not improved in the last forty years. These conditions are usually associated with the presence of endotoxin - lipopolysaccharide (LPS) or inflammatory cytokines - molecules of peptide/protein nature [2]. Advantages of adsorption over other extracorporeal techniques include ability to adsorb high molecular mass (HMM) metabolites and toxins. Conventional adsorbents, however, have poor biocompatibility. They are used coated with a semipermeable membrane of a more biocompatible material to allow for a direct contact with blood. Respectively, ability of coated adsorbents to remove HMM solutes is dramatically reduced. In this paper, preliminary results on adsorption of LPS and one of the most common inflammatory cytokines, TNF-a, on uncoated porous polymers and activated carbons, are presented. The aim of this work is to estimate the potential of extracorporeal adsorption technique to remove these substances and to relate it to the porous structure of adsorbents. 

Adverse effects. Molgramostim causes medullary bone pain, skin rashes, lethargy and myalgia in 10-20% of patients. It may also cause fever, the interpretation of which presents a clinical dilemma in neutropenic patients who are subject to sepsis. Pleural and pericardial effusions occur after high doses. 

Moreover, tHbs have been administered to patient populations that included sizeable fractions of elderly and anemic patients or patients having co-morbidity. Enhanced susceptibility to infection or its exacerbation following the administration of a tHb to these patients has not been reported. Taken together, the preliminary data from clinical trials suggest that a tHb may provide significant benefit in a variety of clinical indications where sepsis may develop or is present. 

Numerous investigators have reported and reviewed the chnical application of monoclonal antibodies in various areas, including organ transplantation, neoplastic diseases, severe sepsis, and chronic inflammatory diseases. Collectively, these antibodies generally did not produce major adverse effects. The rapid development of antibodies against murine monoclonal antibodies is one of the most important clinical hmitations to their therapeutic use, but the development of humanized (chimeric human/ murine) monoclonal antibodies has improved their safety. Monoclonal antibodies have also been used in non-immune mediated diseases, such as cancer, septic shock, reperfusion, and as antiplatelet drugs. Treatment of neoplastic diseases with monoclonal antibodies is theoretically attractive. Unfortunately none of the monoclonal antibodies available at present has been demonstrated to be strictly tumor-specific, and binding of antibody to normal cells has been shown to be the major unknown factor for toxicity (6). 

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