Bacterial-toxic shock

Etiology and pathogenesis

The development of the pathology is caused by infectious agents and their toxins entering the systemic circulation. Most commonly, the trigger is massive endogenous intoxication during purulent inflammation. This process is associated with the resorption (absorption) of bacterial poisons and breakdown products of the body's own tissues from the primary purulent focus. I.V. Davydovsky referred to this condition as suppurative-resorptive fever.

In rare cases, the cause is a blood transfusion that was contaminated during collection or storage.

Mechanism of damage is based on the aggressive impact of toxins on the microvasculature and tissue metabolism. The severity of the condition directly depends on the pathogen: shock triggered by gram-negative bacteria is significantly more severe than that caused by gram-positive flora. Overall, septic shock leads in severity among all shock states, with mortality reaching 80–90%.

Clinical presentation

If the shock is associated with a blood transfusion, it manifests directly during the procedure or 30–60 minutes after its completion.

Initial manifestations:

• Fever: A sharp spike in body temperature up to 40–41 °C, accompanied by severe chills. Later, the chills are replaced by profuse sweating, and the temperature drops to normal or subfebrile values.
• Neurological disorders: Central nervous system changes appear very early—they may precede the drop in blood pressure or occur simultaneously with it and oliguria. The patient experiences marked anxiety, motor agitation, acute psychosis is possible, followed by clouding of consciousness.

Acute vascular insufficiency (main sign):

• A sharp drop in blood pressure (marked hypotension).
• Rapid, thready pulse up to 120–150 beats per minute, frequently arrhythmic.

Additional symptoms:

• Skin becomes pale, acrocyanosis is pronounced.
• Dyspnea develops (respiratory rate increases to 30–40 breaths per minute).
• Oliguria progresses rapidly (impaired urine output).
• In severe cases, involuntary urination and defecation are noted.

Diagnostics and treatment

The key method to confirm the post-transfusion origin of shock is bacteriological examination of the blood remnants from the vial or container.

Therapy must be initiated immediately. It is comprehensive in nature and includes anti-shock, detoxification, and antibacterial measures.

Medical support:

1. Vasopressors: for correcting hypotension (norepinephrine, phenylephrine).
2. Infusion therapy: rheological and detoxifying blood substitutes are used (dextran with a molecular weight of 30,000–40,000, povidone-based solutions). Administration of electrolyte solutions and sodium bicarbonate is mandatory.
3. Antibacterial therapy: broad-spectrum antibiotics are prescribed (cephalosporins, aminoglycosides).
4. Symptomatic agents: analgesics and anticoagulants.

Early application of exchange blood transfusions demonstrates the highest efficacy in relieving the severe condition.

Class and exam questions

What else to study on this topic

• Mechanisms of microcirculatory impairment under the influence of bacterial toxins
• Features of suppurative-resorptive fever according to I.V. Davydovsky
• Indications and technique for performing an exchange blood transfusion
• Differences in the pathogenesis of shock caused by gram-positive and gram-negative flora

Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"

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