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  Sepsis

Sepsis is a life threatening medical condition when the normal reaction of the body to the acute phase of inflammation or specifically to bacterial infection goes into overdrive. Widespread multi-organ inflammation occurs because of the toxins produced by bacteria causing rapid changes in a person's body temperature, blood pressure, and impairment of lung function. Septicemia also known as bacteremia which is a general term referring to the presence of bacteria in the bloodstream.

Sepsis
Sepsis


An increase prevalence rate of sepsis has been found among certain individuals namely: elderly, immunocompromised state (e.g. HIV infected persons), people with chronic illnesses (e.g. bedridden patients), and infants under the age of 2 months whose immune systems are not yet developed to fight off serious infections.

The diagnosis of sepsis is considered if infection is either highly suspected or proven satisfying at least two or more of the following systemic inflammatory response syndrome (SIRS) criteria: tachycardia or a heart rate of more 90 beats per minute; a body temperature of either lower than 36°C (96.8 °F) or above 38 °C (100.4 °F); hyperventilation or rapid respiratory rate of more than 20 breaths per minute or an arterial blood gas (ABG) finding of PaCO2 less than 32 mmHg; white blood cell count of less than 4000 cell/mm³ (leukopenia) or more than 12000 cells/mm³ (leukocytosis), or greater than 10% band forms (immature white blood cells).

In neonates and young infants (less than 3 months old) the signs and symptoms of sepsis are quite different hence; careful monitoring and observation must be done to detect these subtle changes. Immediate medical attention is needed to prevent mortality in the abovementioned patients. The following are some of the common signs and symptoms noted among newborns with sepsis: feeding difficulties; high grade fever (above 100.4°F [38°C] rectally) or sometimes low, unstable temperatures; increased irritability; lethargy (not interacting and listless) ; decreased muscle tone of floppiness; heart rate changes (either tachycardia in early sepsis or bradycardia in late sepsis, usually associated with shock or circulatory collapse; labored breathing or tachypnea (rapid breathing); periods of apnea (“without breath” for more than 10 seconds) and jaundice (yellowish discoloration of the skin and eyes).

In newborns and infants, bacteria are almost always the culprits of sepsis. The more common bacteria involved in neonatal sepsis are: E. coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Salmonella, and Group B streptococcus (GBS). Maternal factor is one aspect in the development of many cases of sepsis in newborns. Most bacteria enter the body of the newborn from the mother during pregnancy, labor, or delivery.

Some complicated high risk pregnancies can increase the incidence rate of sepsis in a newborn which include the following: uterine bleeding; maternal fever; uterine infection (endometritis) or an infection in the placenta; premature rupture of the amniotic sac before 37 weeks of gestation; rupture of the amniotic sac in early labor also known as premature rupture of membranes (PROM), 18 hours or more before delivery and a difficult and long delivery.

Laboratory work-ups are very important in confirming or ruling out septicemia. Although the medical history and complete physical examination is the cornerstone of all medical practice, laboratory tests are still requested to confirm the nature of the infectious disease. These laboratory tests may include: complete blood count (CBC); catheterized urine specimen, cerebrospinal fluid (CSF) and blood for cultures to detect the presence of bacteria; lumbar puncture (spinal tap); chest x-rays, to rule out pneumonia or pneumonitis and if the baby has any kind of medical tubes such as IV tubes, catheters and shunts attached into his or her body, the fluids inside those tubes may also be submitted to the laboratory for culture. The most crucial point in infectious disease is to identify the pathogenic microorganism to be able to select the most appropriate antibiotics for the treatment.

In clinical practice, doctors usually start infants diagnosed with sepsis on empiric treatment with antibiotics right away even before the culture result is released. The main goal of therapy in cases of sepsis rests on antibiotics, surgical drainage of infected or pus-filled collections, fluid replacement and appropriate support for multi-organ failure. The following are some of the supportive treatment for organ dysfunctions: hemodialysis in kidney failure, mechanical ventilation in lung dysfunction, transfusion of blood products, and drug and fluid therapy for circulatory failure. For those with prolonged illness, adequate nutrition is ensured if necessary with total parenteral nutrition or TPN.

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