Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Mar 2010
Randomized Controlled TrialTreatment with granulocyte-macrophage colony-stimulating factor is associated with reduced indoleamine 2,3-dioxygenase activity and kynurenine pathway catabolites in patients with severe sepsis and septic shock.
The immunoregulatory enzyme indoleamine 2,3-dioxygenase (IDO) controls tryptophan metabolism and is induced by pro-inflammatory stimuli. We investigated whether immunostimulatory treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) influences IDO activity and tryptophan metabolism in sepsis. Thirty-six patients with severe sepsis/septic shock and sepsis-associated immunosuppression (assessed using monocytic human leukocyte antigen-DR (mHLA-DR) expression) were assessed in a controlled trial of GM-CSF or placebo treatment for 8 days. ⋯ Moreover, IDO activity correlated with procalcitonin (p< 0.0001, r = 0.56) and mHLA-DR levels (p = 0.005, r = -0.28) in the overall samples group. Thus, GM-CSF therapy is associated with decreased IDO activity and reduced kynurenine pathway catabolites in sepsis. This may be due to an improved antibacterial defence.
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Scand. J. Infect. Dis. · Mar 2010
The importance of pathogens in sepsis: Staphylococcus aureus story.
Different pathogens cause different outcomes for patients with sepsis. They influence intensive care unit (ICU) mortality, ICU length of stay (ICU LOS) and the need for mechanical ventilation (MV). We undertook a retrospective data-based analysis over a 6-y period. ⋯ Logistic regression analysis showed that after adjustment for APACHE II, the chance of ICU death doubled in the MSSA group (odds ratio 2.166; 95% confidence interval 1.004-4.858). The odds for ICU admission were 8 times higher in MSSA patients. MSSA sepsis should be considered as an independent factor for ICU mortality after adjustment for APACHE II.
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Scand. J. Infect. Dis. · Mar 2010
Case ReportsSerum ivermectin levels after enteral and subcutaneous administration for Strongyloides hyperinfection: a case report.
An AIDS patient was diagnosed with Strongyloides stercoralis hyperinfection complicated by ileus. Serum ivermectin concentrations were very low after rectal administration, but increased after subcutaneous doses. Absorption of rectal ivermectin appears poor, and subcutaneous administration can increase serum levels quickly, which may improve treatment in critically ill patients.