Staphylococcal Septicemia Research Articles

Lupus anticoagulant: a clinical and laboratory diagnostic dilemma

Lupus anticoagulants are a group of diverse autoantibodies that interfere in vitro in phospholipid-dependent clotting tests, and inhibit both the common and intrinsic pathways of coagulation. Paradoxically, they are implicated to cause hypercoagulability, thrombotic events in vivo in varied clinical settings like obstetrics and oncology. A 56-year female was referred to the laboratory with complaint of repeated de novo clotting of drawn plasma samples. She was a post-operative case of surgery for superior mesenteric venous thrombosis, and a previously diagnosed case of squamous cell carcinoma of the buccal mucosa, not on treatment. The patient was evaluated clinically for new onset hypercoagulability and the history of exposure to heparin was negative, which ruled out heparin induced thrombocytopenia. The differential diagnosis were lupus anticoagulant, staphylococcal septicemia, and thrombotic thrombocytopenic purpura. On advanced work up, inhibitor screen was negative, dilute Russell's viper venom time was positive.

An unusual association of disseminated staphylococcal infection in dengue fever

Dengue fever is an important mosquito-borne disease with a highly variable clinical spectrum, ranging from self-limiting mild illness to expanded dengue syndrome (EDS). While the immune-pathogenesis of dengue virus (DENV) infection had been studied thoroughly, the exact mechanism remains elusive. The transient suppression of host innate immunity by DENV might be the likely reason for dengue-associated co-infections and/or superinfections. In addition, the dual infection can worsen the clinical outcome of Dengue fever. We are reporting a case of disseminated staphylococcal infection in a 31-year-old healthy male with a recent dengue infection. Blood culture showed methicillin-sensitive Staphylococcus aureus. Selective IgM deficiency has been proved in this patient, which might explain, the occurrence of disseminated staphylococcal septicemia. This case report highlights the importance of early detection of atypical features and the emerging entity called EDS

Role of Antimicrobial Peptides in Skin Barrier Repair in Individuals with Atopic Dermatitis.

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that exhibits a complex interplay of skin barrier disruption and immune dysregulation. Patients with AD are susceptible to cutaneous infections that may progress to complications, including staphylococcal septicemia. Although most studies have focused on filaggrin mutations, the physical barrier and antimicrobial barrier also play critical roles in the pathogenesis of AD. Within the physical barrier, the stratum corneum and tight junctions play the most important roles. The tight junction barrier is involved in the pathogenesis of AD, as structural and functional defects in tight junctions not only disrupt the physical barrier but also contribute to immunological impairments. Furthermore, antimicrobial peptides, such as LL-37, human β-defensins, and S100A7, improve tight junction barrier function. Recent studies elucidating the pathogenesis of AD have led to the development of barrier repair therapy for skin barrier defects in patients with this disease. This review analyzes the association between skin barrier disruption in patients with AD and antimicrobial peptides to determine the effect of these peptides on skin barrier repair and to consider employing antimicrobial peptides in barrier repair strategies as an additional approach for AD management.

Myocardial abscess – case report of a survivor of a fatal disease

Myocardial abscess is a rare and usually a fatal complication which is often secondary to infective endocarditis but it is relatively a rare manifestation of staphylococcal septicemia especially in pediatric population. Here we are presenting a case of intramural myocardial abscess following right thigh abscessand septicemia caused by MRSA in an immunocompetent child with no structural heart disease. Incision and drainage of thigh abscess with aggressive appropriate antibiotic therapy saved the child despite the fatal myocardial abscess. Even in the absence of Infective endocarditis in staphylococcal septicemia, it is mandatory to look for myocardial abscess for early diagnosis and betteroutcome. A high index of clinical suspicion is required to make a prompt diagnosis.

Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark.

The risk of prenatal, obstetric and birth complications in mothers with atopic dermatitis (AD), along with treatment use during pregnancy, is unknown. To examine the associations between prenatal, obstetric and birth complications in mothers with AD and describe the dermatologic care received during pregnancy. Mother-child pairs, in which the mother had a history of AD, were identified through the Danish Medical Birth Registry and matched 1:10 with non-AD pairs. Data on dermatologic treatment and prenatal, obstetric and birth complications were obtained through linkage via nationwide registers. Multiple logistic regression was performed. We identified 10668 births from 1997 through 2014 to women with AD. Women with a hospital/ambulatory contact for AD during pregnancy had increased topical corticosteroid and ultraviolet therapy use during pregnancy compared to prior. However, overall, women with AD received decreased dermatologic therapy during pregnancy compared to prior. In adjusted analysis, maternal AD was inversely associated with gestational diabetes [OR 0.79, 95% CI (0.68-0.92)], but positively associated with premature rupture of membranes [1.15 (1.05-1.27)] and staphylococcal neonatal septicemia [2.45 (1.33-4.49)]-albeit the latter was rare. These associations did not meet statistical significance in sub-analysis where body mass index data were available. No associations were found with preeclampsia, prematurity or non-staphylococcal neonatal septicaemia. Women with AD during pregnancy mainly used topical corticosteroids and ultraviolet therapy to control their disease. While premature rupture of membranes and staphylococcal neonatal septicaemia were over-represented in maternal AD, no associations were found with any other significant prenatal, obstetric or birth outcome.

A serial echocardiographic study of myocardial abscess in a patient surviving staphylococcal septicemia

2D echocardiography was performed on a 4-year-old child suffering from right thigh abscess due to MRSA infection following diagnosis of pericardial effusion by USG abdomen. It revealed myocardial abscess and pericardial effusion. This child underwent series of 2D echocardiographic studies which showed image appearance of myocardial abscess with its time course of healing.

Experimental phage therapy against lethal lung-derived septicemia caused by Staphylococcus aureus in mice

Nosocomial respiratory infections caused by methicillin-resistant Staphylococcus aureus (MRSA) can progress to lethal systemic infections. Bacteriophage (phage) therapy is expected to be effective against these critical infections. Previously, phage S13′ was proposed as a potential therapeutic phage. We here examined phage treatment in a mouse model of lung-derived septicemia using phage S13′. Intraperitoneal phage administration at 6 h postinfection reduced the severity of infection and rescued the infected mice. Phage S13′ can efficiently lyse hospital-acquired MRSA strains causing pneumonia-associated bacteremia in vitro. Thus, phage therapy may be a possible therapeutic intervention in staphylococcal lung-derived septicemia.

Multiple Subcutaneous Abscesses Complicating Staphylococcus aureus Bacteremia associated with BCG Vaccination

Staphylococcus aureus (S. aureus) is one of the most common causes of pyogenic skin and/or soft tissue infections [1]. In bacterial infections, including staphylococcal infections, transient bacteremia are not rarely observed, in particular in febrile children with the infections, but occult severe infections such as sepsis, endocarditis, pneumonia, osteomyelitis, and disseminated multiple abscesses are uncommon in healthy children with bacteremia [2,3]. S. aureus bacteremia can be caused by various conditions including intramuscular injection. However, latter condition has been rarely described as a cause of staphylococcal abscesses and/or septicemia [4], and there are few case reports of bacteremia and subsequent multiple soft tissue abscesses that were originated from the intradermal injection site. We describe a case which had multiple subcutaneous abscesses on right anterior chest wall and osteomyelitis of left clavicle, caused by S. aureus, 1 week after an intradermal Bacillus Calmette-Guerin (BCG) vaccination.

Myocardial abscess secondary to staphylococcal septicemia: Diagnosis with 3D echocardiography

A 56 years old gentleman with staphylococcal septicemia with metastatic abscesses in spleen and heart. Real time 3D trans thoracic echocardiography could not only confirm the diagnosis of myocardial abscess but also well delineate it and identify adjacent structures.

Causes of mortality among inpatients with systemic lupus erythematosus in a tertiary care hospital in North India over a 10-year period

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with significant morbidity and mortality. The present study was undertaken to identify the causes of in-hospital mortality of patients with SLE. This was a retrospective study. The hospital records of patients with SLE who died between 1998 and 2007 were reviewed. Demographic details, organ involvement, treatment received and evidence of infection were recorded. Disease activity was calculated using the SLE Disease Activity Index. The cause of death of each patient was determined and this information was classified into either deaths caused primarily due to SLE, deaths caused due to infection or those that were multi-factorial. Seventeen patients with SLE who were diagnosed according to the revised American College of Rheumatology criteria died between 1998 and 2007. Fifteen of these patients were female and two were male. The median age was 25 years. The average duration of hospital stay was 10.29 days. Seven patients (41%) died of active SLE (three from pulmonary hemorrhage, two had renal failure, one had myocarditis and one had severe thrombocytopenia with upper gastrointestinal bleed), three patients (18%) died from infections (one contracted Staphylococcal septicemia, another contracted tuberculous meningitis and the third patient had Pseudomonas septicemia) and in seven patients (41%) the etiology was multi-factorial (these showed both active SLE and evidence of infection). In total 10 patients had evidence of infection, two of these were community-acquired and the rest were hospital-acquired. Active SLE and/or infection are the major causes of death in hospitalised patients with SLE. To reduce patient mortality improvements in supportive care for patients with active SLE and measures to prevent hospital-acquired infections are required.

Left Ventricular Aneurysm in a Four-Year-Old Child

We describe spontaneous rupture of a congenital left ventricular (LV) aneurysm with subsequent tamponade and cardiac arrest in a 4-year-old male with staphylococcal septicemia. Emergency resuscitation, thoracotomy, and oversewing were successfully undertaken in the pediatric intensive care unit. There was complete cardiovascular recovery without adverse neurodevelopmental sequelae. This article details the difficulties in determining the etiology of ventricular aneurysms but highlights the importance of attempting to do so, particularly in distinguishing between congenital and acquired forms. Congenital aneurysms are usually a stable pathology; mycotic aneurysms are not and should be managed emergently, as survival after rupture is rare.

Unusual cardiac outcomes of bacteremia due to Staphylococcus aureus infection: a case report

IntroductionPatients on hemodialysis, particularly those with temporary non-tunneled dialysis access, constitute a high-risk population for bloodstream infections associated with significant morbidity and mortality rates. This population also has a high prevalence of cardiovascular diseases with poor prognosis.Case presentationWe report the case of a 62-year-old Caucasian man with end-stage renal disease undergoing hemodialysis, who presented with an eventually lethal case of staphylococcal septicemia with an unusual involvement of the heart, including bacterial coronary arteritis, myocardial abscesses and papillary muscle infarction and rupture, along with complications involving other organs.ConclusionsIt is important to try to minimize invasive procedures in patients who are hemodialysis dependent. The strict control of heart function is indicated considering the large spectrum of unusual cardiac complications.

Omental flap transposition with intra-abdominal relocation for LVAD pump-pocket infection

We report salvage of a left ventricular assist device (LVAD) with a complex pump-pocket infection by intra-abdominal relocation and omental transposition. A 59-year-old diabetic male with valvular cardiomyopathy underwent HeartMate II (Thoratec Corporation, Pleasanton, CA) implantation as a bridge to transplantation. Two months post-operatively he developed staphylococcal septicemia with abscess collection involving the pump pocket. There was no evidence of endocarditis or device vegetations by transesophageal echocardiography.

Opalescent Grouped Vesicles Over the Face: An Important Indicator of Staphylococcal Septicemia

We present a report of three cases with vesicles containing opalescent fluid grouped over the face and scattered on the trunk and limbs. Culture of the fluid aspirated from the vesicles grew Staphylococcus aureus in two of the three cases. The observation of vesicles grouped on the face in a sick febrile child should prompt the diagnosis of a severe staphylococcal septicemia.

Thromboembolism and venous thrombosis of the deep veins in surgical children—an increasing challenge?

Children share many known predisposing risk factors for venous thromboembolism and deep venous thrombosis but appears less common and is probably underestimated. Fatal pulmonary embolism is rare but may also be missed because of low level of clinical awareness. The aim of this study was to investigate children with thromboembolism of deep veins to evaluate risk factors and highlight their danger. MethodsThis was a retrospective review of all children (<13 years old) diagnosed with a venous thromboembolism (1993-2009). Clinical and radiologic features and any risk factors were documented. Venous thromboembolism was diagnosed on clinical suspicion together with compressive Doppler studies, spiral computed tomography, or magnetic resonance scan. ResultsEighteen children with a consistent clinical picture were identified (painful unilateral limb swelling). Their mean age was 9.3 years with a male/female ratio of 3.5:1. Predisposing factors were identified in 17 (95%). These included infective conditions (n = 11), previous femoral line (n = 3), trauma (n = 2), and complicated appendicitis (n = 2). Chronic infective and inflammatory conditions included tuberculosis (n = 4), HIV (n = 3), staphylococcal septicemia (n = 2), and Takayasu arteritis (n = 1). Pulmonary embolism occurred in 5 (28%), and 1 presented later with a post-phlebitic leg. Elevated factor VIII was seen in 3. ConclusionThis study identified an association with known risk factors in most children with venous thromboembolism and suggests that those with femoral venous access or ongoing chronic infective states (eg, TB/HIV) are particularly at risk.

Pleurésie exsudative révélant un anévrisme infectieux de l’aorte abdominale

The development of a sero-sanguinous pleural effusion is a rare, often overlooked, manifestation of a ruptured infected aneurysm of the abdominal aorta. A man of 84years was referred for management of a left-sided pleural effusion associated with symptoms of infection. He had presented two months previously with methicillin resistant staphylococcal septicaemia, the origin of which was a plantar ulcer. The patient was apyrexial and had no abdominal pain. A thoraco-abdominal CT scan without contrast showed a peri-aortic abdominal mass suggesting a tumour. A contrast enhanced scan and peri-aneurysmal aspiration showed that it was an infected aneurysm of the abdominal aorta that had ruptured into the left pleural cavity. The progress was unfavourable despite double antibiotic therapy. In the face of a sero-sanguinous pleurisy, particularly if associated with unexplained symptoms of infection, a search should be made for an abdominal aortic aneurysm. Surgical treatment of the aneurysm should be undertaken if the general condition of the patient and the localisation and morphology of the aneurysm permit.

Renal amyloidosis in a child with chronic granulomatous disease and invasive aspergillosis

A boy who had been diagnosed with chronic granulomatous disease (CGD) at the age of 6.5 years had a medical history of multiple bacterial infections, including pneumonia, staphylococcal liver abscesses and septicemia, from birth. At the age of 10 years and 4 months he developed an infection that was accompanied by high fever and pulmonary, mediastinal and paravertebral infiltrations. Aspergillus niger was cultured on bronchial secretions obtained by bronchoscopy. Shortly thereafter, proteinuria manifested and progressed to the nephrotic level. A skin biopsy indicated a diagnosis of amyloidosis. An anti-fungal treatment with amphotericin B and other agents, along with surgical pus drainage, intravenous leukocyte mass, interferon-gamma and immunoglobulin infusions, was ineffective, and the patient eventually died from multi-organ failure. The postmortem examination revealed the presence of disseminated aspergillosis and systemic amyloidosis. Although no direct evidence is available that would confirm the causative role of aspergillosis in the development of systemic amyloidosis, to the best of our knowledge this is the first report of a CGD case with complications of both invasive aspergillosis and systemic amyloidosis.

Staphylococcal Scalded Skin Syndrome as a Harbinger of Late-onset Staphylococcal Septicaemia in a Premature Infant of Very Low Birth Weight

This article does not have an abstract.

Reticulate keloidal purpura associated with transient antiphospholipid antibodies and hyperhomocysteinaemia

A 66-year-old woman presented with a reticulate pattern of purpuric, keloidal scarring affecting her lower legs and necrosis of her left thumb and little finger as sequelae of an episode of staphylococcal septicaemia. Her premorbid past history includes three miscarriages, three episodes of pulmonary embolism and an internal iliac vein thrombosis. Skin biopsy specimens showed keloidal scar tissue in the dermis but no evidence of thrombosis or vasculitis. Blood tests demonstrated moderate hyperhomocysteinaemia. Elevated levels of anticardiolipin antibodies were found on one occasion but this was not detected on initial or repeat testing.

P700 Comparison of antibiotics susceptibility of different vancomycin-resistant Enterococcus faecium clones

This study analyses staphylococcal septicaemia in a series of 1516 burn patients who were admitted to the burn unit of the Al-Babtain Centre for Burns and Plastic Surgery, Ibn Sina Hospital, Kuwait over a period of 6.5 years (1 June 1992–31 December 1998). One hundred and nine patients (7.2%) developed clinically and microbiologically proven septicaemia, of which 80 (73.4%) showed one or the other type of Staphylococcus in their blood. Fifty (62.5%) of them were males and 30 (37.5%) females, with a mean age of 26 years and the mean total body surface area of burns (TBSA) of 45% (range 1–93%). Preschool age children comprised 27.5% of the patients. Flame was the dominant (80%) cause of burn. Of the 80 patients who had 91 episodes of septicaemia, 52 (65%) had MRSA, 8 (10%) MSSA, 11 (13.8%) MRSE and 5 (6.2%) MSSE and 4 (5%) others had mixed organisms. Only the patients with MRSA had multiple episodes. Eight patients (10%) showed septicaemic episodes within only 48 h of admission; however, the majority of the patients (77.5%) had a septicaemic attack within 2 weeks postburn. Of the 52 MRSA septicaemic cases, 39 (75%) survived and 13 (25%) died. Four patients with septicaemia due to mixed infections died. A total of 19 patients were intubated, 14 due to inhalation injury and 5 because of septicaemia; all in the former group died. Glycopeptide therapy (vancomycin/teicoplanin) was instituted immediately following the detection of staphylococci in the blood. No significant difference was noted in relation to mortality amongst the septicaemic patients, whether or not on prophylactic antibiotic. Fifty-six (70%) of the 80 patients had 139 sessions of skin grafting and survived. Of the 52 MRSA patients, 40 had 101 sessions of skin grafting and 33 of them survived. The apparent low mortality was probably due to early detection of the organism, appropriate antibiotic therapy, care for nutrition and early wound cover. This study indicates a high incidence of staphylococcal septicaemia (especially due to MRSA) in the burn unit. A surface wound is the likely source of entry to the blood stream in these immunocompromised patients. The organism could be detected in blood as early as 48 h postburn and in as little TBSA burn as 1% in this MRSA endemic unit. Inhalation injury with major burns and added staphylococcal septicaemia invariably proved to be fatal.