Sepsis: Causes, Symptoms, Diagnosis and Treatment
What it is? Sepsis is a pathological symptom complex, a systemic inflammatory response to infection that is caused by ingress of blood into the blood and tissues of pyogenic microorganisms, their toxins and can complicate the course of any inflammatory-purulent disease.
This is one of the primary medical and biological tasks of intensive therapy of modern times.
The urgency of the problem is determined by the degree of disease frequency, high mortality and significant economic damage caused by sepsis in developed countries.
How does sepsis develop and what is it? Most often, sepsis is caused by streptococci and staphylococci, but among the pathogens there are other bacteria, for example, E. coli and pneumococci, as well as fungi and viruses. Among the possible causes of sepsis can be identified:
There are no specific symptoms with sepsis. The main clinical sign is a prolonged fever with a temperature above 38 ° C, which persists for several weeks.
Typical common symptoms: insomnia, migraine headache( see migraine symptoms), chills and sweat, in severe cases, loss of consciousness, confusion in unconsciousness. Often jaundice develops, accompanied by an increase in the liver. There is a lack of appetite, nausea, vomiting, weight loss.
In local organs and tissues, local pustules are formed. The body can be covered with a specific rash, which is most often localized to the chest, abdomen, hands and does not cause discomfort( it does not hurt, it does not itch).Clinical signs depend on the form of sepsis, the course of which is fulminant, acute, subacute and chronic.
Lightning sepsis is very violent, manifested by tremendous chills, severe intoxication, rapid drop in blood pressure, is complicated by septic shock and ends with a lethal outcome within 1-2 days.
Acute sepsis is characterized by an increase in temperature to 40 ° C and a lytic reduction of up to 37 ° C. Strong sweaty sweats are followed by tremendous chills. There is increased bleeding of the mucous membranes of the oral cavity and petechial hemorrhages on the skin of the forearms and shins. There is jaundice of the skin and sclera. The liver and spleen increase, anemia is diagnosed. There is also an abundant rash in the form of small bubbles with transparent contents. This type of sepsis is considered acute during the first two months.
Subacute sepsis develops three months after the onset of the disease and is characterized by a wavy course. Chill may or may not be as intense. Fever is unstable - from subfebrile to high.
Chronic sepsis develops during a long course of the disease( months and years) and is characterized by periods of remission between the formation of foci of purulent inflammation in the organs and tissues, manifested by a stable subfebrile temperature. The disease is lethargic, steadily progressing, causing atrophic changes in the tissues and ending with a fatal outcome.
Diagnosis of sepsis is based on the clinical understanding of the doctor, on his ability to analyze and compare information from anamnesis, clinic and laboratory examination. To suspect this pathology allows the presence of fever for a long time, shifts in the leukocyte formula, tachycardia.
Diagnostic minimum of examinations required for diagnosis:
Treatment of sepsis is a combined one, aimed at fighting the disease and increasing the body's resistance. Includes:
The prognosis is determined by the severity of the underlying disease against which sepsis has developed, depends on the rate of development of complications, timely and correct treatment and the type of infection( to a lesser extent).
Mortality is very high and in a non-specialized hospital it is 50%.The most common cause of death in the intensive care unit is an infectious-toxic shock.
Complexity consists in a large number of hidden forms of the disease, but the sooner the treatment begins, the more likely a positive result.
This is one of the primary medical and biological tasks of intensive therapy of modern times.
The urgency of the problem is determined by the degree of disease frequency, high mortality and significant economic damage caused by sepsis in developed countries.
Causes of sepsis
How does sepsis develop and what is it? Most often, sepsis is caused by streptococci and staphylococci, but among the pathogens there are other bacteria, for example, E. coli and pneumococci, as well as fungi and viruses. Among the possible causes of sepsis can be identified:
- reduction of the body's defenses;
- infective endocarditis;
- suppuration in the wound;
- injecting drug addiction( angiogenic sepsis);
- chronic purulent diseases( trophic ulcers);
- infected venous catheters;
- complicated course of local purulent diseases( phlegmon);
- infectious complications of injuries;
- burns( severe degrees);
- purulent diseases of the oral cavity;
- increase the resistance of microorganisms to antibacterial drugs;
- childbirth and abortion;
- suppurative complications after surgical interventions;
- damage to the urogenital system.
Symptoms of sepsis
There are no specific symptoms with sepsis. The main clinical sign is a prolonged fever with a temperature above 38 ° C, which persists for several weeks.
Typical common symptoms: insomnia, migraine headache( see migraine symptoms), chills and sweat, in severe cases, loss of consciousness, confusion in unconsciousness. Often jaundice develops, accompanied by an increase in the liver. There is a lack of appetite, nausea, vomiting, weight loss.
In local organs and tissues, local pustules are formed. The body can be covered with a specific rash, which is most often localized to the chest, abdomen, hands and does not cause discomfort( it does not hurt, it does not itch).Clinical signs depend on the form of sepsis, the course of which is fulminant, acute, subacute and chronic.
Lightning sepsis is very violent, manifested by tremendous chills, severe intoxication, rapid drop in blood pressure, is complicated by septic shock and ends with a lethal outcome within 1-2 days.
Acute sepsis is characterized by an increase in temperature to 40 ° C and a lytic reduction of up to 37 ° C. Strong sweaty sweats are followed by tremendous chills. There is increased bleeding of the mucous membranes of the oral cavity and petechial hemorrhages on the skin of the forearms and shins. There is jaundice of the skin and sclera. The liver and spleen increase, anemia is diagnosed. There is also an abundant rash in the form of small bubbles with transparent contents. This type of sepsis is considered acute during the first two months.
Subacute sepsis develops three months after the onset of the disease and is characterized by a wavy course. Chill may or may not be as intense. Fever is unstable - from subfebrile to high.
Chronic sepsis develops during a long course of the disease( months and years) and is characterized by periods of remission between the formation of foci of purulent inflammation in the organs and tissues, manifested by a stable subfebrile temperature. The disease is lethargic, steadily progressing, causing atrophic changes in the tissues and ending with a fatal outcome.
Diagnosis
Diagnosis of sepsis is based on the clinical understanding of the doctor, on his ability to analyze and compare information from anamnesis, clinic and laboratory examination. To suspect this pathology allows the presence of fever for a long time, shifts in the leukocyte formula, tachycardia.
Diagnostic minimum of examinations required for diagnosis:
- an expanded blood test with a formula( several times);
- general urine analysis( detection of the concentration of sepsis in the urinary tract);
- radiography of chest cavity organs.
Treatment of sepsis
Treatment of sepsis is a combined one, aimed at fighting the disease and increasing the body's resistance. Includes:
- sanation of the focus of infection - drainage;washing;surgical intervention;
- antibiotic therapy( broad-spectrum antibiotics);
- massive intravenous infusion therapy;
- correction of protein-energy losses;
- cupping of heart failure;
- anti-inflammatory treatment;
- application of specific sera;
- transfusion of plasma and platelet mass;
- symptomatic therapy;
- strengthening of the body's defenses( adequate nutrition).
Forecast
The prognosis is determined by the severity of the underlying disease against which sepsis has developed, depends on the rate of development of complications, timely and correct treatment and the type of infection( to a lesser extent).
Mortality is very high and in a non-specialized hospital it is 50%.The most common cause of death in the intensive care unit is an infectious-toxic shock.
Complexity consists in a large number of hidden forms of the disease, but the sooner the treatment begins, the more likely a positive result.