Sepsis (cont.)
What are the signs or symptoms of sepsis (blood poisoning)?
The patient should have a proven or suspected source of an infection (usually bacterial) and have at least two of the following problems: an elevated heart rate (tachycardia), either a high (fever) or low temperature (hypothermia), rapid breathing (>20 breaths per minute or a reduced PaCO2 level), or a white blood cell count that is either high, low, or composed of >10% band cells. In most cases, it is fairly easy to ascertain heart rate (count pulse per minute), fever or hypothermia with a thermometer, and to count breaths per minute even at home. It may be more difficult to prove a source of infection, but if the person has symptoms of infection such as productive cough, or dysuria, or fevers, or a wound with pus, it is fairly easy to suspect that a person with an infection may have sepsis. However, determination of the white blood cell count and PaCO2 is usually done by a lab. In most cases, the definitive diagnosis of sepsis is made by a physician in conjunction with laboratory tests.
Some authors consider red lines or red streaks on the skin to be signs of sepsis. However, these streaks are due to local inflammatory changes in either local blood vessels or lymphatic vessels (lymphangitis). The red streaks or lines are worrisome as they usually indicate a spreading infection that can result in sepsis.
What causes sepsis?
The majority of cases of sepsis are due to bacterial infections, some are due to fungal infections, and very few are due to other causes of infection or agents that may cause SIRS. The infectious agents, usually bacteria, begin infecting almost any organ location or implanted device (for
example, skin, lung, gastrointestinal tract, surgical site, intravenous catheter, etc.). The infecting agents or their toxins (or both) then spread directly or indirectly into the bloodstream. This allows them to spread to almost any other organ system. SIRS criteria result as the body tries to counteract the damage done by these blood-borne agents.
Common bacterial causes of sepsis are gram-negative bacilli (for example, E. coli,
P. aeruginosa, E. corrodens), S. aureus, Streptococcus species and
Enterococcus species; however, there are a large number of bacterial genera that have been known to cause sepsis.
Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source.
Next: How is sepsis diagnosed? »
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