Scandinavian journal of infectious diseases. Supplementum
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Scand J Infect Dis Suppl · Jan 1996
ReviewAntibiotics, cytokines, and endotoxin: a complex and evolving relationship in gram-negative sepsis.
Compelling experimental evidence now exists that antimicrobial agents induce the release of endotoxin from Gram-negative bacteria during the process of bacteriolysis. Different antimicrobial classes, particularly those which act upon the outer membrane of bacteria, vary in the amount of free endotoxin released from Gram-negative organisms. ⋯ Complexities in the host-pathogen interactions during actual infection with Gram-negative bacteria may account for the difficulties in demonstrating this phenomena in vivo. This brief review analyses these interactions and defines clinical settings where antibiotic-induced endotoxin release may prove to be clinically relevant.
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Scand J Infect Dis Suppl · Jan 1996
ReviewEvidence for antibiotic-mediated endotoxin release as a contributing factor to lethality in experimental gram-negative sepsis.
Endotoxic lipopolysaccharide (LPS) is a major constituent of the outer membrane of the Gram-negative microbe. Following its release from the bacterium, LPS serves as a potent proinflammatory stimulus by interacting with humoral and cellular mediator systems to stimulate production of an array of inflammatory molecules. Cell-wall active antibiotics are known to promote endotoxin release. ⋯ Lethality data correlate well with circulating levels of interleukin-6 (Il-6) in vivo and with induction of Il-6 in ex vivo studies in which anticoagulated mouse blood is incubated with bacteria and antibiotics. Finally, antiendotoxin agents manifest additional levels of protection in vivo under conditions in which antibiotics alone are not protective. Collectively, these results strongly implicate antibiotic-induced endotoxin release as a significant contributing factor in experimental Gram-negative sepsis.
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Herpes simplex encephalitis (HSE) is a life-threatening condition with high mortality as well as significant morbidity in survivors. In most cases herpes simplex virus type 1 (HSV-1) is responsible for the diseases, however, the type 2 virus (HSV-2) is involved in 4-6% of cases. Primary HSV infection is identified in only one-third of patients with HSE. ⋯ Neurodiagnostic tests which support a presumptive diagnosis of HSE include: CSF analysis, electroencephalography, computer-assisted tomography and magnetic resonance imaging. Although aciclovir is the treatment of choice in HSE, mortality and morbidity still remain problematic. Long-term follow-up indicates that intrathecal cellular and humoral activation persist in HSE.
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Scand J Infect Dis Suppl · Jan 1995
ReviewCommunity-acquired pneumonia requiring hospitalisation. Factors of importance for the short-and long term prognosis.
In 277 patients admitted to hospital for community-acquired pneumonia (CAP) an aetiologic diagnosis was established in 68% with S. pneumoniae being the predominating agent. Four percent of the patients (12/277) died during their hospital stay, and only one of these patients was below 60 years of age. On admission, the most important factor, independently associated with fatal disease was a low serum albumin concentration, which was also a negative prognostic factor for the course of the survivors. ⋯ A high IL-6, but not a high CRP, also seemed to be associated with a higher mortality. The type-specific antibody responses to six pneumococcal capsular polysaccharide antigens included in the 23-valent vaccine as well as antibodies against the vaccine were measured by use of an enzyme-linked immunosorbent assay in 65 middle-aged and elderly individuals treated in hospital for pneumonia eight weeks prior to vaccination. The antibody concentrations before and after the vaccination were comparable with those in a vaccinated age-matched control group who had not recently been treated for pneumonia...
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High-velocity missiles fired from weapons of war cause severe injuries because of the intense energy that they transfer on impact with the living targets. The most important factors in the reduction of morbidity and mortality are first aid, rapid evacuation of victims and early primary surgery. Infection of wounds can arise from skin organisms and from enteric aerobes and anaerobes. ⋯ However, in the prevention of infection, no standard optimal antibiotic regimen or length of treatment has been established. Combination regimens with aminoglycoside antibiotics have been widely used, but single beta-lactam regimens are an attractive alternative because of their wide anti-microbial spectrum and cost effectiveness. Short-term antibiotic regimens are as efficacious as long-term treatment, but certain risk factors must be considered.