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医学英语阅读:败血症

2006-06-15 13:27   我要纠错 | 打印 | 收藏 | | |

  Septicemia

  Alternative names

  Blood poisoning; Bacteremia with sepsis

  Definition

  Septicemia is the presence of bacteria in the blood (bacteremia) and is often associated with severe disease.

  Causes, incidence, and risk factors

  Septicemia is a serious, rapidly progressing, life-threatening infection that can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract. It may precede or coincide with infections of the bone (osteomyelitis), central nervous system (meningitis), or other tissues.

  Septicemia can rapidly lead to septic shock and death. Septicemia associated with some organisms such as meningococci can lead to shock, adrenal collapse, and disseminated intravascular coagulopathy, a condition called Waterhouse-Friderichsen syndrome.

  Septicemia can begin with spiking fevers and chills, rapid breathing and heart rate, the outward appearance of being seriously ill (toxic) and a feeling of impending doom. These symptoms rapidly progress to shock with decreased body temperature (hypothermia), falling blood pressure, confusion or other changes in mental status, and blood-clotting abnormalities evidenced by hemorrhagic lesions in the skin (petechiae and ecchymosis).

  Symptoms

  * fever (sudden onset, often spiking)

  * chills

  * toxic looking (looks acutely ill)

  * changes in mental state

  o irritable

  o lethargic

  o anxious

  o agitated

  o unresponsive

  o comatose

  * shock

  o cold

  o clammy

  o pale

  o cyanotic (blue)

  o unresponsive

  * skin signs associated with clotting abnormalities

  o petechiae

  o ecchymosis (often large, flat, purplish lesions that do not blanch when pressed)

  o gangrene (early changes in the extremities suggesting decreased or absent blood flow)

  * decreased or no urine output

  Signs and tests

  Physical examination may show:

  * low blood pressure

  * low body temperature or fever

  * signs of associated disease (meningitis, epiglottitis, pneumonia, cellulitis, or others)

  Tests that can confirm infection include:

  * blood culture

  * urine culture

  * CSF culture

  * culture of any suspect skin lesion

  * CBC

  * platelet count

  * clotting studies

  o PT

  o PTT

  o fibrinogen levels

  * blood gas

  Treatment

  This disorder must be treated in a hospital, usually with admission to an intensive care unit.

  Intravenous (IV) fluids are given to maintain the blood pressure. Strong IV drugs called sympathomimetics are often needed to maintain the blood pressure. Oxygen therapy is begun to maintain oxygen saturation.

  The infection is treated with broad spectrum antibiotics (those that are effective against a wide range of organisms) before the organism is identified. Once cultures have identified the specific organism that is responsible for the infection, antibiotics that are specific for that organism are begun.

  Plasma or other treatment may be needed for correction of clotting abnormalities.

  Expectations (prognosis)

  Septic shock has a high death rate, exceeding 50%, depending on the type of organism involved. The organism involved and the immediacy of hospitalization will determine the outcome.

  Complications

  * irreversible shock

  * Waterhouse-Friderichsen syndrome

  * adult respiratory distress syndrome (ARDS)

  Calling your health care provider

  Septicemia is not common but is devastating and early recognition may prevent progression to shock.

  * Any child with fever, shaking chills, and who looks acutely ill should be seen immediately as an emergency.

  * Any child with evidence of bleeding into his skin should be seen immediately as an emergency.

  * Any child who has been ill and has any changes in mental status should be seen immediately as an emergency.

  Call your health care provider if your child is not current on vaccinations or has not had immunizations for Hemophilus influenza B, commonly referred to as a HIB shot. If your child has a damaged spleen from any disease or has had it removed, schedule an appointment for an immunization against pneumococcal disease.

  Prevention

  Appropriate treatment of localized infections can prevent septicemia. HIB vaccine for children has already reduced the number of cases of Hemophilus septicemia (and Hemophilus meningitis, epiglottitis, and periorbital cellulitis) and is a routine part of the recommended childhood immunization schedule.

  Children who have had their spleen removed or who have diseases that damage the spleen (such as sickle cell anemia) should receive pneumococcal vaccine. Pneumococcal vaccine is not part of the routine childhood immunization schedule.

  Close contacts (parents, siblings, friends) of septic children with certain organisms such as pneumococcus, meningococcus, and Hemophilus may require preventive antibiotic therapy. This will be prescribed by the health care provider and the type of antibiotic will be determined by the organism involved.

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