Infectious Disease Complications Research Articles

Risk stratification of 4344 patients with gastroschisis into simple and complex categories

Background Gastroschisis is a congenital full-thickness abdominal wall defect characterized by the protrusion of intraabdominal organs outside the abdominal domain that requires surgical management in the early neonatal period. The goal of this study was to validate a previous risk stratification classification of infants born with this defect. Methods A retrospective analysis of a nonoverlapping combination of the databases National Inpatient Sample and Kids' Inpatient Database (1988-2003) was performed. These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by an International Classification of Diseases, Ninth Revision procedure code of 54.71 (repair of gastroschisis) and an age at admission of less than 8 days. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis, or volvulus. Variables of sex, race, geographic region, coexisting diagnoses, hospital type and charges adjusted to 2005 dollars, length of stay, inpatient mortality, and complications were collected. Comparison between the 2 groups was performed using Pearson χ 2 for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables. Results A total of 4344 infants with gastroschisis were identified and divided into simple and complex categories. Simple gastroschisis represented 89.1% (n = 3870) of the group, whereas 10.9% (n = 474) had complex disease. Simple and complex patients differed in coexisting cardiac disease (8.3% vs 11.8%, P = .01), hospital type (78.7% vs 84.1% treated at urban teaching centers, P < .01), median length of stay (28 vs 67 days, P < .01), median inflation-adjusted hospital charges ($90,788 vs $197,871; P < .01), and inpatient mortality (2.9% vs 8.7%, P < .01). Gastrointestinal (14.4% vs 83.5%, P < .01), respiratory (2.6% vs 4.6%, P = .01), and infectious disease complications (24.3% vs 45.4%, P < .01) also differed between the groups. Conclusions These data use the largest data set to date to validate the risk stratification of infants with gastroschisis. This analysis improves the characterization and understanding of clinical subsets of infants in whom this congenital condition is diagnosed.

EFFECTS OF CD14-159 C/T POLYMORPHISM ON CD14 EXPRESSION AND THE BALANCE BETWEEN PROINFLAMMATORY AND ANTI-INFLAMMATORY CYTOKINES IN WHOLE BLOOD CULTURE

CD14 is an important receptor of innate immunity. When CD14 is anchored by ligands to LPS, peptidoglycans, or lipoteichoic acid, it can result in either proinflammatory or anti-inflammatory responses. To determine whether CD14-159 C/T polymorphism is associated with CD14 expression and the balance of proinflammatory and anti-inflammatory responses, we studied 118 healthy ethnic Han Chinese using a whole blood culture model. The CD14-159 C/T polymorphism was determined by polymerase chain reaction and subsequent HaeIII restriction enzyme digestion of the polymerase chain reaction products. Meanwhile, CD14 mRNA expression in leukocytes and the levels of soluble CD14, TNF-alpha, IL-6, and IL-10 were also determined in the supernatants. Among the 118 individuals, there were 40 TT homozygotes, 62 heterozygotes, and 16 subjects homozygous for C allele. After LPS stimulation, the levels of CD14 mRNA expression in TT and TC genotypes were significantly higher than in CC homozygotes (P = 0.017), and soluble CD14 levels were also higher than in CC genotypes (P = 0.008). In addition, TT homozygotes had the highest LPS-stimulated TNF-alpha, IL-6 production (P = 0.044, P = 0.004), and the lowest IL-10 release (P = 0.003). In conclusion, CD14-159 C/T polymorphism is correlated with CD14 expression and may thus influence the balance of proinflammatory and anti-inflammatory responses in ethnic Han Chinese. These results suggest that CD14-159 C/T polymorphism might partly explain the difference in predisposition to develop complications of infectious diseases in different patients and may provide a therapeutic target for sepsis intervention strategies.

Clinical sepsis in neonates is responsible for the lower prevalence of developing allergy

The hygiene hypothesis proposes an association between the change in exposure to microbes and the increased incidence of atopic disease. The purpose of the present study was to perform a prospective epidemiological study of the effect of perinatal infection on the development of allergy. Eight hundred and ten children were born at Umeda Gynecological Hospital in Yamaguchi prefecture in Japan between April 1997 and March 1998. A questionnaire survey on the development of allergic diseases was sent by mail in 2002. The presence or absence of neonatal infectious disease (clinical sepsis) and maternal complications during the gestational period and delivery, and the incidence of bacterial infection during the perinatal period, were investigated by examining hospital records. Data were obtained for 410 children (51%). One hundred and forty-eight children (36.1%) developed allergic diseases. Among children whose mothers had allergies, the percentage of children who developed allergic disease(s) was significantly lower in children who had had clinical sepsis in the neonatal period than in those without clinical sepsis (26.1% vs 49.7%, P < 0.03). Clinical sepsis in neonates might reduce the risk of developing allergic diseases in early childhood in children whose mothers have allergies.

BLOCKADE OF CENTRAL MELANOCORTIN SIGNALING PROMOTES ACCUMULATION OF LEAN BODY MASS IN RODENT MODELS OF CHRONIC HEART FAILURE.

Cachexia is a frequent complication of chronic illness and infectious disease. This devastating state of malnutrition is brought about by a synergistic combination of a decrease in appetite and an increase in metabolism of fat and lean body mass (LBM). Cardiac cachexia is a frequent complication of chronic heart failure (CHF) and is a determining factor in both the quality of life and eventual mortality in CHF patients. Experimental evidence suggests a role for proinflammatory cytokines in the pathogenesis of cardiac cachexia, but the neuronal systems involved in transducing these signals have not been fully defined. To investigate the potential contribution of the central melanocortin system (CMS) in the transduction of cardiac cachexia, we developed two independent rodent models of CHF and measured the effect of CMS signaling blockade on the ability of these animals to accumulate and maintain LBM. In one model, we induced CHF in male 6- to 8-month-old wild-type (WT) C57BL/6J or MC4-RKO mice by permanent coronary artery ligation (CAL) of the left anterior descending coronary artery and measured their LBM 8 weeks after surgery by DEXA analysis. We found that WT mice receiving sham operations (n = 30) gained significantly more LBM compared with WT mice that had undergone CAL (n = 14) (13.0 g ± 1.2 g vs 4.1 g ± 2.9 g; p

Variable Mannose-Binding Lectin Expression during Postoperative Acute-Phase Response

Low plasma concentrations and genetic polymorphisms of mannan-binding lectin (MBL) have been associated with infectious disease complications during various conditions. The present study examined the nature and expression of MBL deficiency during a surgery-induced acute-phase response. Blood was sampled from 20 consecutive patients before and 1, 3, 5, 7, and 10 days and 6 weeks after a uniform abdominal operation (transhiatal esophagectomy). Plasma concentrations of MBL, C-reactive protein (CRP), and secretory phospholipase A2 (sPLA2) were measured. Patients were classified as low- or high-level MBL producers by their preoperative concentration (<0.5 or > or = 0.5 micrograms/mL), and were cross-verified for actual MBL deficiency by nucleotide sequencing of both the MBL promoter and exon-1 alleles. Baseline plasma MBL concentrations correlated with maximal postoperative plasma concentrations (r = 0.88; p < 0.0001). This was not found for CRP and sPLA2 (r = 0.19 and r = 0.08, respectively). Alleles responsible for structural MBL variants were detected in 40% of patients and were associated with significantly reduced MBL concentrations (p = 0.005). The baseline cut-off value in plasma of 0.5 micrograms/mL clearly identified individuals with variant exon-1 alleles (sensitivity 100%, specificity 83%). Baseline MBL plasma concentrations are predictive of MBL expression during the acute-phase response. A baseline cut-off value of 0.5 micrograms/mL can be used to identify patients with variants in the exon-1 region of the MBL gene without the need for nucleotide sequencing. Clinical studies may use this easy and quick method to identify MBL deficient patients preoperatively, as they are conditionally at risk for infectious complications.

Vinorelbine-based salvage therapy for patients with aggressive leukemias and non-Hodgkin’s lymphomas

17563 Background: We treated 26 patients with aggressive lymphohematopoietic malignancies, including 3 chronic myeloid leukemia (CML) patients in blast crisis, 2 chronic lymphocytic leukemia (CLL) patients with rapidly progressive leukemia, 10 acute lymphoblastic leukemia (ALL) patients in therapy refractory relapse, and 11 non-Hodgkin’s lymhoma (NHL) patients (9 in relapse with progressive lymphoma) with vinorelbine-based outpatient salvage chemotherapy. Methods: Patients received vinorelbine-based salvage therapy regimens NND-I (Vinorelbine [Navelbine] 25 mg/m2 d1,d8, Mitoxantrone [Novantrone]10 mg/m2 d1, Dexamethasone [Decadron] 20 mg BID d1 through 7, or NND-II (Vinorelbine 25 mg/m2 d1, Mitoxantrone 10 mg/m2 d1, Dexamethasone 20 mg BID d1 through 7, Fludarabine 25 mg/m2 d1,d2,d3). Rituximab (Rituxan, 375 mg/m2 d1,8,15,29) was used in combination with chemotherapy in patients with CD20 antigen positive malignancies. Treatment responses were evaluated by peripheral blood and bone marrow examinations in patients with leukemia and CT/MRI-PET fusion imaging in patients with non-Hodgkin’s lymphoma using standard response criteria. Results: All patients completed their salvage therapy as an outpatient without infectious disease complications or hospitalizations. Of the 26 patients, 20 (77%) had objective responses, including 14 complete remissions (CR). All 3 CML patients and both CLL patients achieved a CR. Of the 10 ALL patients, 5 achieved a CR and one achieved a partial remission (PR). Of the 11 NHL patients, 4 achieved a CR and 5 achieved a PR. Conclusions: Taken together, these findings demonstrate that patients with high risk/poor prognosis leukemias and non-Hodgkin’s lymphomas can achieve meaningful objective responses in an outpatient setting using vinorelbine-based salvage regimens. No significant financial relationships to disclose.

NNDR Salvage Biochemotherapy Regimens for Therapy-Refractory Leukemia and Lymphoma Patients: A Report from the Parker Hughes Cancer Center.

We examined the activity of vinorelbine-based salvage biochemotherapy regimens NNDR-I (Vinorelbine [Navelbine] 25 mg/m2 d1, d8, Mitoxantrone [Novantrone] 10 mg/m2 d1, Dexamethasone [Decadron] 20 mg BID d1 through 7, Rituximab [Rituxan] 375 mg/m2 d1,8,15,29) and NNDR-II (Vinorelbine 25 mg/m2 d1, Mitoxantrone 10 mg/m2 d1, Dexamethasone 20 mg BID d1 through7, Rituximab 375 mg/m2 d1,8,15,22, Fludarabine 25 mg/m2 d1, d2, d3) in 26 patients with lymphohematopoietic malignancies, including 3 adult chronic myeloid leukemia (CML) patients in blast crisis, 2 adult chronic lymphocytic leukemia (CLL) patients with rapidly progressive leukemia, 10 acute lymphoblastic leukemia (ALL)(2 adults, 8 children) patients in therapy refractory relapse, and 11 adult non-Hodgkin's lymhoma (NHL) patients (9 in relapse with progressive lymphoma). All patients completed their salvage therapy as an outpatient without infectious disease complications or hospitalizations. Of the 26 patients, 20 had objective responses, including 14 complete remissions (CR). The median survival was 1.3 (95% CI:0.5–3.9) y and the probability of survival was 53± 10% at 1 year and 37 ± 10% at 3 years (Figure 1). All 3 CML patients achieved a CR; two subsequently underwent allogeneic stem cell transplantation and remain alive free of leukemia at 4.5 y and 5.0 y, respectively, post blast crisis. One died with progressive disease at 0.7y. Both CLL patients achieved a CR and remain alive in CCR at 0.6y and 4.5y, respectively. Of the 10 ALL patients, 5 achieved a CR; of these 5, 2 died of pulmonary Aspergillosis at 0.3 y, 1 died of CMV pneumonitis at 0.7 y, 1 relapsed and died of gram negative sepsis at 1.2 y during reinduction, and 1 remains alive at 4.5 y in continued CR on maintenance chemotherapy. The median survival was 4 months. Of the 11 NHL patients, 4 achieved a CR and 5 achieved a PR. The median survival was 1.5y and 4 remain alive disease-free at 2.5y, 2.5y, 3.5y and 4.0y, respectively. Drug sensitivity profiling of primary tumor cells was performed in 14 patients: the vinorelbine sensitivity of the patients' leukemia/lymphoma cells predicted their clinical response to the NNDR regimens. Of the 9 responders tested, 8 were vinorelbine sensitive at the primary tumor cell level. Of the 5 non-responders tested, only one was vinorelbine sensitive at the primary tumor cell level. Taken together, these findings demonstrate that patients with high risk/poor prognosis leukemias and lymphomas can achieve meaningful objective responses in an outpatient setting using vinorelbine-based salvage regimens. Future application if the drug sensitivity profiling of primary tumor cells might help tailor the NNDR regimens to those who are most likely to respond. [Display omitted]

Infections and Stroke

We will review cerebrovascular complications of infectious diseases of the CNS. The emphasis will be on common infections causing stroke, including pyogenic meningitis, infective endocarditis, tuberculosis, leptospirosis, syphilis, as well as fungal and parasitic diseases. Most of these conditions cause stroke through a mechanism of angiitis, which is an inflammation of the vessel wall induced by the presence of microorganisms within the CNS. A stroke may occur as the primary or sole manifestation of the infectious disease or may present in the setting of a diffuse encephalopathy. Infection-related strokes may be ischemic or hemorrhagic and range in severity from asymptomatic to fatal. Precise knowledge of the spectrum of these conditions is important to direct prompt therapy to reduce the risk of further vascular damage.

The pregnant wilderness traveler

Travel during pregnancy, especially, when it involves potentially hazardous activities in remote areas, often raises serious concerns regarding the health and safety risks involved. The authors have researched the available medical literature to identify these risks and present the current recommendations for their prevention and treatment. Topics addressed include some political and social issues, insurance, basic comfort measures, complications of pregnancy, infectious diseases, environmental exposures, and trauma. Preventive measures include pre-travel evaluation and teaching, possible modifications of the itinerary, vaccinations and medications. Also briefly discussed are the handling of obstetrical emergencies in the field and medical evacuation of the pregnant patient. The authors conclude that many trips of this nature can be made relatively safe for the pregnant traveler, but she may need to accept some precautions and modifications of the itinerary that might not otherwise be necessary.

Infectious disease complications after unrelated donor hematopoietic stem cell transplantation in children: Impact of stem cell source

Infectious disease complications after unrelated donor hematopoietic stem cell transplantation in children: Impact of stem cell source

The CARI guidelines. CMV disease and kidney transplant: prophylaxis for cytomegalovirus infection in patients following renal transplantation.

The CARI guidelines. CMV disease and kidney transplant: prophylaxis for cytomegalovirus infection in patients following renal transplantation.

Safety and Biocompatibility of the Myosplint System—A Passive Implantable Device That Alters Ventricular Geometry for the Treatment of Heart Failure

A passive implantable device developed for the treatment of heart failure, the Myosplint System, has demonstrated therapeutic efficacy in a canine model of pacing induced heart failure. The current study sought to demonstrate chronic device safety and biocompatibility, in vivo, in a normal porcine model. Two devices were implanted into each normal, beating heart of 6 juvenile and 15 adult pigs without cardiopulmonary bypass. Animals survived 90 (juvenile and adult) or 180 days (adult only). Serial hematologic and biochemical profiles were evaluated in each pig during the study period. A comprehensive necropsy study was performed in each pig to evaluate device stability, healing response, thromboembolism, hemorrhage, and intravascular hemolysis related to the Myosplint system. Six adult animals died from infectious disease (four) or perioperative (two) complications unrelated to device design or function and were excluded from the final analysis. No clinical, biochemical or pathologic evidence of significant, device related adverse events was observed in surviving animals. The chronic myocardial healing response appeared normal at term, and all devices maintained their structural integrity throughout the study. The Myosplint system was easily implanted in beating hearts and was rapidly incorporated into host tissues without clinically significant morbidity in this porcine model.

Tacrolimus-Basiliximab versus Cyclosporine-Basiliximab in renal transplantation “de novo”: acute rejection and complications

Background Optimal immunosuppression is essential to maintain kidney allograft viability but minimizing toxicity is also fundamental. Objective This article compares immunosuppressants, corticosteroids, cyclosporine, tacrolimus, and basiliximab, which are used in the treatment regimens for renal transplantation. The analyses evaluated their effectiveness to prevent acute rejection episodes and to reduce the appearance of other complications, mainly infectious disease complications. Methods Ninety-five patients were analysed during the first year after primary renal transplantion. These patients were included in a random way in 3 different groups according to the immunosuppressant drug therapy: Group I (35 patients) received corticosteroids + CsA; Group II (35 patients) received corticosteroids + CsA + Basiliximab; Group III (25 patients) received corticosteroids + Tacrolimus + Basiliximab. Results Among the 95 patients, 9 presented with an acute rejection episode in Group I. None in Group II, and one in group III. With reference to the infectious disease complications, the incidence of oral herpes was one case in Group I, 4 cases in Group II, and 2 cases in group III. Conclusions Treatment with Basiliximab produced a significantly lower incidence of acute rejection cases and an increase in infectious disease complications, such as lip herpes.

Guillain-Barré syndrome associated with Campylobacter jejuni infection in England, 2000-2001.

Guillain-Barré syndrome (GBS) is a rare but serious complication of infectious intestinal disease due to Campylobacter jejuni. To date, estimates of the burden of C. jejuni-associated GBS have been based on limited data regarding the proportion of GBS attributable to this pathogen. In this paper, we combine data obtained from Sweden and a large study of infectious intestinal disease with routine and surveillance data from England to estimate the number and proportion of GBS cases attributable to C. jejuni. We estimate that, between 1 April 2000 and 31 March 2001, symptomatic C. jejuni infection was responsible for 157 cases of GBS, constituting approximately 15% of all GBS cases in England.

Infectious disease complications of GI endoscopy: part II, exogenous infections.

Infectious complications of GI endoscopy resulting from endogenous bacterial flora were discussed in Part I of this review. Part II deals with patient-to-patient transmission of pathogens during endoscopy (exogenous infection). Not every case of pathogen transmission necessarily results in clinical infection; however, because the ramifications for endoscope reprocessing are similar, cases of pathogen transmission and transmission of infection are discussed collectively.

Infectious disease complications of Gl endoscopy: Part I, endogenous infections

There is a wide variation in the rate of bacteremia after various endoscopic procedures. In general, most procedures are associated with a low frequency of bacteremia that is usually transient and does not cause clinical symptoms. Actual infectious complications are uncommon for most procedures. Recognition of infectious sequelae of endoscopic procedures can aid clinical management of these complications. There is a wide variation in the rate of bacteremia after various endoscopic procedures. In general, most procedures are associated with a low frequency of bacteremia that is usually transient and does not cause clinical symptoms. Actual infectious complications are uncommon for most procedures. Recognition of infectious sequelae of endoscopic procedures can aid clinical management of these complications.

Several simple rules predicted complications in high risk patients with diabetes

(2001) Diabetes Care 24, 1547. Selby JV, Karter AJ, Ackerson LM, et al. . Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population...

Ruptures de rate au cours des maladies infectieuses : splénectomie ou traitement conservateur ? À propos de trois cas

Introduction. – Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment. Exegesis. – We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding. Conclusion. – Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.

IMPACT OF FEBRILE INFECTIONS ON THE LONG-TERM FUNCTION OF KIDNEY ALLOGRAFTS

We prospectively determined the impact of febrile infectious disease on long-term renal graft function compared with a matched control group. Included in our study were 39 patients who presented with episodes of febrile infection with body temperature greater than 38C on 2 consecutive occasions, necessitating hospitalization. In addition, 39 controls without febrile infection requiring hospitalization within 2 months were chosen from the complete data pool of all renal transplant recipients followed at our transplant clinic using the matched pair technique. Renal function was estimated by serum creatinine and calculated creatinine clearance. Of the 39 patients with infection 15 had urinary tract infection and 24 had other, mostly bacterial infection, including pneumonia/severe bronchitis in 12, oral/dental infection in 2, gastroenteritis in 2, shunt sepsis in 1, herpes zoster in 1, cytomegalovirus in 1 and other in 5. Mean estimated creatinine clearance plus or minus standard deviation was similar in the infection and control groups at the beginning of the study (51 +/- 22 and 51 +/- 23 ml. per minute, respectively). During the infectious episode mean creatinine clearance significantly decreased to 38 +/- 17 ml. per minute in the infection group. After infection resolved creatinine clearance returned to an almost baseline mean value of 50 +/- 23 ml. per minute. However, after 2 years of followup there was a significant difference in mean creatinine clearance in the infection group versus controls (45 +/- 25 versus 52 +/- 25 ml. per minute, p = 0.022). To our knowledge we have shown for the first time in a prospective controlled study that febrile infectious episodes correlate with poor long-term renal graft function.

Neonatal bone marrow transplantation for severe combined immunodeficiency

AIMSTo evaluate outcome following neonatal bone marrow transplantation (BMT) for severe combined immunodeficiency (SCID) when there is a family history of a previously affected sibling, and to compare results with...