septicemia
Introduction
Introduction Septicemia refers to a systemic serious infection caused by bacteria entering the blood circulation and growing and breeding to produce toxins. Clinical manifestations include fever, severe toxic symptoms, rash rash, hepatosplenomegaly, and increased white blood cell count. Gram-positive cocci sepsis, Gram-negative bacilli sepsis and sepsis sepsis. Antibiotic treatment is the main treatment, supplemented by other treatment methods. Precautions are taken to prevent damage to the skin and mucous membranes and to prevent bacterial infections.
Cause
Cause
Various pathogenic bacteria can cause sepsis. Commonly known are Staphylococcus aureus, hemolytic streptococcus, Streptococcus pneumoniae, Escherichia coli, meningococcus, Pseudomonas aeruginosa, Proteus, Salmonella, Klebsiella and the like. When the body's resistance is reduced, bacteria with less pathogenicity or conditional pathogens such as Staphylococcus epidermidis can also cause sepsis. In recent years, pathogenic bacteria have changed, and the sepsis caused by Gram-positive cocci has decreased, while those caused by Gram-negative bacilli, anaerobic bacteria and fungi have increased year by year, which is related to vessel intubation, foreign body in the body, etc. The development of new medical technologies has a certain relationship with the excessive application of antibiotics.
Examine
an examination
Blood picture:
The total number of white blood cells is significantly increased, reaching 10 ~ 30 × 109 / L, the percentage of neutrophils increased, more than 80%, there may be obvious nuclear left shift and intracellular poisoning particles. The number of white blood cells in a small number of Gram-negative sepsis and decreased immune function can be normal or slightly reduced.
2. Neutrophil tetrazolium blue (NBT) test:
This test is only positive for bacterial infections, can be as high as 20% or more (normally below 8%), and is helpful for the identification of viral infections and non-infectious diseases and bacterial infections.
3. Laboratory inspection:
(1) The white blood cells and neutrophils are obviously increased. It is obvious that the nuclear lobes are shifted to the left and the cytotoxic granules in the leukocytes, and the acidic granulocytes are reduced or disappeared. The total number of white blood cells in the elderly who are frail or have low body reactions and some Gram-negative bacterial infections may be normal or decreased.
(2) Positive blood and bone marrow culture. If it is consistent with the culture of the local lesion secretion (pus, urine, pleural effusion, cerebrospinal fluid, etc.), it can be confirmed.
Diagnosis
Differential diagnosis
It is distinguished from miliary tuberculosis, malignant histiocytosis, systemic lupus erythematosus, deep lymphoma, allergic subsepticemia, brucellosis, typhoid fever, epidemic hemorrhagic fever, falciparum malaria, and rheumatism. Diseases that are easily misdiagnosed:
1. Intracranial hemorrhage, asphyxia:
Sepsis has apnea, tremor, convulsions, anterior hernia, indicating neurological invasion, especially in children within 1 week of newborn, should be differentiated from intracranial hemorrhage, asphyxia. The latter has an early onset, mostly starting within 1 or 2 days after birth, and has a history of birth injury. When there is a congenital malformation of the nervous system complicated by meningitis, it should also be differentiated from sepsis.
2. Respiratory diseases:
Early symptoms of sepsis may have difficulty breathing, urgency, cyanosis, etc., and should be differentiated from pneumothorax, pneumonia, immature primary respiratory distress syndrome, lung insufficiency, etc. If necessary, chest X-ray films can be taken to assist in diagnosis.
3. Digestive diseases:
Abdominal distension, vomiting, and frequent or frequent bowel movements are manifestations of primary intestinal disease and can also occur during sepsis. The development and causal relationship of each symptom should be analyzed. Be alert to sepsis caused by intestinal bacteria.
4. Blood disease:
Neonatal hemolytic disease, lack of erythrocyte enzymes can also show jaundice, anemia, shortness of breath and difficulty breathing, but severe hemolytic anemia has no signs of infection, can be identified with hyperbilirubinemia caused by sepsis. Neonatal hemorrhagic disease must be differentiated from sepsis and blood. The former has no infection, and blood transfusion and vitamin K treatment can be cured. Idiopathic thrombocytopenic purpura and congenital leukemia should be differentiated from sepsis and can be diagnosed by routine blood tests.
