Sepsis - Symptoms

Characteristic clinical manifestations of sepsis are:

• constantly high or hectic (less often undulating) temperature;
• stunning chills, profuse sweating;
• weight loss;
• deterioration of the condition despite intensive treatment;
• presence of hemorrhagic rash;
• the presence of vascular and trophic disorders (edema, thrombophlebitis, thrombosis, bedsores);
• decrease in blood aggregation properties;
• persistent septic diarrhea;
• nausea and vomiting;
• irritability, depression of the nervous system;
• infectious toxic myocarditis;
• acute respiratory failure (usually caused by pneumonia);
• kidney damage - decreased diuresis often precedes septic shock;
• violation of all types of metabolism;
• in the presence of a wound infection - pallor, swelling, sluggish granulation, scant wound discharge, which has a dirty, cloudy appearance and often a putrid odor.

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

• feeling of weakness, nausea, vomiting, diarrhea,
• feverish state;
• tachycardia;
• hyperventilation;
• enlarged spleen;
• jaundice;
• disturbance of consciousness;
• leukocytosis with a shift in the formula to the left;
• hypochromic anemia;
• increased ESR;
• increased gamma globulin levels;
• electrolyte shifts;
• hyperlipidemia;
• shock.

The authors attribute signs indicating multiple organ failure - sub- or decompensation of functions of various organs and systems - cardiovascular, respiratory - to late symptoms of sepsis. This also includes renal failure and damage to the central nervous system.

More often, sepsis is caused by associative flora, but the prevalence of a particular pathogen can be indirectly judged by the clinical picture of the disease.

Anaerobic sepsis deserves special attention. According to Yu. V. Tsvelev et al. (1995), anaerobic sepsis is usually caused by clostridia, mainly Cl. Perfringens. In the clostridial form of sepsis, mortality previously reached 80-90%. At present, this figure is somewhat lower, but continues to remain high, amounting to 20-45%.

Along with clostridia, non-spore-forming anaerobic organisms (bacteroids, anaerobic streptococci) are a common cause of anaerobic sepsis.

In anaerobic sepsis, both septicemia and septicopyemia may occur. The development of a fulminant form is possible.

In long-term chronic foci of anaerobic infection, anaerobic chronic sepsis is also observed.

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

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

Yu.V. Tsvelev et al. (1995) conducted in-depth studies of anaerobic infection. The authors believe that, along with general manifestations, the following clinical and laboratory symptoms are characteristic of anaerobic sepsis:

• 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 intensifies even with light touch;
• consciousness is often inhibited, agitation, delirium, hallucinations are observed;
• signs of cardiovascular failure are almost always detected; in 20% of patients, a systolic murmur is heard over the apex of the heart, especially in patients with septic endocarditis, which is a poor prognostic sign;
• tachypnea develops (more than 30 per 1 minute), caused by both pulmonary insufficiency and hypoxia due to massive hemolysis of erythrocytes;
• cyanotic or purple-red spots may appear on the skin a few hours after the development of sepsis, alternating with areas of marbled coloration, and with DIC syndrome, large and small hemorrhages are quite common;
• by the end of the first day of illness, the skin becomes an earthy color, and after a few more hours - yellowish-bronze;
• typical is a significant decrease in total protein to 38-40 g/l, an increase in transaminase activity and total bilirubin content, while the latter indicators, combined with an increase in liver size, indicate liver failure;
• characterized by oliguria (below 20 ml/h) followed by persistent anuria and acute renal failure;
• hemolytic anemia develops (hemoglobinemia, hyperbilirubinemia in the blood, hemoglobinuria in the urine). Such changes are predominantly found in postpartum and especially post-abortion sepsis.

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