What are the key warning signs of sepsis. How does sepsis affect the body. When should you seek medical attention for potential sepsis. What are the stages of sepsis progression. How is sepsis diagnosed and treated. Who is at highest risk for developing sepsis. Can sepsis be prevented.

Understanding Sepsis: A Life-Threatening Medical Emergency

Sepsis is a potentially fatal condition that arises when the body’s response to infection spirals out of control. This overactive immune response can lead to widespread inflammation, organ failure, and death if not promptly recognized and treated. With approximately 1.7 million cases and 270,000 deaths annually in the United States alone, understanding sepsis is crucial for early intervention and improved outcomes.

What exactly is sepsis?

Sepsis occurs when an existing infection triggers an extreme immune system response. While the immune system typically protects against illnesses, in sepsis, it goes into overdrive. This hyperactive response leads to extensive inflammation throughout the body, potentially causing severe damage to multiple organ systems.

Common causes of sepsis

Most sepsis cases stem from bacterial infections. However, other pathogens can also trigger sepsis, including:

• Viruses (e.g., COVID-19, influenza)
• Fungi
• Parasites

Infections originating in various parts of the body can lead to sepsis, such as:

• Pneumonia
• Urinary tract infections
• Skin infections
• Abdominal infections

Recognizing the Warning Signs: The TIME Approach to Sepsis Symptoms

Early detection of sepsis is critical for successful treatment. Healthcare professionals and patients alike should be aware of the TIME approach, which highlights key warning signs:

T – Temperature changes

Body temperature fluctuations can indicate sepsis. While fever (hyperthermia) is common, some individuals may experience a drop in temperature (hypothermia). Any significant deviation from the normal body temperature of around 98.6°F (37°C) warrants attention.

I – Signs of Infection

Look for symptoms of an underlying infection, which may include:

• Localized pain or discomfort
• Redness or swelling
• Discharge or pus
• Cough or difficulty breathing (for respiratory infections)

It’s important to note that some infections may not present obvious symptoms, especially in individuals who have recently undergone surgery or invasive procedures.

M – Mental status changes

Sepsis can affect cognitive function, leading to:

• Confusion or disorientation
• Drowsiness or difficulty waking
• Sudden worsening of dementia symptoms in elderly patients

E – Extremely ill feeling

Many sepsis survivors report feeling severely ill, often describing it as the worst they’ve ever felt. This may manifest as:

• Intense pain or discomfort
• Shortness of breath
• A sense of impending doom

The Progression of Sepsis: Understanding the Stages

Sepsis can rapidly evolve through three distinct stages, each with increasing severity and risk:

Stage 1: Sepsis

In this initial stage, an infection enters the bloodstream and triggers an inflammatory response. Symptoms may include:

• Fever or low body temperature
• Rapid heart rate
• Rapid breathing
• Suspected or confirmed infection

Stage 2: Severe Sepsis

As sepsis progresses, it begins to affect organ function. Signs of severe sepsis include:

• Significantly decreased urine output
• Abrupt changes in mental status
• Difficulty breathing
• Abnormal heart function
• Abdominal pain

Stage 3: Septic Shock

The most critical stage of sepsis, septic shock is characterized by a dramatic drop in blood pressure that can lead to:

• Multiple organ failure
• Tissue damage
• Death

Prompt medical intervention is crucial at this stage to prevent fatal outcomes.

Diagnostic Criteria: How Medical Professionals Identify Sepsis

Healthcare providers use a combination of clinical observations and laboratory tests to diagnose sepsis. Key diagnostic criteria include:

Inflammatory Markers

• Elevated white blood cell count
• Presence of immature white blood cells in circulation
• Increased levels of C-reactive protein (CRP)
• Elevated procalcitonin (PCT)

Hemodynamic Changes

• Low blood pressure (hypotension)
• Decreased central venous or mixed venous oxygen saturation
• Elevated cardiac index

Signs of Organ Dysfunction

• Low oxygen levels in the blood
• Reduced urine output
• Elevated blood creatinine levels
• Abnormal blood clotting
• Absence of bowel sounds
• Low platelet count
• Increased bilirubin levels

Tissue Perfusion Indicators

• Elevated blood lactate levels
• Decreased capillary refill or skin mottling

Treatment Approaches: Combating Sepsis and Its Complications

Treating sepsis requires a multi-faceted approach, often in an intensive care setting. The main components of sepsis treatment include:

1. Antimicrobial Therapy

Broad-spectrum antibiotics are typically administered intravenously as soon as sepsis is suspected. Once the specific pathogen is identified through blood cultures, targeted antimicrobial therapy can be initiated.

2. Fluid Resuscitation

Intravenous fluids help maintain blood pressure and organ function. The type and amount of fluid are carefully monitored to prevent complications.

3. Vasopressors

If fluid resuscitation alone is insufficient to maintain adequate blood pressure, medications called vasopressors may be used to constrict blood vessels and increase blood pressure.

4. Oxygen Therapy

Supplemental oxygen or mechanical ventilation may be necessary to ensure adequate oxygenation of tissues and organs.

5. Organ Support

Depending on the affected organs, additional supportive measures may be required, such as dialysis for kidney failure or medication to support heart function.

6. Source Control

Identifying and addressing the original source of infection is crucial. This may involve draining abscesses, removing infected devices, or surgical intervention.

Risk Factors and Prevention: Minimizing the Threat of Sepsis

While sepsis can affect anyone, certain factors increase the risk of developing this life-threatening condition:

High-Risk Groups

• Elderly individuals
• Infants and young children
• People with weakened immune systems
• Individuals with chronic medical conditions (e.g., diabetes, cancer, kidney disease)
• Recent surgery or hospitalization patients
• Those with invasive devices (e.g., catheters, breathing tubes)

Preventive Measures

While it’s not always possible to prevent sepsis, several strategies can reduce the risk:

1. Practice good hygiene, including regular handwashing
2. Keep wounds clean and protected
3. Stay up-to-date on vaccinations
4. Manage chronic conditions effectively
5. Seek prompt medical attention for infections
6. Follow prescribed antibiotic regimens completely

Long-Term Implications: Life After Sepsis

Surviving sepsis is a significant achievement, but many patients face ongoing challenges:

Post-Sepsis Syndrome (PSS)

Some sepsis survivors experience a collection of physical and psychological symptoms known as Post-Sepsis Syndrome (PSS). These may include:

• Fatigue and weakness
• Muscle and joint pain
• Difficulty sleeping
• Cognitive issues (e.g., memory problems, difficulty concentrating)
• Anxiety and depression
• Recurring infections

Rehabilitation and Support

Recovery from sepsis often requires a comprehensive approach:

• Physical therapy to regain strength and mobility
• Occupational therapy to relearn daily living skills
• Psychological support to address emotional trauma
• Nutritional guidance to support overall health
• Regular medical follow-ups to monitor for complications

Long-Term Health Monitoring

Sepsis survivors may have an increased risk of future health problems, including:

• Cardiovascular issues
• Kidney dysfunction
• Respiratory problems
• Cognitive impairment

Regular check-ups and proactive health management are essential for long-term well-being.

Global Impact: Sepsis as a Public Health Concern

Sepsis represents a significant global health challenge, affecting millions of people worldwide each year. Understanding its impact is crucial for developing effective strategies to combat this condition:

Epidemiology and Statistics

The global burden of sepsis is substantial:

• An estimated 48.9 million cases worldwide annually
• Approximately 11 million sepsis-related deaths per year
• Disproportionate impact on low- and middle-income countries
• Higher incidence in vulnerable populations (e.g., neonates, elderly)

Economic Impact

The financial toll of sepsis is significant:

• High healthcare costs associated with intensive treatments
• Lost productivity due to extended hospital stays and recovery periods
• Long-term economic burden from ongoing care and disability

Global Initiatives

Recognizing the severity of sepsis, various global initiatives have been launched:

• World Sepsis Day (September 13th) to raise awareness
• WHO Resolution on Improving the Prevention, Diagnosis, and Clinical Management of Sepsis
• Global Sepsis Alliance efforts to improve sepsis care worldwide

Challenges in Sepsis Management

Despite increased awareness, several challenges persist in managing sepsis globally:

• Limited resources in many healthcare settings
• Lack of standardized diagnostic criteria across different regions
• Antibiotic resistance complicating treatment
• Insufficient public awareness leading to delayed care-seeking

Addressing these challenges requires coordinated efforts from healthcare providers, policymakers, and the public to improve sepsis outcomes worldwide.

Emerging Research: New Frontiers in Sepsis Diagnosis and Treatment

The field of sepsis research is dynamic, with ongoing efforts to improve diagnosis, treatment, and outcomes. Several promising areas of study are shaping the future of sepsis care:

Advanced Diagnostic Techniques

Researchers are exploring novel methods to diagnose sepsis more quickly and accurately:

• Biomarker panels for early sepsis detection
• Machine learning algorithms to predict sepsis onset
• Point-of-care testing devices for rapid diagnosis
• Gene expression profiling to identify sepsis subtypes

Targeted Therapies

Emerging treatments aim to modulate the immune response more precisely:

• Immunomodulatory drugs to balance pro- and anti-inflammatory responses
• Extracorporeal blood purification techniques
• Stem cell therapies for organ repair and regeneration
• Personalized treatment approaches based on genetic profiles

Antibiotic Stewardship

Efforts to combat antibiotic resistance while ensuring effective sepsis treatment include:

• Rapid pathogen identification technologies
• Development of novel antimicrobial agents
• Strategies for optimizing antibiotic dosing and duration
• Implementation of antibiotic stewardship programs in healthcare settings

Prevention Strategies

Research into preventive measures focuses on:

• Vaccines against common sepsis-causing pathogens
• Improved infection control practices in healthcare settings
• Strategies to enhance host immunity in high-risk populations
• Development of sepsis risk assessment tools

These advancements hold promise for improving sepsis outcomes and reducing its global impact. Continued research and collaboration across disciplines will be crucial in translating these findings into clinical practice.

Symptoms | Sepsis Alliance

Click here to download this symptoms card.

It’s important to look for a combination of the warning signs of sepsis. Spotting these symptoms early could prevent the body from entering septic shock, and could save a life.

T – Temperature higher or lower.

Your body’s temperature should stay fairly constant, around 98.6 degrees Fahrenheit (37 degrees Celsius), moving up or down a bit depending on your activity, the environment, and time of day. A temperature of 100 degrees Fahrenheit (37.7 degrees Celsius) is considered to be hyperthermia, a fever. When you have an infection, your body’s temperature usually rises as it tries to fight off the bug causing the infection. Interestingly, some people see their body temperature go down (hypothermia) instead of up. This is why any change, high or low, can be a sign of sepsis.

I – Infection – may have signs and symptoms of an infection.

If you have a local infection, like a urinary tract infection, pneumonia, or an infected cut, the signs and symptoms are localized according to the area affected (needing to urinate or burning on urination for a UTI, coughing and chest pain for pneumonia, redness and pus for an infected cut, for example). If the infection has spread or you have a generalized infection, you may develop other signs and symptoms, such as fever, fatigue, pain, etc.

Sometimes however, you may have an infection and not know it, and not have any symptoms. Keep this in mind especially if you have recently had surgery or an invasive medical procedure, a break in your skin, or you have been exposed to someone who is ill.

M – Mental decline – confused, sleepy, difficult to rouse.

Sepsis can affect your mental status. Some people, especially the elderly, may not show typical signs of infection. Instead, they may show a sudden change in mental status, becoming confused, or a worsening of dementia and confusion. Sleepiness, often severe, is also a common complaint.

E – Extremely ill –  severe pain or discomfort, shortness of breath.

Many sepsis survivors have said that when they were ill, it was the worst they ever felt. It was the worst sore throat, worst abdominal pain, or they felt that they were going to die.

Children developing sepsis may exhibit different symptoms, as seen below.

Healthcare professionals look for the following signs and symptoms, as well as those listed above, to determine a diagnosis. They include:

Inflammatory

• High white blood cell count
• Immature white blood cells in the circulation
• Elevated plasma C-reactive protein
• Elevated procalcitonin (PCT)

Hemodynamic

• Low blood pressure
• Low central venous or mixed venous oxygen saturation
• High cardiac index

Organ Dysfunction

• Low oxygen level
• Low urine output
• High creatinine in the blood
• Coagulation (clotting) abnormalities
• Absent bowel sounds
• Low platelets in the blood
• High bilirubin levels

Tissue Perfusion

• High lactate in the blood
• Decreased capillary filling or mottling

Symptoms, Causes, Treatment, Risks, and More

Sepsis is a life threatening illness caused by your body’s response to an infection. Your immune system protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection.

There are approximately 1.7 million cases of sepsis each year, according to the Centers for Disease Control and Prevention (CDC). In addition, this type of infection kills nearly 270,000 people in the United States every year.

Keep reading to learn more about sepsis symptoms, treatment, and complications.

Sepsis develops when an existing infection triggers an extreme immune system response in your body.

When you experience an infection, your immune system responds by releasing proteins and other chemicals to fight it. Sepsis occurs when this response gets out of control, triggering extensive inflammation.

Most infections that cause sepsis are bacterial. But other infections — including COVID-19, influenza, and fungal infections — can also lead to sepsis.

Sepsis causes fever, a rapid heart rate, and difficulty breathing, among other symptoms. It’s a serious condition that requires swift medical treatment.

Severe sepsis can lead to septic shock, a medical emergency. Septic shock is associated with a significant drop in blood pressure, organ failure, and widespread tissue damage. If left untreated, it can be fatal.

Stages of sepsis

There are three stages of sepsis:

• Sepsis. An infection gets into your bloodstream and causes inflammation in your body.
• Severe sepsis. The infection and inflammation is severe enough to start affecting organ function.
• Septic shock. Septic shock is a severe complication of sepsis that causes a significant drop in blood pressure. This can lead to many serious complications including:
  • organ dysfunction
  • respiratory or heart failure
  • stroke
  • possible death

While sepsis often occurs in hospital settings, it can also happen in other locations. In some cases, you might not even know you have an infection that could potentially lead to sepsis.

It’s important to seek immediate medical attention if you have any symptoms of sepsis. The earlier you seek treatment, the greater chance you have of recovering.

Signs and symptoms of sepsis

Symptoms of sepsis can include:

• fever and/or chills
• confusion or disorientation
• difficulty breathing
• fast heart rate or low blood pressure (hypotension)
• extreme pain
• sweaty skin

It’s possible to mistake the symptoms above for those of another condition, like pneumonia, COVID-19, or cancer.

In addition, sepsis symptoms can be particularly hard to identify in infants, children, and people with:

• communication challenges
• learning disabilities
• dementia

It’s best to seek medical assistance right away if you suspect sepsis. A health professional can examine you or the person you care for to make a diagnosis.

Signs and symptoms of severe sepsis

Severe sepsis is characterized by organ failure. You must have one or more of the following signs to be diagnosed with severe sepsis:

• difficulty breathing
• bluish discoloration of the skin, especially lips, fingers, toes
• chills due to a drop in body temperature
• decreased urination
• dizziness
• changes in mental ability
• extreme weakness (asthenia)
• low platelet count (thrombocytopenia)
• abnormal heart functions
• unconsciousness

Signs and symptoms of septic shock (septicemia)

Sepsis can advance very quickly to severe sepsis and septic shock. As it transitions, it becomes more life threatening.

Some severe sepsis and septic shock symptoms can overlap, like severe difficulty breathing, acute confusion, and bluish skin. Another key symptom of septic shock is very low blood pressure.

If you need help finding a primary care doctor, then check out our FindCare tool here.

Any infection can trigger sepsis, but the following types of infections have a higher risk of causing sepsis:

• pneumonia
• abdominal infections
• kidney infections
• blood poisoning

According to the National Institute of General Medical Sciences, the number of sepsis cases in the United States increases every year. Possible reasons for the increase include:

• an aging population, due to the fact that sepsis is more common in seniors
• an increase in antibiotic resistance, which happens when an antibiotic medication loses its ability to resist or kill bacteria
• an increase in the number of people with illnesses that weaken their immune systems

Although some people have a higher risk of infection, anyone can get sepsis. People who are at the highest risk include:

• young children and seniors
• people with weaker immune systems, including people with HIV or those undergoing chemotherapy treatment for cancer
• people in intensive care units (ICUs)
• people exposed to invasive devices, like intravenous catheters or breathing tubes

Neonatal sepsis occurs when a baby gets a blood infection within the first month of life.

Neonatal sepsis is classified based on the timing of the infection, according to whether the infection was contracted during birth (early-onset) or after birth (late-onset). This helps the doctor decide what kind of treatment to administer.

Low birth weight and premature babies are more susceptible to late-onset sepsis because their immune systems are immature. While symptoms can be subtle and nonspecific, some signs include:

• listlessness
• not breastfeeding/feeding well
• low body temperature
• apnea (gaps in breathing)
• fever
• pale color
• poor skin circulation with cool extremities
• abdominal swelling
• vomiting
• diarrhea
• seizures
• jitteriness
• yellowing of the skin and whites of the eyes (jaundice)

Neonatal sepsis is still a leading cause of infant death. With early diagnosis and treatment, most babies can recover completely and have no other problems.

In addition, universal maternal screening and proper neonatal testing have significantly reduced the risk of neonatal sepsis.

The immune system tends to weaken with age. According to a 2017 review, around 40 to 50 percent of all bacteremia cases occur in older adults, which can lead to sepsis.

But age isn’t the only factor that puts seniors at an increased risk. Older adults are also more likely to have existing chronic illnesses, like diabetes, kidney disease, cancer, or high blood pressure.

Other risk factors pertinent to seniors include increased use of medication, malnutrition, and imbalances in intestinal microbiota.

Older adults can contract sepsis from common infections, like pneumonia or urinary tract infections (UTIs). Infections from pressure sores can also lead to sepsis.

Finally, sepsis symptoms like confusion and disorientation may be particularly difficult to identify in older adults with dementia.

If you have sepsis symptoms, your doctor will order tests to diagnose and determine the severity of your infection. One of the first tests is a blood test. Your blood is checked for complications like:

• infection
• clotting problems
• abnormal liver or kidney function
• decreased amount of oxygen
• an electrolyte imbalance, which affects the amount of water in your body and the acidity of your blood

Depending on your symptoms and the results of your blood test, your doctor may order other tests, including:

• a urine test (to check for bacteria in your urine)
• a wound secretion test (to check an open wound for an infection)
• a mucus secretion test (to identify germs responsible for an infection)

If your doctor can’t determine the source of an infection using the above tests, they may order an internal view of your body using one of the following:

• chest x-rays to view the lungs
• CT scans to view possible infections in the appendix, pancreas, or bowel area
• ultrasounds to view infections in the gallbladder or ovaries
• MRI scans, which can identify soft tissue infections

There are two sets of criteria doctors use to determine the severity of sepsis. One set of criteria is for systemic inflammatory response syndrome (SIRS).

SIRS is defined when you meet two or more of the following criteria:

• a fever of more than 100.4°F (38°C) or less than 96.8°F (36°C)
• a heart rate of more than 90 beats per minute
• a respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO₂) of less than 32 millimeters of mercury (mm Hg)
• an abnormal white blood cell count

Another tool is the quick sequential organ failure assessment (qSOFA). It uses the results of three criteria:

• low blood pressure reading (systolic blood pressure of less than 100 mm Hg)
• high respiratory rate (greater than 22 breaths per minute)
• Glasgow coma scale score of 14 or less to determine your level of consciousness

A positive qSOFA occurs when two or more of the above measurements are abnormal. Some physicians prefer using qSOFA because, unlike the SIRS criteria, qSOFA doesn’t require laboratory tests.

The results of either of these assessments will help your doctor determine the best course of treatment.

Sepsis can quickly progress to septic shock and death if it’s left untreated. Doctors use a number of medications to treat sepsis, including:

• intravenous (IV) antibiotics to fight the infection
• medications to increase blood pressure
• insulin to stabilize blood sugar
• corticosteroids to reduce inflammation
• pain relievers to help with discomfort

Severe sepsis may also require large amounts of IV fluids and a respirator for breathing.

Dialysis might be necessary if the kidneys are affected. Your kidneys help filter harmful wastes, salt, and excess water from your blood. With dialysis, a machine performs these functions.

In some cases, surgery may be needed to remove the source of an infection. This may include draining a pus-filled abscess or removing infected tissue.

Treatment options may vary slightly for older adults, depending on their risk factors. According to a 2016 review, older adults may be more sensitive to medications that increase blood pressure and antibiotics.

Additionally, seniors are more likely to develop delirium in the ICU and should be regularly screened for sepsis symptoms.

Sepsis isn’t contagious. But the pathogens responsible for the original infection, like viral pneumonia or COVID-19, can be contagious.

Sepsis spreads within a person’s body from the original source of infection to other organs through the bloodstream.

Recovering from sepsis depends on the severity of your condition and any pre-existing health issues you might have. While many people make a full recovery, others report lasting effects.

The UK Sepsis Trust reports that it can take up to 18 months before people who’ve had sepsis start feeling like their usual selves again.

According to the Sepsis Alliance, around 50 percent of sepsis survivors deal with a condition called post-sepsis syndrome (PSS). This condition includes long-term effects like:

• damaged organs
• insomnia
• nightmares
• disabling muscle and joint pains
• fatigue
• poor concentration
• lowered cognitive functioning
• lowered self-esteem

You can reduce your risk of sepsis by preventing the spread of infection. In the current COVID-19 pandemic, this is more important than ever.

Severe COVID-19 infections cause symptoms similar to sepsis. In addition, contracting COVID-19 puts you at an increased risk of developing another infection. A 2021 review reported that up to 17 percent of people admitted to the ICU with COVID-19 had additional infections.

You can help prevent both COVID-19 and other infections by taking the following precautions:

• Stay up to date on your vaccinations. Get vaccinated for COVID-19, the flu, pneumonia, and other common infections.
• Keep your distance from people outside your household. Avoid non-essential travel and activities, and stay 6 feet away from people you don’t know.
• Wear a mask. Masks help protect you and others from respiratory infections. Wear a mask in indoor public spaces, like grocery stores and movie theaters.
• Practice good hygiene. This means practicing proper wound care, hand-washing, and bathing regularly.
• Get immediate care if you develop signs of infection. Every minute counts when it comes to sepsis treatment. The sooner you get treatment, the better the outcome.

Sepsis symptoms can range from mild to severe. Complications are more likely in severe cases. These complications can include:

• blood clots
• an increased risk of infection
• tissue death (gangrene)
• organ damage
• organ failure, particularly the kidneys, heart, and lungs

Severe cases of sepsis can be fatal. A 2020 review found that the mortality rate for sepsis after 90 days was 32.2 percent. The mortality rate for septic shock after 90 days was 38.5 percent.

Sepsis is a life threatening illness caused by your body’s response to an infection. Sepsis occurs when your body’s immune system response gets out of control, triggering extensive inflammation.

Sepsis isn’t contagious. But bacterial, viral, and fungal infections that can trigger sepsis can be spread from person to person. COVID-19 is an example of one such infection that can lead to sepsis. Those at the highest risk of sepsis include newborns, seniors, and people with pre-existing health conditions.

Among other symptoms, sepsis causes fever or chills, a rapid heart rate, confusion, and difficulty breathing. Sepsis is a medical emergency.

Seek immediate medical attention if you suspect that you have sepsis, especially if you have a known infection.

Read the article in Spanish.

Purulent-resorptive fever. What is purulent-resorptive fever?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Purulent-resorptive fever is a pathological process that occurs during secondary wound healing. The main symptoms are local complications (purulent streaks, abscesses, phlegmon), fever and general intoxication manifestations. With a long course, traumatic exhaustion develops, a fatal outcome occurs. Diagnosis of the disease is based on the data of the anamnesis, clinical symptoms, detection of pyogenic flora. Treatment is aimed at stopping the entry of wound toxins into the blood, which is usually achieved by surgical excision, pathogenetic and symptomatic treatment, and the appointment of antibiotics.

ICD-10

R50.8 Other specified fever

• Causes
• Pathogenesis
• Symptoms
• Complications
• Diagnostics
• Treatment of purulent-resorptive fever
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Prices for treatment

General information

Purulent-resorptive fever is a local complication, accompanied by a general reaction of the body, adequate to changes in the area of ​​damage. Wound infection has been known since ancient times, however, a complete description of the symptoms, pathogenesis and principles of treatment was made by the Soviet pathologist I. V. Davydovsky only at 1944 year. In fact, this process serves as a prerequisite for the development of sepsis. The importance of pathology for clinical infectology and medicine is to reduce mortality. Up to 5% of cases of fever are caused by injuries of the abdominal cavity and suppuration of various localization against the background of per-site dysfunction of the central nervous and endocrine systems.

Purulent-resorptive fever

Causes

No specific pathogens. The causes of purulent-resorptive fever include the sorption effect of microorganisms, their waste products, toxins, the absorption of exudate from tissue detritus, pro-inflammatory and protective factors of the body. Wound infection is most often introduced from the environment (soil, clothing, fragments of shells, bullets), skin, but bacteria can also enter the wound endogenously (hemato- or lymphogenously) from chronic inflammatory foci – the oral cavity, digestive, urinary, reproductive and other systems.

The main risk factors are extensive, multiple and deep wounds, burn disease, prolonged compression syndrome (crash syndrome). Slow healing, pronounced edema, abundant exudate and simultaneous absence or insufficient wound drainage, a large area of ​​necrotic tissues, the presence of systemic immune deficiency of any etiology, diabetes mellitus, and gastrointestinal pathologies are considered unfavorable prognostic signs.

Pathogenesis

According to modern concepts, purulent-resorptive fever can be equated to systemic inflammatory response syndrome (SIRS), the pathogenesis of which is based on the activation of all components of the cytokine network. In parallel, there is a suppression of cascade proteolysis of blood plasma and inhibition of the synthesis of anti-inflammatory interleukins-10, 13. Tissue decay products accumulate and are absorbed into the bloodstream, spreading through the hematogenous and lymphogenous pathways.

The main difference between this infectious pathology and sepsis is the morphological limitation of local necrotic processes through the formation of a demarcation shaft. Due to local edema, the trophism of damaged tissues worsens, dystrophic and necrotic changes are detected histologically. Hypoxia is especially dangerous for phospholipid membranes and intracellular structures: mitochondria, lysosomes, cytoskeleton due to their swelling, decay, release of enzymes and activation of apoptosis.

Symptoms

For the course of nosology, the correspondence of local symptoms and general intoxication complaints is typical. Pathology should be suspected with prolonged fever over 37.5 ° C, throbbing pain, swelling, redness in the wound area. Perhaps the appearance of a grayish plaque, crust, bleeding during dressing or active movement. Characterized by severe weakness, drowsiness, decreased performance, deterioration of appetite and sleep. Patients with purulent-resorptive fever are concerned about chills, headaches, nausea, stool breakdowns, and weight loss.

Important for the identification and prognosis of the condition is the triad of clinical symptoms: the level of body temperature, respiratory rate and heart rate. It is necessary to urgently seek medical help if a patient with a wound has severe shortness of breath, tachycardia of more than 90 beats per minute, temperature above 38 ° C or below 36 ° C in the presence of local wound inflammatory symptoms, as well as impaired consciousness, a decrease in the amount of urine excreted, the appearance of pinpoint hemorrhages on the skin and mucous membranes.

Complications

The most common complication of purulent-resorptive fever, if left untreated, is sepsis, with the likely development of such a life-threatening condition as septic shock. Long-term consequences include traumatic exhaustion with the formation of cachexia, chronic dystrophic processes in internal organs: heart attacks, lung abscesses, nephritis, ulcerative necrotic colitis, hepatitis, spleen amyloidosis. Probably the development of adrenal and pancreatic insufficiency, hypothyroidism.

Diagnosis

Detection of purulent-resorptive fever is carried out with the participation of an infectious disease specialist and a surgeon. Specialists of other medical profiles are involved in the examination according to indications. It is necessary to carefully collect information about the cause, prescription and nature of the injury, the amount of operational assistance provided. The basic laboratory and instrumental diagnostic signs of the pathological process are:

• Physical data. The edges of the wound are edematous, the granulations bleed easily, grayish, without marginal epithelialization, there is a dense fibrinous coating. On palpation, the wound surface is sharply painful, often with fluctuation, sometimes crepitus is detected. Exudate of various colors, often fetid. The internal organs are usually without pathology; with a prolonged course, cachexia, atrophy of skeletal muscles, hepato- and splenomegaly are formed.
• Laboratory studies. The general clinical blood test is characterized by leukocytosis with a pronounced shift of the formula to the left, moderate anemia, and accelerated ESR. In biochemical and immunological studies, hypoproteinemia, hypoalbuminemia, significant acidosis, increased levels of interleukin-6, TNF-alpha are recorded. In the general analysis of urine – proteinuria, an increase in sediment density, leukocyturia.
• Detection of infectious agents. Mandatory microscopy of the wound or fistulous discharge, sowing on nutrient media. If actinomycosis is suspected, a biopsy of the wound edges, scraping of granulations, an allergic test with actinolysate, a serological test – the Borde-Gangu reaction are performed. To exclude a septic process, a triple blood culture for hemoculture and sterility is performed, a study of the level of procalcitonin, presepsin, proadrenomedullin, troponin.
• Instrumental methods. Chest x-ray is recommended to rule out tuberculous lesions; the study of bones and joints by radiation methods is performed depending on the location of the damage and the depth of inflammatory-necrotic changes. Ultrasound of the musculoskeletal system, soft tissues is prescribed, if available, the area of ​​the postoperative suture.

Differential diagnosis is carried out with actinomycosis (laboratory confirmed), resorptive-toxic fever that occurs with closed injuries, does not cause a long-term increase in body temperature and pronounced local inflammatory changes. For sepsis of any genesis, improvement in the patient’s condition during the sanitation of the focus of infection is uncharacteristic, the primary focus is often not determined or does not cause significant subjective complaints.

Treatment of purulent-resorptive fever

Patients are urgently hospitalized in a surgical hospital. Until 5-7 days of normal body temperature, strict bed rest is prescribed, pressure sores and hypostatic pneumonia are prevented. A high-protein fortified diet is recommended, an increase in water load (in the absence of contraindications), preferably with the use of means to correct electrolyte imbalance and acidosis (oralitis, etc.). If necessary, patients are transferred to the intensive care unit.

Conservative therapy

The management of patients with symptoms of purulent-resorptive fever has much in common with the management of septic patients. The main goals of conservative therapy after sanitation of the primary focus are to combat the causative agent of the local inflammatory process, adequate oxygenation, reduce the systemic inflammatory effect of the body and prevent the development of a septic response. The most commonly used therapeutic support tactics are:

• Etiotropic treatment. Broad-spectrum antibiotics are prescribed because bacterial agents are the most common cause of infection. The first line includes penicillins, fluoroquinolones, metronidazole, linezolid, vancomycin and their combinations. Evaluation of the effectiveness of the selected drug is made no earlier than 48-72 hours from the start of administration.
• pathogenic agents. Massive infusion detoxification with hydroxyethylene starches, crystalloids, administration of albumin solutions, fresh frozen plasma is carried out. Less commonly used extracorporeal detoxification: plasmapheresis, hemofiltration, dialysis. The use of NSAIDs is justified, less often – glucocorticosteroids.
• Symptomatic therapy. According to the indications, antipyretic, analgesic, vasoactive, microcirculation-improving agents, anticoagulants, diuretics are prescribed. The effectiveness of hyperbaric oxygenation in anaerobic etiology of the process is reported. In the presence of hyperglycemia, the administration of adequate doses of insulin has a proven effect on survival.

Nutritional support is important to prevent malnutrition due to hypercatabolism and hypermetabolism, characteristic symptoms of systemic inflammation. To stop violations of systemic coagulation in severe fever, the introduction of activated protein C is recommended. It is possible to use intravenous combined preparations of immunoglobulins, which have a proven effect of enhancing the action of beta-lactam antibiotics, limiting the effect of pro-inflammatory cytokines. Patients with symptoms of wound fever should receive tetanus prophylaxis.

Surgical treatment

Is the main method of treatment. The volume of surgical intervention depends on the extent of the lesion, possibly limited excision of the wound edges, necrectomy, arthrotomy, resection of the joint, amputation of the limb. Revision of the wound channel for streaks and purulent pockets, installation of drains with active aspiration, rinsing with antiseptic solutions, regular dressings with water-based antibacterial ointments are mandatory. After healing with a widespread lesion, various types of dermoplasty are performed.

In case of extensive and deep necrotic changes in the wound, sequential excision is recommended during the next dressings, the use of sorption dressings, proteolytic enzymes, washing with a pulsating jet of oxygenated antiseptic. Instead of drainage tubes, loose tamponade of the infected cavity is allowed. Secondary sutures are applied only after complete cleansing of the infected surface, with good development of granulations.

Prognosis and prevention

Prognosis with timely detection and treatment is favorable, mortality is lower than with sepsis. Prevention of purulent-resorptive fever consists in the correct tactics of primary surgical treatment of wounds, the detection, opening and drainage of purulent wound complications, rational antibiotic therapy, and early skin transplantation in case of burn disease. High-quality sanitation of foci of chronic infection in the body, drug compensation for metabolic diseases, immune deficiency is considered important.

You can share your medical history, what helped you in the treatment of purulent-resorptive fever.

Sources

1. Sepsis / Mironov I.L. – 2005.
2. Vacuum therapy of wounds and wound process / Davydov Yu.A., Larichev A.B. – 1999.
3. Academician Ippolit Vasilyevich Davydovsky (on the 50th anniversary of his death) / Morgoshiya T.Sh., Apchel V.Ya. / / Bulletin of the Russian Military Medical Academy – 2019 – No. 1.
4. Bacterial Sepsis/ Benjamin Bullock, Michael D. Benham// Treasure Island (FL): StatPearls Publishing – 2019.
5. This article was prepared based on the site materials: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Sepsis. What is Sepsis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Sepsis is a common purulent infection that develops due to the penetration and circulation of various pathogens and their toxins in the blood. The clinical picture of sepsis consists of an intoxication syndrome (fever, chills, pale earthy skin color), thrombohemorrhagic syndrome (hemorrhages in the skin, mucous membranes, conjunctiva), metastatic lesions of tissues and organs (abscesses of various localizations, arthritis, osteomyelitis, etc.). Sepsis is confirmed by the isolation of the pathogen from a blood culture and local foci of infection. With sepsis, massive detoxification, antibiotic therapy, and immunotherapy are indicated; according to indications – surgical removal of the source of infection.

• Causes of sepsis
• Pathogenesis
• Classification
• Symptoms of sepsis
• Complications of sepsis
• Sepsis diagnostics
• Treatment of sepsis
• Prognosis and prevention
• Prices for treatment

General

Sepsis (blood poisoning) is a secondary infectious disease caused by the ingress of pathogenic flora from the primary local infectious focus into the bloodstream. Today, from 750 to 1.5 million cases of sepsis are diagnosed annually in the world. According to statistics, abdominal, pulmonary and urogenital infections are most often complicated by sepsis, so this problem is most relevant for general surgery, pulmonology, urology, and gynecology. Within pediatrics, the problems associated with neonatal sepsis are studied. Despite the use of modern antibacterial and chemotherapeutic drugs, mortality from sepsis remains at a consistently high level of 30-50%.

Sepsis

Causes of sepsis

The most important factors leading to the breakdown of anti-infective resistance and the development of sepsis are:

• on the part of the macroorganism – the presence of a septic focus, periodically or permanently associated with the blood or lymphatic channel; disturbed reactivity of the organism
• on the part of the infectious agent – qualitative and quantitative properties (massiveness, virulence, generalization by blood or lymph)

The leading etiological role in the development of most cases of sepsis belongs to staphylococci, streptococci, enterococci, meningococci, gram-negative flora (Pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, Enterobacter), to a lesser extent – fungal pathogens (candida, aspergillus, actinomycetes).

Detection of polymicrobial associations in the blood increases the mortality rate in patients with sepsis by 2.5 times. Pathogens can enter the bloodstream from the environment or be introduced from foci of primary purulent infection.

Nosocomial infection is of great importance: its growth is facilitated by the widespread use of invasive diagnostic procedures, immunosuppressive drugs (glucocorticoids, cytostatics). Under conditions of immunodeficiency, against the background of trauma, surgical stress or acute blood loss, the infection from chronic foci spreads freely throughout the body, causing sepsis. The development of sepsis is more susceptible to premature babies, patients who are on mechanical ventilation for a long time, hemodialysis; oncological, hematological patients; patients with diabetes mellitus, HIV infection, primary and secondary immunodeficiencies.

Pathogenesis

The mechanism of development of sepsis is multistage and very complex. From the primary infectious focus, pathogens and their toxins penetrate the blood or lymph, causing the development of bacteremia. This causes the activation of the immune system, which reacts with the release of endogenous substances (interleukins, tumor necrosis factor, prostaglandins, platelet activating factor, endothelins, etc.), causing damage to the endothelium of the vascular wall. In turn, under the influence of inflammatory mediators, the coagulation cascade is activated, which ultimately leads to the occurrence of DIC. In addition, under the influence of released toxic oxygen-containing products (nitric oxide, hydrogen peroxide, superoxides), perfusion decreases, as well as oxygen utilization by organs. A logical outcome in sepsis is tissue hypoxia and organ failure.

Sepsis

Classification

Forms of sepsis are classified depending on the localization of the primary infectious focus. Based on this feature, primary (cryptogenic, essential, idiopathic) and secondary sepsis are distinguished. In primary sepsis, the entrance gate cannot be found. The secondary septic process is divided into:

• surgical – develops when infection enters the blood from a postoperative wound
• obstetric-gynecological – occurs after complicated abortions and childbirth
• urosepsis – characterized by the presence of an entrance gate in the genitourinary apparatus (pyelonephritis, cystitis, prostatitis)
• dermal – the source of infection is purulent skin diseases and damaged skin (boils, abscesses, burns, infected wounds, etc.)
• peritoneal (including biliary, intestinal) – with localization of primary lesions in the abdominal cavity
• pleuro-pulmonary – develops against the background of purulent lung diseases (abscessing pneumonia, pleural empyema, etc.)
• odontogenic – due to diseases of the dentoalveolar system (caries, root granulomas, apical periodontitis, periostitis, periorbital phlegmon, osteomyelitis of the jaws)
• tonsillogenic – occurs against the background of severe tonsillitis caused by streptococci or staphylococci
• rhinogenic – develops due to the spread of infection from the nasal cavity and paranasal sinuses, usually with sinusitis
• otogenic – associated with inflammatory diseases of the ear, often purulent otitis media.
• umbilical – found in neonatal omphalitis

According to the time of occurrence, sepsis is divided into early (occurs within 2 weeks from the moment the primary septic focus appears) and late (occurs later than two weeks). According to the rate of development, sepsis can be fulminant (with the rapid development of septic shock and the onset of death within 1-2 days), acute (lasting 4 weeks), subacute (3-4 months), recurrent (lasting up to 6 months with alternating attenuation and exacerbations) and chronic (lasting more than a year).

Sepsis in its development goes through three phases: toxemia, septicemia and septicopyemia. The toxemia phase is characterized by the development of a systemic inflammatory response due to the onset of the spread of microbial exotoxins from the primary focus of infection; in this phase, bacteremia is absent. Septicemia is marked by dissemination of pathogens, the development of multiple secondary septic foci in the form of microthrombi in the microvasculature; there is persistent bacteremia. The septicopyemia phase is characterized by the formation of secondary metastatic purulent foci in the organs and the skeletal system.

Symptoms of sepsis

The symptomatology of sepsis is extremely polymorphic, depending on the etiological form and course of the disease. The main manifestations are due to general intoxication, multiple organ disorders and localization of metastases.

In most cases, the onset of sepsis is acute, however, in a quarter of patients, the so-called presepsis is observed, characterized by febrile waves alternating with periods of apyrexia. The state of presepsis may not turn into a detailed picture of the disease if the body manages to cope with the infection. In other cases, the fever takes an intermittent form with severe chills, followed by heat and sweating. Sometimes hyperthermia of a permanent type develops.

The condition of the patient with sepsis is rapidly aggravated. The skin becomes pale gray (sometimes icteric) color, facial features are sharpened. There may be herpetic rashes on the lips, pustules or hemorrhagic rashes on the skin, hemorrhages in the conjunctiva and mucous membranes. In the acute course of sepsis, bedsores quickly develop in patients, dehydration and exhaustion increase.

Under conditions of intoxication and tissue hypoxia, sepsis develops multiple organ changes of varying severity. Against the background of fever, signs of CNS dysfunction are clearly expressed, characterized by lethargy or agitation, drowsiness or insomnia, headaches, infectious psychoses and coma. Cardiovascular disorders are represented by arterial hypotension, weakening of the pulse, tachycardia, deafness of heart tones. At this stage, sepsis can be complicated by toxic myocarditis, cardiomyopathy, and acute cardiovascular failure.

The respiratory system reacts to the pathological processes occurring in the body with the development of tachypnea, pulmonary infarction, respiratory distress syndrome, and respiratory failure. On the part of the digestive tract, anorexia, the occurrence of “septic diarrhea” alternating with constipation, hepatomegaly, and toxic hepatitis are noted. Violation of the function of the urinary system in sepsis is expressed in the development of oliguria, azotemia, toxic nephritis, acute renal failure.

In the primary focus of infection in sepsis, characteristic changes also occur. Wound healing slows down; granulations become lethargic, pale, bleeding. The bottom of the wound is covered with a dirty grayish coating and areas of necrosis. The discharge acquires a cloudy color and a fetid odor.

Metastatic foci in sepsis can be detected in various organs and tissues, which causes the layering of additional symptoms characteristic of the purulent-septic process of this localization. The consequence of the introduction of infection into the lungs is the development of pneumonia, purulent pleurisy, abscesses and gangrene of the lung. With metastases to the kidneys, pyelitis and paranephritis occur. The appearance of secondary purulent foci in the musculoskeletal system is accompanied by the phenomena of osteomyelitis and arthritis. With brain damage, the occurrence of cerebral abscesses and purulent meningitis is noted. There may be metastases of a purulent infection in the heart (pericarditis, endocarditis), muscles or subcutaneous adipose tissue (soft tissue abscesses), abdominal organs (liver abscesses, etc.).

Complications of sepsis

The main complications of sepsis are associated with multiple organ failure (renal, adrenal, respiratory, cardiovascular) and DIC (bleeding, thromboembolism).

The most severe specific form of sepsis is septic (infectious-toxic, endotoxic) shock. It often develops with sepsis caused by staphylococcus aureus and gram-negative flora. The harbingers of septic shock are the disorientation of the patient, visible shortness of breath and impaired consciousness. Disorders of blood circulation and tissue metabolism are rapidly growing. Characterized by acrocyanosis against the background of pale skin, tachypnea, hyperthermia, a critical drop in blood pressure, oliguria, increased heart rate up to 120-160 beats. per minute, arrhythmia. Mortality in the development of septic shock reaches 90%.

Sepsis 1

Sepsis diagnostics

Recognition of sepsis is based on clinical criteria (infectious-toxic symptoms, the presence of a known primary focus and secondary purulent metastases), as well as laboratory parameters (blood culture for sterility).

At the same time, it should be borne in mind that short-term bacteremia is also possible with other infectious diseases, and blood cultures with sepsis (especially against the background of ongoing antibiotic therapy) are negative in 20-30% of cases. Therefore, blood cultures for aerobic and anaerobic bacteria must be carried out at least three times and preferably at the height of a febrile attack. Bacteriological culture of the contents of the purulent focus is also performed. PCR is used as an express method for isolating the DNA of the causative agent of sepsis. In the peripheral blood, there is an increase in hypochromic anemia, an acceleration of ESR, leukocytosis with a shift to the left.

It is necessary to differentiate sepsis from lymphogranulomatosis, leukemia, typhoid fever, paratyphoid fever A and B, brucellosis, tuberculosis, malaria and other diseases accompanied by prolonged fever.

Sepsis treatment

Patients with sepsis are admitted to the intensive care unit. The complex of therapeutic measures includes antibacterial, detoxification, symptomatic therapy, immunotherapy, elimination of protein and water-electrolyte disorders, restoration of organ functions.

In order to eliminate the source of infection that supports the course of sepsis, surgical treatment is performed. It may consist in opening and draining a purulent focus, performing necrectomy, opening purulent pockets and intraosseous abscesses, sanitizing cavities (with soft tissue abscess, phlegmon, osteomyelitis, peritonitis, etc. ). In some cases, it may be necessary to resect or remove the organ along with the abscess (for example, with an abscess of the lung or spleen, carbuncle of the kidney, pyosalpinx, purulent endometritis, etc.).

The fight against microbial flora involves the appointment of an intensive course of antibiotic therapy, flow-through washing of drains, local administration of antiseptics and antibiotics. Prior to culture with antibiotic susceptibility, therapy is started empirically; after verification of the pathogen, if necessary, the antimicrobial drug is changed. In sepsis, cephalosporins, fluoroquinolones, carbapenems, and various combinations of drugs are usually used for empirical therapy. With candidosepsis, etiotropic treatment is carried out with amphotericin B, fluconazole, caspofungin. Antibiotic therapy continues for 1-2 weeks after normalization of temperature and two negative blood cultures.

Detoxification therapy for sepsis is carried out according to general principles using saline and polyionic solutions, forced diuresis. In order to correct the CBS, electrolyte infusion solutions are used; amino acid mixtures, albumin, donor plasma are introduced to restore the protein balance. To combat bacteremia in sepsis, extracorporeal detoxification procedures are widely used: plasmapheresis, hemosorption, hemofiltration. With the development of renal failure, hemodialysis is used.

Immunotherapy involves the use of antistaphylococcal plasma and gamma globulin, transfusion of leukocyte mass, the appointment of immunostimulants. As symptomatic agents, cardiovascular drugs, analgesics, anticoagulants, etc. are used. Intensive drug therapy for sepsis is carried out until a stable improvement in the patient’s condition and normalization of homeostasis.

Prognosis and prevention

The outcome of sepsis is determined by the virulence of the microflora, the general condition of the body, the timeliness and adequacy of the therapy. Elderly patients with concomitant general diseases, immunodeficiencies are predisposed to the development of complications and an unfavorable prognosis.