The sepsis Volodymyr Voloshyn 1 A sepsis is the inadequate reaction of macroorganism to the action of microorganism at the acute mionectic (decreasing) reactivity or paralysis of the immune system. 2 The features of sepsis which select him from other infectious diseases : 1. A sepsis is the polyetiologic disease. It can be caused by many microorganisms. But foremost are staphylococcuss. Meningococcuss, clebsiels, blue pus stick and mixe infections also. 2. Epidemiology feature: it consists in noncontagious of this disease. A sepsis is not reproduced in the experiment. 3. Clinical feature: cyclic absence, it is impossible to select periods which characterized other infectious diseases (no incubation periods, clinical manifestation is same for different agents). 4. Immunologically: immunity is absence (at hyperactivity & unadequate reactions). Pathanatomy: local & general changes haven't specific peculiarities. 3 ENTRANCES GATE (and septic locus) 4 Fig. Chronic abscess of pancreas 5 Local manifestation: Lymphangitis, Lymphthrombosis, Lymphadenitis Phlebitis, Thrombophlebitis, Thrombobacterial emboly 7 Pathoanatomical general manifestations Apostematic nephrite 8 Fig. Septic myocarditis 9 Primary bacterial endocarditis, lingering form. Aortic valves with fibrin changes, mucous degeneration niduses, superficial sores and calcinosis. 10 Hemorrhagic syndrome 11 + jaundice Bone marrow hyperplasia Enlargment of lymphonods 12 Septic spleen According to etiology a sepsis is divided into: staphylococcus meningococcuss collibacylaric streptococcus salmonelly mycotic tubercular Classification according to motion: Lightning Acute Subacute Chronic 13 Acording to infection atrium: therapeutic (parainfection); tonsillar; surgical; Uterine (ginecologic); otogenic; odontogenic umbilical cryptogenic 14 Acording to clinic-signs: septicaemia, septico-piemia, septic (bacterial) endocarditis and chroniosepsis. Stages of pathogeny Syndrome of system inflammatory answer (destruction of endothelia, mediators cascade). Septic arterial hypotensia (TNF). Septic shock (cardiac weakness, violation of microcirculation). Syndrome of polyorganic insufficiency (shock kidney, distress-syndrome and other). 15 Septicemia 16 Enlarged spleen. Blood smear with immature erythroblastic cells (arrows) Septic myocarditis 17 Septicemia Hemorrhagy septic embolus is in lungs 18 Multiple abscesses (arrows) Septicopyemia Septic thromboembol in the veins of mediastinum 19 Septicopyemia Osteomyelitis Primary bacterial endocarditis, subacute lingering form. Aortic valves with fibrin changes, mucous degeneration niduses, superficial sores and calcinosis. 20 Septic (bacterial) endocarditis Secondary septic endocarditis on a background Fallo tetrady 21 Septic endocarditis Septic thromboembol 22 the changes in lungs and kidney at septic shock 23 Peripheral sings Libman's petechial spots Osler's palmar nodules fingers "drumsticks" local necrosis in subcutaneous tissue Jeynuay's spots (hemorrhages in the skin and subcutaneous tissue) jaundice The sepsis of new- born 25 The sepsis of new-born, or neonatal sepsis, is named a sepsis, arising up on the first month of life. The neonatal sepsis selection as special clinico-morphologic variant is depended on contingently in a number of features, characteristic for physiology and pathology of new-born, including substantial alteration of postnatal haemodynamics, special state of immune and haemopoetic systems, exchange of matters and adjusting of homeostasis, high risk of intrawomb infecting and other. 26 To the present tense fundamental in studies about a sepsis there are the followings moments: A sepsis is an original infectious disease with an ancycling & has not a specific exciter and caused by the massive receipt of various conventional-pathogenic microflora in the gumoral environment of organism. A sepsis is accompanied chaotic development of polyorganics pathological processes, primary localization, character and degree of expressed of which, depend on the functional full value of the phagocytes system and adequacy of SIA (system inflammation answer). 27 EPIDEMIOLOGY Frequency of sepsis among new-born makes from 0.1 to 0.8%. The special problem is presented by children, being in the separations of reanimation and intensive therapies, and prematurely new-born, among which frequency of development of sepsis on the average 14% makes (from 8.6 % to 25 % in premature (28 31 weeks). 28 ETIOLOGY The sepsis is a generalized infectious disease, caused by conditioned-pathogenic bacterial microflora. Just with a sepsis does not follow to summarize the viral infections of different etiology and septic forms of pathogenic bacterial infections (salmonellosis, disseminated tuberculosis and other), that have separated rubrics. 29 More often by Str. agalacticae, collibacilluss (E. coli), rarer other representatives families of gram-negative colibacilluss. At the late sepsis of new-born, which develops after 3 days of life and is usually by investigation of the intranatal or postnatal infecting of foetus and new-born, a lead role the B-streptococci group plays. At the postnatal sepsis of new-born the leading etiologic role have staphylococcuss and representatives of colibacilluss family, streptococci groups, enterococci groups and other. 30 NOSOTROPIC FEATURES The fundamental moment of pathogeny of new-born sepsis there are ways of infecting, which have substantial distinctions at the innate and postnatal variants of disease. At innate sepsis infecting new-born carried out to or during births. At a postnatal sepsis the entrances are umbilical vessels, skin covers, outward mucous membranes, lungs and gastroenteric way. The signs of violation of vaginal biocenosis there are more than at the half of pregnant women (52%). The signs of bacterial vaginosis were in 25,4%, heterospecific bacterial kolpitis in 15%, caused conditioned-pathogenic microflora. 31 Classification of new-born sepsis: A. Depending on time and terms of development: 1- Early neonatal sepsis 2- Late neonatal extrahospital sepsis 3- Hospital (nozokomial). B. Depending on the gate of entrances (localization of primary septic focus) Umbilical Lung Enterogenny Dermic Rinopharingea Otogeny Urogeny Abdominal Post-cannulation C. Other Clinical forms Septicaemia Septicopyaemia Septic shock 32 Secondary septic endocarditis on a background Fallo tetrady 33 Septic (bacterial-toxic) shock is the special nosotropic variety of septic process, caused the massive bacteria entering in the circulatory system, them blasted fragments or toxic products of vital functions from making progress niduses festering inflammations (festering meningitis, pneumonia, hypodermic phlegmona, fibrinosis- festering peritonitis, festering osteomielitis and other). The inadequate antibakterial drugs using lead to this very often. The clinical picture of septic shock shows up sudden arterial low blood pressure, resistant to adreno-mimetic introduction, that can arise up not only at bacterial sepsis, but also at any other infectious disease. In this situation in clinical practice more often use the diagnosis "infectiously-toxic shock" which depending from etiologic factor can be bacterial, viral, mikotic and mixed (bacterial-viral, bakterial-mikotic and other). At the same time in majority supervisions of septic shock the gram- negative sticks, streptococci, enterococci are sown from blood of patients. Lethality at development of shock exceeds 40%. The shock are characterized by the expressed displays of intravessels blood aggregation syndrome, which is marked in 1015% cases of sepsis new-born, thus with identical frequency at septicaemia and septicopyaemia. This complication flows with development of trombocytopenia, coagulopathies of consumption and depressions of fibrinolysis. 34 Candida gastric ulcer. 35 Paratherapeutic (cannulation) sepsis. 36 37 39 40 41 THE END again! Thanks again!!! Very thanks, that waited up for the end!!!! 42