The most common cause of sepsis. Causes of development and symptoms of sepsis

A colloquial formulation has taken root among the people - blood poisoning. In medicine, this is sepsis - from the ancient Greek word “rotting.” With such a dangerous disease, living tissue actually disintegrates, and blood poisoning can lead to death. People with weak immune systems are especially at risk of developing it.

What is sepsis

The disease is a massive attack of pathogens. So, sepsis - what is it? Doctors clarify: a severe infectious disease, when poisons produced by pathogenic flora, and inflammatory substances produced by the body itself. Moreover, the immune system is powerless against them if it is very weakened.

This pathological process can also be considered as a generalized infectious blood disease against the background of acute immunodeficiency. It is easy to find sepsis in the international classification of diseases: the ICD-10 code is A41. Varieties of the disease have separate codes. For example, septic shock - A41.9, streptococcal septicemia - A40, newborn sepsis - P36.

Classification of sepsis

In medical practice, two types of the disease are distinguished: early and late. Early sepsis develops quickly from the moment the pyogenic focus appears, in less than 2 weeks. The rapid course of the disease may look like a rapid allergic reaction. Late sepsis develops from the moment the focus of the purulent process appears later than 2 weeks and progresses much longer.

According to the duration and nature of the flow, they are distinguished:

• fulminant sepsis, which often leads to the death of the patient within a day or two;
• acute sepsis, lasting 1-2 weeks and having a more favorable prognosis;
• subacute sepsis, progressing over 1-2 months and ending with recovery or becoming chronic;
• recurrent sepsis, when periods of subsidence of the disease alternate with exacerbations;
• chronic or chroniosepsis, which can last for years.

Septicopyemia

What is septicopyemia? This is a form of pathology in which ulcers form in many organs. The main pathogens are Pseudomonas aeruginosa and staphylococci, which often form a “sweet couple”. At first it is a large primary focus, often in the lungs, then the infection in the blood rushes to new locations. The body's reaction to the attack of pathogenic flora lasts several weeks.

Septicemia

What is septicemia? This is an acute or lightning-fast inflammatory reaction of the body in the virtual absence of ulcers in the internal organs. The most common reason– staphylococcal and streptococcal infection. Septicemia lasts only a day or two, but it is very severe. May affect small (under 3 years of age) children, resembling an acute respiratory infection.

Septic endocarditis

What is septicemia, when an inflammatory focus occurs on the surface of the heart valves? This septic endocarditis- a consequence of a malfunction in the heart that pumps blood. In the future, the patient is at risk of developing heart valve defects: the development of the disease can be suspected if the patient begins to feel his head and neck beating in time with his pulse major arteries, your heart is beating faster, “spots” are flashing before your eyes.

Causes of sepsis

A bacterial, viral or fungal infection that penetrates the body does not always cause disease due to the immune system. However, its protection can become excessive and cause damage to native cells. The immune system produces too many inflammatory mediators - substances that damage blood vessels, disrupt blood flow, and put organs into emergency mode.

The septic process is often complicated by:

• extensive skin ulcers, wounds, burns;
• severe tonsillitis and otitis;
• purulent processes in the lungs, appendix, bladder, prostate;
• peritonitis;
• cancer;
• HIV, etc.

Sepsis can be complicated by any inflammatory pathology. If pyogenic bacteria corrode the tissues of teeth or gums, this is fraught with odontogenic sepsis. However, external infection is not always to blame: pathogenic bacteria, living in the intestines of any person, can also enter the blood. When the underlying cause cannot be identified, a diagnosis of cryptogenic sepsis is made.

Surgical sepsis

This type of disease can develop at any age, but, according to medical statistics, it is more often observed in adults, mainly in men 30-50 years old. It is characterized by the presence of a purulent-inflammatory process (abscess, phlegmon, etc.), which is fraught with the fact that the patient may experience blood sepsis. It is important that the purulent focus is accessible for treatment with surgery.

Urosepsis

Typical features of urosepsis include the presence of foci of suppuration in the kidneys, bladder, and prostate gland. Thanks to intensive therapy with strong antibiotics, these diseases can be successfully cured. Urosepsis often develops with inflammation of the genitourinary system such as pyelonephritis, prostate adenoma and its removal, bartholinitis, etc.

Otogenic sepsis

This is a complication of various forms of otitis, since the primary focus is localized in the organ of hearing. Otogenic sepsis is characterized by a particularly severe course due to the proximity of the brain. Its first symptoms are severe shooting pain in the ear and a rise in temperature to 40 degrees. Either fever or chills lead the patient to a state of exhaustion. If the infection infects the brain, meningitis develops.

Rhinogenic sepsis

This variety diseases are rare. In rhinogenic sepsis, the abscess is localized in the nasal cavity and paranasal sinuses. Its predecessors are sinusitis, thrombophlebitis or thrombosis of local veins, polyposis, even nosebleeds. The rhinogenic variant of sepsis, like the otogenic one, is dangerous due to the proximity of foci of inflammation to the membranes of the brain.

Sepsis in gynecology

Obstetric and gynecological sepsis can be a consequence of complicated childbirth or operations on the female genital organs. This pathology, which occurs as a result of clandestine abortions and miscarriages, is extremely difficult. Sepsis during pregnancy can develop within a day or even in a matter of hours, presenting a mortal danger to the woman and fetus.

Sepsis in children

This pathology sometimes occurs in newborns and infants. Mortality due to sepsis in children is very high, up to 40% of cases. Premature babies are in the first place at risk, since the development of the disease can occur at lightning speed. The main source of sepsis is suppuration of the umbilical cord, but the primary source of pathology can be the respiratory tract and skin ulcers.

Signs of sepsis

The most typical symptoms for this disease are:

• the patient is shaken by severe chills;
• very high temperature – with sepsis it can have wave-like fluctuations;
• profuse sweating.

Sepsis may present as follows: additional symptoms, How:

• skin rash;
• bleeding of mucous membranes;
• pressure drop;
• dyspnea;
• dehydration;
• "waxy" face;
• mild stupor or euphoria.

Diagnosis of sepsis

Doctors have the following methods at their disposal to determine the cause of infection:

• blood and urine tests;
• procalcitonin test (blood serum test).
• bacteriological tests;
• ultrasonography;
• X-ray diagnostics;
• tomography.

Important differential diagnosis, which helps to exclude typhoid, malaria, tuberculosis, brucellosis and other similar pathologies. The criteria for sepsis are clear: at least two of the 4 classic symptoms of the disease must be present:

1. Temperature: above 38°C, below 36°C.
2. Pulse: more than 90 beats/minute.
3. Breathing movements: more than 20 per minute.
4. Leukocytes: more than 12x109/l, less than 4.0x109/l (or over 10% immature neutrophils).

How to treat sepsis

The patient is prescribed emergency drug treatment:

• antibiotics;
• painkillers;
• immunomodulators;
• infusion therapy solutions;
• medications that normalize blood pressure;
• drugs that restore the functions of the heart, liver, kidneys;
• vitamins, antioxidants.

Antibiotics for sepsis play a critical role in the complex treatment of the disease. Intravenous injections are prescribed immediately. More often it is two or three drugs different groups in the highest possible doses. Immunomodulators increase the body's defenses. Infusion blood substitutes, saline, protein solutions help restore blood composition, water-salt balance, activate blood circulation, cleanse the body of toxins.

However, until the source of sepsis is eliminated, drug treatment cannot give the necessary effect, so surgical intervention is carried out as early as possible. The surgeon opens the abscess and removes its purulent contents along with necrotic tissue. Adequate patient care is very important. Sepsis cannot be transmitted from a sick person to a healthy person.

Reliable disease prevention is provided by:

• patients' personal hygiene;
• timely elimination of local abscesses;
• strict compliance by health workers with asepsis requirements;
• minimum terms use of catheters;
• competent antibiotic therapy;
• vaccination of problem patients.

Video: sepsis and its treatment

(sepsis) is the process of general infection of the body by pathogenic microorganisms from the source of infection through the circulatory system. We will talk further in the article about how this condition develops, what consequences it causes and how it is treated.

Causes of sepsis

The development of sepsis can be caused by different microorganisms: viruses, bacteria, fungi, and the symptoms of its manifestation will depend on which of them gets into the blood. But the initiation of the infection process, as a rule, is facilitated by a set of certain circumstances:

• there must be a primary focus of infection in the body associated with the circulatory or lymphatic system;
• the pathogen repeatedly enters the blood;
• there is a formed secondary focus infection, which subsequently supplies pathogens.

And most main reason, which provokes blood sepsis, the consequences of which we discuss in the article, is a weak immune system or the presence of pathologies that suppress it: extensive operations, heavy blood loss, cancer, HIV, blood diseases, etc. Taking immunosuppressive drugs or cytostatics can also play a significant role in this.

How long does sepsis last?

One of the features of the described pathology is its ability to progress at lightning speed. This type of sepsis, called acute in medicine, proceeds rapidly, simultaneously affecting organs and systems. In this case, death occurs within 1-2 days.

In addition to the mentioned clinical course pathologies, acute, subacute and recurrent sepsis are distinguished. They differ in the duration of infection (from a month to six months), and the latter type also has a wave-like course, during which exacerbations can be replaced by normal well-being. The chronic course of sepsis is especially long, which can last up to a year, or even more.

Blood sepsis: symptoms

Signs of blood poisoning, as already mentioned, depend on many reasons: the form of the disease, its course, the location of the source of primary infection and the presence of a secondary one.

But basically, this pathology in all cases is manifested by jumps in body temperature, reaching 39-40 ° C, which are replaced by its normalization. The patient complains of chills, that periods without fever are replaced by a feeling of heat and severe sweating. Besides:

• the onset of the disease may be accompanied by a state of excitement, euphoria in the patient, which then turns into apathy and lethargy;
• the patient's skin takes on a pale, jaundiced tint;
• the pulse quickens to 150 beats per minute, blood pressure drops, shortness of breath appears;
• a rash in the form of bloody blisters or pinpoint hemorrhages may appear on the skin - which is a sign of the development of hemorrhagic syndrome;
• Herpes may appear on the lips;
• the sclera of the eyes turn red, and the oral mucosa bleeds.

As you can see, the onset of blood sepsis entails a wide variety of consequences, but the main signs of its appearance are still considered high temperature, the presence of chills and profuse sweating.

Complications of blood sepsis

Complete intoxication by the results of the vital activity of harmful microorganisms, causing listed symptoms, blood poisoning occurs due to the fact that toxic substances instantly spread throughout all organs and tissues, penetrating the mucous membranes and even bones and joints. And all this results in the fact that both the disease itself and the consequences accompanying blood sepsis chain the patient to a hospital bed for a long time.

The most severe complication of the disease may be septic shock, which can occur at any time during its course. No less dangerous are kidney inflammation (paranephritis) or Bladder(cystitis), formation of purulent cavities in different organs(for example, abscesses in the lungs or brain), development of heart failure or DIC (intravascular

Without proper treatment, sepsis can be fatal.

Forms of the disease

Treatment of blood sepsis is carried out depending on how the microbes entered the blood and where the primary source of infection is located. In medicine, there are several types of pathology.

1. Percutaneous sepsis. It develops when infected through small breaks in the skin in the form of scratches or boils.
2. Obstetrics and gynecology. Women are susceptible to it after childbirth or abortion.
3. Tonsillar. It is the result of a severe course of angina.
4. Otogenic. Infection spreads from the ear cavity (for example, as a result of purulent otitis media).
5. Odontogenic. The result of infection from the oral cavity during severe inflammatory processes of the gums and teeth.
6. Cryptogenic sepsis. In this case we are talking about an indefinite focus

Diagnosis of blood poisoning

In order to accurately determine how to treat blood sepsis, it is necessary to establish the source of infection and the type of pathogen that has entered the bloodstream.

To do this, a blood test is performed, which is taken from different veins, and the isolated microorganisms are inoculated into a nutrient medium. At the same time, their sensitivity to antibiotics is determined.

IN severe cases a rapid analysis is carried out, during which the genetic material of the pathogen is isolated in the blood, so that within 1.5 hours it is possible to identify 25 types of bacteria or fungi that cause sepsis.

How is sepsis treated?

The basic principle of treating blood poisoning is based on finding and eliminating foci of infection. Their sanitation is carried out by wide opening and thorough necroectomy. Additionally, the wound is treated with low-frequency ultrasound, antiseptics (Dioxidin, Dimexidine, etc.), surfactants (Chlorhexine) and proteolytic enzymes (Trypsin, Profezim, etc.).

The maximum possible doses of antibiotics are selected for the patient, depending on the pathogen identified, for example, for staphylococcal sepsis, the drugs “Fuzidin” and “Refampicin” are used. An increase in resistance is stimulated by vitamin therapy and immunostimulating medications, and aggressive enzymes are suppressed by the introduction of inhibitors “Contrical” or “Gordox”.

Detoxification is carried out using a large amount of protein agents and intravenous infusions of glucose solution.

To eliminate the manifestations of hypovolemia (decreased blood volume), preference is given to the drugs “Polidez”, “Polyglyumasol”, etc. in combination with antiplatelet agents “Xanthinol nicotinate” or “Dipyridamole”.

One of the treatment methods is also blood transfusion for sepsis or blood substitutes (“Polyglyukin”, “Reogluman”, etc.). Laser blood treatment also gives good results, and in severe cases plasmapheresis and

Prevention of sepsis

In order to prevent the consequences accompanying blood sepsis, several rules should be followed, which, although they cannot completely insure against the described terrible pathology, but will significantly reduce the possibility of its development.

1. All wounds must be treated
2. Subject purulent foci of inflammation to timely surgical intervention.
3. Carefully follow your doctor's advice after any injury.

And, of course, strengthen the immune system - after all, only it can prevent infection from even starting. Be healthy!

/ 19.02.2018

Is blood sepsis treatable? How dangerous is sepsis - the consequences of the disease.

Blood poisoning, or sepsis, is a serious infectious disease that always develops rapidly and occurs in an acute form. The disease is characterized by a systemic inflammatory response of the body to the invasion of infectious agents from the primary septic focus. If left untreated, this disease poses a threat to human life. The danger of sepsis lies in the dysfunction of organs such as the heart, kidneys, lungs and liver. Circulatory failure and disruption of the blood structure also develop.

People with reduced immunity, which cannot resist pathogenic agents, namely microorganisms, are susceptible to the development of sepsis. Such a decrease in the body's defenses is possible with diabetes, immunodeficiency syndrome, rickets, tumors, and various chronic diseases.

Blood poisoning is caused by:

• pneumococci;
• coli;
• staphylococci;
• meningococci;
• candidiasis and other fungi;
• Mycobacterium tuberculosis, etc.

Bacteria enter the human body through the skin, mucous membranes of the mouth, genitals, eyes, etc. Often, an infection can enter the body during medical procedures (skin punctures, dressings, abortions) if non-sterile instruments are used.

Although adults are more susceptible to sepsis, children are also sometimes diagnosed with this disease. Sepsis most often occurs in newborns. Penetration of infection into the child’s body can occur during the prenatal period or during delivery. The development of sepsis threatens children with underweight.

There are such types of sepsis:

1. Surgical: provoked by contact pathogenic microorganisms from a wound left after surgery.
2. Obstetric-gynecological: infection that occurs after an abortion or childbirth.
3. Urosepsis: provoked by foci of inflammation that have arisen in the organs of the genitourinary system. The cause of urosepsis can be untreated pyelonephritis, cystitis or prostatitis.
4. Skin: develops when infection spreads from foci of purulent inflammation of the skin (boils, carbuncles, etc.), as well as when burns become infected.
5. Peritoneal: foci of infection are located in the abdominal organs.
6. Pleuropulmonary: provoked by purulent inflammatory processes in the lungs.
7. Odontogenic: is a complication of diseases of the dentofacial apparatus. It is provoked by osteomyelitis, caries, periostitis, etc.
8. Tonsillogenic: blood poisoning results from a sore throat caused by streptococci.
9. Rhinogenic: the infection spreads from the inflamed paranasal sinuses and nasal cavity.
10. Otogenic: provoked by inflammatory diseases of the ears, in particular purulent otitis media.
11. Umbilical: is a complication of infection of the umbilical wound in newborns.

Sepsis can also occur during fetal development.

Symptoms

Common signs of blood poisoning:

• increase in body temperature to 40-41 degrees;
• chills;
• pale skin;
• profuse sweating;
• herpes on the lips;
• bleeding of mucous membranes;
• dyspnea;
• skin rash.

Fever can provoke disorders of the central nervous system - a person experiences symptoms such as headache, weakness, and nervousness. Advanced sepsis can also result in coma. From the cardiovascular system, hypotension and tachycardia develop. Infection of the heart threatens the development of myocarditis and pericarditis. The consequence of these diseases is disruption of the functioning of the organ.

Complications of sepsis can include pulmonary ischemia and respiratory failure. Due to dysfunction of the gastrointestinal tract, body weight rapidly decreases. The risk of developing toxic hepatitis also increases. Symptoms of advanced blood infection include dehydration and loss of muscle mass.

Metamorphoses also occur at the primary site of infection: the wound healing process slows down, and the granular tissue (granulation) becomes inelastic and bleeding. Areas of necrosis form on the wound. The pus released from the wound becomes putrid smell and a brown tint.

A symptom of advanced sepsis is the formation of metastatic foci. They are formed in various organs and tissues. Penetration of metastases into the lungs provokes purulent pneumonia and gangrene of the organ. Paranephritis and pyelitis result from kidney infection. If brain damage occurs, the likelihood of developing purulent meningitis increases. Such consequences can lead to death.

Symptoms of sepsis in newborns include a purulent skin rash, lack of appetite, restlessness, sallow skin tone, diarrhea and fever.

Diagnosis and treatment

Sepsis can be diagnosed by studying the symptoms present in the patient, as well as after culture of the contents of a purulent lesion, a general blood test and culture of blood for aerobic and anaerobic microorganisms. It is recommended to carry out the above tests repeatedly, at the peak of fever. The difficulty of diagnosing sepsis lies in the fact that its manifestations are also characteristic of other diseases:

• typhoid fever;
• stage four lymphogranulomatosis;
• malaria;
• tuberculosis;
• stage four leukemia;
• brucellosis.

Therapy for blood infection is used on an emergency basis. The patient is indicated for hospitalization in the infectious diseases department of the hospital. Treatment for sepsis includes the following areas:

• elimination of intoxication;
• destruction of bacteria that provoked sepsis;
• stimulation of immunity;
• restoration of functions of organs affected by sepsis;
• elimination of symptoms.

First of all, the patient is prescribed bed rest and treatment with large doses of antibiotics. The choice of antimicrobial drug depends entirely on the type of pathogen that provoked blood poisoning. For advanced disease, treatment with corticosteroids is prescribed. If necessary, the patient is given a blood plasma transfusion and glucose (gamma globulin) injection. To restore immunity, it is necessary to transfuse leukocytes and take immunostimulants.

To restore the functions of the affected organs, antihistamines, cardiac and other drugs can be prescribed. In severe sepsis, the risk of venous thrombosis increases, so patients need appropriate prophylaxis. For this purpose, treatment with Heparin may be prescribed. If this drug is contraindicated, the patient is prescribed mechanical thrombosis prophylaxis, such as wearing compression stockings.

Treatment of sepsis also includes monitoring the state of the inflammation. If treatment with medications does not bring results, surgery is required to open the purulent lesion and drain it. If the surrounding soft tissues are damaged, their sanitation is necessary. During treatment the patient is shown drinking plenty of fluids and fractional meals. Preference is given to protein foods.

Prevention

The consequences of sepsis are serious. Complicated disease is associated with a high mortality rate, especially among children. Prevention of the disease consists of treating foci of inflammation that have arisen due to otitis media, osteomyelitis, tonsillitis, sinusitis, etc. If purulent inflammations and boils occur, you should contact a medical facility, because opening abscesses on your own can increase the risk of blood poisoning. Prevention of sepsis in newborns involves monitoring the course of pregnancy and monitoring the condition of the already born child. If your baby develops pustules on the skin or the umbilical wound becomes inflamed, you should immediately contact your pediatrician.

At all times, problems have existed in medicine and persist at its present stage that are extremely difficult to solve. These include the diagnosis and treatment of septic conditions. They can be called differently: bloodstream infection, blood poisoning, sepsis, but the essence of the disease remains the same. Therefore, criteria and signs of blood poisoning have been developed, by paying attention to which you can prevent the serious consequences of this condition. They will be discussed in this article.

The essence of the problem from the point of view of doctors

A lot of controversial opinions about bloodstream infections persist even among the luminaries of this area of ​​medicine. The new ideas are radically different from those that were accepted before. Today, the concept of blood poisoning is understood as systemic inflammatory response syndrome. Previously, it involved only the isolation of a culture of certain microorganisms from the blood, which should not exist under any circumstances. After all, blood is normally sterile. But due to the fact that it is possible to isolate pathogens from the blood in no more than 30% of cases of overt sepsis, this rule had to be revised in favor of partially neglecting it. Clinical symptoms and laboratory signs of disturbances in the normal functioning of the body should come to the fore regarding the possibility of blood poisoning.

Important to remember! Sepsis or blood poisoning is an abnormal reaction of the body to certain types infections resulting from a collision between an inadequate immune system and highly pathogenic pathogens. Inferiority is perceived as both excessive and insufficient immunity, leading either to the penetration of the bacteria themselves or toxins from their massive destruction into the blood!

Presence of a focus of infection

The first thing that will allow you to think about the presence of blood poisoning is the symptoms of the source of infection. If there is none, it is almost impossible to suspect a septic condition. This is one of the main criteria. Having discovered such a focus, the nature of the pathogen that caused its appearance must be established. To do this, culture of smears or contents from areas affected by microbial inflammation is performed. It is advisable to do this before starting antibacterial therapy, which will make it possible to more accurately determine the nature of the pathogen. The role of such foci can be purulent-inflammatory processes of any localization (pneumonia, lung abscess, purulent sinusitis and tonsillitis, furunculosis, kidney infection, etc.).

Temperature response

Regarding body temperature, as one of the signs of blood poisoning, the following symptoms can be considered:

• A prolonged increase above 38.0˚С in the form of regular sudden jumps;
• Decrease in temperature to less than 36.0˚C.

In the first case, the situation is caused by the reaction of immune blood cells to the entry of bacteria or toxins released during their destruction into the blood. In the second case, we are talking about depletion of immune resources and adrenal organ failure. These signs of sepsis occur in all cases of this disease and indicate widespread toxic damage to internal organs.

Blood poisoning is a serious disease requiring specialized treatment

Pronounced and persistent changes in heart rate

In patients with blood poisoning, constant tachycardia remains. Its presence is indicated by an increase in heart rate of more than 90 beats per minute in a state of complete rest of the patient at normal body temperature and the absence of disturbances various types heart rate. Symptoms of bradycardia in the form of a decrease in heart rate to less than 60 beats per minute have the same diagnostic value. Its occurrence indicates severe toxic damage to the myocardium by microbial toxins. Typically, tachycardia and bradycardia are accompanied by increased breathing more than 18-20 times per minute (tachypnea).

Changes in blood tests

Diagnostic criteria for bloodstream infection and sepsis are changes in the leukocyte blood count. These symptoms may include:

• Leukocytosis in the form of an increase in the number of leukocytes more than 9 g/l;
• Leukopenia in the form of a decrease in the number of leukocytes less than 4 g/l;
• A shift of the leukocyte formula to the left in the form of an increase in the percentage of immature forms of leukocytes in relation to their mature forms and lymphocytes (increase in the number of rod cells by more than 7%;
• Lymphopenia in the form of a decrease in the level of lymphocytes less than 18%.

Important to remember! Any signs of sepsis are evidence of this disease only if they occur in the presence of a focus of infection in the body. Its absence indicates that any symptoms are the result of other causes!

Isolation of the pathogen in the blood

The only reliable criterion for blood poisoning can only be laboratory diagnosis of the presence of microbes in it. To do this, fresh blood is inoculated on nutrient media on which pathogens should grow if they are present in the blood at the time of taking the test. Therefore, it is best to carry out sampling at the height of fever, which will increase the reliability of the study. Ideally, the procedure should be performed before administering antibiotics, which cause false-negative results. Unfortunately, in most cases of overt sepsis, it is extremely rare to isolate a culture of the pathogen.

Multiple foci of infection

In a person with blood poisoning, not only pathogenic microbes enter the blood. With its current, they can be carried into any organs and tissues located at a great distance from the primary focus. This is manifested by widespread pustular rashes on the skin and the addition of synchronous inflammatory damage to several organs with the formation of multiple abscesses. The spleen and liver react most to this process, which sharply increase in size. No less important is the long-term and progressive course of the purulent-inflammatory process in the primary focus of infection, which remains active despite the treatment.

Blood poisoning, the symptoms of which we will consider in this article, is scientifically called sepsis. This concept refers to an infectious disease caused by toxins entering the blood. In a healthy person, the immune system can easily cope with bacteria. However, since they tend to multiply quickly, and not every organism is able to destroy the emerging infection, blood poisoning occurs. We will discuss the symptoms of sepsis and its treatment.

What can cause infection?

Blood poisoning can be caused by staphylococci, streptococci, E. coli, pneumococci and other bacteria. As a rule, sepsis develops during wounds and inflammatory processes, when the body is especially weak due to blood loss, poor nutrition, transferred operations. Blood poisoning has the following causes:

• complications caused natural childbirth, abortions;
• formation of pus, damage to the genitourinary system, stagnation of urine and its infection (urosepsis);
• obstetric and gynecological sepsis;
• complications of purulent diseases (carbuncle, boil), suppuration of wounds, sutures;
• purulent diseases of the oral mucosa.

How does blood poisoning manifest?

Sepsis or blood poisoning has the following symptoms:

1. The appearance of causeless chills.
2. Pain and aches in bones and muscles.
3. The appearance of a hemorrhagic or papular rash.
4. Formation of abscesses in various tissues and organs (spread of infection).
5. Increased size of the liver and spleen.
6. Increased body temperature.
7. Fever.
8. General weakness, lethargy.
9. Weight loss.

The combination of most of the above symptoms indicates the presence of sepsis. Self-medication in this situation is pointless and dangerous. First of all, you need to see a doctor.

Before prescribing therapy to a patient, the doctor determines the source of infection, which is necessary to combat it. After this, a set of actions is prescribed to destroy bacteria and purulent microorganisms. It includes treatment with antibiotics, serums, rich nutrition and so on. If blood poisoning comes from the wound, then the abscess is opened, ulcers and dead tissue are removed. fabrics and treatment with antibacterial agents. Treatment occurs under the supervision of a doctor in the intensive care unit and can take several months. Without medical intervention, the risks of contracting HIV and other serious diseases increase.

How to avoid sepsis?

None of us can be protected from infection entering the body. However, we can do everything we can to reduce the risk of infection as much as possible. Firstly, any abrasion or scratch can lead to blood poisoning, especially during a period of decreased immunity. Therefore, it is recommended to treat cut areas with antiseptic agents. Secondly, if you notice that the injury you received has begun to fester, and along with it other symptoms have appeared, then it is better not to hesitate and contact a medical facility. Blood poisoning, the symptoms of which we discussed above, is a serious disease and requires qualified treatment.

What it is? Blood poisoning is a condition in which pathogenic microorganisms enter the blood, quickly multiplying and spreading throughout the body. Causal agents may include bacteria, viruses and fungal flora.

However, not every entry of a microorganism into the blood leads to infection - a combination of several factors is necessary:

• simultaneous entry of a large number of pathogens into the blood;
• insufficiency of immune resources in the body that can stop the growth and reproduction of microorganisms.

Therefore, the likelihood of blood poisoning is highest in the following cases:

1. If there is a source of infection in the body having close connection with a blood or lymphatic vessel. This situation occurs when:

• pyelonephritis;
• dental infections;
• pathologies of ENT organs, etc.

2. When the immune system is suppressed:

• HIV infection
• treatment with cytostatics or steroids (these drugs neutralize antibodies, reduce their production and suppress the activity cytotoxic cells, i.e. they inhibit both cellular and humoral immunity)
• splenectomy
• lymphogranulomatosis and other leukemias (tumors of the hematopoietic system)
• tumor damage to any organ (oncological diseases are always combined with a depressed state of immunity, which is considered as the root cause of the tumor)
• prolonged excessive insolation (sun rays can have a detrimental effect on the immune organs - the thymus, Bone marrow, The lymph nodes).

3. When combined chronic infection and suppressed immune system (this is the most severe case).

The nature of the course of blood poisoning can range from acute (fulminant) to chronic. In the latter case, with various concomitant diseases accompanied by immunodeficiency, an exacerbation is observed. Early initiation of antibiotics leads to complete cure.

This is also reflected in the nature of the infection, which has now changed significantly (the number of fulminant forms has decreased). Without treatment, blood poisoning is always fatal.

Main causes of blood poisoning

The routes of blood infection in all cases are associated with any (even the slightest) possibility of direct contact of the pathogen with the blood, where it immediately enters. It can be:

• extensive festering wounds;
• boils;
• postoperative wounds.

In some cases, the cause of blood poisoning may be infection of a blood clot that has entered the filter of the inferior vena cava or is located in.

Infection occurs in a similar way in the presence of intravascular catheters. They become especially dangerous if installed on long term. Therefore, the optimal time between changing catheters is 72 hours. The risks of venous catheters are twofold:

• Direct possibility of contact between blood and microorganisms living in the environment;
• Possibility of thrombus formation and infection.

There is also a possibility of infection through blood transfusion. Therefore, the prepared donor material is tested for 6 months. This is the window stage for most infections when serological studies cannot detect antibodies to them.

Risk also exists during operations. It is especially significant during gynecological interventions performed according to emergency indications. The intra-hospital route can be realized through dressings, the hands of staff and instruments.

Often the source of bacterial invasion cannot be detected. This condition is called cryptogenic sepsis.

Various microorganisms can cause blood poisoning:

• staphylococci;
• meningococci;
• pneumococci;
• Pseudomonas aeruginosa;
• Proteus;
• coli;
• herpes virus;
• mushrooms (Candida, Aspergillus and others).

As a rule, this is the result of blood poisoning by one type of microorganism, which begins to divide uncontrollably, “breaking through” all protective barriers. The combination of several pathogens or their change during the course of the disease is the exception, not the rule.

The first signs and symptoms of blood poisoning

When blood is infected, the symptoms and manifestations of the disease depend on the type of causative microbe and the state of the immune system. Clinical symptoms consist of general and specific manifestations. Common features are:

• A significant rise in temperature to 39-40° C;
• Chills;
• Increased sweating, especially at night, replacing chills;
• Weakness;
• Hepato- and splenomegaly (enlarged liver and spleen, respectively);
• A rash that appears on the skin and has various characteristics(spot rashes, spots with uneven contours, etc.);
• Lack of appetite, leading to significant weight loss up to cachexia;
• Pain in muscles and joints (in the absence of morphological changes in them);
• A drop in pressure to critical values, which may be accompanied by the development of septic shock with loss of consciousness.

The appearance of the first symptoms of blood poisoning is not always acute. Sometimes there may be a gradual increase in temperature and intoxication. However, in a short period of time, a person’s condition becomes noticeably worse - it becomes difficult for him to move, do any work, he completely refuses to eat, etc.

Specific manifestations are determined by the type of causative microorganism. Depending on this fact, blood poisoning has the following features.

Staphylococcal sepsis manifested by severe muscle pain and high fever. Single rashes in the form of blisters appear on the skin. The patient's condition is initially extremely serious, but consciousness remains at the proper level. At the same time, a dry cough may be present, which is then accompanied by the release of yellow sputum in large quantities.

Meningococcal sepsis It starts off very stormy. The patient's condition is very serious. Shock may develop within a few hours. The distinctive features of this infection are the rapid increase in workload with loss of consciousness, and multiple hemorrhages of various shapes appear on the skin.

The development of septic shock is facilitated by hemorrhage in the adrenal glands, which often complicates meningococcal infection.

Pneumococcal blood poisoning is characterized by the following symptoms: an increase in temperature to very high values, the appearance of severe chills and weakness, adynamia (both physical and mental), intoxication of the body.

For generalized Loss of consciousness and shock are not typical for pneumococcal infection. Despite the extremely serious condition of the patient, this type of blood poisoning is not characterized by muscle pain, rash, or severe disturbances in the functioning of organs.

In comparison with meningococcal infection, pneumococcal infection is not characterized by a rapid course. At the same time, clinical improvement during therapy occurs much later.

This fact is explained by the characteristics of meningococci, which are resistant to many antibacterial drugs. In most cases, their final choice becomes possible only after receiving the results of a bacteriological study.

Gram-negative sepsis most often accompanies immunodeficiency and is caused by an infection that develops as a result of postoperative complications (suppuration in abdominal cavity or pelvis during gynecological operations). Blood poisoning after childbirth is also very often associated with gram-negative microorganisms.

The clinical difference between these microbes is an increased tendency to necrotic hemorrhages into the skin. They are single painful dark red rashes surrounded by a dense shaft, which gradually increase in size.

Gram-negative infection is characterized by low body temperature (up to 38°C). Therefore, patients often seek medical help late.

An exception to the typical clinical course is pseudomonas form, developing against the background of suppression of the immune system. It occurs at lightning speed, with the likelihood of rapid development of shock (2-3 hours after the onset of elevated temperature).

The development of herpetic blood infection always occurs due to severe immunodeficiency, which is observed in leukemia and lymphogranulomatosis (due to a decrease in the body's antiviral activity), HIV infection in the AIDS stage and after transplantation.

Infectious generalized the process begins with the appearance of rashes of herpetic blisters on the skin along the ribs. Then there is a massive spread of rashes on other areas of the skin, on the mucous membrane of the trachea and bronchi, oral cavity and esophagus.

After opening the bubbles, it may rejoin staphylococcal infection leading to suppuration.

A feature of the infectious disease is the massive microbial contamination of the blood in combination with severe disturbances of coagulation activity (DIC syndrome). Therefore, treatment of blood poisoning is aimed at eliminating these two pathogenetic factors.

Etiology of the disease

The causative agents of sepsis are a variety of microorganisms: Escherichia coli (colisepsis), pneumococci (pneumococcal c), staphylococci (staphylococcal sepsis), meningococci (menincococcal c), Mycobacterium tuberculosis, Klebsiella, fungi such as Candida (visceromycotic), herpes viruses. An important role in the development of sepsis is played by human immunity and its properties, as well as the state of the body as a whole. A healthy immune system will not allow full-fledged sepsis to develop, identifying the pathogen in time and blocking it, preventing uninvited guests from getting inside the organs.

The method of infection depends on the specific type of pathogen. Each one has its own characteristics. IN separate group Only nosocomial sepsis can be distinguished, when one can become infected due to poorly cleaned premises, instruments, etc. Other routes of infection:

• through the skin;
• oral;
• otogenic;
• obstetrics and gynecology;
• infection during surgical or diagnostic procedures and injuries (surgical sepsis);
• cryptogenic

In order to begin treatment as effectively as possible, it is first important to identify the route of infection. Timely diagnosis will help to separate sepsis from a short-term infection at an early stage and take measures to activate the body's defenses. For the development of sepsis, several factors must be present:

• primary focus directly connected to the lymphatic and circulatory system;
• multiple penetration of microbes into the blood;
• the appearance of secondary foci from which pathogens also penetrate into the blood;
• sluggishness of the immune system.

If all these factors and corresponding symptoms are present, a diagnosis of sepsis is made.

The development of blood poisoning is also affected by some serious diseases such as cancer, HIV, diabetes, rickets, congenital pathologies immunity. Some therapeutic measures, taking immunosuppressants, and radiotherapy also provoke the occurrence of sepsis.

Separately, it is necessary to say about sepsis in children. In childhood, among all inflammatory diseases, sepsis is extremely rare and usually occurs in newborns (0.1-0.4%). Distinguish intrauterine infection and infection during or after childbirth. The focus of intrauterine sepsis is outside the fetus (chorionitis, placentitis) and the child is already born with signs of the disease or they appear on the second day of life. Newborn babies become infected through umbilical wounds and blood vessels due to improper care or poor bacterial conditions in the hospital.

Symptoms of blood poisoning

There are no specific definitive symptoms, but the main symptoms can be identified:

• increased body temperature;
• severe chills;
• unstable mental condition patient (apathy, euphoria);
• pale skin;
• indifferent look;
• facial hyperemia;
• hollow cheeks;
• sweating;
• petechial hemorrhage (spots or stripes on the forearms and legs);
• possible herpes on the lips;
• bleeding of mucous membranes;
• labored breathing;
• pustules and lumps on the skin.

The main symptoms sufficient to make a diagnosis are fever, chills, and profuse sweating. Once you notice these symptoms, it is important to begin treatment as quickly as possible.

Diagnostics

Diagnosis is based on a blood test for the presence of pathogens, and it is necessary to do multiple cultures with prolonged incubation. This process is lengthy and not always accurate. Latest Methods Studies show that in severe diseases of infectious origin, the level of procalcitonin in the blood plasma increases sharply, as this is the immune system’s response to the pathogen. Procalcitonin begins to be synthesized in monocytes and macrophages much earlier than other proteins of the acute phase of the inflammatory process. To determine the level of procalcitonin, a diagnostic procalcitonin test was invented, which has already been early stages may help in making a diagnosis.

Treatment

In essence, the treatment of sepsis is absolutely no different from the methods used in the treatment of other infectious diseases, but it is important to consider the possible risk of complications or fatal outcome. Treatment options include:

• fight against intoxication;
• blocking harmful microflora;
• stimulation of the body's immunity;
• correction of the work of all vital important systems body;
• symptomatic treatment.

Antibiotics, corticosteroids, blood plasma transfusions, and administration of gamma globulins and glucose are prescribed. If conservative treatment does not give the expected effect, they are considering the possibility of surgical treatment, which includes opening abscesses, amputation of limbs, etc.

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Blood poisoning is a specific systemic pathogenetic condition of the human body that develops as a result of the introduction of infectious agents and the subsequent development of a generalized infectious inflammatory response against the background of a decrease in the functioning of the immune system.

Acute general blood infection debuts at the moment of spread of infectious agents from the primary focus into the general bloodstream, and such a primary focus of infection is most often a suppurative focus of soft tissues, joints, internal structures and even bones. Acute infectious blood poisoning almost always develops against the background of a pronounced decrease in immunity, which occurs when the primary inflammatory focus is not detected in time, resulting in a massive spread of toxic substances into various structures human body along with the blood flow.

It should be borne in mind that there are various etiopathogenetic types of blood poisoning, each of which is not a contagious infection, that is, even infectious blood poisoning cannot be transmitted from one person to another. The maximum severity of the current and extremely negative influence The patient’s health condition is characterized by purulent general blood infection, which develops as a result of the entry of pathogenic microorganisms from a purulent focus into the blood stream. Almost all etiopathogenetic types of blood poisoning provoke death in 90% of cases, so it is not possible to talk about the sufficient effectiveness of therapeutic measures for this pathological condition.

The main etiological provocateurs for the development of blood poisoning are various pathogens in the form of protozoa, fungi, viral particles and, of course, bacteria. The pathogenetic stages of blood poisoning begin as soon as the first portion of toxic substances enters the general bloodstream.

Blood poisoning in pediatric practice is classified as practically incurable pathological conditions due to the development of irreversible, pronounced systemic inflammatory reactions that affect all structures of the child’s body.

Regardless of the clinical and etiopathogenetic forms of blood poisoning, clinical symptoms are characterized by a rapid increase in the intensity of clinical manifestations and their polymorphism.

Blood poisoning belongs to the category of extremely unfavorable pathological conditions in terms of prognosis for recovery due to the high mortality rate due to the low effectiveness of available treatment methods.

The development of such a serious condition for the human body as blood poisoning is largely due not to the concentration or pathogenicity of the pathogen, but to a decrease in the function of the immune system. In one person, whose immune system functions quite well, the pathogen provokes the development of a limited inflammatory response, while in another it may provoke the development of blood poisoning. A separate nosological form is blood poisoning after surgery, as well as during long-term use of immunosuppressive therapy. Blood poisoning after childbirth, as well as in the post-abortion period, the occurrence of which is caused by the contact of infectious agents on the wound surface of the myometrium, is extremely serious in terms of its impact on a woman’s health.

The development of this pathological condition occurs gradually, therefore, the indication of the pathogenetic and clinical stage of blood poisoning in the diagnosis is mandatory for the attending physician.

Causes of blood poisoning

Such a pathological condition as blood poisoning in humans develops against the background of a massive attack of infectious agents and their toxins, which, together with an inadequate treatment regimen, creates conditions for the rapid generalization of the inflammatory process. Considering the issue of etiology and the main pathogenetic mechanisms of the development of blood poisoning, it should be noted the undeniable role of the bacterial coccal flora, Pseudomonas aeruginosa, fungi, viruses and protozoa in its development. Pathogenetic mechanisms for the development of blood poisoning begin from the moment an active pathogen enters the human body, after which an active or latent inflammatory response develops, which, against the background of increased individual reactivity of the body, is a favorable background for enhancing inflammatory reactions.

Of course, there is a certain relationship between the concentration of the pathogen and the risk of developing blood poisoning, that is, the more bacteria or viruses enter the human body through the entrance gate, the greater the chance of developing blood poisoning. And at the same time, in the pathogenesis of the development of blood poisoning, the main role belongs to an imbalance in the functioning of the human immune system, as a result of which a person is not able to resist even a small concentration of infectious agents. So, such pathological and physiological conditions How somatic disease, endocrine disorders, oncopathology, changes in blood composition, chronic vitamin deficiency, psycho-emotional stress, have an inhibitory effect on the main factors of immunity, which becomes a favorable background for the development of blood poisoning.

The development of blood poisoning occurs with some consistency and stages. Thus, the primary pathogenetic link is the spread of a large concentration of pathogens from the primary inflammatory focus through the blood reservoirs and the further formation of secondary septic metastases, which intensify the inflammation process. Thus, a pathomorphological marker of blood poisoning is the detection of a large number of ulcers in various structures of the human body.

Polymicrobial blood infection occurs, as a rule, in a group of HIV-infected patients suffering from a pronounced decrease in the function of the immune system and the rapid proliferation of various kinds of pathological microorganisms. In the category of clinically healthy individuals, the main provocateurs of the development of blood poisoning are staphylococcus, pneumococcus and meningococcus.

Symptoms and signs of blood poisoning

The clinical course of blood poisoning is accompanied by the appearance of polymorphic and at the same time low-specific clinical symptoms, which often simulate the clinical picture of other pathological conditions and diseases. Absence of pathognomonic clinical symptoms, which would help the attending physician on early stage to establish blood poisoning is largely due to the fact that in medical practice doctors use rather aggressive and intensive antibacterial drugs. Thus, against the background of powerful antibiotic therapy, an atypical clinical picture of blood infection develops, consisting of low severity or complete absence pyretic reaction as the main marker of the inflammatory response.

In the classical course, blood poisoning is accompanied by the development of hectic fever, the attack of which ends with profuse sweating and impaired activity. of cardio-vascular system in the form of irregular pulse and blood pressure, chills, general malaise, vomiting and diarrhea, as well as severe dyspeptic syndrome, causing dehydration and rapid weight loss.

Objective signs of blood poisoning, which are identified by the attending physician already during the initial examination of the patient, are a decrease in the elasticity and turgor of soft tissues and skin, which acquire an earthy color, and the presence of many common foci of purulent infection in the form of abscesses.

Pediatricians note that blood poisoning in children, already at an early stage of development, is accompanied by the development of pronounced psychomotor impairments with the appearance of severe neurological changes and deep disturbance of consciousness up to coma. The chronic course of blood poisoning is characterized by the development of slowly progressive multiorgan disorders and the appearance of many inflammatory foci in various internal organs.

In many ways, the appearance of any pathognomonic manifestations in a patient directly depends on the etiopathogenetic type of blood infection. Thus, blood poisoning after surgery is manifested primarily by a local reaction in the area of ​​the postoperative suture in the form of inflammation, after which an increase in general intoxication syndrome is noted.

In almost 99% of cases, blood poisoning after childbirth is lightning fast due to the rapid increase in intensity and polymorphism of clinical symptoms. In this situation, a good help for making a diagnosis of “blood poisoning” is a careful collection of anamnestic data. The fulminant course of blood poisoning always ends in death due to the development of pathogenetic mechanisms.

Diagnosis of blood poisoning

Staging clinical diagnosis“blood poisoning”, although difficult, is possible, subject to an adequate assessment of the patient’s clinical manifestations, as well as the typicality of its individual symptoms. An obligatory step for verifying the diagnosis of “blood poisoning,” and especially determining its etiopathogenetic form, is the collection of anamnestic data that preceded the development of clinical symptoms of the disease (the period after surgery, injury, delivery and severe infectious diseases).

Based on the analysis of a detailed hemogram of a patient in whom the attending physician suspects the development of blood poisoning, in most situations a pronounced and obvious band shift of the formula to the left is determined with a simultaneous critical decrease in platelet counts. blood cells. Great importance in determining the treatment tactics for patients with blood poisoning has the identification of the pathogen, for which various types are currently successfully used bacteriological research blood tests, carried out three times at least an hour before taking the antibacterial drug.

To assess the severity of the condition of a patient who has been previously diagnosed with “blood poisoning,” it is necessary to take into account the characteristics of the individual “systemic inflammatory response,” which is a systemic unique reaction of the body to the introduction of any active infectious agents. Distinctive features blood poisoning in this situation is the development of generalization of the pathological inflammatory response and the formation of many limited inflammatory-purulent foci.

Additional instrumental techniques that allow visualization of blood poisoning are various radiation diagnostic techniques such as standard fluoroscopy, ultrasound scanning and computed spiral tomography. When localizing the main pathomorphological changes of blood poisoning in the patient’s bone tissue, the main thing is instrumental method The study is radiography, which allows you to visualize signs (limited or extended areas of destruction of the bone tissue structure).

With the development of multiple organ disorders caused by the development of a powerful inflammatory process, blood poisoning is quite effectively diagnosed on ultrasound, as well as on tomographic scans (intra-abdominal and intrathoracic abscesses, unlimited infiltrates).

A severe course of blood poisoning in a patient is manifested by the appearance of symptoms, manifested by hypotension and hypoperfusion. Characteristic biochemical laboratory markers of blood poisoning appear at the terminal pathogenetic stage and act as a sign of multiple organ failure.

Treatment of blood poisoning

When determining the therapeutic tactics for managing a patient suffering from blood poisoning, one should first of all take into account the features of the pathogenetic mechanisms of development of this pathology. Considering the two main mechanisms for the development of blood poisoning in the form of the development of massive intoxication syndrome and the symptom complex of disseminated intravascular coagulation, therapeutic measures should be aimed at stopping precisely these links of pathogenesis. All patients in whom the development of blood poisoning was suspected are subject to immediate hospitalization in the infectious diseases intensive care unit. Signs of belated medicinal correction blood poisoning is the development of multiple hemorrhages in the adrenal glands, gangrene of the extremities, irreversible changes internal organs.

Immediately after taking blood for biochemical and other types of tests, the patient must be administered the first maximum dose of an antibacterial drug intravenously. In the case of the appearance of minimal signs in the form of nonspecific myalgia and muscle soreness, interstitial on standard radiographs of organs chest cavity, medicinal types of correction are ineffective and the plasmapheresis procedure should be started immediately. To carry it out, it is necessary to remove about 1.5 liters of plasma from the patient’s body, followed by parenteral administration of 2/3 of this volume of fresh frozen plasma. The fulminant severe course of blood poisoning is the basis for expanding the volume of administered fresh frozen plasma to 2 liters or more.

Often to get quick effect to relieve DIC syndrome due to blood poisoning, the patient is treated with combined therapy with plasmapheresis and Heparin in maximum dose 24,000 units/day. This drug in case of blood poisoning, it is preferable to administer continuously intravenously, especially on the first day of therapy.

In cases where blood poisoning is accompanied by the development cardiovascular failure in a patient, it is advisable to use drugs from the sympathomimetic group, and in the absence of a pharmacological effect, therapy should be supplemented with intravenous administration of hydrocortisone. The presence of signs of arterial hypotension in a patient suffering from blood poisoning is not considered a contraindication for plasmapheresis, however, the volumes of removed and injected plasma should be slightly reduced.

When selecting a drug for antibacterial therapy for blood poisoning, one should first of all be based on the expected type of pathogen. In case of difficult early verification of the causative agent of blood poisoning, empirical drug antibacterial therapy should be started early, implying the appointment of Gentamicin in a daily dose of 240 mg in combination with Ceporin in a maximum daily dose of 4 g intravenously. Reliable signs of sufficient pharmacological effectiveness of antibacterial therapy for blood poisoning are an improvement in the patient’s subjective well-being, relief of hemodynamic disturbances, a decrease in the body’s pyretic reaction, the disappearance of chills, and a decrease in rash elements. Laboratory criteria improvement of the condition is a decrease absolute number band cells in the hemogram.

Consequences of blood poisoning

The generalized course of blood poisoning often provokes the development of complications associated with hemodynamic and respiratory disorders caused by a sharp drop in PaO2, as well as an increase in the permeability of the air-hematological barrier. As a result of these changes, when blood is infected in the patient’s body, the liquid component of the blood sweats into the alveoli, the excursion of the lungs decreases, and further violation gas exchange function. If an X-ray of a patient suffering from blood poisoning reveals increasing bilateral opacities of the pulmonary parenchyma, decreased compliance of the pulmonary parenchyma, and laboratory signs hypoxemia should imply the development respiratory distress syndrome, which occurs in 50% of all cases of this pathology. If a rise in the pulmonary papillar pressure is detected to a level of more than 18 mm Hg. Art. the development of hypervolemia and rather than respiratory distress syndrome should be suspected.

Another variant of the complicated course of blood poisoning in humans is the development of septic shock, caused by a sharp drop in peripheral vascular resistance, and, to a greater extent, by a redistribution of blood flow and a decrease in the volume of circulating blood. The leading mechanism for the development of septic shock during blood poisoning is an increase in permeability vascular wall at the level of the capillary bed and the exit of the liquid component of the blood into the perivascular space. An aggravating factor in septic shock is the ongoing decrease in circulating blood volume due to dehydration of the body, which develops in most infectious diseases. At the onset of the development of the clinical picture of blood poisoning, there is no disturbance in cardiac output, and in some situations even a compensatory increase may be observed, which makes it possible to differentiate septic shock from cardiogenic, obstructive and hypovolemic types of shock.

The development of acute cardiovascular failure due to blood poisoning is observed after one day, as evidenced by an increase in end-diastolic and end-systolic volumes, as well as a decrease in ejection fraction. At the same time, there is no change in cardiac output, even despite developing myocardial dysfunction and arterial hypotension. The development of death in this situation is due to refractory shock and multiple organ failure, and not heart failure.

Signs of impaired renal function due to blood poisoning are the detection of signs of oliguria, azotemia, proteinuria and cylindruria in the patient. The development of renal failure due to blood poisoning is associated with the formation of damage to the renal capillary network and acute tubular necrosis caused by arterial hypotension. In addition, when blood is infected, signs of glomerulonephritis, interstitial nephritis, and cortical necrosis of the kidneys may develop. A situation that aggravates the course of renal failure due to blood poisoning is the use of antibacterial drugs of the aminoglycoside group in the presence of arterial hypotension.

The consequences of blood poisoning also include a long-term blood clotting disorder caused by blood clotting, which is observed in 30% of all cases of this pathology. With a prolonged course of blood poisoning, the development of severe, often irreversible neurological disorders in the form of polyneuropathy is observed. To establish these pathological changes, it is recommended to use electrophysiological studies, complete exclusion, as well as various types of metabolic disorders and toxic damage nervous system.

Prevention of blood poisoning

After suffering blood poisoning, each patient requires long-term immunorehabilitation in order to prevent re-development of the disease, which involves the use of various types of extra-immune therapy drugs (vitamin-mineral complexes, herbal immunoactive drugs and adaptogens). In addition, as preventive measures after suffering blood poisoning, patients are recommended to periodically use prolonged courses of mild immunocorrectors such as thymomimetics, as well as derivatives of bacterial muraldipeptides and drugs of the antioxidant group.

To prevent the development of complicated forms of blood poisoning, the duration of inpatient treatment in a highly specialized medical institution should be based on clinical and laboratory “recovery” combined with complete sterility of blood cultures. The duration of the certificate of incapacity after discharge of a patient who has suffered blood poisoning is on average two months, during which he is under the dynamic supervision of a therapeutic specialist. During this time, the patient is required to conduct thermometry at least three times a day, and visit the attending physician once every two weeks with a detailed blood and urine test.

Even after the patient has fully recovered and there are no complaints on his part for three years after blood poisoning, he should be kept under dispensary registration in order to completely prevent the development of chronicity pathological process and the development of relapse of blood poisoning.

In some situations with for preventive purposes after cessation of hospital treatment for blood poisoning, the use of several courses of antibacterial drugs lasting two weeks every two months is indicated.

Blood poisoning - which doctor will help?? If you have or suspect the development of blood poisoning, you should immediately seek advice from doctors such as an infectious disease specialist or a neurologist.

(from the Greek sepsis - rotting) is a general non-specific infectious disease of a non-cyclic type, caused by the body's response against the background of its reduced resistance to the periodic or constant entry of pathogenic microorganisms and their metabolic products from the infectious focus into the bloodstream.

Despite the invention of new antibiotics of the latest generation with an extended spectrum of action, sepsis remains a serious, difficult-to-treat disease with a progressive course and high mortality rates.

Classification

Cryptogenic (primary)- a process without a visible source of infection, that is, in which the entrance gate for pathogenic flora was not detected.

Secondary– detection of a purulent focus and the presence of a pathogen in it.

Regarding the nature of the entrance gate microflora disease is divided into burn, wound and starting against the background of purulent-inflammatory diseases of any organs.

Depending from the location of the primary infectious focus The following types of disease are distinguished:

Oral (dental). The entrance gate is oral cavity.
Odontogenic. The source of infection is located directly in the hard tissues of the teeth or the periodontal attachment.
Otogenic. It begins after acute or chronic otitis media.
Rhinogenic. The gates of pathogenic flora are paranasal sinuses and the nasal cavity itself.
Tonsilogenic. With a focus in the tonsils.
Umbilical. Characteristic for children in the first 12 months of life. The focus is the area where the stump is separated from the umbilical cord.
Urosepsis. The source of pyogenic flora is the kidneys and other organs of the urinary system.
Angiogenic. Occurs after repeated intravenous injections or intravascular instrumental manipulations.
Obstetrics and gynecology. The appendages or uterus are the source of infection.
Endocardial. Pathogens enter the blood from a focus located in the endocardium, mainly on the heart valves.
Intestinal. The primary focus is all ulcerative processes of the intestine, including ulcerative necrotizing enterocolitis or colitis.
Cutaneous. The entry point for infection is in the skin. Bacteria enter the blood from pustules with purulent contents or from boils.
Abdominal. It has three forms: peritoneal, pancreatogenic and intestinal. It is a common complication of secondary peritonitis.

In addition to the above locations, the source of infection can be located in other organs with purulent-destructive lesions, for example, in the lungs, pleura, bile ducts, and so on.

Special emphasis is placed on surgical sepsis, which combines all variants of the secondary process with the presence of a primary or metastatic focus accessible to surgical removal. This group includes:

Wound sepsis. Penetration of pyogenic pathogens occurs through open wound.
Postoperative sepsis. The infection occurs during surgery or through festering sutures in the postoperative period.
Postpartum sepsis. Germs come from ruptures birth canal, uterine mucosa. In obstetrics, this type of disease accounts for more than 65% of maternal deaths.

There are several clinical and anatomical forms of the disease:

Septemia is the course of the process without purulent metastases.
Pyemia is a process with metastases.
Septicopyemia is a mixed form of sepsis.

According to the process and clinical picture distinguish:

Fulminant sepsis developing over 1–3 days.
Spicy– from 4 to 60 days from the moment of formation of the infectious focus.
Subacute sepsis with increasing symptoms over 2–6 months.
Chronic– for up to six months or more.
Recurrent– periodic exacerbations of the process.

Regarding the type of pathogen sepsis happens:

staphylococcal,
streptococcal,
meningococcal,
fungal,
putrefactive,
Pseudomonas,
pseudomonas,
colibacillary and so on.

Deserves special attention neonotal sepsis– generalized infectious process, developing when pyogenic or other pathogenic flora penetrates from the initial local focus into the blood of a newborn. Characterized by severe symptoms infectious intoxication and metastasis of purulent foci to various organs. The early variant is diagnosed in children in the first three days of life, the late variant - during the first three months.

Happens intrauterine sepsis detected in an infant immediately after birth. Some of the symptoms are jaundice and hemorrhagic diathesis.

Etiology of sepsis

Endogenous etiology implies the entry of an infectious agent from environment, autoinfection - the source of microbes entering the blood is a purulent focus located in any organ. A severe process can be triggered by an association of various pathogens.

The septic condition is caused not so much by the influence of microorganisms as by a decrease in immunity, sensitization to antigens and, because of this, the inability to localize pathogens in the primary focus of inflammation.

Reasons predisposing to the occurrence of sepsis:

Incurable diseases: diabetes, oncology;
congenital or acquired immunodeficiencies;
extensive burns;
multiple injuries;
forced reduction of immunity due to long-term use of immunosuppressants.

Pathogenesis of sepsis

The type of microorganism and its biological characteristics significantly influence the development of sepsis. For example, with staphylococcal sepsis, the spread of infection with metastasis of foci to other organs is observed, in contrast to streptococcal sepsis, in which the likelihood of metastases is much lower, but symptoms of intoxication predominate.

The appearance and severity of complications depend on the properties of bacteria: with gram-positive flora, such a complication as septic shock occurs only in 5% of cases, and with gram-negative flora - in 20–25% of patients.

The route of bacterial dissemination from the primary focus affects the severity of symptoms. As a rule, bacteremia is less pronounced with lymphogenous dissemination, since not all of the toxins and microbes themselves enter the blood; some of them are retained in the lymph nodes. Hematogenous dissemination is characterized by high fever with chills.

Manifestations of sepsis

The lightning-fast form develops rapidly and rapidly. The disease progresses rapidly, characterized by a picture of infectious-toxic shock. Death often occurs 1–3 days after the first signs appear.

At acute form Sepsis symptoms increase over a month or two. Symptoms of intoxication are expressed:

Heat(up to 39 – 400C) does not subside during the process without metastases, and if they are present, significant temperature fluctuations (more than one degree) are noted in the morning and evening;
chills with profuse sweat;
tachycardia, with an increase in heart rate relative to body temperature;
arterial hypertension;
anemia;
skin rashes;
irritability;
headache;
insomnia;
cardiac arrhythmias;
swelling due to oliguria;
dyspeptic disorders: diarrhea, nausea, vomiting;
earthiness of the skin;
cachexia.

Examination often reveals an enlarged spleen (splenomegaly) and liver (hepatomegaly). With metastatic abscesses, pneumonia begins in the lungs, and meningitis in the brain. Bacterial sepsis affects the heart, liver, and other organs, disrupting their functions and leading to decompensation. Respiratory, cardiac, and renal failure develops. Hypoxia and intoxication of the brain leads to the development of various mental disorders.

After this period, clinical manifestations subside, but often the course becomes wave-like and sepsis passes into a subacute form.

Chroniosepsis is characterized by a long, sluggish course with blurred, subtle symptoms. The recurrent process is distinguished by alternating periods of exacerbations with remissions.

Diagnosis of sepsis

Hyperthermia > 380C or hypothermia 20 per minute;
tachycardia with heart rate in adults > 90 beats per minute;
leukocytopenia 12.0*10 9/l or immature forms of leukocytes up to 10%.

The diagnosis is made when a lesion is detected and proven + 2 or more signs of SIRS + detection of at least one organ failure.

Statistics
According to WHO statistics, up to 14 patients die from sepsis every minute in the world. Disappointing figures indicate that the disease is diagnosed annually in more than 18 million people living in different countries.

Blood tests (biochemical and clinical);
urine test (general);
coagulogram;
bacteriological culture material (urine, sputum, blood, pus from serous cavities and wounds) to identify the pathogen and determine its sensitivity to antibiotics;
blood for sterility (for different types of sepsis, sampling is carried out both venous and arterial blood);
coagulological tests to detect disseminated intravascular coagulation (disseminated intravascular coagulation).

To search for a purulent focus, chest x-rays, ultrasound and other studies are prescribed.

Treatment of sepsis

Intensive therapy includes:

Antibiotic therapy;
extracorporeal detoxification and hemocorrection;
infusion therapy;
restoration of tissue and organ perfusion;
immunocorrection;
desensitization using glucocorticoids and inhibitors free radicals.

Complications of sepsis

Sepsis can have other consequences in the form of various pathologies and diseases. Some of them:

endocarditis,
thrombosis,
pneumonia,
pyelitis,
bedsores,
embolism,
hepatorenal syndrome,
bleeding.

Prognosis for sepsis

Prevention of sepsis

Strengthening immunity;
minimizing injuries;
timely recognition and treatment of any foci of infection and purulent-inflammatory diseases;
compliance with all rules of antisepsis and asepsis during various invasive procedures, surgical interventions, infusion therapy, IM