Actinomycotic sepsis
Actinomycotic sepsis most often occurs as a severe complication of visceral actinomycosis. The pathogenesis of fungal dissemination in the body can develop according to three different scenarios. In some cases, there is isolated metastasis of the pathogen to only one organ. In others, simultaneous massive metastasis to many internal organs occurs. With total generalization of the process, the fungi themselves are rarely detected in the systemic bloodstream.
The clinical picture proceeds as actinomycotic pyemia and includes:
- A sharp and significant exacerbation of the underlying infectious process.
- Body temperature rise up to 38–39 °C.
- Active formation of new inflammatory infiltrates and secondary purulent foci in various body areas and organs.
- Pronounced pain syndrome (severe pain).
- Extremely severe general condition of the patient, accompanied by rapid exhaustion.
Treatment tactics are based on standard intensive care for sepsis, which is obligatorily supplemented by the administration of massive doses of antibiotics and blood transfusion. A specific and key component of conservative treatment is the use of actinolyzates.
Anaerobic sepsis
Anaerobic sepsis in the overwhelming majority of cases is caused by clostridia and develops against the background of progressive anaerobic gangrene. Much less commonly, other types of anaerobic microorganisms are the cause. In peacetime, this pathology is extremely rare. The main prerequisites for its occurrence are severe, extensive wounds, as well as marked weakening and exsanguination of the patient's body.
The clinical picture is distinguished by the rapid, stormy development of anaerobic gangrene phenomena. The patient exhibits hectic fever with temperature rising to critical figures — 40–40.5 °C. The pulse becomes frequent and low in volume. The patient's condition is assessed as extremely severe. Profound disorders of consciousness are characteristic: they can manifest both as its depression (confusion or complete loss of consciousness) and paradoxical agitation passing into euphoria.
Treatment requires the immediate start of standard anti-sepsis methods in combination with intensive specific therapy. Patients are indicated for intramuscular and intravenous drip administration of antigangrenous serum in a large volume (from 10 to 20 prophylactic doses per day). In addition, intravenous drip and intramuscular administration of a special mixture of antigangrenous phages is used.
Neonatal sepsis
Neonatal sepsis is a special form of generalized infection where the main etiological factor is most often staphylococcus. The portals of entry for the infection into the child's body are usually the umbilical wound, as well as various abrasions and skin lesions.
The disease is characterized by a specific clinical picture:
- "Jumping" body temperature.
- Pronounced lethargy of the infant.
- Appearance of a skin rash and development of jaundice.
- Dyspeptic disorders (persistent diarrhea, vomiting).
- Formation of multiple small hemorrhages in the skin and mucous membranes.
An important feature of the course of sepsis in this age group is that rigors are rarely observed, while an enlargement of the spleen occurs very early.
Diagnostic challenges In clinical practice, serious errors are often made when diagnosing neonatal sepsis. Doctors may mistakenly take a generalized infection for pneumonia, purulent pleurisy, lung abscesses, or pericarditis. It is important to understand that these conditions are not independent diseases, but secondary metastatic foci of sepsis. Also, in some cases, the clinical picture is masked by symptoms of common food poisoning.
To remember the triad of specific sepsis types, recall the rule "AAN": Actinomycotic (treated with actinolyzates), Anaerobic (treated with antigangrenous serum and phages), Neonatal (pathogen is staphylococcus, entry is the umbilicus).
Class and exam questions
What is the feature of the fever syndrome in neonatal sepsis?
Body temperature has a characteristic "jumping" character. At the same time, unlike adult sepsis, classic rigors in infants are extremely rare.
What specific treatment is mandatory in anaerobic sepsis?
In addition to basic sepsis therapy, the use of antigangrenous serum (10–20 doses per day intravenously and intramuscularly) and a mixture of antigangrenous bacteriophages is necessary.
What diseases are most often mistakenly confused with neonatal sepsis?
It is often mistaken for pneumonia, purulent pleurisy, lung abscesses, pericarditis, or food poisoning. The listed purulent processes are actually secondary foci.
What else to study on this topic
- Mechanisms of metastasis in visceral actinomycosis
- Differential diagnosis of neonatal sepsis and food-borne toxicoinfection
- Criteria for the transition of local anaerobic gangrene to anaerobic sepsis
- Dosing regimens and administration rules for antigangrenous sera
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