Sepsis
Sepsis
Sepsis
SEPSIS (Lecture 17/2/10) Before fever, there are 3 types of changes of fever that is
called pre-sepsis : 1° purulent focus
= systemic disease triggered by special kind of infectious,
endogenic microorganisms and characterised by prolonged 1. Short time 1-day ↑ of temperature during 1-2
unrestricted hyperaemia with hemodynamic abnormalities weeks
and end-organ failure 2. 2-3 days period of high fever during some weeks
3. Undulant fever last 3-4 weeks
Main peculiarities : There is no cyclic course (dt unrestricted)
Fever
Septicemia Bacteremia - can be hectic or remittent
Triggered by special kind of Isolation of bacteria from - Hectic is a difference of temperature > 2 C
infection, so called endogenic peripheral blood & mb - Remittent is a difference of temperature between 1 – 2 C
microorganism transient or
inconsequential Toxicosis
Char by unrestricted May progress to septic - Shaking chills
bacteremia, hemodynamic shock if unRx - HA
dist n organ F - Prostration
Cause by conditional Cause : absolute - n+v
pathogen, colonizing human pathogenic microbe
body after procedure(abortion,
Enlarged spleen
skin abrasion)
- HSM early symptom. Develop in the first few days of
disease
- USE can reveal it in the beginning and after some time, it
ETIOLOGY can be revealed by palpation.
- Structure of liver is soft, sagging and painless
– Can be caused by a lot of commensals
– They colonize human body since neonatal period, Changes in blood
during which time immune mechanisms are absent. - ↑ leukocytes
They colonize mucosa of the respiratory tract, GIT and - Neutrophils have toxic granularities
co-exist with microorganism - TCP
– Play a great role -> Immunogenic readiness to defend - ESR
organism against pathogenic microbes - anemia at later terms of disease
Causes: Hemorrhagic rash symptom of generalized vasculitis
range from point elements to extensive
• Gram –ve Proteus, Klebsiella, Enterobacter,
Bacteriods (Cl. Perfringens) Primary purulent foci
• Gr. +ve Staphylococcus, Streptococcus
Not obligate sign of sepsis
Sometimes the microbe associated may cause sepsis Local inflammation
X always the SOI
PATHOGENESIS Trigger factor
Their sanation don’t lead to restriction of sepsis
Main factor : breakdown of defence mechanism against
commensals & generalisation of endogenous infection Secondary purulent foci
Sepsis CM + Lab confirmation If epidemic data of contact with animals, then suspect :
– HFRS
Severe sepsis CM + forming of 2° purulent foci, – Yersiniosis
poor prognosis and risk of – Brucellosis
death
Differential diagnosis with non-infectious disease
Outcome = Septic Shock – Collagenosis
○ Different temperature curve, in this case
3 types of Sepsis : it is not ‘correct’ fever, for example high
1. Fulminant fever for 2 -3 days then no fever for a
2. Acute ( >3 days) few days then again fever…
3. Chronic (>1.5 months) ○ In spite of high fever, ↓ leukocytes
○ Oral steroids are effective
DIAGNOSIS – Tuberculosis
○ Fever, x like sepsis
- Bacteria isolated from blood ○ We don’t see typical changes of blood
There are a few techniques on how to obtain blood
○ +ve skin test (Mantoux test)
specimen
• Site of venopuncture must be disinfected ○ APR
• Blood should be drawn at 2 different sites – Pathology of blood
• Multiple samples should be drawn (3 samples over ○ Myeloleucosis
a 24h period) Fever + hemorrhagic syndrome
• Blood should be drawn before antibiotics – Tumors with metastasis
administration – Post-vaccination reaction
○ Difficult because fever precede vaccine
The best period to take samples is during chills period 10 – 15 days
because this means there is output of bacteria into the blood – Schizophrenia
stream. The period of max temperature signifies the release ○ Have hallucinations, thought echo, etc
of pyrogens after bacteria destruction.
Chronic Sepsis must be differentiated with
Maisarah Repin
– TB
– Pathology of thyroid gland
– Encephalic symptoms (febrile for months)