Sepsis Disease

DESCRIPTION
The systemic response to infection; it encompasses a broad array of clinical manifestations and overlaps with inflammatory reactions to other clinical insults (e.g., severe trauma or burn)
  • Bacteremia: Bacteria in the blood; may have no accompanying symptoms
  • Systemic inflammatory response syndrome (SIRS): inflammatory reaction to different clinical insults manifest by two of the following: (1) temperature >38°C or 90/min; (3) respiratory rate >20/min or PaCO2 12,000/mm3, 10% immature forms (bends)
  • Sepsis: SIRS with documented infection (typically bacterial)
  • Septic shock: Sepsis-induced hypotension (systolic BP < 90 mmHg or ≥ 40 mmHg drop from baseline) despite adequate fluid resuscitation, plus hypoperfusion abnormalities (oliguria, lactic acidosis, acute change in mental status)
  • Multiple organ dysfunction syndrome (MODS): altered organ function in an acutely ill patient – requires intervention to maintain homeostasis
  • System(s) affected: Cardiovascular, Endocrine/Metabolic, Hemic/Lymphatic/Immunologic, Renal/Urologic, Nervous, Pulmonary, Gastrointestinal
  • Genetics: N/A
  • Incidence/Prevalence in USA: 176/100,000 persons/year
  • Predominant age: All ages
  • Predominant sex: Male = Female
SIGNS AND SYMPTOMS
  • Fever
  • Chills, rigors
  • Myalgias
  • Changes in mental status – restlessness, agitation, confusion, delirium, lethargy, stupor, coma
  • Tachycardia
  • Tachypnea
  • Hypotension
  • Skin lesions – erythema, petechiae, ecthyma gangrenosum, embolic lesions
  • Signs and symptoms related to site of primary infection:
    • Respiratory tract – cough, sputum production, dyspnea, chest pain
    • Urinary tract – dysuria, flank pain, frequency, urgency
    • Intra-abdominal source – nausea, vomiting, diarrhea, constipation, abdominal pain
    • Central nervous system – stiff neck, headache, photophobia, focal neurologic signs
  • Signs and symptoms related to end organ failure:
    • Pulmonary – cyanosis
    • Renal – oliguria, anuria
    • Hepatic – jaundice
    • Cardiac – congestive heart failure
CAUSES
  • Specific etiologic agents include:
    • Gram positive organisms – most commonly Staphylococcus sp, Streptococcus sp, Enterococcus sp
    • Gram negative organisms – most commonly Escherichia coli, Klebsiella sp, Proteus sp, Pseudomonas sp
    • Fungi – most commonly Candida sp
    • Other agents – anaerobes. Also, see Differential diagnosis.
  • Common sources of septicemia include:
    • Lungs
    • Urinary tract
    • Intra-abdominal focus – biliary tree, abscess, peritonitis
    • Intravascular catheters
    • Skin – cellulitis, decubitus ulcer, gangrene
    • Heart valves
RISK FACTORS
  • Age extremes (very old and very young)
  • Impaired host (see associated conditions)
  • Indwelling catheters – intravascular, urinary, biliary, etc.
  • Complicated labor and delivery – premature and/or prolonged rupture of membranes, etc.
  • Certain surgical procedures
LABORATORY
  • Positive blood cultures
  • Positive cultures from other sites (sputum, urine, cerebrospinal fluid [CSF], etc.)
  • Gram stain of clinical specimens (sputum, urine, CSF, etc.)
  • Common:
    • Leukocytosis
    • Proteinuria
    • Hypoxemia
    • Eosinopenia
    • Hypoferremia
    • Hyperglycemia
    • Hypocalcemia
    • Mild hyperbilirubinemia
  • Less common:
    • Lactic acidosis
    • Leukopenia
    • Azotemia
    • Thrombocytopenia
    • Prolonged prothrombin time
    • Anemia
    • Hypoglycemia

Drugs that may alter lab results: Prior antibiotic use
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS
  • Inflammation at primary site of infection
  • Disseminated intravascular coagulation
  • Non-cardiogenic pulmonary edema
SPECIAL TESTS
  • Antigen detection systems – counterimmunoelectrophoresis (CIE) and latex agglutination tests (pneumococcus, H. influenzae type B, group B streptococcus, meningococcus)
  • Gram stain of buffy coat smears – occasionally useful
IMAGING
  • X-rays (e.g., chest)
  • Ultrasound, CT scan, or MRI – may be useful in delineating sites of infection
DIAGNOSTIC PROCEDURES
  • Aspiration of potentially infected body fluids (pleural, peritoneal, CSF) when appropriate
  • Biopsy, drainage of potentially infected tissues (abscess, biliary tree, etc.) when appropriate
APPROPRIATE HEALTH CARE
  • Hospitalization
  • Intensive care treatment of patients with shock, respiratory failure
GENERAL MEASURES
  • Removal or drainage of septic foci
  • Correction of metabolic abnormalities (hypoxemia, hyperglycemia, hypoglycemia, severe acidemia [pH < 7.10])
  • Mechanical ventilation for respiratory failure
  • Transfusion of RBC, platelets, and/or fresh frozen plasma for bleeding
  • Volume replacement followed by pressors for hypotension
  • Stress ulcer and deep venous thrombosis prophylactic measures
SURGICAL MEASURES

Drainage of infected sites, débridement of necrotic tissues

ACTIVITY

Bedrest

DIET

NPO initially; intravenous hyperalimentation appropriate in some severely malnourished patients and in patients who will be unable to receive enteral alimentation within the week

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE
  • Vaccination – pneumococcal (geriatric patients, patients with certain chronic diseases), Haemophilus influenzae type B (infants, young children)
  • Gamma globulin – for hypo- or agammaglobulinemic patients
  • Hand washing by hospital personnel, appropriate catheter care, etc., for hospitalized patients
POSSIBLE COMPLICATIONS
  • Death
  • Adult respiratory distress syndrome (ARDS)
  • Multi-organ failure (cardiac, pulmonary, renal, hepatic)
  • Disseminated intravascular coagulation (DIC)
  • Gastrointestinal hemorrhage
EXPECTED COURSE AND PROGNOSIS

Even with optimal care, mortality will be 10-50% overall; this is increased in patients with neutropenia, diabetes, alcoholism, renal failure, respiratory failure, hypogammaglobulinemia, certain etiologic agents (e.g., Pseudomonas aeruginosa), a delay in appropriate antimicrobial therapy, and those patients at the age extremes

ASSOCIATED CONDITIONS
  • Neutropenia
  • Diabetes mellitus
  • Alcoholism
  • Leukemia, lymphoma, and solid tumors
  • Cirrhosis
  • Burns
  • Multiple trauma
  • Intravenous drug abuse
  • Malnutrition
  • Complement deficiencies
  • Hypo- or agammaglobulinemia
  • Splenectomy
  • HIV infection
AGE-RELATED FACTORS

Pediatric: Screen newborns for infection due to prolonged rupture of membranes (> 24 h), maternal fever, prematurity
Geriatric:

  • Often more difficult to diagnose clinically in the elderly
  • Change in mental status/behavior may be only early manifestation

Others: N/A

PREGNANCY

Beta lactam antibiotics, aminoglycosides, erythromycin are considered safe

OTHER NOTES

High dose steroids of no benefit

ABBREVIATIONS

N/A

Clinical Investigations
  • Cardiology
  • Dermatology
  • General Destistry
  • Cardiology
  • Dermatology

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.

Facebook X-twitter Instagram Google-plus-g
QUICK LINKS
contact

Copyright © 2025 Selkey. All Rights Reserved.