Systemic purulent infection
Introduction
Introduction to generalized purulent infection Pathogenic bacteria invade the human blood circulation, and grow or reproduce in it, causing serious symptoms of systemic infection and symptoms of poisoning, collectively referred to as systemic infection, and systemic purulent infections are often secondary, secondary to pollution Or severely injured wounds and various purulent infections such as extensive burns, open fractures, diffuse peritonitis, biliary tract or urinary tract infections. Generally divided into sepsis and sepsis, and sepsis is the most common and most important. The pathogens causing systemic purulent infections are mainly Staphylococcus aureus, hemolytic streptococcus, Escherichia coli, anaerobic bacteria and spoilage bacteria. Sometimes it is a single infection, sometimes a mixed infection of two or three pathogenic bacteria. Overwork, exhaustion, vitamin deficiency or deficiency, and certain chronic infectious diseases are all factors that are prone to systemic purulent infections. In addition, the violent treatment of wounds causes damage to the defensive granulation surface, creating a large amount of pus in the memory, the decomposition products of wounds and necrotic tissue can not be excreted, and foreign bodies, necrotic foci and sinus are easily caused in the body. The occurrence of purulent infection. basic knowledge The proportion of illness: 10% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, empyema, myocarditis, endocarditis, osteomyelitis, septic arthritis, meningitis, shock
Cause
Causes of systemic purulent infection
Pathogen infection (30%):
The pathogens causing systemic purulent infections are mainly Staphylococcus aureus, hemolytic streptococcus, Escherichia coli, anaerobic bacteria and spoilage bacteria, sometimes in a single infection, sometimes mixed infection of two or three pathogenic bacteria.
Other factors (20%):
Overwork, exhaustion, lack of vitamins or deficiency, and certain chronic infectious diseases are all factors that are prone to systemic purulent infection. In addition, the violent treatment of wounds causes damage to the defensive granulation surface, creating a large amount of pus in the memory. The decomposition products of wounds and necrotic tissue can not be excreted and foreign bodies are found in the wounds. Necrotic lesions and sinus are easy to cause generalized purulent infection.
Prevention
Systemic purulent infection prevention
Prevention of systemic purulent infection requires timely and correct treatment of all trauma and various primary sources, avoiding iatrogenic infections, proper use of antibiotics and hormones, strict indications of supportive therapy, enhancement of physical fitness, and improvement of human body disease Resistance. Go to bed early and get up early and exercise. Insufficient sleep can reduce the body's immune function, and it is also easy to stimulate the fire, causing external injuries. Quit smoking, drink less and drink coffee. Smoking is the most vulnerable to damage to the respiratory surface barrier and induces disease onset. Tobacco, alcohol and coffee all stimulate nervous excitement. Some people want to "eliminate tension and fatigue", but actually weaken the body's disease resistance. Diet should be light and nutritious and easy to digest, eat less greasy frying and spicy food.
Complication
Systemic purulent infection complications Complications pneumonia empyema myocarditis endocarditis osteomyelitis septic arthritis meningitis shock
If the initial infection is not treated with timely and effective treatment, it will cause the disease. Further development will cause more serious complications. Common complications include pneumonia. Pneumonia usually occurs earlier, more common, and develops. Rapid, in addition to concurrent empyema, myocarditis, endocarditis, osteomyelitis and septic arthritis, deep abscess, suppurative meningitis (almost one third of children can occur), and nervous system symptoms are not obvious, need Highly vigilant, severe cases can cause shock and death. The main cause of these complications is related to bacterial emboli with blood circulation.
Symptom
Symptoms of generalized purulent infection Common symptoms High fever, loss of appetite, irritability, restlessness, shortness of breath, disgusting heart pulse, acceleration of abdominal distension, joint pain, apathy
1. Clinically, it is sometimes difficult to distinguish between sepsis, sepsis and toxemia, but it has many things in common: rapid onset, rapid development, and serious illness; systemic symptoms are obvious, such as high fever, body temperature can be as high as 40-41 ° C Shortness of breath, rapid pulse, headache, dizziness, joint pain, loss of appetite, nausea, vomiting, bloating, sweating, anemia, even indifferent, irritated, paralyzed or coma; liver, splenomegaly, severe Axillary sputum, subcutaneous blood stasis or hemorrhage; white blood cells 20 × 10 9 power -30 × 10 9 power / L (20,000 -30,000 / mm3) or more, neutrophils increased, nuclear left shift, poisoning Particles, such as when the patient's resistance is reduced, the white blood cell count can be reduced.
The disease develops and septic shock can occur.
2. Septicemia: There is often a severe chill before high fever. Because the pathogenic bacteria persist in the blood, the body temperature does not fluctuate daily, about 0.5-1 °C, and it is a heat retention type. Blood stasis points appear in the conjunctiva, mucous membranes and skin. Blood culture is often positive, but due to the application of antibiotics, sometimes it can be yin, and generally no metastatic abscess occurs.
Lang's positive bacteria sepsis: generally no chills, heat is reserved or relaxation heat, complexion flushing, warm limbs, often rash, metastatic abscess, and myocarditis or warm shock later. Gram-negative bacteria sepsis: chills, heat is intermittent heat, when the temperature is not rising or lower than normal, the white blood cell count is not increased or decreased, shock occurs early, long duration, wet limbs, purpura, cold performance Shock, generally no metastatic abscess. Fungal sepsis: sudden chills, high fever, generally rapid deterioration, neurological symptoms and shock. The white blood cells are 25×10 9th power/L (25,000/mm 3 ) or more.
3. Sepsis: paroxysmal chills and high fever, intermittent body temperature is normal or lower than normal, showing a fever. Most of the course of the disease is subacute or chronic. From the second week on the lower back and limbs subcutaneous or deep soft tissue, metastatic abscess can occur continuously, such as abscess metastasis to various organs, the corresponding symptoms may appear. Blood culture is often positive during chills and high fever.
Examine
Examination of generalized purulent infection
1, the cause of systemic infection can be found clearly ECG, serum creatinine, blood urea nitrogen (BUN) can be.
2, for the cause of systemic infection is not clear, according to the suspected organs, parts of the choice of ECG, serum creatinine, blood urea nitrogen (BUN) + secretions and tissue culture + drug sensitivity, blood culture + drug sensitivity test items Check it up.
Diagnosis
Diagnosis and identification of generalized purulent infection
diagnosis
Judgment can be made based on medical history, clinical performance and laboratory data.
Diagnose based on
Septicemia
(1) acute onset, sudden chills and high fever, body temperature as high as 40 ~ 41 ° C, often in the form of detention.
(2) often accompanied by headache, dizziness, fatigue, nausea, vomiting and other symptoms of poisoning, severe irritability, paralysis, coma and shock.
(3) The skin and mucous membranes may have bleeding spots or ecchymoses, often hepatosplenomegaly, and even jaundice.
(4) There are many primary pus scabs, and blood cultures are often positive.
2. Sepsis
(1) The onset is mostly subacute, intense chills, cold and hot, and is a type of relaxation.
(2) often appear physical weakness, anorexia, nausea, vomiting and weight loss and other symptoms.
(3) After two weeks, metastatic abscesses often appear in the lumbar back and soft tissues of the extremities, which are difficult to be found.
(4) Blood culture can be positive in high fever and chills.
Differential diagnosis
Mainly to identify sepsis and sepsis.
