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PubMed1986

Septic thrombosis of the dural venous sinuses.

From 1940 to 1984, 19 cases of septic dural-sinus thrombosis have been diagnosed at the Massachusetts General Hospital, and some 136 cases have been reported from other institutions. Septic thrombosis most frequently involves the cavernous sinuses (96 cases). Facial or sphenoid air sinus infection often precede cavernous-sinus disease. In addition to the classical signs of proptosis, chemosis, and oculomotor paralysis, isolated sixth-nerve palsy and hypo- or hyperesthesia of the fifth nerve may be found. The major pathogens associated with cavernous-sinus infection include Staphylococcus aureus, other gram-positive organisms, and anaerobes. Septic lateral-sinus thrombosis (64 cases) is almost exclusively a complication of otitis media and/or mastoid infection. Organisms causing this infection include Proteus species, Escherichia coli, S. aureus, and anaerobes. Septic thrombosis of the superior sagittal sinus (23 cases) most frequently accompanies bacterial meningitis or air sinus infection. Causative organisms include Streptococcus pneumoniae, S. aureus, other streptococci, and Klebsiella species. Because septic dural-sinus thrombosis is rare, this disease is frequently misdiagnosed. Evaluation should include lumbar puncture, air sinus films, and computed tomographic scan with contrast. Other helpful diagnostic tests may include carotid angiography, and dynamic brain scan. Orbital venography is the most definitive study in cases of chronic cavernous-sinus thrombosis. Therapy should include intravenous antibiotics and early surgical drainage of purulent exudate in the air sinuses or mastoid regions. Retrospective analysis suggests that treatment with heparin may reduce mortality in carefully selected cases of septic cavernous-sinus thrombosis. Anticoagulation is not recommended in other forms of septic dural-sinus thrombosis. Mortality in the antibiotic-era remains high, particularly in patients with septic thrombosis of the cavernous (30%) and superior sagittal (78%) sinuses.

Adolescent↗
PubMed1964

ACUTE PURULENT MENINGITIS IN CHILDREN: EXPERIENCE AT THE HOSPITAL FOR SICK CHILDREN, TORONTO.

Sixty-eight children with acute purulent meningitis were treated at The Hospital for Sick Children, Toronto, in 1962; nine deaths occurred. Hemophilus influenzae type B and meningitis in which no organism was cultured accounted for 35 and 17 cases, respectively. A number of other etiological agents caused six or fewer cases each.The principal presenting complaints were fever and vomiting, the more familiar symptoms of meningeal irritation occurring in 20% or less. A short duration of onset suggested a more severe illness and graver prognosis. Seven of the nine fatal cases had a presenting history of less than 24 hours' duration. Persisting high fever, convulsions, cyanosis and abdominal distension were also associated more specifically with the fatal cases.The laboratory examination of the initial spinal fluid sample, while of value in the identification of the causative organism, was not of prognostic value.The value of general treatment measures, as well as specific therapy, was evident in all cases.

Cerebrospinal Fluid↗
PubMed1984

Endotoxemia induced by antibiotic therapy: a mechanism for adrenal corticosteroid protection in gram-negative sepsis.

The following have been demonstrated: With a standardized model of P. mirabilis peritonitis in ICR mice, when optimal doses of an aminoglycoside antibiotic (kanamycin) are given so as to reduce mortality maximally, abrupt and significant increments occur in endotoxemia, which cannot be attributed to impairment of clearance of endotoxin. Within the antibiotic-treated groups, these increments in endotoxemia correlate with mortality. The level of endotoxemia in the antibiotic-treated survivors is significantly greater than in animals dying without antibiotic therapy. MP, although unable to reduce mortality from P. mirabilis peritonitis in the absence of antibiotic therapy, does so when endotoxin is added to the challenge inoculum. It is concluded from these observations that aminoglycoside antibiotic treatment can shift the lethal mechanisms during P. mirabilis peritonitis from those involving bacterial proliferation and low levels of endotoxemia to those involving bacterial death and release of large amounts of endotoxin. It is postulated that this shift in lethal mechanisms could account for the ability of MP to reduce mortality when used in conjunction with antibiotics. Finally, since animals surviving after antibiotic treatment have significantly greater endotoxemia than those dying without such treatment and since MP does not reduce mortality in the absence of antibiotic therapy but does so if endotoxin is added to the challenge inoculum, it appears that endotoxin may not play a critical role in the pathogenesis of mortality from untreated P. mirabilis peritonitis. Whether the present correlation observed between the significant rises in endotoxemia produced by antibiotics and the protection afforded by MP extends to other models of gram-negative sepsis, or to human gram-negative sepsis, is under study.

Animals↗
PubMed1976

Animal models of peritonitis.

A reproducible animal model of peritonitis has been developed. It uses standard animals, standardized cultures of bacteria and simple techniques. Use of this model would facilitate comparison of data from workers in this field. The use of small rodents permits the use of comparatively large populations for statistical evaluation. The method is cheap and economic of laboratory space and does not require surgical expertise.

Animals↗
PubMed1991

Bacterial colonization behaviour: a new virulence strategy in urinary infections?

The urinary bladder resists bacterial colonization and infection by a number of mechanisms, one of which involves the sloughing of colonized uroepithelial cells. Pathogens which thus become detached from bladder tissue are rapidly eliminated upon voiding of urine. During a recent study of bacterial colonization by the urinary pathogen, Proteus mirabilis, we noted that it colonized glass surfaces such that organisms became widely and evenly dispersed over the surface. In contrast, Pseudomonas fluorescens, a non-pathogen in the urinary tract, did not disperse over the surface but colonized and grew in such a manner as to form small clumps or microcolonies. Other investigators have also shown that Escherichia coli, a common urinary pathogen, initially colonizes bladders in a random, widely-dispersed fashion. We propose that successful bladder pathogens will predominantly adopt colonization behaviour that enables them to widely disperse over bladder tissue and, in so doing, avoid being cleared by the desquamation of uroepithelial cells. Colonization behaviour would therefore represent a previously uncharacterized virulence strategy.

Bacterial Adhesion↗
PubMed1982

[Compared studies of antimicrobial agents against E. coli, Klebsiella, Citrobacter and Proteus isolated from urinary tract infections].

In vitro activities of antibacterial agents against E. coli, Klebsiella, Citrobacter and Proteus which were isolated from patients urinary tract infections at 8 hospitals in Japan, were investigated by agar dilution method from July to October in 1979. The summarized results are as follows. 1. Among oral antibacterial agents, MPC and PPA have showed potent antibacterial activities against E. coli and Klebsiella. Among parenteral antibiotics, CTM was the most active against E. coli and Klebsiella. However, ABPC-resistant E. coli and Klebsiella have appeared to occupy about 40% and 96% of bacteria isolated from urinary tract infections, respectively. 2. In vitro activities of antibacterial agents against Proteus and Citrobacter showed not so potent. 3. Causative organisms in female patients with simple urinary tract infections were mainly E. coli and Klebsiella. 4. Among oral antibacterial agents, PPA have shown similar antimicrobial activities against E. coli isolated from simple and complicated urinary tract infections. ABPC and MPC have been influenced in some degree by these factors. However, parenteral antibiotics are not influenced by these factors. On the other hand, in vitro activities of antibacterial agents against Klebsiella isolated from simple and complicated urinary tract infections were similar.

Adult↗