Systemic Infectious Complications Research Articles

Infectious Complications of 393 Peripherally Implantable Venous Access Devices in HIV-Positive and HIV-Negative Patients

To compare and investigate the rate of infection in patients with and without human immunodeficiency virus (HIV) who have implantable venous access devices placed by interventional radiologists. Three hundred ninety-one patients undergoing radiologically guided placement of peripheral arm ports were grouped according to their HIV serologic status. Findings were prospectively reviewed in 393 peripherally placed arm ports that were implanted in the basilic, cephalic, or brachial vein under fluoroscopic or sonographic guidance over a 4-year span. Infectious complications were categorized according to severity (local or systemic) and time (periprocedural or late). Three hundred ninety-three ports have been indwelling for a total of 97,256 patient days (range, 1-694; mean duration, 247 days). Among the 30 catheter placements in 29 HIV-positive patients with a total exposure time of 7,242 days, five (one local and four systemic) infections occurred, resulting in a 16.6% overall infection rate, yielding 0.069 infections per 100 catheter days at risk (95% confidence interval [CI], 0.032-0.127). In the remaining 362 HIV-negative patients, 27 (14 local and 13 systemic) infectious complications (7.4%) occurred, translating into 0.030 infections per 100 catheter days (95% CI, 0.021-0.042). The odds ratio of getting an infection from the implantable arm ports in the HIV-positive group was 2.5 times higher than that of the HIV-negative group. The relative risk was similar and was calculated to be 2.3. The P value was .084 (P < .05 required to be considered significant). These results suggest a significant difference in the infectious complication rate encountered in HIV-positive patients compared with the general population. However, the HIV-positive peripheral arm port infection rate compares favorably with the surgically placed catheters and ports. Many more arm ports in HIV-positive patients must be evaluated for the data to achieve an acceptable level of statistical significance.

Feasibility of the titration method of mild hypothermia in severely head-injured patients with intracranial hypertension.

Clinical strategy to maximize effectiveness and to minimize adverse influences remains to be determined for mild hypothermia therapy for traumatic brain injury. This study was conducted to evaluate the clinical feasibility of the titration method of mild hypothermia in severely head-injured patients in whom a reduction in intracranial pressure was regarded as the target effect. Nine consecutive patients with severe head injury were studied. Patient age ranged between 18 and 66 years, Glasgow Coma Scale scores were equal to or less than 8, and intracranial pressures were equal to or greater than 20 mm Hg despite removal of intracranial hematoma and drugs, including glycerol and thiopental. During a maximum of 6 days of hypothermia therapy, jugular venous blood or cerebrospinal fluid temperature was titrated to reduce intracranial pressure to less than 20 mm Hg by means of repeated intragastric cooling with our nasoduodenal tube and surface cooling. The feasibility and the effects on systemic complications of this titration method of mild hypothermia were evaluated. Intracranial pressure variably decreased from before to 3 hours after the beginning of all procedures of cooling. The mean intracranial pressure significantly decreased from 24 to 15 mm Hg with cooling, while temperature reduced an average of 2.0 degrees C. Four patients had systemic infection complications. Increased C-reactive protein and decreased platelet count were observed in all patients during hypothermia. The incidence of good recovery and moderate disability according to the Glasgow Outcome Scale was seven of nine patients. The titration method of mild hypothermia to control intracranial hypertension in severely head-injured patients is clinically feasible. However, the method failed to reduce the incidence of infectious and hematological complications.

Intestinal Permeability Correlates with Severity of Injury and the Development of the Systemic Inflammatory Response Syndrome and Infectious Complications in Blunt and Penetrating Trauma

Intestinal Permeability Correlates with Severity of Injury and the Development of the Systemic Inflammatory Response Syndrome and Infectious Complications in Blunt and Penetrating Trauma

Orbital Infections in Patients with Human Immunodeficiency Virus Infection

Opportunistic infections frequently involve the anterior and posterior segments of the eye but rarely occur in the orbit in patients with human immunodeficiency virus (HIV) infection. The authors managed eight patients with HIV and unilateral orbital infections who presented between July 1988 and March 1995. Records of the patients were reviewed. A literature review of orbital infections in patients infected with HIV also was conducted. There were five men and three women, with a mean age of 33.8 years. The mean CD-4 cell count from five of the eight patients was 18.4 cells/mm3. Invasive aspergillosis was the most common orbital infection occurring in four patients, all of whom had contiguous sinus involvement and intracranial extension. Orbital cellulitis with subperiosteal abscesses secondary to ethmoiditis caused by Propionibacterium acnes and Pseudomonas aeruginosa developed in two patients. Orbital cellulitis and panophthalmitis secondary to Staphylococcus aureus endogenous endophthalmitis developed in one patient, and one patient had presumed syphilitic optic neuritis, orbital periostitis, and necrotizing vasculitis. Five patients had permanent visual loss, including four who had loss of light perception. Four patients died of orbital diseases within 1 year of presentation, and three deaths were attributed to intracranial spread of Aspergillus fumigatus. Other organisms reported in the literature that caused orbital infections in patients with HIV include Rhizopus arrhizus, Toxoplasma gondii, and Pneumocystis carinii. Opportunistic infections of the orbit from bacterial, fungal, and parasitic organisms should be recognized as a serious complication of systemic HIV infection and are associated with a high ocular morbidity and mortality rate.

Fungal endocarditis — a report on seven cases and a brief review

Candida endocarditis is an unusual but severe complication of systemic infection caused by Candida albicans and occasionally by other fungal species. We describe seven cases that occurred during a period of 20 years in western Sweden. In four cases infections were located on prosthetic valves and in three cases native valves were involved. Three patients died of the disease in the acute phase. A definite diagnosis was established in one of four survivors. This patient had an aortic valve endocarditis and a saddle embolisation and was treated with immediate surgery, followed by intensive treatment with liposomal amphotericin B+ flucytosine. Fungal endocarditis is still a serious disease with a high mortality and whenever the diagnosis is suspected, antifungal therapy must be started and transesophageal sonography should be performed to visualize vegetations. Immediate surgery should be considered.

Microbial Keratitis in Patients Infected with the Human Immunodeficiency Virus

Posterior segment complications of systemic infection with the human immunodeficiency virus (HIV) are well recognized. The anterior segment complications often are, however, overlooked. The author treated 20 episodes of nonherpetic infectious keratitis in 17 eyes of 13 patients infected with HIV who presented between August 1990 and May 1994. Review of records. Nine patients were women, and four were men. Mean age was 35.2 years. The keratitis was bilateral in four patients, polymicrobial in four, and recurrent in two. The most common infecting organism was Candida albicans (5 eyes), a rare cause of keratitis in immunocompetent individuals. Other organisms included Staphylococcus aureus in four eyes, Staphylococcus epidermidis in four, Bacillus sp in two, and one each Pseudomonas aeruginosa, alpha-hemolytic Streptococcus, Micrococcus sp, and Capnocytophaga sp. Seven eyes retained 20/30 or better visual acuity after treatment, eight had visual acuity of 20/50 or worse, and two were eviscerated. Classic predisposing factors for infectious keratitis were found in only two patients and included contact lens wear and atopy in one patient each. Twelve patients had a history of intravenous drug abuse. Infectious keratitis should be recognized as a complication of systemic HIV infection, especially in the context of drug abuse. The prognosis for recovery of vision in these patients often is poor.

Acute viral encephalitis in childhood

Painstaking precision in diagnosis rationalises treatment and improves prognostic certainty Viral infections of the central nervous system are mostly uncommon complications of common systemic viral infections. Remarkably little is known about the factors that determine why a few patients are affected but most are not. While this uncertainty continues the immunisation of the whole child population is necessary for effective prevention. Acute encephalopathies of viral (or unknown) origin occur most commonly in the first decade of life, with a peak incidence of 1 in 500–1000 infants in their first six months. 1 2 In practice the diagnosis of encephalitis is often based on an assessment of the clinical features and the exclusion of other possibilities. These include other intracranial infections; Reye's syndrome; hypoxia-ischaemia; haemorrhagic shock and encephalopathy; and metabolic, toxic, vascular, and traumatic disorders. Sometimes the pathogenesis and indeed the diagnosis are left in doubt. Pleocytosis in the cerebrospinal fluid is found in only half of patients with clinically suspected encephalitis, but it helps to narrow the wide differential diagnosis. No one clinical picture is specific to a single virus or several viruses, and the neurological illness may be triggered by the infecting virus through more than one infective or immune mediated mechanism.3 4 Nevertheless, a careful history that takes account of geographical …

Vascular diseases and oral infections

Vascular diseases are multifactorial, and several risk factors, such as increasing age, male sex, hypertension, diabetes, dyslipidemias and smoking, are well-known. In recent studies, associations have also been found between preceding infections and development of myocardial or cerebral infarction. Preceding acute respiratory infections are reported to be more common in patients with myocardial or cerebral infarction. Cerebral infarction may follow infective endocarditis, bacterial meningitis or any other bacteremic infection. Oral infections are common chronic bacterial infections. Although oral infections are local, they may lead to systemic infectious complications via stransient bacteremias, and there may also be other systemic effects, for instance, via immunologic or toxic mechanisms. Association between oral infections and vascular diseases has been studied in 2 Finnish case-control studies concerning myocardial and cerebral infarction. In these case-control studies, it was found that oral infections were more common in patients with myocardial or cerebral infarction than in their age- and sex-matched community controls. There are many factors, such as diabetes, smoking and alcohol abuse, which may predispose to both development of infarction and oral infections. Therefore, the observed association between oral infections and vascular diseases may result from these common predisposing factors, and causality between them cannot be inferred. There are, however, several possible links between oral infections and infarction. Although causality between oral infections and infarction cannot be proven, patients who have poor oral health need health education, paying attention to those common risk factors of oral infections and vascular diseases. Furthermore, their oral infections should be treated, because they may predispose to infectious complications, which may lead to infarction.

Principles of Intramedullary Pinning

Decompressive craniectomy may be used as a primary or secondary treatment for intracranial hypertension and is clearly associated with reduced mortality. The removed bone flap is usually preserved in the abdominal subcutaneous tissue or in the bone bank. The aim of this study was to describe an option for preserving the bone flap after decompressive craniectomy using bone flap preservation in the skull subcutaneous tissue in subgaleal space over the pericranium contralateral to the craniectomy site.This was a multicenter retrospective study including patients with severe traumatic brain injury from 2014 to 2016. There were 23 patients who had their bone fragments preserved below the scalp in the subcutaneous tissue for analysis. The following results were analyzed: surgical site infection, bone flap resorption during the period of preservation, and patient discomfort.Five patients died of systemic infectious complications, and the remaining patients underwent cranioplasty a mean 118 days after craniectomy. There were no surgical wound infections, macroscopically evident bone absorption, or site discomfort in any of the patients during a period of 18 months.This variant of the bone flap preservation technique has been shown to be satisfactory as an option for routine use.

Neurologic diseases associated with viral infections.

Meningitis and encephalitis are uncommon but important complications of many acute systemic viral infections. In addition, the recent association of viruses with several subacute and chronic diseases has widened the potential spectrum of virus-related neurologic diseases.

Immune-complex arthritis in viral hepatitis?

Joint involvement is now a well recognized complication of systemic infections produced by both RNA (e.g., rubella or mumps) and DNA (e.g., vaccinia or variola) viruses.1 Although arthralgia is a c...

Parotitis after diuretic therapy.

FEW diseases illustrate the prophylactic benefit of current fluid-balance concepts as well as that of acute suppurative parotitis. As recently as ten years ago, suppurative parotitis occurred by and large as a complication either of an acute systemic infection or of the postoperative state1 — hence the name "surgical parotitis." That the infection for the most part arises from a retrograde invasion of the gland by oral bacteria has been supported by bacteriologic and other studies over the past fifty years,2 , 3 the most necessary prerequisite appearing to consist of dehydration and a reduced flow of saliva from the gland. It . . .