RESUMEN
Amatoxins are produced primarily by 3 species of mushrooms: Amanita, Lepiota, and Galerina. Because amatoxin poisonings are increasing, the objective of this review was to identify all amatoxin-containing mushroom species, present a toxidromic approach to earlier diagnoses, and compare the efficacies and outcomes of therapies. To meet these objectives, Internet search engines were queried with keywords to select peer-reviewed scientific articles on amatoxin-containing mushroom poisoning and management. Descriptive epidemiological analyses have documented that most mushroom poisonings are caused by unknown mushrooms, and most fatal mushroom poisonings are caused by amatoxin-containing mushrooms. Amanita species cause more fatal mushroom poisonings than other amatoxin-containing species, such as Galerina and Lepiota. Amanita phalloides is responsible for most fatalities, followed by Amanita virosa and Amanita verna. The most frequently reported fatal Lepiota ingestions are due to Lepiota brunneoincarnata, and the most frequently reported fatal Galerina species ingestions are due to Galerina marginata. With the exception of liver transplantation, the current treatment strategies for amatoxin poisoning are all supportive and have not been subjected to rigorous efficacy testing in randomized controlled trials. All patients with symptoms of late-appearing gastrointestinal toxicity with or without false recovery or quiescent periods preceding acute liver insufficiency should be referred to centers providing liver transplantation. Patients with amatoxin-induced acute liver insufficiency that does not progress to liver failure will have a more favorable survival profile with supportive care than patients with amatoxin-induced acute liver failure, about half of whom will require liver transplantation.
Asunto(s)
Agaricales/química , Amanitinas/envenenamiento , Intoxicación por Setas/diagnóstico , Intoxicación por Setas/terapia , Amanita/química , Insuficiencia Hepática/diagnóstico , Insuficiencia Hepática/microbiología , Insuficiencia Hepática/terapia , Humanos , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/microbiología , Fallo Hepático Agudo/terapia , Trasplante de Hígado/estadística & datos numéricos , Intoxicación por Setas/microbiologíaRESUMEN
ANTECEDENTES: La sepsis por Clostridios es una entidad poco frecuente que conlleva una mortalidad del 8090% a pesar del tratamiento antibiótico y quirúrgico. A pesar de que la mayoría de los casos de septicemia secundaria a Clostridios se originan en el aparato genital femenino tras un aborto séptico, solo un pequeño porcentaje de abortos sépticos (1%) se siguen de septicemia. CASO CLÍNICO: Gestante de 15 semanas que acude a urgencias por rotura prematura de membranas pretérmino. Ante el deseo de la paciente se mantiene actitud conservadora con antibioterapia iv, produciéndose a las pocas horas el aborto de forma espontánea junto con aparición de signos de infección. Rápidamente la paciente evoluciona a sepsis grave, y ante la sospecha de aborto séptico se efectúa histerectomía. Tras la intervención ingresa en situación de shock séptico con insuficiencia renal, hepática y respiratoria. Durante el ingreso se confirma Clostridium perfringens como agente responsable del proceso séptico. Finalmente la paciente es dada de alta definitiva tras seis meses, una vez resueltas las alteraciones derivadas del proceso séptico.
BACKGROUND: Clostridial sepsis is a rare condition which carries a mortality of 80-90% despite antibiotic and surgical treatment. Although most cases of septicemia due to Clostridium are originated in female genital tract after septic abortion, only a small percentage of septic abortions (1%) are followed by septicemia. CLINICAL CASE: Our case is about a 15 weeks pregnant woman attended the emergency room for preterm premature rupture of membranes. Due to the desire of the patient we proceed conservative treatment with antibiotics iv, in the following few hours the abortion develops spontaneously along with signs of infection. Rapidly the patient progresses into a severe sepsis, due to suspected septic abortion, the patient is intervened urgently by hysterectomy. After the intervention she enters into septic shock state with respiratory, kidney and liver failure. During the admission Clostridium perfringens is confirmed as a causative agent for septic process. Finally the patient is discharge after six months once resolved all complications arising from septic process.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Choque Séptico/microbiología , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/diagnóstico , Aborto Séptico/fisiopatología , Choque Séptico/cirugía , Clostridium perfringens , Aborto Séptico/cirugía , Insuficiencia Hepática/microbiología , Insuficiencia Renal/microbiología , HisterectomíaRESUMEN
BACKGROUND: Nearly 20% of tuberculosis (TB) patients die within one year, and TB-related mortality rates remain high in Taiwan. The study aimed to identify factors correlated with TB-specific deaths versus non-TB-specific deaths in different age groups among TB-related mortalities. METHODS: A retrospective cohort study was conducted from 2006-2008 with newly registered TB patients receiving follow-up for 1 year. The national TB database from the Taiwan-CDC was linked with the National Vital Registry System and the National Health Insurance database. A chi-squared test and logistic regression were used to analyse the correlated factors related to TB-specific and non-TB-specific deaths in different age groups. RESULTS: Elderly age (odds ratio [OR] 2.68-8.09), Eastern residence (OR 2.01), positive sputum bacteriology (OR 2.54), abnormal chest X-ray (OR 2.28), and comorbidity with chronic kidney disease (OR 2.35), stroke (OR 1.74) or chronic liver disease (OR 1.29) were most likely to be the cause of TB-specific deaths, whereas cancer (OR 0.79) was less likely to be implicated. For non-TB-specific deaths in patients younger than 65 years of age, male sex (OR 2.04) and comorbidity with HIV (OR 5.92), chronic kidney disease (OR 8.02), stroke (OR 3.75), cancer (OR 9.79), chronic liver disease (OR 2.71) or diabetes mellitus (OR 1.38) were risk factors. CONCLUSIONS: Different factors correlated with TB-specific deaths compared with non-TB-specific deaths, and the impact of comorbidities gradually decreased as age increased. To reduce TB-specific mortality, special consideration for TB patients with old age, Eastern residence, positive sputum bacteriology and comorbidity with chronic kidney disease or stroke is crucial. In particular, Eastern residence increased the risk of TB-specific death in all age groups. In terms of TB deaths among patients younger than 65 years of age, patients with HIV, chronic kidney disease or cancer had a 6-10 times increased risk of non-TB-specific deaths.
Asunto(s)
Enfermedad Hepática en Estado Terminal/epidemiología , Insuficiencia Hepática/epidemiología , Insuficiencia Renal Crónica/epidemiología , Accidente Cerebrovascular/epidemiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , Preescolar , Enfermedad Crónica , Comorbilidad , Enfermedad Hepática en Estado Terminal/microbiología , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/patología , Femenino , Estudios de Seguimiento , Insuficiencia Hepática/microbiología , Insuficiencia Hepática/mortalidad , Insuficiencia Hepática/patología , Humanos , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/microbiología , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/patología , Estudios Retrospectivos , Factores de Riesgo , Esputo/microbiología , Accidente Cerebrovascular/microbiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/patología , Análisis de Supervivencia , Taiwán/epidemiología , Tuberculosis/microbiología , Tuberculosis/mortalidad , Tuberculosis/patología , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/patologíaRESUMEN
OBJECTIVES: High physical activity levels are associated with wide-ranging health benefits, disease prevention, and longevity. In the present study, we examined the impact of regular physical exercise on the severity of organ injury and survival probability, as well as characteristics of the systemic immune and metabolic response during severe polymicrobial sepsis. DESIGN: Animal study. SETTING: University laboratory. SUBJECTS: Male C57BL/6N mice. INTERVENTIONS: Mice were trained for 6 weeks by treadmill and voluntary wheel running or housed normally. Polymicrobial sepsis in mice was induced by injection of fecal slurry. Subsequently, mice were randomized into the following groups: healthy controls, 6 hours postsepsis, and 24 hours postsepsis. MEASUREMENTS AND MAIN RESULTS: Blood and organ samples were collected and investigated by measuring clinical chemistry variables, cytokines, plasma metabolites, and bacterial clearance. Organ morphology and damage were characterized by histological staining. Physical exercise improved survival and the ability of bacterial clearance in blood and organs. The release of pro- and anti-inflammatory cytokines, including interleukin-6 and interleukin-10, was diminished in trained compared to untrained mice during sepsis. The sepsis-associated acute kidney tubular damage was less pronounced in pretrained animals. By metabolic profiling and regression analysis, we detected lysophosphatidylcholine 14:0, tryptophan, as well as pimelylcarnitine linked with levels of neutrophil gelatinase-associated lipocalin representing acute tubular injury (corrected R=0.910; p<0.001). We identified plasma lysophosphatidylcholine 16:0, lysophosphatidylcholine 17:0, and lysophosphatidylcholine 18:0 as significant metabolites discriminating between trained and untrained mice during sepsis. CONCLUSIONS: Regular physical exercise reduces sepsis-associated acute kidney injury and death. As a specific mechanism of exercise-induced adaptation, we identified various lysophosphatidylcholines that might function as surrogate for improved outcome in sepsis.
Asunto(s)
Lesión Renal Aguda/prevención & control , Coinfección/complicaciones , Insuficiencia Hepática/prevención & control , Lesión Pulmonar/prevención & control , Condicionamiento Físico Animal , Sepsis/complicaciones , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/microbiología , Adaptación Fisiológica/inmunología , Animales , Coinfección/mortalidad , Citocinas/metabolismo , Insuficiencia Hepática/metabolismo , Insuficiencia Hepática/microbiología , Lesión Pulmonar/metabolismo , Lesión Pulmonar/microbiología , Masculino , Ratones , Ratones Endogámicos C57BL , Condicionamiento Físico Animal/métodos , Distribución Aleatoria , Sepsis/mortalidad , Análisis de SupervivenciaRESUMEN
The article providing in-depth analysis of pathogenesis of obstructive jaundice shows that this disease is manifest not only as changes at the hepatic level (cholestasis, cholehemia, cholangitis, cholangio- and lymphovenous shunts, hepatic encephalopathy) but also as marked dysbiotic disturbances due to anacholia and toxic metabolites that cause bacterial translocation and endotoxemia complicating liver insufficiency. Based on the literary data and original observations, a new scheme for the treatment of obstructive jaundice is proposed including simultaneous correction of both components of hepatoenteric turnover, also, it permits to improve the outcome of the postoperative period.
Asunto(s)
Traslocación Bacteriana/fisiología , Colangitis/microbiología , Colestasis/microbiología , Endotoxinas/sangre , Contenido Digestivo/microbiología , Insuficiencia Hepática , Ictericia Obstructiva/microbiología , Colangitis/etiología , Colangitis/metabolismo , Colangitis/fisiopatología , Colestasis/etiología , Colestasis/metabolismo , Colestasis/fisiopatología , Terapia Combinada , Descompresión Quirúrgica/efectos adversos , Insuficiencia Hepática/metabolismo , Insuficiencia Hepática/microbiología , Insuficiencia Hepática/fisiopatología , Humanos , Ictericia Obstructiva/complicaciones , Ictericia Obstructiva/metabolismo , Ictericia Obstructiva/fisiopatología , Ictericia Obstructiva/terapia , Complicaciones Posoperatorias/mortalidad , Desintoxicación por Sorción/efectos adversosRESUMEN
No disponible
Asunto(s)
Masculino , Femenino , Adulto , Persona de Mediana Edad , Humanos , Insuficiencia Hepática/microbiología , Hepatitis A/complicaciones , Virus de la Hepatitis A/patogenicidad , MigrantesRESUMEN
No disponible
Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Herpes Simple/complicaciones , Simplexvirus/patogenicidad , Insuficiencia Hepática/microbiología , Choque Séptico/microbiología , Aciclovir/uso terapéuticoRESUMEN
Thirty three cases of death from icterohemorrhagic leptospirosis were clinically and morphologically analyzed. The disease is characterized by the affliction of two major target organs: the kidney and liver. Infectious-toxic shock underlies the pathogenesis of specific fetal complications of icterohemorrhagic leptospirosis. In the latter, acute renal-hepatic failure is always followed by the structural damage and dysfunction of other organs, which are less pronounced and, at the same time, presents multiple organ dysfunction.