Septic Reactions Research Articles

Platelet bacterial contamination and the use of a chemiluminescence-linked universal bacterial ribosomal RNA gene probe.

Currently, the maximum outdate for platelets is 5 days, because of the increasing chance of bacterial growth over time. Various methods for rapid detection of bacterial contamination of blood components have been described, with mixed results and no general acceptance. A recently described, molecular biologic approach for the detection of bacterial contamination involves a chemiluminescence-linked universal DNA bacterial probe to a highly conserved bacterial region of ribosomal RNA (rRNA). A multicenter trial of a chemiluminescence-linked universal bacterial rRNA probe for the detection of bacterial contamination in platelet concentrates is described. At each of five sites, platelet concentrates (no older than 1 day from date of phlebotomy) were inoculated in triplicate with isolates of four bacterial species (Pseudomonas aeruginosa, Bacillus cereus, Staphylococcus epidermidis, and Staphylococcus aureus) to a final concentration of 10 to 50 colony-forming units (CFUs) per mL and in triplicate to a final concentration of 1000 CFUs per mL. At one site, an additional 6 platelet concentrates were inoculated with sterile saline to serve as controls. Inoculated units were then subjected periodically to quantitative cultures and probe analyses. A total of 126 platelet concentrates were studied over a period of 7 days (120 inoculated with bacteria and 6 with sterile saline). This assay was, in some cases, able to detect S. aureus bacterial contamination in the range of 100 to 1000 CFUs per mL; the majority of samples (B. cereus, P. aeruginosa, S. aureus, and S. epidermidis) with contamination exceeding 10(4) CFUs per mL; and all samples with contamination of 2.1 x 10(5) CFUs per mL or greater. Increasing the sample size from the recommended 0.4 mL to 1.0 mL resulted in an unacceptable loss of specificity (83.3%). The routine use of this assay would be expected to result in a decreased risk of septic platelet transfusion reactions and could lead to a lengthening of the current 5 day storage period for platelets. Further, the pooling of random-donor platelet concentrates before storage instead of immediately before transfusion may be possible if this rRNA probe is employed to detect bacteria in the pool.

Antibiotic And Steroid Therapy of Massive Systemic Bacillus Calmette-Guerin Toxicity

Intravesical bacillus Calmette-Guerin (BCG) is the most effective treatment of carcinoma in situ available today and is superior to chemotherapy in the prevention of bladder tumor recurrence. While therapy is generally well tolerated, serious and even life threatening toxicity can occur. Treatment options for serious infection include isoniazid, rifampin, ethambutol, and cycloserine, but shock may also be secondary to hypersensitivity and require the addition of corticosteroids. The morbidity and mortality of systemically BCG-infected mice treated with single and combined antimicrobial and/or corticosteroid therapies was evaluated. BCG immunized mice were unable to survive doses of BCG which were uniformly tolerated in naive mice. The addition of cycloserine increased survival in mice treated with isoniazid and rifampin, but optimal survival was achieved with isoniazid, rifampin, and prednisolone. These experimental results support the previously reported clinical success of isoniazid, rifampin and prednisolone in patients with septic BCG reactions.

Septic Reactions to Platelet Transfusions

To determine the medical and laboratory characteristics of bacteremia secondary to transfusion of microbiologically contaminated platelet concentrates. Febrile transfusion reactions were prospectively monitored over 42 months. Units involved in reactions were evaluated with Gram's stain and culture tests. Comprehensive cancer center. Patients receiving platelet transfusions for thrombocytopenia secondary to bone marrow failure. Seven cases of transfusion-associated sepsis were observed. Multidonor platelet products stored for 5 days resulted in an incidence of sepsis five times higher than those stored for 4 days or less (P less than .01). Investigation indicates that contamination most likely occurred at the time of blood collection. Clinically, septic reactions were associated with greater temperature elevations (average increase, 2.0 degrees C) than febrile reactions to sterile products. Contamination of platelet concentrates remains a significant clinical problem. Septic episodes may be reduced by transfusion of platelets with shorter storage intervals.

Septic reactions to platelet transfusions. A persistent problem

Septic reactions to platelet transfusions. A persistent problem

Platelet activating factor is produced during infectious peritonitis in CAPD patients

Peritonitis, a frequent complication of continuous ambulatory peritoneal dialysis (CAPD), is a model of inflammation which provides the opportunity to recover the exudate fluid. To date, various endogenous mediators (histamine, bradykinin, activated complement factors, prostanoids) have been implicated in the mediation of peritoneal inflammation and increased peritoneal permeability. In the present study, a lipid compound with physicochemical and biological characteristics similar to platelet activating factor (PAF) (1-0-alkyl-2-acetyl-sn-glyceryl-3-phosphorylcholine) was extracted in significant amounts from the dialysate of eight out of nine peritonitis episodes in seven CAPD patients (Group A; 6771.4 +/- 3025.9 pM, mean +/- SEM at the first exchange during peritonitis). The amounts of PAF recovered in the first exchange dialysate from patients of Group A were linearly correlated with the loss of albumin (y = -3157.64 + 91.4x; r = 0.7394; N = 9; P less than 0.03) and number of leukocytes (y = 902.45 + 1.52x; r = 0.7576 N = 9; P less than 0.02). PAF was not detectable in the dialysate fluid from patients of Group A after recovery. Twelve patients on CAPD who had no past or present history of peritonitis (Group B) were used as controls; no PAF (9 patients) or only minimal amounts (3 patients: 7.0 pM; 23.0 pM; 70.0 pM) of this mediator were detected. This is the first direct demonstration of the local generation of PAF in a septic inflammatory reaction involving the peritoneal serosa in man. PAF produced by various cell types (neutrophils, peritoneal macrophages, endothelial cells) during peritoneal inflammation may contribute to the increased permeability of the peritoneal vascular bed.

Escherichia coli Sepsis From Contaminated Platelet Transfusion

Transfusion of pooled platelet concentrate (PC) caused a septic reaction characterized by sustained hypotension, high cardiac output, and low systemic vascular resistance. Investigation demonstrated the same strain of Escherichia coli in the patient's blood, the transfused pooled PC, and recalled packed red blood cells separated from the same unit of whole blood as one of the platelet units in the contaminated pool. Five hundred other units of PC from the same supplier were cultured prospectively, and 7% were bacterially contaminated. The level of contamination was 20 or fewer colony-forming units per milliliter in all except one unit, the only one associated with a febrile transfusion reaction. This episode illustrates the continuing importance of sepsis as a cause of platelet transfusion reactions and demonstrates the usefulness of appropriate cultures and epidemiologic information in assessing the source.

Pseudomonas fluorescens bacteremia from blood transfusion

In October 1980, two units of blood contaminated with Pseudomonas fluorescens caused septic tranfusion reactions in two recipients at a Chicago hospital; one patient died. Both units had been purchased from the same blood center. Investigation at the blood center and at other hospitals it supplied revealed another fatal case of P. fluorescens sepsis that had occurred one year earlier. Despite extensive environmental culturing at the blood center, the source of P. fluorescens was not identified. However, comparison of the interval between collection and administration of contaminated and noncontaminated units indicated that prolonged storage was a risk factor that may have caused clustering of cases in one hospital. Laboratory studies showed that small inocula of P. fluorescens proliferated in refrigerated fresh whole blood and reached 10 6 to 10 7 colonyforming units per milliliter seven days after incubation. These data suggest that prolonged storage of blood may be an important risk factor for the development of transfusion-related sepsis.

Diagnostic value of percutaneous transhepatic cholangiography judged by personal experience of 58 patients

During the last seven years percutaneous transhepatic cholangiography (PTC) using a fine needle was performed in 58 patients. The biliary tract was visualised and opacified in the 52 patients with dilated biliary ducts. The correct diagnoses were made in 51 of them. In six patients with a non-dilated biliary system, successful PTC was carried out with the correct diagnoses in four of them. There were four non-fatal complications; two septic reactions, one haemobilia, and one subcapsular haematoma, but all were controlled by conservative treatment alone. The PTC with a fine needle is an accurate, useful and safe procedure of choice for the diagnosis of obstructive jaundice and jaundice of obscure origin. It is useful in distinguishing hepatocellular jaundice from obstructive jaundice thus preventing an unnecessary operation. Failure to visualise the biliary tract by an experienced hand strongly indicates that the jaundice is non-obstructive.

Alterations of mitochondrial structure and energy-linked functions in hemorrhagic shock and endotoxemia.

Gross metabolic aspects of injury have been under intensive study for years and thus a lot of useful information about the metabolic effects of injury is available (l,2). On the other hand, until a couple of years ago, there were hardly any reports about specific cellular metabolic changes occurring during clinical or experimental shock reactions, such as the hypovolemic hemorrhagic shock or the normovolemic, primarily septic shock reaction, endotoxemia. Recently a few reports have appeared in the literature, indicating a block at the mitochondrial level of the cellular metabolic pathway (3–12).

Intraperitoneal hemorrhage caused by strangulation and rupture of a normal ovary in an 8-year-old girl

Summary Torsion and strangulation of a normal ovary and Fallopian tube, complicated by spontaneous rupture of the ovary and severe intraabdominal bleeding, which occurred in an 8-year-old child, is reported. Only one other similar case has been described in the literature. Pain is the most constant symptom, but it is so variable in location, intensity, and duration that it possesses little diagnostic significance. Bimanual rectal and abdominal palpation frequently locates the offending organ and establishes its relationship to the uterus. Neoplastic enlargements of the ovaries can be determined by this maneuver. Torsion and strangulation of the ovary must be differentiated from pelvic peritonitis, acute salpingitis, inflammatory, cystic or neoplastic enlargement of the ovary, intussusception of the bowel, acute appendicitis, and appendiceal abscesses. Crushing clamps or transfixion ligatures should be placed on the gangrenous pedicle proximal to the point of torsion before any attempt is made to release the strangulation or to remove the ovary. This minimizes septic and embolic reactions which may be produced if the material from the degenerating organs be given free access to the systemic circulation. It is imperative that the strangulated structures be studied microscopically, as 38 per cent of all ovarian tumors in children are malignant.

SOME EXPRESSIONS OF ABORTIVE ATTEMPTS AT INSTRUMENTAL ABORTION.

Without doubt, of all the cavities of the gynecean body not intended by nature to be invaded with impunity, the impregnated uterine cavity enjoys the distinction of being the most often explored. This is so, not only because of the many delicate perplexities ofttimes presented for differential diagnosis, but also because of the many other less scientific, but ethically regarded purposes. Most often abortion, with its sequelae, follows these instrumental invasions. Not seldom, and in the hands of skilled operators, these attempts and even repeated attempts to induce abortion prove abortive, much to the surprise of the patient and discomfiture of the operator; the reaction caused by the attempts passes off and pregnancy continues. In a few cases trauma and infection are caused by these attempts, yet pregnancy continues, but sooner or later and before full term is attained, dangerous inflammatory and septic reaction follow from these traumatisms and infection,