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Sunday, November 22, 2009

What is Septicemia ?

[Extracted from Family Health GuideCo.UK]

An Overview

Septicemia is the presence of bacteria in blood. It is commonly known as blood poisoning or bacteremia. It is an acute infection caused by the presence of certain microorganisms and their toxic products in the bloodstream.

The human body has many microorganisms on the skin and in the intestines, which are usually beneficial and pose no threat to good health. But when these organisms enter the bloodstream and spread throughout the body, they can progress to an overwhelming infection. Septicemia is one such infection which contaminates your blood with various bacteria. If not treated appropriately, the infected blood may contaminate other organs or tissues of the body like the brain, liver or kidney, which can be fatal.

If neglected in the early stages, septicemia can rapidly progress to a septic shock. According to the University of Virginia Health System, septicemia that progresses to septic shock has a death rate as high as 50%, depending on the type of bacteria involved. It is therefore a serious medical emergency and requires urgent medical treatment.

What is Septicemia ?

Causes of Septicemia

Septicemia is most commonly caused by cuts and wounds that are infected. These include surgical wounds, burns, miscarriage, diabetic wounds and any internal injury or bleeding due to accidents. It can also arise from infections within the body including infections in the lungs, abdomen and the urinary tract.

Symptoms of Septicemia

Septicemia is characterized by spiking fevers and chills, rapid breathing, increased heart rate and an outward appearance of being toxically ill. Septicemia, if not attended to immediately, can rapidly progress to shock. A person in a state of septic shock has a low body temperature (hypothermia), drop in blood pressure, confusion, and blood-clotting abnormalities.

Diagnosis & Treatment of Septicemia

Diagnosis of septicemia includes physical examination and blood tests. Septicemia must be treated in a hospital, as it requires immediate attention and intensive care. It can be prevented by appropriate treatment of the primary infection. Also vaccination against certain infections can reduce the risk of septicemia. For example the Haemophilus Influenza B (HIB) vaccination, which is a part of the recommended childhood immunization schedule for children, is proven to reduce the number of cases of Haemophilus septicemia.

Several factors can cause septicemia

* Cuts or wounds that are infected: These include cuts caused during surgical procedures for handling infected tissues or any invasive diagnostic procedures, intravenous lines, urinary catheters, and knife or bullet wounds. Burn injuries, especially third degree burns, may also lead to septicemia. The larger the burn, the greater is the risk of infection.

* Internal Injuries: These include stomach injuries, intestinal rupture, gall bladder disease and rupture of the appendix or spleen. In the presence of intestinal perforations, bowel contents spill into other parts of the body and the blood is instantly exposed to high and dangerous levels of bacteria, causing septicemia almost immediately. In women, a miscarriage can also result in septicemia.

* Medical Conditions: Certain existing disease conditions can make you more vulnerable to septicemia. People with diabetes are at a higher risk since they lack the ability to heal from cuts. Others at high risk include patients with burns, chronic cardiac, liver or kidney disorders, malnutrition and excessive/long-term antibiotic use.

* Oral cavity: Infections of the mouth or teeth, if not treated using antibiotics, can cause septicemia.

Symptoms of Septicemia

Septicemia is a serious, life-threatening infection that worsens rapidly. The signs and symptoms are as follows :

* Sudden onset of spiking fevers with chills.

* Rapid breathing with increased heart rate.

* Toxic appearance with a feeling of impending doom.

These symptoms, if not controlled at the earliest, will rapidly progress to a septic shock.

Septic shock

Septic shock is a serious condition that occurs when an uncontrolled/untreated infection leads to low blood pressure and low blood flow. Major organs like your brain, heart, kidneys, and liver may not work properly and may also fail.

The symptoms of a septic shock include the following.

* Cold, clammy, pale and cyanotic (blue) appearance.

* Changes in mental state such as irritability, lethargy, anxiety, agitated, unresponsive and comatose condition.

* Blood-clotting abnormalities characterized by red spots on the skin
(petechiae), large, flat, purplish lesions that do not blanch when pressed (ecchymosis) and decreased or absent blood flow (gangrene).

* Decreased or no urine output.

Diagnosis of Septicemia

The diagnosis of septicemia includes physical examination and blood tests. You doctor will conduct a clinical examination to detect the following :

* Low blood pressure.

* Low body temperature or fever.

* Signs of any underlying disease that may have lead to sepsis such as cellulitis (infection of internal tissues of the skin), epiglottitis (inflammation at the base of the tongue), meningitis (inflammation of membranes around the brain and spinal cord), and pneumonia.

Following the physical examination, your doctor will run a few confirmatory tests. These include :

Microbiological analysis

* Blood culture

* Urine culture

* CSF (Cerebrospinal fluid) culture

* Culture of skin lesion if present

Blood tests

* CBC (Complete Blood Count)

* Platelet count

* Clotting studies 1. Prothrombin time (PT) 2. Partial prothrombin time (PTT) 3. Fibrinogen levels

* Arterial Blood Gas (ABG): This is a test that measures the levels of oxygen and carbon dioxide in the blood to determine how well your lungs are working.

Treatment of Septicemia

Septicemia needs immediate attention and the patient is admitted to an intensive care unit (ICU). Reversal of septicemia or septic shock is essentially dependent on aggressive treatment of the underlying infection. The treatment will vary according to the severity of septicemia and the underlying disease.

The first step of the treatment involves control and maintenance of blood pressure levels. Fluids and medicines are administered intravenously to maintain the blood pressure. The patient may also be put on oxygen therapy. If needed and if possible, the source of the infection is surgically removed or drained. If clotting abnormalities are present, they are treated by administration of plasma, clotting factors or drugs.

Until the precise cause of septicemia is identified, the infection is treated with broad-spectrum antibiotics that are effective against a wide range of organisms. When the specific organism responsible for the infection has been identified, the patient is given specific antibiotics during treatment.

Complications

Septicemia when associated with some organisms such as meningococci can lead to :

* Irreversible shock

* Adrenal collapse

* Bleeding disorders (disseminated intravascular coagulopathy)

* Waterhouse-Friderichsen syndrome: This is the failure of the adrenal gland caused by bleeding. It is caused by severe meningococcal infection and is characterized by profound shock. It can be fatal if not treated immediately. • Adult Respiratory

* Distress Syndrome (ARDS)

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