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sepsis

Sepsis

Keywords: Blood-poisoning, blood infection, septic, septic shock, refractory septic shock, Systemic Inflammatory Response Syndrome (SIRS), catheter sepsis, shock, low blood pressure, blood infection, severe infection, septic, immune system, bacteremia, severe bacteremia, Septic shock, ecthyma gangrenosum, Pseudomonas aeruginosa, immunology, pathology, dendritic cells, natural killer cells, invariant natural killer T cells, gamma delta T lymphocytes.

Because lymphedema involves having a immunodeficient limb, we are prone to and susceptible to infections. These range from Cellulitis, lymphangitis, impetigo, or even erysipelas. It is critical that these infections, whatever type they may be to get treated immediately and they can quickly turn to being septic.

What is sepsis?

Simply defined, sepsis is a severe illness in which the bloodstream is overwhelmed by bacteria.

It is a potential deadly complication of infection. It occurs as the body release chemicals into the bloodstream to fight the infection trigger inflammation throughout the body. “This inflammation creates microscopic blood clots that can block nutrients and oxygen from reaching organs, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically and the person may die.” (1) Emedicine health defines it as Sepsis is a condition in which the body is fighting a severe infection that has spread via the bloodstream. If a patient becomes “septic,” they will likely have low blood pressure leading to poor circulation and lack of perfusion of vital tissues and organs. This condition is termed “shock.” This condition can develop either as a result of the body's own defense system or from toxic substances made by the infecting agent (such as a bacteria, virus, or fungus). (2)

Who is at Risk

People with compromised immune systems, those with certain illnesses such as lymphedema, diabetes,HIV, AIDS, people who are undergoing medical treatments for cancer, the eldery and the very young. Others include those with a genetic tendence towards the condition, those on a mechanical ventilation system or those having any invasiive procedure or having IV lines in place. Finally, it is important to remember that even healthy individuals can become septic if they have a serious untreated infection.

Signs and Symptoms

Sepsis is the body's response to an infection. The symptoms can include:

Altered kidney or liver function Fever and shaking chills Reduced mental alertness, sometimes with confusion Nausea and vomiting Diarrhea Increased heart rate, greater than 90 beats per minute Increased respiratory rate, greater than 30 breaths per minute High or low white blood cell count Hyperventilation Low blood pressure Rapid heart beat Shaking Warm skin

Stages of sepsis

Sepsis To be diagnosed with sepsis, you must exhibit at least two of the following symptoms:

Fever above 101.3 F (38.5 C) or below 95 F (35 C) Heart rate higher than 90 beats a minute Respiratory rate higher than 20 breaths a minute Probable or confirmed infection Severe sepsis Your diagnosis will be upgraded to severe sepsis if you also exhibit at least one of the following signs and symptoms, which indicate organ dysfunction:

Abnormal white blood cell count Areas of mottled skin Significantly decreased urine output Abrupt change in mental status Decrease in platelet count Difficulty breathing Abnormal heart function (elevated heart rate, tachycardia) Septic shock

To be diagnosed with septic shock, you must have the signs and symptoms of severe sepsis — plus extremely low blood pressure. (1)

Causes:

The over whelming cause of most sepsis is bacterial infections although it is possible also to be caused by a fungal agent. The invasive bacteria may be located in any organ and then spread directly or indirectly into the bloodstream.

The most common bacterial causes include gram-negative bacilli (for example, E. coli, P. aeruginosa, E. corrodens and Haemophilus influenzae in neonates), S. aureus, Streptococcus species and Enterococcus species; however, there are a large number of bacterial genera that have been known to cause sepsis. Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source. (3)

Diagnoses

A person may have sepsis if he or she has:

A high or low white blood cell count A low platelet count Acidosis (too much acid in the blood) A blood culture that is positive for bacteria Abnormal kidney or liver function

There are other laboratory tests that may include urine being checked for infection, if you have a weeping or infected wound a culture may be taken and any respiratory secretions may be tested as well.

Diagnostic radiology test includes computerixzed tomography (CT) scans, Ultrasounds, Magnetic resonance imaging {MRI)

Possible Complications

Blood clots Death Disseminated intravascular coagulation Organ failure Problems with blood flow to vital organs (brain, heart, kidneys) Septic shock Tissue death

Treatment

Treatment should be immediate and aggressive andmay include a number of medications. These include antibiotics, either orally or preferably intravenousl (IV). Because an extreme low blood pressure is a common part of sepsis you may also be prescribe vasopressors. These are medication that constrict the blood vessels and helps to increase blood pressure.

There are a number of other medications that may be used as well. These include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.

If the patient has difficulty in breathing they may receive oxygen and due to the elevated body temperature, large amounts of fuilds. To help with the sever pain associated with sepsis painkillers or sedatives may also be used.

Prognosis

Prognosis is dependent upon several factors. These include age, previous health history, overall health status, how quickly the diagnosis is made, and the type of organism causing the sepsis.

Overall though the death rate from sepsis is approximately 40%, therefore it is essential for treatment to begin immediately.

Reference:

(1) Sepsis - Definition Mayo Clinic

(2) eMedicine

(3) Medicinenet

Abstracts and Studies

Extracorporeal therapy in sepsis: are we there yet? Feb 2012

Shukla AM.

Source

Division of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Abstract

The role of extracorporeal therapies (ECTs) in sepsis is unclear and is a strongly debated topic in critical-care medicine. Unfortunately, much of this debate arises because we lack a clear understanding of what defines the stage and severity of the disease, and the pivotal pathophysiological events dictating outcomes. In the absence of this knowledge, ECTs remain among a large group of therapies with high promise but unproven efficacy.

PubMed

Sepsis due to Pseudomonas aeruginosa in a previously healthy infant. Dec 2011

[Article in Spanish]

Sandoval C C, Moreno M C, Abarca V K.

Source

Infectología Pediátrica, Departamento de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Abstract

Key words: Septic shock, ecthyma gangrenosum, Pseudomonas aeruginosa.

Pseudomonas aeruginosa, is an opportunistic organism widely distributed in both environmental and nosocomial settings. Invasive infections typically occur in immunocompromised patients, but this agent can also produce sepsis in the immunocompetent host. We report the case of an 8 months old infant, previous healthy, who presented septic shock by P. aeruginosa. Lesions of ecthyma gangrenosum in his limbs required surgical debridement. The patient presented transitory neutropenia and reduced C4 levels but subsequent study of immune defects was normal.

ScieLo

Cells with immunoregulatory properties and their impact in the pathogenesis of sepsis]. Dec. 2011

[Article in Spanish]

Diosa-Toro MA, Jaimes B FA, Rugeles L MT, Velilla H PA.

Source

Sede de Investigación Universitaria, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Abstract

Key Words Sepsis, immunology, pathology, dendritic cells, natural killer cells, invariant natural killer T cells, gamma delta T lymphocytes.

Sepsis, defined as a systemic inflammatory response syndrome caused by an infection, is a significant cause of mortality worldwide. It is currently accepted that death associated to sepsis is due to an immune hyperactivation state involving the development of a broad proinflammatory response along with alterations in the coagulation system. It is now clear that besides the inflammatory events, the clinical course of sepsis is characterized by the development of an anti-inflammatory response that could lead to death in its attempt to balance the initial response. The purpose of this review is to summarize current mechanisms that explain the pathogenesis of sepsis, underlying the role that cells with immunoregulatory properties play during the course of this complex syndrome. A better understanding of these processes will contribute in the search of more successful therapeutic strategies.

ScieLo

External Links

Diagnostic Images

ICD Codes

ICD-9 995.91

ICD-10 A40 - A41

Disease DB 11960

MedlinePlus 000666

MeSH D018805

Lymphedema People Internal Links

Lymphedema People Resources

sepsis.txt · Last modified: 2012/10/16 14:40 (external edit)