Sepsis: symptoms

Typical clinical manifestations of sepsis are:

• a constantly high or hectic (rarely wavy) temperature;
• tremendous chills, heavy sweats;
• decreased body weight;
• deterioration despite intensive treatment;
• presence of hemorrhagic rash;
• the presence of vascular and trophic disorders (edema, thrombophlebitis, thrombosis, decubitus);
• decrease in aggregation properties of blood;
• resistant septic diarrhea;
• nausea and vomiting;
• irritability, depression of the nervous system;
• infectious-toxic myocarditis;
• acute respiratory failure (due, as a rule, to pneumonia);
• kidney damage - a decrease in diuresis often precedes a septic shock;
• violation of all types of exchange;
• in the presence of wound infection - pallor, swelling, lethargy, the scarcity of the wound that is separated, which has a dirty-muddy appearance and often a putrid smell.

According to W. Siegenthaler (1972), septicemia is characterized by:

• a feeling of weakness, nausea, vomiting, diarrhea,
• feverish condition;
• tachycardia;
• hyperventilation;
• enlarged spleen;
• jaundice;
• impaired consciousness;
• leukocytosis with a shift of the formula to the left;
• hypochromic anemia;
• increased ESR;
• increase in the content of gamma globulins;
• electrolyte shifts;
• hyperlipidemia;
• shock.

To late symptoms of sepsis, the authors refer to signs that indicate a multi-organ failure - sub- or decompensation of the functions of various organs and systems - cardiovascular, respiratory. This includes renal failure, central nervous system damage.

More often sepsis is caused by associative flora, but indirectly to judge the prevalence of one or another pathogen can be on the clinical picture of the disease.

Anaerobic sepsis deserves special attention. According to Yu.V. Tsveleva et al. (1995), anaerobic sepsis is usually caused by clostridia, mainly Cl. Perfringens. With clostridial form of sepsis, lethality earlier reached 80-90%. At present, this indicator is somewhat lower, but continues to be high, accounting for 20-45%.

Along with clostridia, a frequent cause of anaerobic sepsis is non-spore-forming anaerobic organisms (bacteroides, anaerobic streptococci).

With anaerobic sepsis, both septicemia and septicopyemia can occur. Perhaps the development of a lightning-fast form.

With long-term chronic foci of anaerobic infection, anaerobic chroniosepsis is also observed.

The classical clinical triad of Nuremberg is known in patients with anaerobic sepsis:

1. Bronze or saffron color of the skin.
2. Dark color of urine (color of meat slops).
3. Dark brown color of blood plasma (varnish blood).

Yu.V. Tsevelev with co-workers. (1995) conducted an in-depth study of anaerobic infection. The authors believe that along with common manifestations for anaerobic sepsis, the following clinical and laboratory symptoms are characteristic:

• repeated chills, accompanied by a rapid rise in body temperature to 40-41C;
• in many patients, fever is accompanied by paresthesia or severe muscle pain, which is intensified even with a slight touch;
• consciousness is often inhibited, excitement, delirium, hallucinations are observed;
• almost always show signs of cardiovascular insufficiency; in 20% of patients, systolic murmur over the apex of the heart is heard, especially in patients with septic endocarditis, which is a poor prognostic sign;
• tachypnea develops (more than 30 per 1 minute), due to both pulmonary insufficiency and hypoxia due to massive hemolysis of red blood cells;
• on the skin a few hours after the development of sepsis, cyanotic or purplish-red spots may appear, alternating with areas of marble color, and in the DIC-syndrome, large and minor hemorrhages are frequent;
• by the end of the first day of the disease the skin becomes earthy in color, and after a few hours - yellowish-bronze;
• typical is a significant reduction in the total protein to 38-40 g / l, an increase in the activity of transaminases and the content of total bilirubin, the latter in combination with an increase in liver size indicate a liver failure;
• characteristic oliguria (below 20 ml / h) followed by persistent anuria and acute renal insufficiency;
• hemolytic anemia develops (in the blood hemoglobinemia, hyperbilirubinemia, in the urine - hemoglobinuria). Similar changes are mainly found in postpartum and especially post-abortion sepsis.

[1], [2], [3], [4], [5]