Septic Course Research Articles

Surgical Management of Acute Septic Pericarditis

Four patients with acute septic pericarditis were treated by emergency pericardiectomy through a bilateral anterior thoracotomy. The findings of exudative loculated fluid, extensive granulation tissue and septate adhesions, not only indicated the limitations of antibiotic therapy, but portended the development of subsequent chronic constrictive pericarditis. There was immediate relief of cardiac tamponade and dramatic interruption of the septic course. All have been longterm survivors who have exhibited no postoperative complications. Four patients with acute septic pericarditis were treated by emergency pericardiectomy through a bilateral anterior thoracotomy. The findings of exudative loculated fluid, extensive granulation tissue and septate adhesions, not only indicated the limitations of antibiotic therapy, but portended the development of subsequent chronic constrictive pericarditis. There was immediate relief of cardiac tamponade and dramatic interruption of the septic course. All have been longterm survivors who have exhibited no postoperative complications.

Pasteurella pseudotuberculosis

There are two clinical patterns of human infection with<i>Pasteurella pseudotuberculosis</i>, an animal pathogen having a wide distribution. The more common form presents as a mesenteric lymphadenitis and has been well reported in Europe¹and Canada.²The second form occurs less commonly, presents an acute septic course, and usually ends fatally. There have been three reported cases of the septic form in the United States,^3-5while two other cases have been alluded to in personal communications.^6,7There have been no published reports of sepsis with<i>P pseudotuberculosis</i>in the United States in over 25 years. Recently, in the European literature, autopsy findings in two cases of diabetes mellitus, cirrhosis, and sepsis due to<i>P pseudotuberculosis</i>have been reported.^7,8We have recently seen a patient with diabetes mellitus and hemochromatosis who developed the septicemic form of<i>P pseudotuberculosis</i>and who survived following intensive antibiotic therapy. <h3>Patient</h3>

Pasteurella pseudotuberculosis. Acute sepsis with survival.

There are two clinical patterns of human infection with Pasteurella pseudotuberculosis , an animal pathogen having a wide distribution. The more common form presents as a mesenteric lymphadenitis and has been well reported in Europe 1 and Canada. 2 The second form occurs less commonly, presents an acute septic course, and usually ends fatally. There have been three reported cases of the septic form in the United States, 3-5 while two other cases have been alluded to in personal communications. 6,7 There have been no published reports of sepsis with P pseudotuberculosis in the United States in over 25 years. Recently, in the European literature, autopsy findings in two cases of diabetes mellitus, cirrhosis, and sepsis due to P pseudotuberculosis have been reported. 7,8 We have recently seen a patient with diabetes mellitus and hemochromatosis who developed the septicemic form of P pseudotuberculosis and who survived following intensive antibiotic therapy. Patient

Mixed septicemias and gastrointestinal disease.

Mixed bacterial species were recovered from blood cultures of 32 patients, of whom 21 were classified as having probable, 7 possible, and 4 improbable mixed septicemias. Those with probable mixed septicemia were characterized by a high incidence of alcoholism, hepatic and gastrointestinal disease; by a severely septic course, and high mortality rate (81%), despite vigorous antibiotic therapy. Mixed septicemia has been described most often in association with leukemia and gastrointestinal disease. Therefore the recovery of mixed bacterial species from blood cultures should alert the physician to the possible presence of such conditions.

Fatal systemic moniliasis following pancreatitis.

Candida albicans and related organisms rarely produce septicemia and widespread lesions which can be considered the immediate cause of death. The patient reported here developed C. albicans septicemia while recovering from severe pancreatitis. Broadspectrum antibiotics given during the acute episode of pancreatitis probably allowed this organism to establish itself in necrotic areas of the pancreas and peripancreatic tissues. Oral nystatin* therapy failed to influence the rapidly fatal septic course. Report of a Case A 68-year-old single, white, retired laborer was admitted to the King County Hospital on Sept. 18, 1955, complaining of severe pain throughout the abdomen of 14 hours' duration. He had also noted low back pain and had vomited several times. He recalled two similar episodes within the preceding two years, but otherwise had been in good health. No dietary or alcoholic excess preceded the onset of abdominal pain. The patient was moderately obese and appeared acutely ill.

SUPPURATIVE INTRATHORACIC THYROIDITIS

Although intrathoracic goiter is relatively frequent, its complication by suppuration is exceedingly rare. In a careful review of the literature, the only case found was one reported by Kalbfleisch1in 1920, in which the condition occurred in a young woman following a spontaneous abortion. Gas bacilli were present in the uterine secretions, although no local infection was observed. In the course of her illness, it was noted that a substernal goiter was present. In view of the septic course and local symptoms referable to the goiter, the diagnosis of either a complicating suppuration or a hemorrhage into the thyroid was considered. Operation was performed, and a suppurative intrathoracic goiter due to gas bacilli was found. Drainage was instituted, and recovery followed. Acute thyroiditis has often been observed. Clute and Lahey2described two types: (1) simple thyroiditis, which is more common, usually follows infection of the upper respiratory tract

BILATERAL GANGRENE OF THE FEET FOLLOWING TONSILLECTOMY

A search of the literature has failed to reveal a single instance which parallels the case herein reported. Three features, each a most unusual sequel of tonsillectomy, are outstanding: (<i>a</i>) a markedly septic course with development of a heart murmur, (<i>b</i>) bloody stools and (<i>c</i>) gangrenous areas on both feet, involving the toes, followed by clinical recovery except for a residual systolic cardiac murmur and the loss of one toe. <h3>REPORT OF CASE</h3> <i>History</i>.—J. R., a girl, aged 2 years, 3 months, of Italian parentage, was admitted to the hospital for tonsillectomy and adenoidectomy on March 3, 1928. At that time the heart was of normal size and shape and murmurs were not heard; except for hypertrophied tonsils and adenoids the results of the physical examination were negative. The past history of the child was that of a normal, healthy child without previous illnesses, except for repeated attacks of

Intrapartum and postpartum streptococcus septicemia of extrapelvic origin

I T HE occurrence of a systemic infection arising from an extrapelvic focus and accompanying labor and the puerperium is unique and warrants report. CASE No. 446, 1921.-Mrs. J. M., para vi, was admitted in labor to Dr. Polak% Service at the Long Isl,and College’ Hospital on January 26th, 1921. The patient had been under supervision in the prenatal clinic for three months. Previous labors and pregnancies normal. I?resent prsegnancy uneventful until three days before admission at which time she complained of cough and sore throat. Lab’or began noon January 26th. Notification of same at R:15 P. M. Seen by outpatient service at 9 P. 1~. Exammation showed temperature 102, pulse 116, respirations 24; face flushed; pharynx injected, few subcrepitant rales over both bases. Presentation R. S. A.; cervix 3 cm.; pains every four minutes. Admitted to hospital at 11:30 P. X. with similar findings. Blood count showed 9000 white cells, polys 53 per cent. Labor proceeded s,atisfactorily. At S:50 A. M. (l/27) membranes rupturled spontaneously and living female was delivered spontaneously wi& the next two aontractions. Third stage uneventful. Child weighed 3100 gm.; cried spontaneously but remained cyanotic. The progress of labor was followed throughout by rectal examination. One hour after delivery tempelrature was 104, pulse 130, respiration 38. At this time throat showed white patch on left tonsil in addition to marked injection. Chest showed persistent rbles. Ssecond blood count 12 hours after labor showed (white eells, 24,000, polys 85 per clsnt; high for physiological count). The puerperium was stormy and prolonged and can for purposes of brevity be, divided into three phases. The first periled includes the 1st to 3rd days postpartum. In. this interval the clinical course was characterized by absenee of subjective &symptoms. The physical signs in pharynx and iungs remained unchanged and uterine involution progressed normally. The temperature, however, continued a septic course and varied between 100s and 1042. , pulse persisted between 120 and 140 and respiration b,etween 30 and 40 (see Fig. 2). Laboratory Data :