SEPSIS (generalized purulent infection) is a common severe infectious disease resulting from the spread of infection from the primary focus in connection with a violation of the mechanisms of local and general immunity. The primary septic focus can be any suppurative process of soft tissues, bones, joints and internal organs. The prolonged existence of a local purulent focus (for example, in connection with the patient's refusal of timely medical care, the ineffective long-term polyclinic stage of treatment), as well as non-radical surgical intervention for a purulent process may be accompanied by the development of sepsis. Sometimes the primary septic focus cannot be detected - the so-called cryptogenic, or primary, sepsis.
There are surgical, odontogenic, otogenic, rhinogenic, obstetric-gynecological sepsis, urosepsis. The most common surgical sepsis can be a complication of various surgical diseases, especially purulent (peritonitis, lung abscess , etc.), and injuries (for example, with burns - burn sepsis). The primary septic focus in odontogenic sepsis is purulent processes in the gums or jaws; the latter can be complicated by suppuration of the submandibular lymph nodes and phlegmon of the oral cavity. It can also be the result of a sore throat (tonsillogenic sepsis). Otogenic sepsis occurs as a complication of purulent otitis media and can quickly lead to the contact spread of pathogens to the membranes of the brain with the development of meningitis. Rhinogenic sepsis can occur as a complication of purulent diseases of the nose and paranasal sinuses. Local distribution of the process leads to regional thrombophlebitis or osteomyelitis of the bone structures that form the walls of the sinuses, phlegmon of the orbit, accompanied by conjunctivitis, exophthalmos. Possible thrombosis of the sagittal sinus and meningitis . Obstetric and gynecological sepsis can be the result of complicated births, surgical interventions on the female genital organs or their purulent-inflammatory diseases. Extremely difficult (often in the form of septic shock) occurs sepsis that occurs as a result of criminal abortion. The primary septic lesion in urosepsis is localized in the genitourinary system (ascending urethritis, cystitis , pyelitis, nephritis , bartholinitis in women, prostatitis in men).
By the type of pathogen, staphylococcal, streptococcal, pneumococcal, gonococcal, colibacillary, anaerobic, mixed sepsis, etc. are distinguished. Anaerobic sepsis can be observed with anaerobic infection. The leading mechanism in the pathogenesis of sepsis is bacteremia and intoxication. Septicemia (sepsis with bacteremia, but without purulent metastases) is the most common form of sepsis. It usually proceeds acutely and is accompanied by intoxication, dystrophic changes in internal organs. The causative agents are staphylococci, streptococci, often gram-negative microorganisms (Pseudomonas aeruginosa and Escherichia coli), as well as non-spore-forming (non-clostridial) anserobes (bacteroids, fusobacteria, peptostreptococci, etc.). Septicopyemia (pyemia) is sepsis with the formation of purulent metastases in the internal organs. The causative agents can be any microorganisms located in the primary purulent focus, which, with the flow of blood, enter the vascular system, most often the lungs and kidneys.
Common symptoms of sepsis are high body temperature (up to 39 - 40 ° C), severe tachycardia , often chills and sweating. Intoxication is manifested by a sharp weakness, loss of appetite; enlargement of the liver and spleen is often detected. Multiple lesions of organs and systems with the development of cardiac, respiratory, renal, liver, adrenal insufficiency are characteristic; blood clotting disorder in the form of thrombosis in combination with hemorrhage, hemorrhagic skin rash. The examination revealed high leukocytosis , less often leukopenia with a shift in the leukocyte formula to the left, a sharp increase in ESR, lymphopenia, hypoproteinemia, as well as signs of damage to internal organs (toxic nephritis , hepatitis , myocarditis).
According to the clinical course, lightning, acute, subacute, recurrent and chronic sepsis are distinguished. With fulminant sepsis, clinical symptoms rapidly increase, and within 1-3 days the disease ends in death. With the most common acute sepsis, a rapid development of symptoms is noted; the duration of the course depends on the nature and effectiveness of the treatment - usually 1.5 - 2 months, after which there is a period of recovery or the disease becomes subacute. In subacute sepsis, acute events (fever, intoxication, etc.) gradually subside. Chronic sepsis is spoken while its manifestations persist for more than 6 months, which is usually explained by the presence of purulent foci that are difficult to undergo surgical treatment (in the bones, joints, but more often in the internal organs - endocarditis , chronic lung abscess , pleural empyema). Recurrent sepsis is characterized by a change in periods of exacerbation with vivid symptoms and periods of remission, when it is not possible to identify any noticeable clinical symptoms.
One of the complications of sepsis is bacterial-toxic shock - the body's reaction to a breakthrough in the blood of pyogenic microorganisms or their toxins, which can occur at any time during the course of the disease. The initial signs of shock are high fever (up to 40 - 41 ° C) with tremendous chills, which are replaced by severe sweating (heavy sweats) with a drop in body temperature to normal or subfebrile. The main sign of bacterial toxic shock, like any shock, is acute vascular insufficiency: frequent pulse (120 - 150 beats per 1 min) of weak filling, drop in blood pressure. Motor excitement, pallor of the skin, acrocyanosis, rapid breathing (up to 30-40 in 1 min) are noted. Severe changes in hemodynamics and impaired coagulation of the blood lead to a sharp sudden decompensation of the functions of vital organs and systems.
Complex treatment should be carried out in an intensive care unit for patients with purulent infection. It includes active surgical treatment of purulent foci (accessible for surgical intervention) and general intensive multicomponent therapy. Surgical treatment consists in excision of all affected tissues, prolonged active drainage of the surgical wound and the closure of wound surfaces as quickly as possible by suturing or using skin grafting. After surgical treatment of the purulent lesion, osmotically active ointments on a water-soluble basis (levosin, levomekol, dioxid ointment) with pronounced antiseptic and sorption properties are used to quickly cleanse it and prepare for closure. For extensive flat wounds, treatment is used in a controlled microbial environment: the affected area of the body is placed in a plastic insulator through which sterile air is blown.
Intensive therapy of sepsis involves the administration of antibiotics and antiseptics, taking into account the sensitivity of microflora to them (at the stage of empirical therapy, i.e., before receiving an antibiotic picture, a combination of cephalosporins I-III generations and aminoglycosides is usually used). They carry out detoxification therapy, anti-inflammatory treatment with glucocorticoids, correction of protein-energy losses (high-calorie nutrition, probe and parenteral nutrition), infusion therapy (transfusion of electrolytes, poly- and reopoliglyukin, fat and protein emulsions), use pressor amines (dopamine) with persistent hypotension oxygen therapy, carry out the correction of impaired functions of various organs and systems, according to the indications, heparin is prescribed, platelet mass is transfused and freshly frozen Lazmu.
The prognosis for any form of sepsis is always serious. The earlier the patient is hospitalized, the faster the primary septic focus is established and surgical debridement is performed, the more intensive the complex treatment, the more likely the patient is to recover.
Prevention is based on the correct and timely treatment of local purulent processes. If outpatient treatment is ineffective, the patient should be hospitalized in the surgical department.