Sepsis

Alternative Names: Systemic inflammatory response syndrome (SIRS),blood poisoning or septicaemia.

Definition:
Sepsis is a bacterial infection of the blood.It is a severe illness in which the bloodstream is overwhelmed by bacteria.While sepsis can happen to anyone, it’s most common and most dangerous in people who are elderly or who have weakened immune systems.

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Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body. This inflammation creates microscopic blood clots that can block nutrients and oxygen from reaching organs, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically and the person may die.

Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

Symptoms:
In addition to symptoms related to the provoking infection, sepsis is characterized by presence of acute inflammation present throughout the entire body, and is, therefore, frequently associated with fever and elevated white blood cell count (leukocytosis) or low white blood cell count and lower-than-average temperature, and vomiting. The modern concept of sepsis is that the host’s immune response to the infection causes most of the symptoms of sepsis, resulting in hemodynamic consequences and damage to organs. This host response has been termed systemic inflammatory response syndrome (SIRS) and is characterized by an elevated heart rate (above 90 beats per minute), high respiratory rate (above 20 breaths per minute or a partial pressure of carbon dioxide in the blood of less than 32), abnormal white blood cell count (above 12,000, lower than 4,000, or greater than 10% band forms) and elevated or lowered body temperature, i.e. under 36 °C (97 °F) or over 38 °C (100 °F). Sepsis is differentiated from SIRS by the presence of a known or suspected pathogen. For example SIRS and a positive blood culture for a pathogen indicates the presence of sepsis. However, in many cases of sepsis no specific pathogen is identified.

This immunological response causes widespread activation of acute-phase proteins, affecting the complement system and the coagulation pathways, which then cause damage to the vasculature as well as to the organs. Various neuroendocrine counter-regulatory systems are then activated as well, often compounding the problem. Even with immediate and aggressive treatment, this may progress to multiple organ dysfunction syndrome and eventually death.

Causes:
Sepsis is often a complication of another infection, such as of the lungs or kidneys, and occurs when the bacteria escape that part of the body and get into the bloodstream.

This bacteria can also come from burns, infected wounds, boils and tooth abscesses. Sometimes it isn’t obvious how it has got into your blood.

Anyone can develop sepsis. The people most at risk are those with weakened immune systems, because of an existing illness, for example, or medication.

Older people, children and intravenous drug users are also more susceptible.

In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitalized patients, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers).

Risk Factors:
Sepsis is more common and more dangerous in people who:

*Are very young or very old
*Have compromised immune systems
*Are already very sick, often in a hospital’s intensive care unit
*Have invasive devices, such as intravenous catheters or breathing tubes

Complication:
As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis can also cause blood clots to form in your organs and in your arms, legs, fingers and toes — leading to varying degrees of organ failure and tissue death (gangrene).

Most people recover from mild sepsis, but the mortality rate for severe sepsis or septic shock is close to 50 percent.

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Diagnosis:
The infection is often confirmed by a blood test. However, a blood test may not reveal infection in people who have been receiving antibiotics.

Other tests that may be done include:
•Blood gases
•Kidney function tests
•Platelet count
•White blood cell count
•Blood differential
•Fibrin degradation products
•Peripheral smear

Treatment;
Early, aggressive treatment boosts your chances of surviving sepsis. People with severe sepsis require close monitoring and treatment in a hospital intensive care unit. If one has severe sepsis or septic shock, lifesaving measures may be needed to stabilize breathing and heart function.

Medications
A number of different types of medications are used in treating sepsis. They include:

*Antibiotics. Treatment with antibiotics begins immediately — even before the infectious agent is identified. Initially you’ll receive broad-spectrum antibiotics, which are effective against a variety of bacteria. The antibiotics are administered intravenously (IV). After learning the results of blood tests, your doctor may switch to a different antibiotic that’s more appropriate against the particular bacteria causing the infection.

*Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication, which constricts blood vessels and helps to increase blood pressure.

*Others. Other medications you may receive include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.Therapy

People with severe sepsis usually receive supportive care including oxygen and large amounts of intravenous fluids. Depending on your condition, you may need to have a machine help you breathe or dialysis for kidney failure.

Surgery
Surgery may be needed to remove sources of infection, such as collections of pus (abscesses).

Prognosis:
This section requires expansion.

Prognosis can be estimated with the Mortality in Emergency Department Sepsis (MEDS) score.  Approximately 20–35% of patients with severe sepsis and 40–60% of patients with septic shock die within 30 days. Others die within the ensuing 6 months. Late deaths often result from poorly controlled infection, immunosuppression, complications of intensive care, failure of multiple organs, or the patient’s underlying disease.

Prognostic stratification systems such as APACHE II indicate that factoring in the patient’s age, underlying condition, and various physiologic variables can yield estimates of the risk of dying of severe sepsis. Of the individual covariates, the severity of underlying disease most strongly influences the risk of death. Septic shock is also a strong predictor of short- and long-term mortality. Case-fatality rates are similar for culture-positive and culture-negative severe sepsis.

Some patients may experience severe long-term cognitive decline following an episode of severe sepsis, but the absence of baseline neuropsychological data in most sepsis patients makes the incidence of this difficult to quantify or to study. A preliminary study of nine patients with septic shock showed abnormalities in seven patients by MRI.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Resources:
http://www.mayoclinic.com/health/sepsis/DS01004
http://www.nlm.nih.gov/medlineplus/ency/article/000666.htm
http://en.wikipedia.org/wiki/Sepsis
http://www.bbc.co.uk/health/physical_health/conditions/sepsis.shtml
http://www.humenhealth.com/sepsis/sepsis.asp
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