An Analysis Of Septicaemia Biology Essay

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The human body has microorganisms which are beneficial and make no harm to good health. But if these organisms enter the bloodstream and distribute throughout the body, then it can progress to an overwhelming infection e.g. Septicaemia. Septicaemia can be defined as

"It's a condition When microorganisms in particular bacteria or their products escape local portals of entry and invade the blood stream, there develops a drastic and often devastating constellation of clinical symptoms and signs know clinically as Septicaemia" [1]

Septicaemia has some alternative names like Blood poisoning, Bacteremia with sepsis, Systemic inflammatory response syndrome (SIRS). There is more chance for Septicaemia or Sepsis if someone body's immune system is weak. When some microorganisms such as bacteria, virus or fungi enter the bloodstream, they produce some toxic substances which can cause some severe infection like Blood Poisoning. Damage can measure with levels of toxins in the blood. If we neglect in early stages of this infection then it can cause damage to your organs like liver, kidney and brain etc. and may lead to Septic Shock. [2, 3, 4]

EPIDEMIOLOGY

Sepsis is the 10th leading cause of death in the US and in critically ill patients. Its morbidity and mortality is high. In UK, Sepsis seems to be a serious issue in children and others. The number of cases increases in each year. Over past 20 years the incidence of Septic and Septic Shock increases and yearly less than 700,000 cases are reporting.(3 per 1000 population).In that two third of the cases are because of significant underlying illness. The main factor which relate to Sepsis is Age and Pre-existing comorbidity.

Drugs and Mechanical devices play a role in this condition. Wide use of anti-microbial agents, immunosuppressive agents, indwelling catheters, mechanical devices and mechanical ventilation become a cause for this infection. Invasive bacterial infection is the main cause of death around the world, particularly in small children e.g. In Sub-Saharan Africa. While screening for positive blood culture they found that community-acquired bacteremia accounted for one fourth of death of children less than one year of age. [2,4,12]

Septicaemia become common hospital acquired infection in children. The study which held in Florida explains about children who admitted in hospital with some diseases. Dr.Veerajalandher who was the one studied this case. He studied in two groups of children's. One with Circulating system disorders and other with cardiovascular disease and sickle cell anemia.he came to a conclusion that children who admitted in hospital with these disorders develop Septicaemia and other bacterial infections. In hospitals mortality rate increases in children because of these bacterial infections and these bacterial infection increases the hospital stay and expenses. So totally outcome is very poor. [6]

CAUSES AND RISK

The main cause of the infection will be weakening of Immune system. When a patient had some local inflammation it will make immune system weak. If immune system is weak then infection will start to spread throughout the body .Sometimes it damage the tissues with bleeding and lower the blood pressure.

The main sites of infection in Sepsis are lungs, urinary tract, pelvis, bone, Central nervous system, abdomen and heart. Sometimes Septicaemia occurs because of other infection like flu, peritonitis, urinary tract infections, post-surgery infection, skin infection, indwelling vascular and bladder catheters, excess use of anti-microbial agents and immunosuppressive agents and meningitis etc. In children, mainly Septicaemia occurs because of hospital stay and some local infection like flu and Meningitis. [4, 7, 8]

SIGNS AND SYMPTOMS

Signs and Symptoms are very important in Diagnosis of Septicaemia. Most of children report with a fever that's the common sign in Septicaemia. High temperature over 380C (100.4F),chills, a fast heartbeat, rapid breathing, confusion, very low blood pressure, looks ill, skin red spots, nausea, vomiting, diarrhoea, decreased urine output, blood clotting problems these are some signs and symptoms usually patient experience. When infection become severe patient may experience some infections in Gastro intestinal tract, head and neck, abdominal, bone and soft tissues, pelvic, respiratory. WBC count may increase in case of Sever Sepsis. If you find anyone having these symptoms or you have symptoms then phone 999 and ask for an ambulance because it's a serious condition need treatment. [4,7,8]

Qualitative study conducted in children on Signs and Symptoms reported that behavioural signs and symptoms in children are very important in order to diagnosis it. [9]

DIAGNOSIS

There is no specific diagnosis test for these types of infections. In general practice, it's difficult to diagnosis a serious infection in children. If children's present in early stages of infection then it can diagnosis through their physical examination, clinical history and signs and symptoms. If a patient reported with some signs and symptoms like hypothermia, tachypnea, tachycardia and leucocytosis acutely altered mental status, thrombocytopenia, an elevated blood level, or hypotension then we should suggest the diagnosis. [2, 9]

If a child got some symptoms and signs of Septicaemia they should consult the doctor immediately because septicaemia is not a common illness, it's a serious issue that need hospital stay. Determining the source of infection and the specific microbial agent is the primary step of diagnosis. Medical history, including pre disposing disorders, recent anti-microbial therapy, diet, and travel and exposure information is important .if we can get the information history symptoms, that will help to identify the source of infection.

The main diagnosis studies are

WBC count (It is an important laboratory parameter in bacterial infections. The children who have increased WBC counts may not have underlying bacterial infection as a cause of fever. When we examine children with laboratory tests, it will give a report of Risk of infection.it help to decide whether patient can manage the infection with antibiotics in their homes or need hospital stay.

Coagulation Studies (Specially Platelet Count,Prothrombin time, Activated thromboplastin time ,fibrin and fibrinogen levels)

Blood Culture (it helps to identify the specific micro-organisms and to start antibiotic therapy. Blood cultures are positive in less than 50% cases of sepsis. How fast the culture contaminates that help to distinguish the pathogen in sepsis. Most of true pathogen grows faster than contaminates. Culture from intravenous indwelling catheter is always important because it been a cause for Bacterial infections.

Urinalysis and culture (infection in urinary tract is common in sepsis.it also help to identify the pathogen and to start antibiotic therapy.

Cytokines (in gram negative and positive sepsis interleukin(IL)-1,IL-6 and Tumor necrosis factor(TNF) alpha all increases in serum and cerebrospinal fluid(CSF),so we should check the levels. The level increases with severity of illness.

Procalcitonin level (it is a pro hormone of calcitonin. When patient expose to bacterial endotoxin procalcitonin level increases in serum. It increases more rapid i.e. 2-4 hours and seen in CRP levels.

Some other diagnosis studies

ESR level, CRP level, Urine, Stool

Sodium and Chloride level will be abnormal in severe dehydration.

Decreased bicarbonate can give idea about Acute Acidosis.

Blood,urea,nitrogen and creatine levels can predict Renal failure

Check Glucose control because which cause hyperglycaemia. Hyperglycaemia can cause higher mortality.

Liver function test and bilirubin, alkaline phosphate and lipase levels should measure because the level changes may due to some potential source

Chest radiography, abdominal pain films, abdominal ultrasonography Abdominal CT scan etc.[7,11,12]

From a study which reported in "Early diagnosis of gram negative septicaemia in paediatric surgical patient". The test carried with 93 post-operative patients from 1 day to 13 years of age had blood cultures, limulus lysate assay, white blood cell, platelet counts, and determination of fibrin degradation products. Seven group were studied and they came to a conclusion that platelet count is main indicator of treatment and effectiveness of therapy .it can detect early gram negative Septicaemia. [13]

According to infection and source we will treat and manage Bacterial infections.

Table 1.Diagnosistic Criteria for Sepsis

(Data from: Netter's Internal Medicines .2nd Edition, 2003.p.645)

Diagnostic Criteria for Sepsis

Syndrome

Criteria

Sepsis

Confirmed or Suspected infection in normally sterile site

Temperature >38°C or 36°C

Heart rate >90 beats/minute

Respiratory rate >20 breaths/minutes or Paco2a<32 mm Hg.

WBCb>12,000 cells/mm3or <4000 cells/m3 , or >10% immature forms

Systolic blood pressure of <90mm Hg, MAPc<70 mm Hg, or a reduction of >40 mm Hg from baseline

Severe Sepsis

Lactic acidosis

Oliguria

Altered mental status

Acute lung injury

Septic Shock

Requires administration of pressure therapy to maintain blood pressure.

a Arterial carbon dioxide partial pressure

b White blood cells

c Mean arterial pressure

TREATMENT AND MANAGEMENT

If the child had found with some suspicious pathogen then we need to start specific antibiotic treatment. Depending on severity, child will admit in hospital. If the risk of patient is low then advice patient to take antibiotic tablets and if the risk is more than, patient should admit to ICU immediately and start proper treatments like maintain blood pressure, start antibiotic therapy and oxygen supply.[8]

Treatment will be depending up on the nature of infection. Some of the evidence based treatments for sepsis are Antimicrobials, Bicarbonate cultures, deep venous thrombosis prophylaxis, and Fluid resuscitation, glucose control, initial resuscitation within first 6 hours, mechanical ventilation, Recombinant human activated protein C, blood transfusion, dialysis, steroids, and stress ulcer prophylaxis. Recent treatment for sever sepsis include Recombinant human activated protein C. [12, 14]

Sepsis can manage in 2 steps i.e. Primary and Secondary Step. Primary step includes

Airway and breath (In the case of sever septic patients, depressed conscious level may be a cause of breath obstruction, so patient should give adequate ventilation.

Circulation (In most of septic patient have been give fluid therapy to restore circulating volume, cardiac output and reversal of hypotension. Usually vasopressors (mainly Dopamine and Nor adrenaline) will give with fluid to treat low blood presser)

Secondary step include

Check the patient History

Perform full physical examinations by using systems and diagnosis the tests for examine the underlying source of infection.

Assess patient clinical state

The major step in Management is treating the underlying problem.it can be two type

Antibiotic therapy (There are some initial approach to antibiotic therapy, they are Suspected site of infection and likely bacterial pathogen, Hospital or community acquired, Bacterial resistance patterns in a given place, Patient history like allergy or any organ dysfunctions.)

Surgical debridement (it is necessary because some of group tissue contamination cannot treat with antibiotic alone). [3,5,10]

Table 2.Emperical Antibiotic Therapy

(Data from: Netter's Internal Medicines .2nd Edition, 2003.p.648)

Clinical Setting

Possible Therapies

Outpatient admission

Third-generation Cephalosporin (e.g. Ceftriaxone, Cefotaxime ) or Piperacillin/Tazobactam or imipenem (or Meropenem or Ertapenem) each with an amino glycoside; plus Vancomycin

Intra-abdominal

Piperacillin/Tazobactam or Imipenem (or Meropenem or Ertapenem),each with an amino glycoside, Tigecycline is an alternative when Pseudomonas coverage is not thought to be indicated; plus Vancomycin

Hospitalized patient

Imipenem (or Meropenem or Ertapenem) or Piperacillin/Tazobactam (at doses to cover Pseudomonas aeruginosa) plus amino glycoside; Ceftazidime, Cefepime and Ciprofloxacin are alternatives; plus Vancomycin.

Neutropenic patient

Imipenem (or Meropenem or Ertapenem),Cefepime, Ceftazidime alone or with an amino glycoside; Piperacillin/Tazobactam (at doses to cover Pseudomonas aeruginosa) is alternative; plus Vancomycin plus Fluconazole (Caspofungin is an alternative)

Possible methicillin-resistant staphylococcus aureus

Linezolid and Daptomycin are possible alternative to Vancomycin depending on the site of infection. (Daptomycin should not be used in the case of pneumonia, and there is limited experience with Linezolid for certain syndromes such as endocarditis and meningitis

Possible tick exposure

Add Doxycycline

PREVENTION

Prevention offers the best opportunity to reduce morbidity and mortality. In develop countries, the reduced use of indwelling vascular and bladder catheters made huge reduction in number of cases of Septicaemia and Sever Sepsis. Septicaemia can prevent if we treat the local infection. There are some vaccines i.e. child immunization are available which can effectively reduce Septicaemia in children. They are Haemophilus influenza B (HIB) vaccine and S. pneumoniae vaccine. Most of these conditions come because of weaken immune system, so if we have proper life style that can reduce number of infections. [8,12]

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