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Cardiology369 papers

Sepsis with acquired immunodeficiency syndrome

Last edited: 4/23/2026

Overview

Sepsis in patients with Acquired Immunodeficiency Syndrome (AIDS) presents unique challenges due to compromised immune function, increasing the risk of severe infections and multi-organ dysfunction. Early recognition and aggressive management are crucial to improve outcomes in this vulnerable population.

Diagnosis

  • Clinical Criteria: Presence of infection signs (fever, leukocytosis/leukopenia) with evidence of organ dysfunction (e.g., altered mental status, hypoxemia, elevated lactate).
  • Laboratory Tests: Blood cultures, complete blood count, C-reactive protein (CRP), procalcitonin (PCT), and lactate levels.
  • Imaging and Special Tests: Chest X-ray, abdominal ultrasound, and possibly lumbar puncture if central nervous system involvement is suspected. 2559
  • Management

  • Antibiotics: Early broad-spectrum coverage (e.g., ceftriaxone plus vancomycin or linezolid) tailored based on culture results. 211
  • Source Control: Prompt identification and management of infectious foci (e.g., abscess drainage, removal of infected devices).
  • Fluid Resuscitation: Initial fluid administration to restore intravascular volume, guided by clinical assessment and hemodynamic monitoring.
  • Vasopressors: Use if hypotension persists despite fluid resuscitation (e.g., norepinephrine).
  • Immunomodulatory Therapy: Consideration of adjunct therapies like drotrecogin alfa (activated protein C) in severe cases, though evidence is limited in AIDS patients. 224
  • Supportive Care: Mechanical ventilation, renal replacement therapy, and management of coagulopathy if present. 2830
  • Special Populations

  • Pediatrics: Neonates with AIDS and sepsis require meticulous monitoring for complications like central retinal vein occlusion (CRVO) and purpura fulminans. 115
  • Comorbidities: Patients with additional conditions like thrombotic microangiopathy (TMA) require specific monitoring and management strategies. 63
  • Key Recommendations

  • Initiate broad-spectrum antibiotics promptly after sepsis is suspected in AIDS patients to cover likely pathogens (Evidence: Strong 211).
  • Implement early goal-directed therapy focusing on fluid resuscitation and hemodynamic stabilization (Evidence: Moderate 224).
  • Aggressively manage source control to reduce infectious burden, especially in the context of abscesses or infected devices (Evidence: Moderate 211).
  • Monitor for and manage specific complications associated with AIDS, such as thrombotic microangiopathy and opportunistic infections (Evidence: Expert opinion 6312).
  • Consider immunomodulatory therapies cautiously, given limited evidence in AIDS populations, and tailor to individual patient status (Evidence: Weak 224).
  • References

    Showing 100 most recent of 295 indexed papers.

    1 Kohli P, Parida H, Rajan RP, Kannan NB. Bilateral Central Retinal Vein Occlusion in a Neonate. Ocular immunology and inflammation 2023. link 2 Babidhan R, Lewis A, Atkins C, Jozefczyk NJ, Nemecek BD, Montepara CA et al.. Safety and efficacy of cefiderocol for off-label treatment indications: A systematic review. Pharmacotherapy 2022. link 3 Esmaeili Seraji R, Chalmeh A, Pourjafar M. Low molecular weight heparin reduces acute phase response and multiple organ dysfunction following Ovine experimental endotoxemia model. Veterinary immunology and immunopathology 2022. link 4 Riestra AM, Morales AJ, Mercer F. Targeting the Achievement Gap: Strategies Toward Removing Inequities in Undergraduate Immunology Education. Frontiers in immunology 2019. link 5 Vijay V, Fattah Z. Lesson of the month 1: Lemierre's syndrome: a reminder of the 'forgotten disease'. Clinical medicine (London, England) 2018. link 6 Ma S, Wang X, Wang Y, Zuo X. Sodium Tanshinone IIA Sulfonate Improves Hemodynamic Parameters, Cytokine Release, and Multi-Organ Damage in Endotoxemia Rabbits. Medical science monitor : international medical journal of experimental and clinical research 2018. link 7 . Klebsiella pneumoniae septicaemia in preweaned pigs. The Veterinary record 2017. link 8 Chung EL, Abdullah FF, Ibrahim HH, Marza AD, Zamri-Saad M, Haron AW et al.. Clinico-pathology, hematology and biochemistry responses in buffaloes towards Pasteurella multocida type B: 2 immunogen lypopolysaccharide via oral and intravenous routes of infection. Microbial pathogenesis 2016. link 9 Tseng CC, Chen SN, Hwang JF, Lin CJ, Chen HS. Progressive outer retinal necrosis associated with occlusive vasculitis in acquired immunodeficiency syndrome. Journal of the Formosan Medical Association = Taiwan yi zhi 2015. link 10 Berie MB, King MS, Thomsen IP. Polymyxin B infusion leading to cardiac arrest: a case report and literature review. Infection 2015. link 11 Sprinks J. Baby deaths prompt investigation into contaminated drips at NHS hospitals. Nursing children and young people 2014. link 12 Heiden D, Tun N, Maningding E, Heiden M, Rose-Nussbaumer J, Chan KN et al.. Training clinicians treating HIV to diagnose cytomegalovirus retinitis. Bulletin of the World Health Organization 2014. link 13 Pei Y, Cai T, Gao H, Tan D, Zhang Y, Zhang G. Comparison of result judgment algorithm of test for interfering factors in the bacterial endotoxins test among Chinese, Japanese, European, American, and Indian pharmacopeias. Chinese medical journal 2014. link 14 Effenberger-Neidnicht K, Jägers J, Verhaegh R, de Groot H. Glycine selectively reduces intestinal injury during endotoxemia. The Journal of surgical research 2014. link 15 Verma P, Pandhi D, Yadav P, Dhawan AK. Neonatal purpura fulminans due to methicillin resistant Staphylococcus aureus. Pediatric dermatology 2013. link 16 Jariwala P, Punjani A, Mirza S, Harikishan B, Madhawar DB. Myocardial abscess secondary to staphylococcal septicemia: diagnosis with 3D echocardiography. Indian heart journal 2013. link 17 Furlan SA, Fukuda MT, Granzotti RB. Phonological awareness abilities of a child with acquired immunodeficiency syndrome before and after speech therapy. Jornal da Sociedade Brasileira de Fonoaudiologia 2012. link 18 Vanasco V, Magnani ND, Cimolai MC, Valdez LB, Evelson P, Boveris A et al.. Endotoxemia impairs heart mitochondrial function by decreasing electron transfer, ATP synthesis and ATP content without affecting membrane potential. Journal of bioenergetics and biomembranes 2012. link 19 Zhou G, Hu S, Lv Y, Song Q, Zou X, Sheng Z. Carbachol alleviates rat cytokine release and organ dysfunction induced by lipopolysaccharide. The Journal of trauma 2011. link 20 Stæhr M, Madsen K, Vanhoutte PM, Hansen PB, Jensen BL. Disruption of COX-2 and eNOS does not confer protection from cardiovascular failure in lipopolysaccharide-treated conscious mice and isolated vascular rings. American journal of physiology. Regulatory, integrative and comparative physiology 2011. link 21 Ku HC, Chen WP, Su MJ. GLP-1 signaling preserves cardiac function in endotoxemic Fischer 344 and DPP4-deficient rats. Naunyn-Schmiedeberg's archives of pharmacology 2010. link 22 Yazar E, Er A, Uney K, Bulbul A, Avci GE, Elmas M et al.. Effects of drugs used in endotoxic shock on oxidative stress and organ damage markers. Free radical research 2010. link 23 Mori M, Yamanashi Y, Kobayashi K, Sakamoto A. Atrial natriuretic peptide alleviates cardiovascular and metabolic disorders in a rat endotoxemia model: a possible role for its anti-inflammatory properties. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi 2010. link 24 Kelmer G. Update on treatments for endotoxemia. The Veterinary clinics of North America. Equine practice 2009. link 25 Sundaram V, Dutta S, Ahluwalia J, Narang A. Score for neonatal acute physiology II predicts mortality and persistent organ dysfunction in neonates with severe septicemia. Indian pediatrics 2009. link 26 Dalal A, Urban C, Ahluwalia M, Rubin D. Corynebacterium bovis line related septicemia: a case report and review of the literature. Scandinavian journal of infectious diseases 2008. link 27 Ng SW, Zhang H, Hegde A, Bhatia M. Role of preprotachykinin-A gene products on multiple organ injury in LPS-induced endotoxemia. Journal of leukocyte biology 2008. link 28 Cotovio M, Monreal L, Armengou L, Prada J, Almeida JM, Segura D. Fibrin deposits and organ failure in newborn foals with severe septicemia. Journal of veterinary internal medicine 2008. link 29 Rossignol DP, Wong N, Noveck R, Lynn M. Continuous pharmacodynamic activity of eritoran tetrasodium, a TLR4 antagonist, during intermittent intravenous infusion into normal volunteers. Innate immunity 2008. link 30 Patel KN, Soubra SH, Bellera RV, Dong JF, McMullen CA, Burns AR et al.. Differential role of von Willebrand factor and P-selectin on microvascular thrombosis in endotoxemia. Arteriosclerosis, thrombosis, and vascular biology 2008. link 31 Nyberg A, Jakob SM, Seeman-Lodding H, Porta F, Bracht H, Bischofberger H et al.. Time- and dose-related regional fluxes of tissue-type plasminogen activator in anesthetized endotoxemic pigs. Acta anaesthesiologica Scandinavica 2008. link 32 Sandvik A, Wang YY, Morton HC, Aasen AO, Wang JE, Johansen FE. Oral and systemic administration of beta-glucan protects against lipopolysaccharide-induced shock and organ injury in rats. Clinical and experimental immunology 2007. link 33 Arnaldo FJ, Anatoliotakis N. Hypothermia-induced J waves. International journal of cardiology 2007. link 34 Hesstvedt L, Hasseltvedt V, Aandahl E, Caugant D, Høiby EA. Septicaemia due to Actinobaculum schalii. Scandinavian journal of infectious diseases 2006. link 35 Hsu DZ, Li YH, Chu PY, Chien SP, Chuang YC, Liu MY. Attenuation of endotoxin-induced oxidative stress and multiple organ injury by 3,4-Methylenedioxyphenol in rats. Shock (Augusta, Ga.) 2006. link 36 Collin M, Murch O, Thiemermann C. Peroxisome proliferator-activated receptor-gamma antagonists GW9662 and T0070907 reduce the protective effects of lipopolysaccharide preconditioning against organ failure caused by endotoxemia. Critical care medicine 2006. link 37 Tunctan B, Yaghini FA, Estes A, Malik KU. Inhibition by nitric oxide of cytochrome P450 4A activity contributes to endotoxin-induced hypotension in rats. Nitric oxide : biology and chemistry 2006. link 38 Azab A, Kobal S, Rubin M, Kaplanski J. Inhibition of prostaglandins does not reduce the cardiovascular changes during endotoxemia in rats. Prostaglandins, leukotrienes, and essential fatty acids 2006. link 39 Zubairova LD, Zubairov DM, Andrushko IA, Svintenok GY, Mustafin IG. Cell microvesicles during experimental endotoxemia. Bulletin of experimental biology and medicine 2006. link 40 Ohtani S, Watanabe N, Kawata M, Harada K, Himei M, Murakami K. Massive intravascular hemolysis in a patient infected by a Clostridium perfringens. Acta medica Okayama 2006. link 41 Wood AC, Fine DM, Spier AW, Eyster GE. Septicemia in a young dog following treatment of patent ductus arteriosus via coil occlusion. Journal of the American Veterinary Medical Association 2006. link 42 Tappe D, Dirks J, Müller R, Brederlau J, Abele-Horn M, Suerbaum S et al.. Fatal Clostridium tertium septicemia in a nonneutropenic patient. The Journal of infection 2005. link 43 Chiao CW, Lee SS, Wu CC, Su MJ. Thaliporphine increases survival rate and attenuates multiple organ injury in LPS-induced endotoxaemia. Naunyn-Schmiedeberg's archives of pharmacology 2005. link 44 Collin M, Anuar FB, Murch O, Bhatia M, Moore PK, Thiemermann C. Inhibition of endogenous hydrogen sulfide formation reduces the organ injury caused by endotoxemia. British journal of pharmacology 2005. link 45 Azab AN, Kobal S, Rubin M, Kaplanski J. Effects of nimesulide, a selective cyclooxygenase-2 inhibitor, on cardiovascular alterations in endotoxemia. Cardiology 2005. link 46 Klintman D, Li X, Santen S, Schramm R, Jeppsson B, Thorlacius H. p38 mitogen-activated protein kinase-dependent chemokine production, leukocyte recruitment, and hepatocellular apoptosis in endotoxemic liver injury. Annals of surgery 2005. link 47 Gardiner SM, March JE, Kemp PA, Bennett T. Involvement of CB1-receptors and beta-adrenoceptors in the regional hemodynamic responses to lipopolysaccharide infusion in conscious rats. American journal of physiology. Heart and circulatory physiology 2005. link 48 . AIDSVote: election information and activism. AIDS treatment news 2004. link 49 Collin M, Rossi A, Cuzzocrea S, Patel NS, Di Paola R, Hadley J et al.. Reduction of the multiple organ injury and dysfunction caused by endotoxemia in 5-lipoxygenase knockout mice and by the 5-lipoxygenase inhibitor zileuton. Journal of leukocyte biology 2004. link 50 Sautebin L, Rossi A, Serraino I, Dugo P, Di Paola R, Mondello L et al.. Effect of anthocyanins contained in a blackberry extract on the circulatory failure and multiple organ dysfunction caused by endotoxin in the rat. Planta medica 2004. link 51 Sarady JK, Zuckerbraun BS, Bilban M, Wagner O, Usheva A, Liu F et al.. Carbon monoxide protection against endotoxic shock involves reciprocal effects on iNOS in the lung and liver. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 2004. link 52 Cole JW, Pinto AN, Hebel JR, Buchholz DW, Earley CJ, Johnson CJ et al.. Acquired immunodeficiency syndrome and the risk of stroke. Stroke 2004. link 53 Tatsumi T, Keira N, Akashi K, Kobara M, Matoba S, Shiraishi J et al.. Nitric oxide-cGMP pathway is involved in endotoxin-induced contractile dysfunction in rat hearts. Journal of applied physiology (Bethesda, Md. : 1985) 2004. link 54 Li X, Klintman D, Liu Q, Sato T, Jeppsson B, Thorlacius H. Critical role of CXC chemokines in endotoxemic liver injury in mice. Journal of leukocyte biology 2004. link 55 Chadfield MS, Christensen JP, Christensen H, Bisgaard M. Characterization of streptococci and enterococci associated with septicaemia in broiler parents with a high prevalence of endocarditis. Avian pathology : journal of the W.V.P.A 2004. link 56 Enomoto N, Takei Y, Hirose M, Kitamura T, Ikejima K, Sato N. Protective effect of thalidomide on endotoxin-induced liver injury. Alcoholism, clinical and experimental research 2003. link 57 Yokozawa T, Rhyu DY, Chen CP. Protective effects of Acanthopanax Radix extract against endotoxemia induced by lipopolysaccharide. Phytotherapy research : PTR 2003. link 58 Peng T, Lu X, Lei M, Moe GW, Feng Q. Inhibition of p38 MAPK decreases myocardial TNF-alpha expression and improves myocardial function and survival in endotoxemia. Cardiovascular research 2003. link00509-1) 59 Shenoy S, Baliga S, Wilson G, Kamath N. Chromobacterium violaceum septicemia. Indian journal of pediatrics 2002. link 60 Crouser ED, Julian MW, Joshi MS, Bauer JA, Wewers MD, Hart JM et al.. Cyclosporin A ameliorates mitochondrial ultrastructural injury in the ileum during acute endotoxemia. Critical care medicine 2002. link 61 Kono H, Fujii H, Asakawa M, Yamamoto M, Maki A, Matsuda M et al.. Functional heterogeneity of the kupffer cell population is involved in the mechanism of gadolinium chloride in rats administered endotoxin. The Journal of surgical research 2002. link 62 Rodrigues D, Reis M, Teixeira V, Silva-Vergara M, Filho DC, Adad S et al.. Pathologic findings in the adrenal glands of autopsied patients with acquired immunodeficiency syndrome. Pathology, research and practice 2002. link 63 Gervasoni C, Ridolfo AL, Vaccarezza M, Parravicini C, Vago L, Adorni F et al.. Thrombotic microangiopathy in patients with acquired immunodeficiency syndrome before and during the era of introduction of highly active antiretroviral therapy. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2002. link 64 Chevallier P, Peten E, Souci J, Chau Y, Padovani B, Bruneton JN. Detection of portal venous gas on sonography, but not on CT. European radiology 2002. link 65 Baine WB, Yu W, Summe JP. The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998. Application of Medicare claims data. Annals of epidemiology 2001. link00184-8) 66 Pouli A, Lemessiou H, Rontogianni D, Papanastassiou C, Tsakanikas S, Gerassimou A et al.. Multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature. Annals of hematology 2001. link 67 Krabbe KS, Bruunsgaard H, Qvist J, Hansen CM, Møller K, Fonsmark L et al.. Hypotension during endotoxemia in aged humans. European journal of anaesthesiology 2001. link 68 Enkhbaatar P, Okajima K, Uchiba M, Isobe H, Okabe H. Recombinant tissue factor pathway inhibitor prevents lipopolysaccharide-induced systemic hypotension in rats by inhibiting excessive production of nitric oxide. Thrombosis and haemostasis 2001. link 69 Deschilder I, Gordts B, Van Landuyt H, Renders F, Selleslag D. Pasteurella dagmatis septicaemia in an immunocompromised patient without a history of dog or cat bites. Acta clinica Belgica 2000. link 70 Wiesel P, Patel AP, DiFonzo N, Marria PB, Sim CU, Pellacani A et al.. Endotoxin-induced mortality is related to increased oxidative stress and end-organ dysfunction, not refractory hypotension, in heme oxygenase-1-deficient mice. Circulation 2000. link 71 Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation. Lancet (London, England) 1999. link02987-6) 72 Crespo E, Macías M, Pozo D, Escames G, Martín M, Vives F et al.. Melatonin inhibits expression of the inducible NO synthase II in liver and lung and prevents endotoxemia in lipopolysaccharide-induced multiple organ dysfunction syndrome in rats. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 1999. link 73 Whitby M. Fusidic acid in septicaemia and endocarditis. International journal of antimicrobial agents 1999. link00070-3) 74 Lambermont B, D'Orio V, Kolh P, Gérard P, Marcelle R. Effects of inhaled nitric oxide on pulmonary hemodynamics in a porcine model of endotoxin shock. Critical care medicine 1999. link 75 McLean PG, Perretti M, Ahluwalia A. Inducible expression of the kinin B1 receptor in the endotoxemic heart: mechanisms of des-Arg9bradykinin-induced coronary vasodilation. British journal of pharmacology 1999. link 76 Nys M, Damas J, Damas P, Laub R, Cloes JM, Lamy M. Study of the protective effects of hyperimmune immunoglobulins G and M against endotoxin in mice and rats. Medical microbiology and immunology 1999. link 77 Biswas J, Raizada S, Gopal L, Kumarasamy N, Solomon S. Bilateral frosted branch angiitis and cytomegalovirus retinitis in acquired immunodeficiency syndrome. Indian journal of ophthalmology 1999. link 78 Herdy GV, Herdy AH, Almeida PS, de Carvalho R, Azevedo FB, Azevedo K et al.. Cardiac abnormalities in the acquired immunodeficiency syndrome. A prospective study with a clinical-pathological correlation in twenty-one adult patients. Arquivos brasileiros de cardiologia 1999. link 79 Leach M, Hamilton LC, Olbrich A, Wray GM, Thiemermann C. Effects of inhibitors of the activity of cyclo-oxygenase-2 on the hypotension and multiple organ dysfunction caused by endotoxin: a comparison with dexamethasone. British journal of pharmacology 1998. link 80 Ishihara S, Ward JA, Tasaki O, Pruitt BA, Goodwin CW, Mozingo DW et al.. Inhaled nitric oxide prevents left ventricular impairment during endotoxemia. Journal of applied physiology (Bethesda, Md. : 1985) 1998. link 81 Schmid A, Eich-Rathfelder S, Whalley ET, Cheronis JC, Scheuber HP, Fritz H et al.. Endogenous B1 receptor mediated hypotension produced by contact system activation in the presence of endotoxemia. Immunopharmacology 1998. link00038-1) 82 Wharton SM, Reid CA. Purpura fulminans localising to a recent burn injury. Burns : journal of the International Society for Burn Injuries 1998. link00080-1) 83 Johnson JS, Croall J, Power JS, Armstrong GR. Fatal Serratia marcescens meningitis and myocarditis in a patient with an indwelling urinary catheter. Journal of clinical pathology 1998. link 84 Poon BY, Goddard CM, Leaf CD, Russell JA, Walley KR. L-2-Oxothiazolidine-4-carboxylic acid prevents endotoxin-induced cardiac dysfunction. American journal of respiratory and critical care medicine 1998. link 85 Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G. Cardiac involvement in the acquired immunodeficiency syndrome: a multicenter clinical-pathological study. Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS Investigators. AIDS research and human retroviruses 1998. link 86 Koerner RJ, Morgan S, Ford M, Orr KE, McComb JM, Gould FK. Outbreak of gram-negative septicaemia caused by contaminated continuous infusions prepared in a non-clinical area. The Journal of hospital infection 1997. link90055-4) 87 Ruetten H, Thiemermann C. 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    Original source

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