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Sepsis

more about Sepsis


Systemic Inflammatory Response Syndrome or SIRS


  • Sepsis refers to an overwhelming infection that causes a series of dangerous changes to take place in the body.  Severe sepsis can damage the vital body organs, leading to septic Shock (sepsis accompanied by a dangerous drop in blood pressure) and cause multiple organs to fail (e.g., liver, kidney, lungs, brain, heart etc.) and death.

  • May develop very rapidly
  • Fever
  • Chills
  • Poor appetite
  • Confusion
  • Agitation
  • Stupor or Coma
  • Muscle and joint pain
  • Weakness
  • Skin rash, jaundice or bleeding (petechiae)
  • Symptoms of primary infection sources (e.g., cough, abdominal pain, stiff neck, Seizures, etc.) or organ failure (Heart Failure, renal failure, respiratory failure, etc.)

  • In a majority of cases, bacteria called gram-negative bacteria (e.g., E. coli, Klebsiella, Pseudomonas) are responsible for the condition.  The mechanism involved is extremely complex, and includes the toxins produced by bacteria that enter the blood stream, where they are attacked by the body's immune system (white blood cells and specific Proteins that fight foreign invaders), and which, if it advances, will also involve the circulatory, endocrine, renal, respiratory, pulmonary, gastrointestinal, nervous, hematological (disseminated intravascular coagulation or activation of coagulation and fibrolytic systems), and metabolic systems and functions.
  • The blood vessels also widen (dilate) to facilitate the transport of the white blood cells, antibodies, nutrients, and other factors to the organs, and continue the fight, repair damaged tissues, disable the toxins, and kill the bacteria. The toxin also damages the cells lining the tiny blood vessels with leakage of blood into tissues, and along with their effect on the heart and the circulatory system, blood pressure falls drastically and Shock may develop.
  • Gram-positive bacteria such as (e.g., Staphylococcus, Streptococci and enterococci species) and fungi (e.g., candida).
  • Primary sources of the bacteria are often infections of the lungs (bacterial Pneumonias), urinary tract, abdomen (e.g., biliary tract, peritonitis), skin (surgical sites, intravenous catheters, wounds, Pressure Sores, cellulitis, gangrene), infected heart valves, Bone Infections (Osteomyelitis), and the nervous system (Meningitis).

  • Must be made rapidly
  • A complete medical history and exam must be done.
  • Multiple specialists may be consulted.
  • The exam will show a rapid pulse rate, rapid breathing, Low Blood Pressure, skin lesions, jaundice, low urinary output, bleeding or Thrombosis, and Shock.  During the exam, the patient may appear lethargic.
  • The tests may show:
    1. Blood in the Urine (Hematuria), loss of Proteins (proteinuria)
    2. Positive Blood cultures
    3. Low or elevated white blood cell count
    4. Lactic acidosis (changes in blood acid)
    5. anemia
    6. thrombocytopenia (low platelet count)
    7. Signs of renal failure (elevation of BUN and Creatinine)
    8. Analysis of certain bacterial surface Proteins (antigen) in the blood may help in some cases, such as meningococcus.  Counter immune electrophoresis is another useful test in this regard.
    9. Hypoxemia
    10. Cultures of wounds, Abscess, sputum, bone, spinal fluid, abdominal fluid, and urine may also be done.
    11. Chest X-Ray, Ultrasound, CAT scan, and MRI may be used to localize the source of infection if hidden.

  • Recent surgical or dental procedures
  • Recent endoscopy
  • Very old
  • Very young
  • Intravenous drug abusers
  • Recent long term antibiotic therapy
  • Urinary catheters
  • Those without a spleen (surgically removed or not present at birth)
  • Immunosuppressed as in AIDS, Malnutrition, diabetes, complement deficiencies, or those receiving chemotherapy for cancers

  • Admittance to a hospital and the intensive care unit (ICU)
  • Oxygen and intravenous fluids
  • Broad-spectrum intravenous antibiotics started right away until diagnostic tests can find the exact bacterial type, at which point more specific antibiotics are given
  • Drain the infected site or surgically remove the Abscess or infected wound tissue.
  • The most important bit is to stabilize the cardiovascular system using fluids, medications, and monitor it closely.
  • Respiration may need support, necessitating the need to place the patient on artificial or mechanical ventilation.
  • Metabolic parameters such as the acid /base status of the body may need to be normalized.
  • Electrolytes in the blood may need to be normalized.
  • Disseminated Intravascular Coagulopathy (DIC), Thrombosis (clotting), or bleeding may develop, and actions need to be taken to combat these findings.
  • Transfusion with blood products may be necessary (e.g., blood transfusion, platelets, fresh frozen plasma).
  • Steroids may be used in certain instances to combat the effects of sepsis.
  • New treatments are under investigation.

  • Other infections -- viral, fungal, other organisms (spirochetes, protozoa)
  • Hemolytic uremic syndrome
  • Acute adrenal insufficiency
  • Severe Burns
  • Severe trauma




more about Sepsis


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