Cases reported "Sepsis"

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1/2. Acquired haemophilia in a patient with gram-negative urosepsis and bladder cancer.

    We here report a patient who developed a high titer antibody to factor viii (FVIII) during gram-negative urosepsis caused by enterobacter cloacae after complete resection of rectal cancer. The patient initially presented with a life threatening spontaneous hematothorax and multiple large haematomas. Coagulation studies revealed a severe FVIII deficiency <1% with a high FVIII antibody titer of 64 BU. The bleeding responded rapidly to infusions of recombinant factor viia. After achievement of a partial remission (FVIII activity 28%) by combined immunosuppressive therapy (prednisone, cyclophosphamide, plasmapheresis and immunoadsorption), subsequently, two relapses occurred following steroid tapering. Resumption of prednisone and cyclophosphamide treatment combined with immunoadsorption induced a second and third remission, respectively. After resection of a papillary carcinoma of the bladder 6 months later and continuous immunosuppressive therapy with cyclophosphamide, FVIII levels remained stable within normal ranges. This clinical course suggests that the cause of inhibitor formation against FVIII resulting in severe acquired haemophilia was multifactorial and was initiated by the gram-negative urosepsis and probably by the underlying malignancies.
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ranking = 1
keywords = enterobacter
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2/2. Acquisition of multiple antibiotic resistance by salmonella dublin from the gramnegative hospital flora, in a kidney allograft recipient.

    The case of a kidney allograft recipient, who suffered from several episodes of salmonella dublin sepsis following massive immunosuppressive therapy to overcome a transplant rejection crisis, is presented. The focus of sepsis was the chronic inflamed gallbladder. The salmonella dublin strain isolated from the blood during the last episode was found to exhibit multiple resistance to antimicrobiol drugs. Because the resistance phenotype was characteristic for the gramnegative flora of the university hospital, it was suggested that transfer of a resistance plasmid, frequently found in gramnegative enterobacterial isolates, to the salmonella strain had occurred in the patient. The comparative examination of a klebsiella pneumoniae strain, representing the hospital flora, and salmonella dublin revealed that both strains produced the aminoglycoside 3'-phosphotransferase type 1, the 2''-nucleotidyltransferase and the 3''-adenylyltransferase, enzymes responsible for resistance to aminoglycoside antibiotics. Furthermore, in both strains a TEM type beta-lactamase was found to render the organism resistant to penicillins and cephalosporins. Transfer experiments showed that the host ranges of the R-plasmids of both strains were identical. Furthermore, both plasmids were found to be the fi type. These data support the view of in vivo transfer of an R-plasmid from the enterobacterial hospital flora to a potential pathogen in a patient.
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ranking = 2
keywords = enterobacter
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