Sepsis

The reasons

Kinds

Features of the septic process

Manifestations of sepsis

Course of sepsis

Diagnostics

Treatment of sepsis

Forecast

Sepsis (infection of the blood) is a serious pathological condition, which is described as the presence of a pathogen (microbe or fungus) in the blood.

The development of the septic process is a life-threatening condition and, if delayed treatment, can lead to death.

The reasons

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Microbes or pathogenic fungi can become pathogens. The main microbial agents are:

  • blue pus bacillus, pathogenic strains Staphylococcus,
  • pathogenic strains of E. coli,
  • pneumococcus, meningococcus, Klebsiella,
  • Mycobacterium tuberculosis
  • in rare cases, sepsis can occur caused by Candida fungi or other types of fungi.

The process develops in case of a decrease in the general body resistance to infection, depletion of the immune system by chronic infectious processes or the presence of purulent foci, in the case of a decrease in the protective function of natural barriers – skin, intestines, and lungs.

As a result, the body can not localize and destroy microbes, they easily penetrate into the blood, while in the blood, due to a violation of immunity, the number of bactericidal components and immune cells is reduced.

In each case, the foci of primary infection can be different – from carious teeth and tonsils, to abscesses in the abdominal cavity and purulent wounds of the skin.

Usually sepsis occurs

  • at diabetes,
  • at oncological diseases
  • at rahite or immunodeficiencies (congenital or acquired),
  • with severe injuries or burns,
  • with long-term use of immunosuppressants or in the case of prolonged X-ray and chemotherapy.

Kinds

There are several types of sepsis, differing in the mechanism of development and types of pathogens:

  • Skin sepsis – foci of infection primarily occur on the skin (burns, wounds, purulent processes).
  • Oral (oral) sepsis – the primary lesions are located in the oral cavity or pharynx (carious cavities,   pulpitis,   osteomyelitis   jaws, tonsils, pharyngeal abscesses).
  • Obstetric (gynecologic) with primary lesions in the uterus or genital area after childbirth, in pelvic inflammatory processes.
  • Otogenic sepsis, with primary focus in the middle ear or near it.
  • Surgical (diagnostic) – occurs after surgical interventions with the introduction of infection or after diagnostic manipulations.
  • Cryptogenic, with unknown or unexplained primary source of infection.
  • Nosocomial sepsis is a special condition characterized by infection with dangerous strains of microbes that are resistant to therapy.

It is extremely important to ascertain the “entrance gate” or primary focus of sepsis, since this provides the key to the causes of infection and an exemplary list of possible pathogens, and therefore allows you to choose the most effective therapy.

Features of the septic process

Unlike common infections, sepsis has special flow conditions. It is typical for him:

  • Mandatory presence of the primary focus, even if unexplained, but it is always there. Moreover, this focus should be closely related to the blood or lymphatic pathways.
  • In sepsis, the pathogen must repeatedly enter the bloodstream (this condition is called septicemia).
  • The formation of secondary infectious foci, in which the pathogen multiplies and re-enters the bloodstream ( septicopyemia ), is characteristic.
  • The body is not able to provide the proper immune response to the infection and activate the protective reactions of cells and tissues against pathogens.

Only in the presence of all these conditions is diagnosed with sepsis.

Manifestations of sepsis

Signs of sepsis are largely dependent on the primary focus and the type of pathogen, but several typical clinical symptoms are characteristic of the septic process:

  • severe chills,
  • increase in body temperature (permanent or wavy, associated with the entry into the blood of a new portion of the pathogen),
  • sweating with changing several sets of linen per day.

These are the three main symptoms of sepsis, they are the most constant manifestations of the process. In addition to them can be:

  • pallor of skin and mucous membranes, waxy complexion,
  • fatigue and indifference of the patient, changes in the psyche from euphoria to severe apathy and stupor,
  • sunken cheeks with a strong blush on the cheeks against the background of general pallor,
  • hemorrhages on the skin in the form of spots or stripes, especially on the hands and feet,
  • herpes-like rash on the lips, bleeding mucous,
  • impaired breathing, reduced pressure,
  • seals or pustules on the skin,
  • decrease in urine volume.

Course of sepsis

The process can evolve in the following scenarios:

  • lightning fast – develops in 1-3 days,
  • acutely – develops 4-60 days after the formation of the primary focus,
  • subacute – the course lasts from two to six months,
  • chronically – lasts more than six months,
  • relapsing – alternating periods of sepsis with periods of complete health.

Diagnostics

The diagnosis is established in the presence of a typical picture of sepsis with confirmation of its laboratory data.

Produced by sowing blood and discharge from the foci of inflammation. Conducting crops with the detection of the pathogen must be multiple, since the pathogens have life cycles, and therapy can significantly change the picture of the blood and the level of the microbe in it.

When detected in the blood and the contents of the primary focus of similar microbes, the diagnosis is confirmed.

To clarify the treatment is carried out and the determination of the sensitivity of microbes to antibiotics.

In addition, a complete blood count with the identification of the inflammatory picture, a biochemical blood test with the identification of inflammatory changes, gas composition, electrolyte composition and its clotting are carried out.

Chest X-ray, ultrasound of the internal organs with the search for primary foci of infection.

Treatment of sepsis

Sepsis is treated only in an infectious or therapeutic hospital, in the intensive care unit and intensive care.

The principles of treatment are similar to those of other foci of infection, but take into account the overall serious condition and the risk of death.

Apply:

  • antibiotics in maximum doses given sensitivity, intravenously.
  • conduct an active struggle with toxemia,
  • activate their own immune system, corrects disturbed vital processes.

It is necessary to create peace and isolation, a special diet is prescribed, in case of a serious condition – artificial intravenous nutrition.

It is important to remove the infection from the primary focus, the use of two or more antibiotics, sometimes in combination with hormones.

If necessary, patients are infused with blood plasma, gamma globulin and glucose.  

When forming secondary purulent foci, their surgical treatment is necessary – opening of abscesses, removal of pus and washing of wounds, excision of the affected areas.

Forecast

Despite all the measures, the prognosis for sepsis is serious – the mortality rate reaches 60%, the disability after suffering sepsis is also quite high.

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