Obesity and infection

Falagas, Matthew E.; Kompoti, Maria

doi:10.1016/s1473-3099(06)70523-0

Cited by 735 publications

(607 citation statements)

References 111 publications

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“…Although more extensively studied in patients with diabetes, both individuals with obesity and those with type 2 diabetes mellitus have an increased susceptibility to infections compared with healthy individuals. [14][15][16] A strong association between diabetes mellitus and susceptibility to tuberculosis has been reported almost a century ago, and validated by recent studies. 17,18 Several explanations have been proposed for the increased susceptibility to infections in these patients, such as the facilitation of bacterial growth by hyperglycemia, negative effects of ketoacidosis on the function of the leukocytes, and also a disturbed activation of cellular and/or humoral immunity due to impaired production of proinflammatory cytokines.…”

Section: Introductionmentioning

confidence: 72%

“…[37][38][39] Similar to the patients with diabetes, obese individuals have been reported to display an increased susceptibility to the same types of common infection. 15 Because central obesity, insulin resistance and diabetes are components of the metabolic syndrome, one may speculate that similar pathophysiological mechanisms are responsible for the increased susceptibility to infections in both these two clinical conditions. Several mechanisms of host defense have been described to contribute to the susceptibility to infections of patients with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

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Interleukin-18 resistance in patients with obesity and type 2 diabetes mellitus

et al. 2008

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Objective: Interleukin-18 (IL-18) has been recently demonstrated to improve experimental hyperphagia and insulin resistance. Paradoxically, concentrations of circulating IL-18 in obese subjects and in patients with type 2 diabetes are increased. The objective of this study is to provide an explanation for this paradox. Design: We have hypothesized that cells from obese individuals or from patients with type 2 diabetes mellitus have a diminished response to stimulation with IL-18. IL-18 responsiveness was tested by stimulating blood monocytes of obese or diabetes patients with rIL-18 or microbial components. Results: Obese individuals and patients with type 2 diabetes mellitus exhibit increased circulating concentrations of IL-18. More importantly, leukocytes isolated from obese or type 2 diabetes patients respond poorly after stimulation with IL-18, as reflected by defective interferon-g (IFNg) production. The defective response to IL-18 stimulation was accompanied by a 50% reduction in the expression of IL-18R a and b chains. In addition, cells of patients with obesity and diabetes displayed an impaired release of IFNg after challenge with bacterial or fungal pathogens, which was due to defective IL-18-mediated signaling. Conclusion: Patients with obesity or type 2 diabetes mellitus are characterized by lower responses after stimulation with IL-18. This IL-18 resistance explains the association of obesity and diabetes with high IL-18 circulating concentrations, similar to hyperinsulinemia and hyperleptinemia. IL-18 resistance may represent an important mechanism of the increased susceptibility of these patients to a number of infections.

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Section: Introductionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Interleukin-18 resistance in patients with obesity and type 2 diabetes mellitus

et al. 2008

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“…Obesity is associated with increased health care use and multiple adverse health outcomes, including increased prevalence and severity of infections (2).…”

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confidence: 99%

Pharmacokinetics of Clindamycin in Obese and Nonobese Children

Smith

González

Goldman

et al. 2017

Antimicrob Agents Chemother

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Although obesity is prevalent among children in the United States, pharmacokinetic (PK) data for obese children are limited. Clindamycin is a commonly used antibiotic that may require dose adjustment in obese children due to its lipophilic properties. We performed a clindamycin population PK analysis using data from three separate trials. A total of 420 samples from 220 children, 76 of whom had a body mass index greater than or equal to the 95th percentile for age, were included in the analysis. Compared to other metrics, total body weight (TBW) was the most robust measure of body size. The final model included TBW and a sigmoidal maturation relationship between postmenstrual age (PMA) and clearance (CL): CL (liters/hour) ϭ 13.8 ϫ (TBW/70) 0.75 ϫ [PMA 2.83 /(39.5 2.83 ϩPMA 2.83 )]; volume of distribution (V) was associated with TBW, albumin (ALB), and alpha-1 acid glycoprotein (AAG): V (liters) ϭ 63.6 ϫ (TBW/70) ϫ (ALB/3.3) Ϫ0.83 ϫ (AAG/2.4) Ϫ0.25 . After accounting for differences in TBW, obesity status did not explain additional interindividual variability in model parameters. Our findings support TBW-based dosing for obese and nonobese children.

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“…In our experience, the patient had greater BMI (40.1 Kg/m 2 ) and the VV-ECMO was performed for 21 days and in addition our patient confirmed that the obesity decreases the sensitivity of peripheral tissues to leptin signals and can compromise the immune system as reported in literature. (6,7,8).…”

Section: Discussionmentioning

confidence: 99%

Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

2016

ARC Journal of Anesthesiology

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Veno -venous extracorporeal membrane oxygenation (VV-ECMO) is an extracorporeal respiratory support used as therapeutic option in patients affected Abbreviations: VV-ECMO-Veno-venous Extracorporeal Membrane Oxygenation, ARDS-Acute Respiratory Distress Syndrome, BMI-Body Mass Index, CT-Computed Tomography, ABG-Arterial blood gases, WBC-White Blood Count, CRP-C-Reactive Protein, TEE-Transesophageal Echocardiographic, APTT-Activated Partial Thromboplastin Time, SIMV-Synchronized,Intermittent Mandatory Ventilation, PS-Pressure Support, PEEPPositive end-expiratory pressure, RR-Respiratory Rate MAIN BODY TEXTA 49-year-old male affected by severe obesity (BMI 40.1 Kg/m 2 ), sleep apnea syndrome and type II diabetes mellitus, developed severe ARDS by influenza A, which was not responsive to maximal ventilatory support and to cycles of prone positioning in a secondary hospital. After 48 hours, the patient was recovered to our Cardiovascular Intensive Care Unit to perform VV-ECMO treatment.Upon admission, the chest Computed Tomography (CT) scan showed an extensive case of ARDS with pulmonary infiltrates affecting all lung fields (Figure 1). The Murray Score (1) was 3.5 and arterial blood gases (ABG) showed: pH 7.33, pO 2 40 mmHg, pCO 2 51 mmHg, HCO3 25 mmol/L, pO 2 /FiO 2 ratio 172 and evidence of mild tissue hypoxia (Lactate 3.4, SVO2 74.7, Table 1). Laboratory values revealed white blood count (WBC) 4.420 x 10 9 /l,C-Reactive Protein (CRP) 8,45 mg/dl, the cultural samples were collected and both the tracheal aspirate and the nasal swab tested were positive to Influenza A (not type H1N1). The patient had no other sign of systemic failure (PA 165/50 mmHg, HR 95 beats/min, diuresis 70 ml/h).

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Obesity and infection

Cited by 735 publications

References 111 publications

Interleukin-18 resistance in patients with obesity and type 2 diabetes mellitus

Interleukin-18 resistance in patients with obesity and type 2 diabetes mellitus

Pharmacokinetics of Clindamycin in Obese and Nonobese Children

Single or Double Site Cannuation for Veno-Venous Ecmo in Severe Obese Patient?

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