| Septic shock in coccidioidomycosis. | |
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MedLine Citation:
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PMID: 9428544 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To describe the clinical and laboratory parameters of patients with septic shock following infection with Coccidioides immitis, estimate the incidence of septic shock from coccidioidomycosis, and outline clues that may be helpful in early diagnosis of this syndrome. DESIGN: Retrospective, descriptive case series. SETTING: A 250-bed general public hospital in Kern County, CA. PATIENTS: Eight patients diagnosed with septic shock from infection with C. immitis from September 1991 to December 1993. Five were Hispanic, two were Filipino, and one was African-American. The diagnosis of C. immitis was made by microscopic examination and culture of the organism from sputum or other sites. Septic shock was diagnosed using criteria formulated by the American College of Chest Physicians Consensus Conference/Society of Critical Care Medicine. MEASUREMENTS AND MAIN RESULTS: No patient had traditional immunocompromising conditions. All patients had pulmonary symptoms and were symptomatic for a mean duration of 19.4 +/- 19.8 days before admission. One patient presented with septic shock and the remaining seven developed shock during their hospital course. Serology for coccidioidomycosis was positive in six patients. The mean cardiac index was 5.8 +/- 1.9 (SD) L/min/m2, the mean arterial pressure was 71.0 +/- 16.7 mm Hg, the mean pulmonary artery occlusion pressure was 16.9 +/- 3.5 mm Hg, and the mean systemic volume resistance index was 846.6 +/- 224.1 dyne-sec/cm5xm2. All patients developed acute respiratory distress syndrome. Coccidioidomycosis was recognized or considered in only five of eight patients before they developed septic shock. Despite therapy with amphotericin B, all patients died. One patient died of progressive pulmonary disease, two patients suffered an acute arrest, and five patients developed progressive multiple organ system failure and died with additional organ involvement. CONCLUSIONS: Septic shock following infection with C. immitis is an ominous yet underrecognized condition. Hemodynamic parameters and cytokine concentrations were not significantly different from values seen in gram-negative septic shock. Clinical clues to the diagnosis include duration of illness and conspicuous pulmonary involvement. Patient outcome in this series was poor but may improve with increased recognition of septic shock in infections from C. immitis. |
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Authors:
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E L Arsura; P L Bellinghausen; W B Kilgore; J J Abraham; R H Johnson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 26 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 1998 Jan |
Date Detail:
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Created Date: 1998-01-28 Completed Date: 1998-01-28 Revised Date: 2009-11-19 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 62-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Kern Medical Center, Bakersfield, CA 93305, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Amphotericin B / therapeutic use Antibodies, Fungal / analysis Antifungal Agents / therapeutic use Case-Control Studies Coccidioides / isolation & purification* Coccidioidomycosis / complications*, drug therapy, pathology Female Humans Lung Diseases, Fungal / drug therapy, microbiology*, pathology Male Middle Aged Respiratory Distress Syndrome, Adult / drug therapy, microbiology, pathology Retrospective Studies Shock, Septic / drug therapy, microbiology*, pathology Sputum / microbiology Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Fungal; 0/Antifungal Agents; 1397-89-3/Amphotericin B |
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