Cutaneous manifestations of bacterial sepsis

In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial. In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage. Endotoxin probably plays a prominent role in producing these lesions. That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures. More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved. The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation. Lesions of symmetric peripheral gangrene characteristically do not have bacteria present. The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon. However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction. In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage. An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction. Favoring a role for other bacterial substances is the predisposition of V. vulnificus to cause cellulitis or of C. fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown. It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both. In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process. In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded. In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm. As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)

Septicaemia – what to look out for

Septicaemia or blood poisoning, is a potentially life-threating infection caused by large amounts of bacteria entering the bloodstream. Here we discuss what it is, and the symptoms and treatment of septicaemia.

What is septicaemia?

Septicaemia is also called blood poisoning. It happens when a bacterial infection enters the bloodstream from somewhere else in the body, like the lungs or urinary tract (NHS, 2016a; Healthline, 2018).

As the bloodstream can carry the infecting bacteria and their toxins throughout the body, septicaemia can quickly become dangerous. If caught early, antibiotics at home might treat it but more severe cases must be treated in hospital (GOSH, 2011).

What are the symptoms of septicaemia?

The immune system’s attempts to fight the infection causes symptoms such as:

• a high temperature
• chills and shivering
• rapid, shallow breathing
• extreme fatigue
• feeling faint
• pale, clammy skin
• pinprick spots on the skin, or large purple areas that stay the same colour if you roll a glass over them (see below for the glass test).

(GOSH, 2011)

The pinprick spots or large purple areas are often seen in a type of blood poisoning that meningococcal bacteria causes, called meningococcal septicaemia. Meningococcal bacteria can also cause meningitis (GOSH, 2011).

If your child has any of the symptoms of septicaemia, get medical help straight away (GOSH, 2011). Make sure you don’t wait until a rash develops – trust your instincts (NHS, 2016b).

Call 999 for an ambulance or go to your nearest accident and emergency department if you think your child might be seriously ill. Phone NHS 111 or your GP if you’re not sure whether it’s serious.

How is septicaemia treated?

If blood poisoning is diagnosed early and it hasn’t affected any internal organs, it can be treated with oral antibiotics (GOSH, 2011).

If it’s severe your child might need to intravenous antibiotics in hospital (GOSH, 2011). If it’s particularly serious, medication for low blood pressure and machines to support organ function might be needed (GOSH, 2011).

What is sepsis?

If septicaemia is not treated, it can turn into sepsis. This is where the reaction to the infection affects the whole body (Patient, 2016; Healthline, 2018).

If your child has ANY of the following symptoms, go straight to A&E or call 999 for an ambulance:

• mottled, pale, blue-tinged skin
• very lethargic or you’re having trouble waking them
• they feel cold when you touch them
• very fast breathing
• a rash that doesn’t fade when pressed
• they have a fit or convulsion

If your child has ANY of the symptoms as follows, you must seek urgent medical advice from NHS 111:

• A high temperature of above 38⁰C for babies under three months and 39⁰C from three to six months, or any high temperature if your child is showing no interest in anything.
• A low temperature of under 36⁰C when checked three times during 10 minutes.
• They’re having trouble breathing, making grunting noises, are unable to say more than a few words when they normally talk more, or have pauses in their breathing.
• They haven’t had a wee for 12 hours.
• They haven’t fed for more than eight hours despite being awake, or if your baby is under one month old and is disinterested in feeding.
• They’re being sick with green, bloody or black vomit.
• Your baby’s soft spot is bulging.
• Their eyes seem sunken.
• They’re disinterested in everything, or they’re not responding or they’re irritable.
• They’re weak, floppy, whining or crying continuously.
• They have a stiff neck, particularly when they look up and down.

(NHS, 2016a)

If you suspect your child has sepsis, get medical advice fast (NHS, 2016a).

Sepsis affects blood flow, and can cause a life-threatening drop in blood pressure, which prevents oxygen from reaching vital organs (NHS, 2016a; Healthline, 2018).

What is septic shock?

People with dangerously low blood pressure from the inflammation have what’s called septic shock (GOSH, 2011; Healthline, 2018). Septic shock can be treated but it’s a very serious condition that people can die from.

The glass test

If you find a blotchy rash that does not fade when you press a glass firmly over it, this is a typical symptom of meningitis. Yet this symptom doesn’t always develop (NHS, 2016b).

This rash can also be more difficult to see on darker skin. So check paler areas, like the tummy, the palms of the hands, soles of the feet, inside the eyelids, and the roof of the mouth, for spots (NHS, 2016b).

The rash often starts off looking like small, red pinpricks. You would then see it spread quickly and turn into red or purple blotches. A non-fading rash seen under a clear glass firmly pressed against the skin is a sign of septicaemia caused by meningitis (NHS, 2016b).

You must get medical advice for your child immediately if you find this rash on them.

This page was last reviewed in May 2018.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of NCT’s Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Trust your instincts. Meningitis, septicaemia and sepsis are medical emergencies. Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department if you think you or your child might be seriously ill.

NHS Choices has more information on meningitis, complications of meningitis and sepsis.

Meningitis and septicaemia in children and babies

Meningitis is a very serious illness. It is an infection of the lining of the brain and spinal cord. There are two main types of meningitis: bacterial and viral.

Call 999 or bring your child immediately to the nearest hospital emergency department that deals with children if you think your child is seriously ill

The germs that cause bacterial meningitis can also cause septicaemia (blood poisoning). Like meningitis, septicaemia is a serious illness that can be life-threatening.

Fast treatment can save lives and prevent long-term disability. Symptoms can include a rash, but not always.

If you’re not sure, contact your GP or GP Out of Hours Service immediately. Bring your child immediately to your nearest hospital emergency department for children if:

• you are unable to contact your GP
• they are unable to see your child urgently

Meningitis and septicaemia symptoms

Babies and children with meningitis and septicaemia won’t usually have every symptom.

They might not have any rash. Symptoms can appear in any order.

Think about meningitis and septicaemia if your child has any of the following.

A high temperature

A temperature of 38°C or higher or cold hands and feet and is shivering.

Dislikes bright lights

Squints or covers their eyes when exposed to light.

Headache and neck stiffness

Has a very bad headache or a stiff neck

Pain or body stiffness

Has aches or pains – stomach, joint or muscle pain. Has a stiff body with jerking movements or a floppy lifeless body.

Tummy symptoms

Is vomiting or refusing to feed.

Confused, tired or irritable

Is very sleepy, lethargic, not responding to you or difficult to wake. Is irritable when you pick them up or has a high-pitched or moaning cry. Is confused or delirious.

Skin colour

Has pale or bluish skin.

Unusual breathing

Is breathing fast or breathless.

Soft spot

Has a tense or bulging soft spot on their head – the soft spot on their head is called the anterior fontanelle.

Seizures

Has a seizure.

Rash

A rash that doesn’t fade when you press a glass tumbler against it.

How to check for a rash

Check all of your child’s body.

Look for tiny red or brown pin-prick marks that do not fade when a glass is pressed to the skin.

These marks can later change into larger red or purple blotches and into blood blisters.

The rash can be harder to see on darker skin, so check on the palms of the hands or the soles of the feet.

A rash is not the only symptom of blood poisoning (septicaemia). Do not wait for it to appear before getting medical help. The rash may be the last symptom to appear and can spread very quickly

The glass or tumbler test

1. Press the bottom or side of a clear drinking glass firmly against the rash
2. Check if the rash fades under the pressure of the glass
3. If the rash does not fade, your child may have septicaemia caused by the meningitis germ
4. Get medical help at once

Meningitis tumbler test – The rash doesn’t fade if you press the side of a clear glass firmly against the skin

Above: It doesn’t fade if you press the side of a clear glass firmly against the skin

If you think your child is seriously ill, call 999 or bring your child immediately to the nearest emergency department

If you’re not sure, contact your GP or GP Out of Hours Service immediately and ask for an urgent appointment. Bring your child immediately to your nearest hospital emergency department for children if:

• you are unable to contact your GP
• they are unable to see your child urgently

Types of meningitis

There are two main types of meningitis: bacterial and viral.

Viral meningitis is usually milder than bacterial meningitis. Most people make a full recovery from viral meningitis after 5 to 14 days.

Bacterial meningitis is more severe. It can be life-threatening and requires medical attention more quickly.

Septicaemia is a blood poisoning caused by bacteria. You can have septicaemia without meningitis.

How bacterial meningitis spreads

Bacterial meningitis is spread by prolonged close contact between people. The germ can be coughed out and breathed in. It can also be transferred in saliva, for example during intimate kissing.

The infection is usually spread by people who are not sick themselves. They carry the germs at the back of their nose or throat.

If your child is in close contact with meningitis

Your local public health doctor will advise you if your child has been in close contact with a person who has meningitis.

They might give a short course of antibiotics to your child.

Outside normal working hours you need to ask your GP or doctor on call for advice.

Meningitis vaccines

Make sure your baby gets all their vaccines on time from your GP. Vaccines are the best protection you can give your baby to prevent meningitis.

A baby who has had all their vaccines might still get meningitis. Vaccines don’t prevent every kind of meningitis.

Related topic

Your child’s vaccines

page last reviewed: 26/03/2018
next review due: 26/03/2021

Sepsis | Cedars-Sinai

Not what you’re looking for?

What is sepsis?

Sepsis is your body’s most extreme response to an infection. You
may hear it called septicemia, which is the medical name for blood poisoning by
germs, like bacteria, viruses, or fungi. Sepsis can cause shock (called septic
shock) and organ failure, which can be fatal in up to half of cases. This depends
on the type of germ involved. Sepsis is a medical emergency. You need medical care
right away. If not treated, sepsis can quickly cause tissue damage, organ failure,
and death.

What causes sepsis?

These infections are most often linked to sepsis:

The 3 germs that most often develop into sepsis are:

• Staphylococcus aureus (staph)

• Escherichia coli (E. coli)

• Some types of streptococcus

Who is at risk for sepsis?

An infection can happen to anyone. But certain things can make it
more likely for you to get sepsis. These include:

• Having a chronic health condition such as diabetes,
  cancer, lung disease, weakened immune system, or kidney disease

• Being age 65 or older

• Being younger than 1 year old

• Having community-acquired pneumonia

• Having been in the hospital in the past. This is
  especially true if you were in the hospital for an infection.

What are the symptoms of sepsis?

Sepsis develops very quickly. You quickly get very ill. You
may:

• Lose interest in food and surroundings

• Become feverish, very cold, or have the chills

• Have problems breathing

• Have a high heart rate or low blood pressure

• Become nauseated

• Vomit

• Be sensitive to light

• Complain of a lot of pain or discomfort

• Feel cold, with cool hands and feet

• Become lethargic, anxious, confused, or agitated

• Develop a rash that can look like bruises

You may also fall into a coma. Sepsis can also be fatal.

. The symptoms of sepsis may look like other health conditions.
Always see your healthcare provider for a diagnosis.

How is sepsis diagnosed?

Your healthcare provider look for physical symptoms such as low
blood pressure, fever, higher heart rate, and higher breathing rate. You will need
lab tests to check for signs of infection and organ damage. Some symptoms of sepsis
can often be seen in other health conditions. These include fever and trouble
breathing. This makes sepsis hard to diagnose when it first starts.

How is sepsis treated?

Treatment will depend on your symptoms, age, and general health.
It will also depend on how severe the condition is.

Sepsis is a life-threatening emergency that needs to be treated
right away. You will need to be in a hospital. Treatment will start as soon as
possible.

Treatment includes:

Many people need oxygen and IV (intravenous) fluids to help get
blood flow and oxygen to the organs. You may need to use a breathing machine
(ventilator). You may also need kidney dialysis. Sometimes you may need surgery to
remove tissue damaged by the infection.

How can I prevent sepsis?

Preventing infection is the way to prevent sepsis. One of the best
ways to prevent infection is to wash your hands often. Wash your hands with clean,
running water for at least 20 seconds. Wash your hands:

• Before eating

• After using the toilet

• Before and after caring for a sick person

• Before, during, and after preparing food

• Before and after cleaning a wound or cut

• After blowing your nose, coughing, or sneezing

• After touching an animal or handling pet food or pet
  treats

• After changing diapers or cleaning up after a child who
  has used the toilet

• After touching garbage

Keeping your immune system strong can also help prevent sepsis. To
do this:

• Keep cuts clean and covered until healed.

• Manage chronic health conditions such as diabetes.

• Maintain a healthy weight.

• Eat a healthy, well-balanced diet.

• Get regular exercise.

• Get recommended vaccines on schedule.

• When an infected area is not getting better or is getting
  worse, get medical care.

Key points about sepsis

• Sepsis is a medical emergency and needs to be treated
  immediately. It is caused by an infection in the blood that harms your
  body and organs. It can cause death if not treated.

• It is caused by bacteria, viruses, or fungi. Certain
  infections such as pneumonia and urinary tract infections can lead to
  sepsis.

• People who have chronic conditions are more likely to
  develop sepsis.

Next steps

Tips to help you get the most from a visit to your healthcare
provider:

• Know the reason for your visit and what you want to
  happen.

• Before your visit, write down questions you want
  answered.

• Bring someone with you to help you ask questions and
  remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and
  any new medicines, treatments, or tests. Also write down any new
  instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and
  how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the
  results could mean.

• Know what to expect if you do not take the medicine or
  have the test or procedure.

• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.

• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Barry Zingman MD

Medical Reviewer: L Renee Watson MSN RN

Medical Reviewer: L Renee Watson MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Woman, 25, dying of blood poisoning texted photos of deadly rash to her mother as doctors ignored her

Woman chronicled her own death from meningitis in phone pictures as doctors told her spreading rash was only a ‘minor infection’

By Daily Mail Reporter
Updated: 08:54 BST, 31 July 2010

• Doctors stopped antibiotics and gave her headache tablets
• Medics ‘didn’t see’ deadly rash spreading across her limbs
• Patient died just 14 hours after being admitted to hospital

A desperate patient texted photos of a deadly rash spreading across her body to her mother as she lay dying on a hospital bed while being ignored by NHS doctors.

Critically ill Jo Dowling, 25, sent more than 40 pictures and messages to her mother and best friend as her life ebbed away.

Doctors ignored the rash and refused to believe she had blood poisoning caused by the meningitis bug, taking her off antibiotics and giving her painkillers instead. 

Rash: Joanne Dowling died from blood poisoning after doctors denied her antibiotics

Hours earlier, the young woman had been diagnosed by her family GP with suspected meningococcal septicaemia after developing a purple skin rash and low blood pressure.

She was rushed to Milton Keynes Hospital where A&E doctors rejected the diagnosis believing instead her illness was a mild infection caused by her cystic fibrosis.

But doctors abandoned Miss Dowling on an observation ward and gave her headache tablets and fluids as they failed to spot the purple rash spread over her arms, hands and legs.

As the hours passed, terrified Miss Dowling took photos of her rash on her mobile phone and sent them to her mum and best friend describing her condition as ‘getting worse’.

The meningitis bug left her in septic shock choking and coughing as fluid filled her lungs and she died four hours after her last text message – just 14 hours after arriving at hospital.

Text messsages: Miss Dowling sent photos of her deadly rash to her mother and friend as her life ebbed away

Her family yesterday accused the hospital of ‘neglect’ after an inquest at Milton Keynes Coroners’ Court heard doctors failed to spot she was suffering ‘blood poisoning shock’.

Coroner Tom Osborne criticised the hospital for a ‘communication breakdown’ that led to her death as tragically a simple dose of penicillin and antibiotics would have saved Miss Dowling’s life.

The inquest heard there were only two doctors on duty to cover the entire hospital the night she died last November.

Her devastated mother Sue Christie, 48, of Milton Keynes, a distribution worker, said: ‘Our doctor knew it was meningitis but when we got to hospital all the care seemed to stop.

Critical: Miss Dowling had already been diagnosed with suspected meningococcal septicaemia by her family doctor before she arrived at hospital

Text message sent from Joanne Dowling to her mother reads… ‘All getting worse’

‘They didn’t seem to know what they were meant to do or what meningococcal septicaemia was.

‘The hospital was saying it was just an infection. She had a lot of infections with cystic fibrosis but never a rash like this.

‘I saw her picture messages and the rash was really bad. You couldn’t miss them but the nurses did. I thought she was in hospital and with the best people.

‘She wasn’t given a chance and was left to die without being given any treatment.

‘It is so sad as Jo had got through everything with her cystic fibrosis and was such a strong girl.’

Grieving: Miss Dowling’s parents, Sue and Ivor, said their daughter ‘wasn’t given a chance’

Jo was given penicillin and admitted to hospital at 3.25pm on November 23 last year with a letter from her GP Dr Nessan Carson diagnosing meningococcal septicaemia.

Dr Carson listed symptoms as low blood pressure, a raised pulse and a purple rash that would not disappear when pressed with a glass.

The inquest heard locum consultant Dr Bakhtawar Shah Khattak sent Jo for a CT Scan and lumber puncture and results were sent to micro-biology to determine which type of antibiotics to use.

When the scans showed no traces of meningitis Dr Chris Akubuine, physician in general medicine, refused to continue treating Jo’s symptoms with antibiotics.

Instead Dr Akubuine administered headache pills and fluids and left her in the Clinical Decision Unit (CDU) for overnight observations, the inquest heard.

Trainee GP Vivake Roddah failed to keep a written observation record but told the inquest he did not see the purple rash on Miss Dowling’s hands, arms and legs.

Five nurses also told the two day hearing they did not spot any rash on Jo’s body.

As her condition worsened Miss Dowling swapped 42 text messages with friends and her mother describing her illness and symptoms.

Just two hours after doctors ruled out meningitis she texted a friend to say ‘rash is getting worse’.

She took around ten photos of the purple rash on her legs, hands and arms and sent one to her mum complaining her condition was not improving.

Miss Dowling’s messages

15.55pm: Jo to friend Jess: ‘I’ve been blue-lighted to A&E. Could have meningitis.’

15.59pm: Jo to friend Jess: ‘They’ve got my sats up to 100 but going to treat me for meningitis.

20.11pm: Jess to Jo: ‘I hope it’s just an infection and not meningitis.”

21.42pm: Jo to Jess: ‘Rash is getting worse.’

21.43pm: Jo to mum: ‘Dad got angry with doctors he said she’s got cystic fibrosis. Dad cried in front of me.’

22.45pm: Jo to mum: ‘It’s getting worse.’

Last message from Jo to Jess at 00.13: ‘CRP 67, white cells 25, not had spinal one back yet, but rash still growing. What’s your result?’

Jess to Jo at 00.19: ‘CRP 97, white cells 24, x-ray showed I have a blockage in my left lung.’

No reply from Jo.

04.55am: Jess to Jo: ‘Hi are you OK hon?’

Jo died at 05.20am.

Her death was pronounced at 5.20am on November 24 three hours after hospital logs show she was last checked on.

Her father Ivor Dowling, 52, a mechanic, said: ‘If she had been given antibiotics she would have survived. The hospital failed her.

‘The first doctor who saw my daughter did everything he was supposed to do. But after that these doctors and nurses failed to spot her failing vital signs.

‘They were obnoxious and arrogant. She was neglected.’

Delivering a narrative verdict on Wednesday Deputy Coroner Tom Osborne ruled Miss Dowling died from a combination of Meningococcal Septicaemia and Cystic Fibrosis.

He criticised hospital doctors for failing to realise she was in ‘blood poisoning shock’.

Mr Osborne said: ‘As a result of a breakdown in communication the antibiotics was not continued and resulted in lost opportunities to render further medical treatment.’

Miss Dowling, who was on a waiting list for a lung transplant, occasionally needed a wheelchair to get around after she was diagnosed with cystic fibrosis as a baby.

She worked as a cashier at Great Mills and The Bag Shop, in Milton Keynes, and competed in junior cross country championships as a child.

Her best friend Jess Wales, 20, from Kent, who received the other messages, also suffered from cystic fibrosis and died in January shortly after a lung transplant.

A spokesman for Milton Keynes Hospital said: ‘Following Joanne’s unexpected death, the Trust conducted a comprehensive internal investigation to review her care and treatment.

‘The findings of the investigation were presented in detail at the inquest today and the recommendations are already being implemented.

‘The Trust fully accepts the verdict of the inquest.’

Action: Milton Keynes Hospital launched a ‘comprehensive internal investigation’ after Miss Dowling’s death

Former director Maggie Southcote-Want, 48, alleged a series of shocking incidents at the hospital at an employment tribunal claiming unfair dismissal in May.

Ms Southcote-Want claimed bodies were routinely dumped on the floor of the mortuary fridge and photographs of a car crash victim uploaded to websites, prompting a police inquiry.

She also claimed a locum doctor wrongly analysed dozens of breast cancer biopsies, a leading consultant was suspended for surgical blunders and two employees were caught having sex in the pharmacy during working hours.

The hospital denied the claims.

Meningitis and septicaemia in adults

Meningitis is an infection of the meninges – the membranes that cover the brain and spinal cord.

Babies and young children are most at risk of getting meningitis, but it can affect anyone. Meningitis sometimes causes a serious type of blood poisoning called septicaemia.

• About meningitis
• About septicaemia
• Symptoms
• Complications
• Causes
• Diagnosis
• Treatment
• Prevention
• Further information
• Sources
• Related topics

About meningitis

Meningitis is usually caused by a bacterial or viral infection.

Everybody carries bacteria and viruses harmlessly in their nose and throat. But occasionally, specific types can overcome the body’s immune system and cause meningitis. The infections can be spread through close contact, eg from kissing, coughs and sneezes.

These bacteria and viruses are very common and only cause meningitis rarely. No one fully understands why babies and young children are more likely to get meningitis yet, but it’s probably because their immune systems are less developed. For more information on meningitis in children, please see Related topics.

Sometimes meningitis can be a complication of another infection, or a head injury or brain surgery. Very rarely, it can be caused by a fungal infection or amoeba.

About septicaemia

Bacterial meningitis sometimes causes a type of blood poisoning called septicaemia, which happens if bacteria or their toxins enter the bloodstream and the rest of the body. Septicaemia is a very serious condition that can be fatal.

Symptoms

It can be very difficult to recognise meningitis, because at first the symptoms can resemble those of flu. However, you should seek urgent medical advice if you suspect meningitis.

Bacterial meningitis usually develops over a few hours. Viral meningitis can occur suddenly or develop gradually over a number of days.

Meningitis symptoms

The symptoms of viral and bacterial meningitis are similar, although the viral form of the disease is generally far less severe. They can appear in any order, and may include some, but not necessarily all, of the following:

• fever
• vomiting
• severe headache
• stiff and painful neck
• confusion
• fits (seizures)

Less common symptoms include:

• drowsiness, muscle aches, weakness or tingling throughout the body
• sensitivity to light and sore eyes
• blotchy skin
• dizziness
• mood changes

Septicaemia symptoms

Septicaemia can occur with or without meningitis. The symptoms include:

• fever
• drowsiness
• confusion
• fast breathing
• shivering, or having cold hands and feet
• aching limbs or joints
• rash

The rash caused by septicaemia looks like tiny bright red spots, which may join together to give the appearance of fresh bruises. If the spots don’t disappear when a glass is pressed against the skin you should seek medical help immediately. This is known as the “tumbler test”.

Complications

Recovery times vary from person to person, but it usually takes two to three weeks.

However, bacterial meningitis, and septicaemia, can have serious complications – sometimes it can even be fatal. These days this is rare – people are more aware of the symptoms, and there are more effective treatments available.

Although most people have no after effects from meningitis, severe cases can cause lasting complications, including:

• learning difficulties, memory loss, coordination problems or paralysis of parts of the body – often these are temporary
• loss of sight or vision problems
• deafness or hearing problems
• skin scarring from septicaemia
• liver or kidney damage

Causes

Bacterial meningitis

Over 50 different types of bacteria can cause meningitis.

In the UK, the most common form of meningitis is meningococcal meningitis, which is caused by the bacterium Neisseria meningitidis. This occurs in several different strains, but most cases in the UK are caused by strain B. Strain C used to be common, but vaccination now prevents most cases.

As well as infecting the meninges, meningococcal bacteria can also cause septicaemia. This may also be called meningococcal septicaemia.

The second most common form of meningitis in the UK is pneumoccocal meningitis, which is caused by the bacterium Streptococcus pneumoniae. It can also result in septicaemia. These bacteria usually cause less serious illnesses than meningitis, such as ear infections and sore throats.

Viral meningitis

Viral meningitis doesn’t usually cause septicaemia. Most cases of viral meningitis are relatively mild, and it is only rarely fatal. It’s more common in the summer.

The most common cause of viral meningitis are enteroviruses, which normally live in the lining of the bowels (intestines). Usually, however, you only get a mild cold or flu-like illness when you are infected by these viruses.

Many other types of virus, such as herpes or measles, can also cause viral meningitis. The mumps virus used to be the most common cause of meningitis, but the MMR vaccine means this is now very rare in the UK.

Diagnosis

If your doctor thinks that you have meningitis, he or she will refer you to hospital immediately. There, a test called a lumbar puncture (spinal tap) may be carried out. This involves inserting a needle between two bones of the lower spine to take a sample of the spinal fluid for analysis.

A computerised tomography (CT) scan, which uses X-rays to make a three-dimensional image of part of the body may be carried out to check for swelling or damage to the brain tissue. A magnetic resonance imaging (MRI) scan, which uses magnets and radiowaves to create images, may be performed instead.

Other tests may include a blood test, to see if the infection has reached the blood (septicaemia), throat and nose swabs, a chest X-ray, and a faeces sample may be sent to a laboratory to be checked for viruses.

Treatment

How you are treated depends on the type of infection causing the meningitis and/or septicaemia.

Bacterial meningitis

Bacterial meningitis or septicaemia requires urgent hospitalisation. Treatments include antibiotics, usually given with a “drip” directly into a vein (intravenously), oxygen to help with breathing difficulties and intravenous fluids to combat dehydration and shock.

Viral meningitis

If you have viral meningitis, rest and take over-the-counter painkillers. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. The symptoms usually clear up within two weeks. Supportive care in hospital may be required for a severe infection, but there is no specific treatment for the virus infection.

Prevention

If you come into contact with someone with meningococcal meningitis or septicaemia, you should seek medical advice – you may need to take a preventive course of antibiotics. Other types of meningitis tend to be less infectious.

Other steps to prevent the spread of meningitis include avoiding contact with people known to have possible meningitis. Regular hand-washing also helps stop it spreading from person to person.

Further information

Meningitis Research Foundation

Sources

• Understand meningitis and septicaemia. Meningitis Research Foundation. www.meningitis.org.uk, accessed 27 February 2007
• Symptoms of meningitis and meningococcal septicaemia. The Meningitis Trust. www.meningitis-trust.org, accessed 28 February 2007
• Longmore M, Wilkinson IB and Rajagopalan S. Oxford handbook of clinical medicine. 6th ed. New York: Oxford University Press, 2004: 808
• Vaccine information. The Meningitis Trust. www.meningitis-trust.org, accessed 28 February 2007
• The meningitis C campaign. Department of Health. www.dh.gov.uk, accessed 27 February 2007

Related topics

Meningitis and septicaemia in children

A Case of Eryth” by Jake N. Cho, Selsabeel A. Elyaman et al.

Title

Diffuse Exfoliative Rash with Sepsis and Eosinophilia: A Case of Erythroderma?

Hospital

Ocala Regional Medical Center

Document Type

Case Report

Publication Date

9-20-2019

Keywords

erythroderma, dermatitis, dermatitis – exfoliative, case reports, rashes

Disciplines

Dermatology | Internal Medicine | Medicine and Health Sciences | Skin and Connective Tissue Diseases

Abstract

BACKGROUND Erythroderma is an exfoliative dermatitis that manifests as generalized erythema and scaling that involves 90% of the body surface. If untreated, erythroderma can be fatal because of its metabolic burden and risk of secondary infections. CASE REPORT The patient was a 56-year-old male with prior rash attributed to group A Streptococcal cellulitis and discharged on Augmentin, Clindamycin with hydrocortisone cream, and Bactrim, but he had been noncompliant. He was admitted again for rash involving the face, torso, and extremities characterized by diffuse, desquamative, dry scales in morbilliform pattern. The patient was septic with Staphylococcus aureus bacteremia and compromised skin barrier. He was started on vancomycin and switched to Cefazolin IV due to concern for drug reaction. Autoimmune workup included antibodies for anti-Jo-1, anti-dsDNA, anti-centromere, and ANCA. However, only antinuclear antibody and scleroderma antibody were positive. Given the unclear workup results and lack of response to antibiotics, the patient was started on prednisone 60 mg PO and topical Triamcinolone 0.1% cream. A skin biopsy revealed psoriasiform hyperplasia with atypical T cell infiltrate and eosinophils, but negative for T cell gene rearrangement. The rash resolved after day 12 of application of topical Triamcinolone. CONCLUSIONS This case is unique in terms of the rarity of erythroderma and the diagnostic challenge given confounding factors such as noncompliance and drug reaction. Serious causes, such as SLE and cutaneous T cell lymphoma, were ruled out. Fortunately, the rash responded well to steroids; however, given the adverse effects of long-term use of topical steroids, the patient will need follow up with Dermatology.

Publisher or Conference

American Journal of Case Reports

Recommended Citation

Cho J, Elyaman SA, Avera SA, Iyamu K. Diffuse Exfoliative Rash with Sepsis and Eosinophilia: A Case of Erythroderma?. Am J Case Rep. 2019 Sep 20;20:1387-1393. doi: 10.12659/AJCR.917427. PubMed PMID: 31541072.

Sepsis

General information

Sepsis is a life-threatening dysfunction of internal organs caused by dysregulation of the body’s response to infection (7). If sepsis is not recognized early and treated promptly, it can cause septic shock, multiple organ failure, and death. Sepsis can be caused by any type of infectious pathogen. Antimicrobial resistance is a leading factor in the lack of clinical response to treatment and the rapid development of sepsis and septic shock.Patients with sepsis due to drug-resistant pathogens have an increased risk of hospital mortality.

Who is at risk?

Anyone with an infection can develop sepsis, but vulnerable populations such as the elderly, pregnant women, newborns, hospitalized patients and people with HIV / AIDS, cirrhosis of the liver, cancer, kidney disease, autoimmune diseases and a removed spleen are at increased risk (eight).

Signs and symptoms

Sepsis is a medical emergency. However, the signs and symptoms of sepsis in patients can be different at different points in time, since a clinical condition such as sepsis can be caused by many pathogens and change its character at different stages. Alarming signs and symptoms include fever and chills, change in mental state, shortness of breath / rapid breathing, heart palpitations, weakened heart rate / low blood pressure, oliguria, cyanosis or marbling of the skin, cold extremities, and severe pain or discomfort in the body ( 9-11).The suspicion of sepsis is the first step towards early recognition and diagnosis.

Prevention

There are two main ways to prevent sepsis:
1. Prevention of transmission of microorganisms and infection;
2. Prevention of complications of infection to the state of sepsis.

Infection prevention in the community involves good hygiene practices such as handwashing and safe food preparation, improving the quality and availability of water and sanitation, ensuring access to vaccines, especially for those at high risk of sepsis, and proper nutrition including breastfeeding of newborns.
Prevention of nosocomial infections is generally ensured by functioning infection prevention and control programs and appropriate personnel groups, effective hygiene practices, including hand hygiene, as well as clean rooms and proper equipment operation.

Prevention of sepsis in both the general public and in health care settings involves appropriate treatment of infections with antibiotics, including regular assessment of patients for the rational use of antibiotics, prompt medical attention, and early detection of signs and symptoms of sepsis.
The effectiveness of infection prevention is clearly supported by scientific evidence. For example, with strict adherence to hand hygiene practices in health care settings, the reduction in the number of infections can be up to 50% (12), and in public places, these measures can reduce the risk of diarrhea by at least 40% (13). Measures to improve water supply, sanitation and hygiene (WASH) have the potential to reduce the overall burden of disease worldwide by 10% 90,031 14 90,032. Every year, vaccinations help prevent 2-3 million deaths from infections (15).

Diagnostics and clinical management

In order to detect sepsis in the early stages and organize its proper clinical management in a timely manner, it is extremely important to recognize and not ignore the signs and symptoms listed above, as well as to identify certain biomarkers (in particular procalcitonin). In the post-early stage, diagnostic procedures are important to help identify the causative agent of the sepsis-causing infection, as this determines the choice of targeted antimicrobial treatment.Antimicrobial resistance (AMR) can impede the clinical management of sepsis, as it often requires empirical antibiotic selection. Therefore, it is necessary to understand the epidemiological parameters of AMR spread in the given setting. Once the source of the infection has been identified, the most important task is to eliminate it, for example, by draining the abscess.
Infusion therapy is also important in the early management of sepsis to normalize the volume of circulating fluid.In addition, vasoconstrictor drugs may be required to improve and maintain tissue perfusion. Further measures for the correct management of sepsis are selected based on data from repeated examinations and diagnostic measures, including monitoring the patient’s vital signs.

Sepsis and Sustainable Development Goals

Sepsis is an extremely important cause of maternal mortality, as well as mortality of newborns and children under five years of age.For this reason, tackling sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).

Sepsis is an extremely important cause of maternal mortality, as well as mortality of newborns and children under five years of age. For this reason, tackling sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).
Indicators for achieving these two SDG targets are maternal, newborn and under-five mortality rates.Sepsis is an important contributor to these preventable deaths. It is he who is often a clinical condition that ultimately causes the death of patients suffering from HIV, tuberculosis, malaria and other infectious diseases mentioned in task 3.3, but at the same time he, as a rule, is not recorded as the cause of death of such patients and is not included in statistics on SDG target 3.3 indicators.
Sepsis is also important, albeit more indirectly, to other health-related targets under SDG 3.For example, prevention and / or proper diagnosis and management of sepsis are also related to adequate vaccine coverage, universal quality health coverage, capacity to comply with the International Health Regulations, preparedness, and water and sanitation services. However, ensuring widespread prevention, diagnosis and management of sepsis remains challenging.

WHO activities

In May 2017, the Seventieth World Health Assembly adopted a resolution on sepsis based on a report from the WHO Secretariat.

Resolution WHA70.7. Improving the prevention, diagnosis and clinical management of sepsis
Report of the WHO Secretariat A70 / 13. Improving the prevention, diagnosis and clinical management of sepsis
Several programs at the WHO headquarters level, in collaboration and coordination with WHO regional offices, are investigating the public health impact of sepsis and providing guidance and support at the country level on the issues of prevention, early and correct diagnosis, as well as the timely and effective clinical management of sepsis in the interests of a comprehensive solution to this problem.The Global Infection Prevention and Control Team, located at WHO headquarters in the Department of Service Delivery and Safety, provides coordination and leadership for sepsis prevention.

Bibliography

(1) Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.Am J Respir Crit Care Med 2016; 193 (3): 259-72.

(2) Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. The Lancet Respiratory medicine 2018; 6 (3): 223-30.

(3) Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016; 387 (10014): 168-75.

(4) Say L, Chou D, Gemmill A, et al.Global causes of maternal death: a WHO systematic analysis. The Lancet Global health 2014; 2 (6): e323-33.

(5) Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank (c) 2016 International Bank for Reconstruction and Development / The World Bank.; 2016.

(6) World Health Organization. WHO Report on the burden of endemic health care-associated infection worldwide. 2017-11-21 15:11:22 2011.

http://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf?sequence=1 (accessed April 10 2018).

(7) Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 801-10.

(8) Gotts JE, Matthay MA.Sepsis: pathophysiology and clinical management. British Medical Journal 2016.

(9) United States Centers for Disease Control and Prevention. Healthcare Professional (HCP) Resources: Sepsis. 2018-02-01T06: 23: 15Z.

https://www.cdc.gov/sepsis/get-ahead-of-sepsis/hcp-resources.html (accessed April 10 2018).

(10) Global Sepsis Alliance. Toolkits. https://www.world-sepsis-day.org/toolkits/ (accessed April 10 2018).

(11) UK SepsisTrust.Education. 2018.https: //sepsistrust.org/education/ (accessed April 10 2018).

(12) Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. British Medical Journal. 2015; 351: h4728.

(13) UNICEF. UNICEF Data: Monitoring the Situation of Children and Women – Diarrhoeal Disease. https://data.unicef.org/topic/child-health/diarrhoeal-disease/ (accessed April 10 2018).

(14) Pruss-Ustun A, Bartram J, Clasen T, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical medicine & international health: TM & IH 2014; 19 (8): 894-905.

(15) World Health Organization. Fact sheet: Immunization coverage. 2018-04-10 14:55:37.

what is it, symptoms, treatment “- Yandex.Q

Contents:

Sepsis is a purulent-septic infectious disease that affects the blood.Pathology is accompanied by the spread of infection throughout the body and is very difficult, posing a threat to the life of a sick person. The most common causative agents of sepsis are staphylococci, Escherichia coli, streptococci, pneumococci. Sepsis often develops as a result of an unfavorable course of purulent inflammation of soft tissues (abscess, peritonitis), against the background of a weakening of the body’s defenses.

What can contribute to the development of sepsis?

1. Failure to comply with the rules of asepsis and antiseptics during the treatment of purulent wounds, during surgery.
2. Incorrect selection of medicines, an error in prescribing the dosage of antibacterial drugs.
3. Immunological disorders.
4. Progression of antibiotic-resistant infectious agents.

Sepsis symptoms

The clinical picture of sepsis depends on the nature of the pathogen that provoked the development of the disease. Often there is a combined form of pathology, which is based on the active reproduction of several pathogens at once.

Staphylococcal sepsis, which is highly antibiotic resistant, is rightfully considered the most dangerous. If the disease is caused by E. coli, then pus is formed in the focus of inflammation. In this case, the affected area does not have clear forms.

Sepsis can have various manifestations. The course of the disease is most often stormy and rapid, therefore, treatment must be started as early as possible, until irreversible consequences for the body have occurred. Recently, sepsis with erased symptoms or atypical forms of the infectious process has been detected.

Main signs of sepsis:

• high body temperature;
• increase in leukocytes in the blood;
• heart palpitations;
• slowing down the formation of urine;
• violation of the circulatory system.

Septicemia and septicopyemia

Septicopyemia is a type of sepsis in which the general symptoms of the disease are combined with the formation of characteristic purulent abscesses in various organs and tissues.Patients feel very bad, body temperature is often elevated to 39-40 ° C, consciousness is usually inhibited. The main pathogens in septicopyemia are staphylococcus and Pseudomonas aeruginosa. Septicopyemia develops less rapidly than septicemia. In patients with septicopyemia, purulent damage to all vital organs (heart, liver, kidneys, brain) is revealed.

With septicopyemia, cardiopulmonary failure often develops rapidly. The defeat of the urinary system is accompanied by pain syndrome, oliguria.If purulent meningoencephalitis occurs, patients note the appearance of severe headaches, clouding of consciousness, agitation, followed by sharp depression and lethargy. Purulent foci are subject to urgent surgical removal with powerful antibiotic therapy.

Septicemia is characterized by a pronounced intoxication syndrome:

• fever;
• clouding of consciousness;

90 130 muscle pain;

• feeling unwell.

The infectious process is rapid.Septicemia develops mainly against the background of the progression of streptococcal infection. Due to the development of hemorrhagic syndrome, a petechial rash occurs on the patient’s skin, hemorrhages are also detected in the internal organs. Vascular permeability increases, internal edema occurs. The spleen is dramatically enlarged, as are the lymph nodes. The mucous membrane and skin are cyanotic (cyanotic).

Diagnosis of sepsis

Examination for sepsis is prescribed in accordance with the form of the disease and the localization of the septic focus.Can be held:

• laboratory blood tests (neutrophilic leukocytosis is observed with a shift of the leukocyte formula to the left, a decrease in hemoglobin), urine;

• Ultrasound of the kidneys, liver and other organs;
• X-ray diagnostics;
• computed tomography;
• ECG;
• bacterioscopic examinations;
• magnetic resonance imaging.

Features of sepsis treatment

Sepsis is a medical emergency that requires emergency resuscitation.Treatment is reduced to the fight against infectious pathogens and the progression of complications, which are often fatal to the patient. The appearance of symptoms of the development of renal failure requires hemofiltration, hemodialysis, urgent restoration of hemodynamic parameters.

If a patient develops signs of heart failure, vasomotor drugs are prescribed, as well as drugs that stimulate the work of the heart. Pulmonary insufficiency requires the use of a ventilator.Antibiotics are prescribed to patients with sepsis after obtaining reliable results of bacterioscopic examination and determining the sensitivity of infectious pathogens.

Sepsis in Newborn Babies

Sepsis in the neonatal period is a very dangerous infectious disease, the causative agents of which can be various pathogenic and opportunistic microorganisms. In 50% of cases of infection, the reason lies in the progression of staphylococcal infection, the multiplication of hemolytic streptococcus.Slightly less often, the disease occurs due to the active reproduction of Pseudomonas aeruginosa, Klebsiella, Escherichia coli. Sometimes the cause of sepsis in newborns is a mixed bacterial flora.

Entrance gate for infection:

• umbilical wound;
• damaged skin, mucous membranes;
• genitourinary organs;
• gastrointestinal tract.

Sepsis of newborns most often develops against the background of pyoderma, otitis media, enteritis, intestinal infection, bronchitis, pneumonia, pharyngitis.

Who is at risk for neonatal sepsis? Predisposing factors and conditions:

• fetal hypoxia;

• birth trauma;
• Injury to the head and neck during childbirth;
• continuous artificial ventilation of the lungs;
• baby tube feeding;
• vein catheterization;
• immune disorders;
• HIV infection;

90 130 deep prematurity;

90 130 difficult labor;

• hereditary pathologies accompanied by immunoreactivity;

90 130 conjunctivitis;

• complex operations performed in the first weeks of a child’s life.

Common pathologies of pregnancy contribute to the development of sepsis in early childhood. Sexually transmitted and genitourinary infections, syphilis, HIV, chronic stomatitis, candidiasis, lack of nutrients in the diet of the expectant mother, overwork of a woman, oxygen starvation of the fetus due to anemia and lack of iron negatively affect the immunity of the fetus.

Symptoms of sepsis in newborns

Septicemia is most common in newborns.The pathological process begins to progress against the background of a prolonged weeping umbilical wound, abscesses on the body, severe stomatitis, conjunctivitis. Parents should be alerted by the harbingers of the disease:

• frequent regurgitation;

90 130 redness of the navel;

90 130 diaper rash that does not respond to treatment;

• discharge of blood, pus, clear fluid from the umbilical wound;
• child’s passivity;
• insufficient weight gain;
• Newborn anxiety.

A characteristic sign of sepsis is an increase in body temperature. A pustular rash may appear all over the body. The skin takes on a characteristic earthy tint, mucous membranes can turn yellow. With sepsis, intoxication syndrome is observed.

All organs of the child are affected, which leads to the progression of dangerous diseases and the development of the following disorders:

• tachycardia, bradycardia;
• increase in the amount of urine;
• hemorrhagic syndrome;
• pneumonia;
• malfunctions of the adrenal glands, liver, kidneys;
• the appearance of chronic purulent foci in bone tissue, brain, lungs, liver;

90 130 abscesses;

• purulent arthritis;
• phlegmon in the digestive organs.

With the development of a fulminant form of sepsis, septic shock occurs, which in most cases ends in death. The disease leads to a sharp decrease in body temperature, accompanied by severe weakness, lethargy, increased bleeding, pulmonary edema, cardiovascular disorders, acute renal failure.

Diagnosis and treatment of sepsis in children

The diagnosis of neonatal sepsis is established by the clinical picture and examination results.The main diagnostic method is blood donation for sterility. Also, a bacterioscopic examination of the discharge from the umbilical wound is carried out, a smear is taken from the conjunctiva, oropharynx, urine is examined for microflora, feces for the presence of dysbiosis, and a PCR analysis is performed. The task of specialists engaged in diagnostics is to differentiate sepsis from pneumonia, mediasthenitis, enterocolitis, inflammation of the meninges, candidiasis, enterovirus infection.

Treatment of sepsis in children is carried out using resuscitation equipment and the most modern antibacterial drugs.Antibiotics are injected directly into the vein of the child – so they act almost instantly and allow you to effectively fight the infectious pathogen.

All purulent abscesses on the skin are opened, treating septic foci with anti-inflammatory, antimicrobial compounds, special enzymes that increase local immunity. To enhance the immune activity, hemosorption and plasmapheresis are performed. Detoxification measures can reduce the load on the kidneys and liver, improve the child’s condition and prognosis.It is recommended to feed a sick baby exclusively with breast milk, as it contains antibodies and helps to recover sooner from an illness.

Material provided

bezboleznej.ru

Sepsis as an acute infectious disease

Sepsis is a pathological condition that is the result of a generalized inflammatory reaction in response to a bacterial pathogen entering the bloodstream. Sepsis can be triggered by a wide variety of bacterial infections, as well as viruses and fungi pathogenic to humans.In some cases, sepsis can develop under the influence of conditionally pathogenic microflora, which, under normal conditions, passively lives on the human skin.

Pathogenesis of the development of the disease

The pathogenesis of the development of sepsis is based not only on the concentration of pathological pathogens, but also on the reactivity of the human immune system. The occurrence of a pronounced inflammatory reaction occurs as a result of the release of bacterial endotoxin into the general systemic bloodstream of a person.

Typical symptomatic signs in sepsis

Unlike all possible infectious diseases, sepsis has an acyclic variant of the course of the disease. The lightning-fast variant of the development of symptomatic signs is characterized by a rapid course and a greater likelihood of a lethal outcome.

The first symptoms of sepsis are considered to be a pronounced febrile state, body temperature can rise to 40 degrees. Patients may complain of intense headache, pain, muscle pain and aches in large joints.

Clinical manifestations in this disease can be very diverse, depending on what has become the primary focus of the infectious process in the human body.

Febrile syndrome is considered to be a general symptom, and it can last for a long time. As the disease progresses, a characteristic hemorrhagic rash begins to appear on the body of a sick person. Under the influence of a pronounced spasm of the vascular bed, compensatory mechanisms are activated due to an increase in cardiac output.Under the influence of compensation, there is a decrease in blood pressure and a decrease in the number of heart contractions. Under the influence of septic shock, insufficient blood supply to arterial vessels occurs, which leads to oxygen starvation of organs and body systems. At this stage, a violation of tissue trophism and the functioning of internal organs develops.

Diagnosis of the disease

To make the final diagnosis of the patient, a number of measures are taken that are approved by the Ministry of Health:

· determination of the type and concentration of bacterial pathogens in the blood;

· signs of vasodilation of arterial and venous vessels;

· the presence of symptomatic signs of impaired blood supply to organs and tissues;

· determination of markers of inflammation during biochemical blood tests.

It is customary to begin treatment of the disease with etiotropic therapy, the next step is detoxification.

Sepsis in children – Symptoms, diagnosis and treatment

Have a low threshold for suspicion of sepsis, since the initial clinical picture may be nonspecific (especially in the younger age group).

Since timing is extremely important in severe sepsis and septic shock, if sepsis is suspected on the basis of the clinical presentation, it is best to initiate research for sepsis and its treatment, which includes antibiotic and fluid therapy.It should be continued until the diagnosis of sepsis is ruled out.

Progression to multiple organ failure and shock is often very rapid, so early detection and treatment is critical.

Empiric broad spectrum antibiotic therapy (based on the most likely pathogen) should be initiated as soon as possible and always within the first hour of detection.

Further treatment is primarily supportive and should be carried out in accordance with internationally recognized consensus guidelines.

Sepsis is a clinical syndrome resulting from dysregulation of the immune response to infection. [1] Bone RC. The sepsis syndrome: definition and general approach to management. Clin Chest Med. 1996 Jun; 17 (2): 175-81.
http://www.ncbi.nlm.nih.gov/pubmed/8792059?tool=bestpractice.com
It is characterized by a disorder of many pathobiological processes that can lead to extensive tissue damage. [2] Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med.2013 Aug 29; 369 (9): 840-51.
http://www.nejm.org/doi/full/10.1056/NEJMra1208623

http://www.ncbi.nlm.nih.gov/pubmed/23984731?tool=bestpractice.com
It includes a number of severe clinical conditions, including severe sepsis, septic shock, and multiple organ failure [3] Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med.2005 Jan; 6 (1): 2-8.
http://www.ncbi.nlm.nih.gov/pubmed/15636651?tool=bestpractice.com
Sepsis is the leading cause of severe morbidity and mortality in children worldwide. [4] World Health Organization Global Health Observatory. Causes of child mortality. 2017 [internet publication].
https://www.who.int/gho/child_health/mortality/causes/en/

According to the prevailing views, sepsis is defined on the basis of the presence or absence of systemic inflammatory response syndrome (SIRS).In adults, the definition of sepsis was updated in 2016 when there was a departure from the definition of SIR and the deletion of the term “severe sepsis.” [3] Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan; 6 (1): 2-8.
http://www.ncbi.nlm.nih.gov/pubmed/15636651?tool=bestpractice.com
However, at present, the international consensus definition of sepsis in children, formulated back in 2005, has not been revised.[3] Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan; 6 (1): 2-8.
http://www.ncbi.nlm.nih.gov/pubmed/15636651?tool=bestpractice.com

Prevention of meningococcal infection

Meningococcal infection, commonly known as meningitis, is an infectious (contagious) disease.It manifests itself in the form of an acute
diseases of meningitis (inflammation of the meninges) or meningococcal sepsis (blood poisoning), and sometimes nasopharyngitis
(inflammation of the nasal and pharyngeal mucosa). The first signs of the disease are no different from the common cold: runny nose, cough. Then
three main symptoms appear: high body temperature up to 38-40 degrees, sudden bouts of vomiting and severe headache.
In infants, harsh crying occurs.A posture characteristic of such patients also appears: they lie with their heads thrown back,
the legs are tucked into the stomach. When trying to tilt the head to the chest, resistance is noted, tension in the muscles of the neck and occiput. If
the immune system is weakened, the microbe enters the bloodstream and appears on the skin of the limbs, buttocks, lateral surfaces of the body
a rash of an irregular star-shaped purple-red color that does not disappear with pressure. A severe form develops, often
lightning-fast – meningococcal sepsis with damage to the kidneys and adrenal glands, the occurrence of cerebral edema,
infectious toxic shock and death.

Who is the source of the infection?

The source of infection can be a sick person and carriers of meningococcus. The most dangerous are carriers (seemingly healthy people,
having microbes in the body), since there are 1,800 carriers per sick person. Danger of carriers of meningococcal
infection is due to the fact that they themselves do not get sick, but can infect others.Meningococcal disease is ubiquitous
in all countries of the world. More often children are sick at the age of 1-2 years, who have insufficient immunity, among adults – young people
up to 30 years. The incidence increases in the winter-spring period, which is facilitated by the crowding of people in public places, transport,
insufficient exposure to fresh air.

How is the disease transmitted?

The route of transmission of infection is airborne (when coughing, sneezing, talking).The causative agent – meningococcus is extremely unstable
in the external environment, quickly dies when cooled and dried, when boiled – in 30 seconds. The microbe penetrates the mucous membranes
membranes of the upper respiratory tract into the body of a healthy person with prolonged and close contact with the source of infection (near
sleep, eat, study, are brought up). From the moment of infection to the onset of the disease, it takes from one to ten days.
The patient is contagious to others from the first days of the illness.The susceptibility to the disease is high. Meningitis is accompanied by inflammation
membranes of the brain and spinal cord, can be caused by viruses (serous) and bacteria (purulent). More dangerous of course
are bacterial meningitis, the mortality rate from which reaches 40%, even with timely treatment started.

What are the consequences?

After a disease, a complication may develop – deafness, in young children – deaf-mute, in rare
cases – paralysis.Do not self-medicate, immediately call a doctor at home or an ambulance than
the earlier qualified medical care is provided, the faster and more effective the results of recovery will be.

Non-specific prophylaxis measures.

Avoid hypothermia,

Limit travel on public transport with your child,

· Do not visit entertainment events, shops, hairdressing salons and other places of mass presence of people with your child,

Walk more outdoors with your child,

· Holiday events associated with the birth of a child, it is better to spend outside the apartment where he is,

· The adoption of water procedures, adherence to the daily regimen – increase the body’s resistance.

· In case of colds in adults, it is necessary to use gauze (disposable masks).

In the room where the patient was (outbreak), it is necessary to carry out daily, wet cleaning, frequent ventilation;

In children’s institutions it is necessary to disinfect the air with bactericidal lamps,

· Crowding of children in sleeping quarters is unacceptable.

All persons who have communicated with the patient in the family, collectively, within 10 days, must undergo medical supervision,
examination for the carriage of meningococci.

Is there a vaccine against meningococcal disease?

According to the national vaccination calendar, vaccination against meningococcal disease is carried out
for epidemic indications.

Children, adolescents, adults are vaccinated in foci of meningococcal infection caused by meningococcal serogroups A or C.

Vaccination is carried out in endemic regions, as well as in the case of an epidemic caused by meningococcal serogroups A or C.

Self-medication is not allowed!

90,000 What did Alla Verber die of

Meningococcal sepsis: what killed Alla Verber

Department “Science”

Alla Verber, fashion director of TSUM, has died of meningococcal sepsis, according to her representatives.What is it scary and how to recognize it in time, says “Gazeta.Ru”.

Representatives of TSUM fashion director Alla Verber named the official cause of her death. The statement was posted at page Werber on Instagram.

“To put an end to all rumors and speculations in the media, we would like to inform you that the official cause of death for Alla Verber is meningococcal sepsis. Due to weak immunity, the body was unable to overcome this infection. Alla Konstantinovna left us on the afternoon of August 6.Many thanks to everyone who expresses condolences to family and friends, ”the message says.

Meningitis is a pathological process in which the lining of the brain becomes inflamed.

Despite the abundance of microbes and other causes of meningitis, its general symptoms are similar. Headache is the most common symptom that occurs in almost all patients.It is also common for the occipital muscles to become hard, along with fever, altered states of consciousness, and sensitivity to light or sound. For an accurate diagnosis, it is necessary to take cerebrospinal fluid for analysis.

Depending on the pathogen, the clinical picture may vary.

So, with meningococcal meningitis, the disease begins acutely – with high fever and chills. Already on day 1-2, the main symptoms of meningitis appear, a hemorrhagic rash may form on the body.

Pneumococcal meningitis is preceded by otitis media, sinusitis or pneumonia in about half of cases. Symptoms appear somewhat later than with meningococcal meningitis, but even with early hospitalization, the disease progresses rapidly, disorders of consciousness, convulsions appear.

Viral meningitis may begin with symptoms consistent with the underlying infection. The picture of meningitis develops later. Unlike bacterial meningitis, with viral fever is moderate, and symptoms may appear on 3-4, or even 5-7 days of illness.With the exception of a severe headache and feeling unwell, the rest of the symptoms are practically not pronounced.

Tuberculous meningitis begins with fever, headache and vomiting appear after a few days. By the end of the second week, symptoms of general brain damage develop. If untreated, the patient dies by the end of the month.

Meningitis is treated with antibiotics, antiviral or antifungal agents, depending on the pathogen. Sometimes steroids are used to prevent complications from severe inflammation.

A late start of treatment can lead to a protracted and recurrent course of the disease, since the pathogen, being in the compacted areas of pus, is little available to the action of antibiotics. Recurrent cases of meningitis are associated with complications and persistent residual effects.

Meningococcal sepsis (meningococcemia) is the most severe form of meningococcal infection, rapidly developing and life-threatening.

Meningococcemia begins acutely – the temperature rises sharply, there is a headache, sometimes vomiting, in small children – convulsions.During the first two days, a rash appears all over the body, the spots first disappear with pressure, but as the infection progresses, they turn purple-red, with a bluish tinge and stop disappearing.

The rash is localized in the lower body, from the heels to the buttocks. In the center of the spots, necrosis occurs, where there are extensive rashes, ulcers form. In severe cases, gangrene of the fingers, feet, ears is possible. Rashes in the first hours of the disease on the face, upper body significantly worsen the prognosis.

Meningococcemia can start with lightning speed.

After the temperature rises, the rash appears suddenly, resembling cadaveric spots. The skin turns pale, becomes cold, and may be covered with clammy sweat. The pressure gradually drops, tachycardia develops, shortness of breath appears.

With this form of meningococcal infection, acute swelling and edema of the brain develops. Clinically, this is manifested by severe headache, convulsions, repeated vomiting, loss of consciousness.

In the absence of proper and prompt medical care, meningococcemia inevitably leads to the development of infectious-toxic shock and death of the patient.

90,000 Meningococcal disease

The most reliable protection against infectious diseases is your knowledge about them and measures to prevent them

Meningococcal infection is one of the most severe and insidious infectious diseases. With a lightning-fast course, it can develop in a matter of hours and if medical care is not provided in a timely manner within 12-24 hours, the patient may die or get permanent brain damage.

Cases of the disease are registered throughout the year, but the season of colds and flu is the most favorable time for the active spread of this infection.The insidiousness of meningococcal infection is also in the fact that its initial clinical signs are very similar to the onset of any acute respiratory infection, which makes it difficult to diagnose it in a timely manner and provide full assistance.

Meningococcal infection is an acute infectious bacterial disease caused by meningococci. Meningococcus (Neisseria meningitidis) refers to diplococci (“double or paired cocci”). Meningococci usually parasitize in the nasopharynx of a person, but are extremely unstable outside his body in the external environment: it is sensitive to low and high temperatures, exposure to the ultraviolet spectrum of sunlight.For infection and the development of the disease, a sufficiently long and close contact with the patient, a long stay in a poorly ventilated room is necessary. For this reason, group diseases are most often recorded in newly formed children’s and student groups and military units, hostels. Children under 3 years old are most susceptible to meningococcus – they account for about 60% of cases in Belarus.

The disease is most often transmitted by airborne droplets with microscopic droplets of mucus during the so-called expiratory acts: breathing (exhaling), talking, crying, coughing and sneezing.

The source of infection can be both patients with various clinically expressed forms of infection, and healthy asymptomatic carriers.

In case of meningococcal infection, the incubation period, i.e. the time from the moment of infection to the manifestation of the first clinical signs of the disease ranges from 1 to 10 days (usually 2 days).

The entrance gate of infection is the mucous membrane of the upper respiratory tract. In most cases, the presence of meningococci on the mucous membrane of the nasopharynx does not lead to the development of the disease – the infection proceeds in a localized form of carriage, which is usually short-lived (several weeks).Most often, the body itself is able to get rid of meningococcus after a while. Asymptomatic meningococcus carriage is quite widespread and it is the carriers that help maintain the circulation of meningococcus among people – at different times of the year and depending on the epidemiological situation, carriers can be from 1 to 10% of the population. At the same time, meningococcus is released into the external environment in insignificant concentrations, most often insufficient for the development of the disease.

The most common form of meningococcal infection is nasopharyngitis (or inflammation of the nasopharynx), in which, as with nasopharyngitis of any other nature, there is a slight increase in body temperature, sore throat, nasal congestion and runny nose, headache (mainly in the fronto-parietal area), sometimes dry cough.The phenomena of nasopharyngitis can disappear on their own after 2-3 days with complete recovery, but it can also be the first stage of the generalized form of meningitis.

For generalized forms of meningococcal infection, an acute and violent onset is characteristic, most often against the background of complete health: the temperature in the first hours of the disease rises to 39 – 41 ° C. The main and most common generalized form of meningococcal infection is cerebrospinal meningitis (purulent inflammation of the meninges).This form of infection is known at least by hearsay to everyone. But it should be noted that meningitis can be caused by a variety of pathogens: meningococcus, pneumococcus, hemophilus influenzae, viruses.

The most severe course is most often in meningococcal meningitis – the disease begins acutely with chills, fever, agitation, restlessness, or vice versa, the child becomes lethargic, complains of weakness. The disease develops rapidly, but you can tell the exact time when it started.With the development of meningitis, when the membranes of the brain are affected, there is a strong, painful, often pulsating or bursting headache (mainly in the fronto-parietal region), which cannot be relieved by conventional anesthetic drugs, which intensifies when exposed to any sharp sound, bright light, touch.

Meningitis due to increased intracranial pressure is characterized by non-relieving vomiting, without prior nausea and not associated with food intake.Symptoms of irritation of the meninges are expressed in the impossibility and pain when the child tries to bend his head to the chest. In advanced cases, the patient takes a forced posture with his head thrown back. One of the complications of this form is cerebral edema. If a child has seizures or paralysis of certain areas of the body, one can think of meningoencephalitis – this is an extremely unfavorable variant of the development of the disease with possible consequences of organic damage to the brain matter.

If the pathogen breaks into the bloodstream, then the patient develops meningococcal sepsis – meningococcemia.With this clinical form of the disease, toxic damage to organs and an abundant rash come first. Meningococcemia, especially in young children, often occurs in a severe, prognostically extremely unfavorable, fulminant form. It is also characterized by a sudden onset and violent course, when all severe symptoms develop within a matter of hours, and in the absence of rational therapy, patients die from acute cardiovascular or renal failure. Initially, there is a headache, high fever, often there are pains in muscles and joints, vomiting, agitation or growing lethargy and weakness, up to loss of consciousness.Urination decreases, stool retention is more often noted, although babies, on the contrary, may have diarrhea. After a few hours, a rash appears on the body. At first, these are pale pink stars, then the rash becomes pronounced: the classic rash occurs in the form of hemorrhages, i.e. has a hemorrhagic character, purple-cyanotic hue, its elements of an irregular “star” shape are located against the background of pale skin. The favorite localization of the rash is the lower and lateral surface of the abdomen, the outer surface of the thighs, feet and buttocks, in very severe cases – the face and eyelids.Hemorrhage into the adrenal glands leads to acute adrenal insufficiency often ending in death, the clinical picture of which resembles any shock: the patient is in serious condition, pale, wet. Simultaneously with the appearance of a rash, a drop in temperature may occur, blood pressure decreases, palpitations, shortness of breath appear, and motor agitation and convulsions are replaced by coma. Possible development of skin necrosis, arthritis, pneumonia, endocarditis.

In the vast majority of cases, meningococcal sepsis is combined with meningitis.All clinical forms, especially in children, can proceed in a lightning-fast form, when the lesion occurs so quickly that the doctor does not have time to make a diagnosis, especially during the seasonal rise in the incidence of ARI, or even reach the patient. Therefore, it is necessary to remember about its symptoms. And the sooner you seek medical help, the sooner the appropriate diagnosis is made, the more chances you have to save the patient. In controversial, erased cases, you should never be afraid that the diagnosis will not be confirmed – this is exactly the situation when you need to play it safe.But in any case, you will need hospitalization and you shouldn’t give it up. And before the ambulance arrives, you can give the patient anesthetic and antipyretic drugs.

There are prophylactic vaccinations against meningococcal infection caused by meningococcal types A and C. In Belarus, meningococcus type B has been circulating for a long time. Therefore, vaccination is recommended only during the epidemic, before traveling to regions of Africa that are unfavorable for meningococcal infection, including pilgrims going to Hajj.

Prevention measures are nonspecific and practically the same as for other infections transmitted by airborne droplets. The main efforts are aimed at observing the sanitary – anti-epidemic and air – thermal regime in children’s institutions, classrooms, hostels, incl. organizing frequent and effective ventilation, maintaining optimal temperature and humidity parameters, observing the occupancy of groups and classes, using bactericidal lamps, outdoor activities and rational nutrition.The instability of the pathogen in the external environment makes disinfection impractical.

During the seasonal autumn-winter rise in the incidence of meningococcal infection, as well as other ARIs, it is advisable to limit communication as much as possible, stay in crowded places, attend all kinds of entertainment, cultural and sports events, contact of children with strangers .