Sign of infected blood. Sepsis in children: symptoms, causes, signs, treatment. Multiple foci of infection

Sepsis is a special type of reaction of the body, the phase of a general infectious disease of the body caused by the continuous or periodic entry into the bloodstream of pathogens from the existing obvious or latent purulent inflammatory focus with altered reactivity of the body and reduced general and local natural immunity.

The causative agents of septic processes are: staphylococcus, streptococcus, pneumococcus, Escherichia coli, Pseudomonas aeruginosa, proteus, etc. The initial foci of sepsis can be contaminated wounds, purulent processes in the skin and subcutaneous tissue, infected chickenpox pustules, insect bites, ulcerative processes in the mucous membrane mouth, purulent tonsils, retropharyngeal abscess, purulent inflammation of the salivary glands, purulent otitis media, abscess pneumonia, suppuration of the umbilical wound (in newborns). Sometimes the focus cannot be found. Infection can also occur in utero. The course of sepsis depends on the patient's reactivity, the type and virulence of the microbe, the localization of purulent foci, the allergic mood of the body. In childhood, up to 85% of sepsis diseases occur in the first half of the year, mainly in the first 3 months of life. A feature of the course of sepsis in early childhood is the predominance of general symptoms.

According to the clinical and anatomical picture of sepsis, two forms can be distinguished: septicemic (sepsis with a sharp predominance of toxicosis without metastasis), predominantly in premature and newborn infants in the first weeks of life, and septicopyemic (sepsis with many hematogenous metastatic purulent foci with less pronounced toxic manifestations).

Common main symptoms of sepsis:

mostly periodic, irregular temperature increase (alternating heat with chills with periods of low-grade, rarely normal temperature), often sweat;

intoxication phenomena (decreased appetite, malaise or anorexia, worsening sleep);

discoloration of the skin (pale, gray, earthy), often acrocyanosis or cyanosis of the nasolabial triangle, often skin rashes, often hemorrhagic, dry tongue;

increased heart rate;

enlarged soft spleen.

Umbilical sepsis ... There are two variants of the course of umbilical sepsis. In the first option, gradual development with a wave-like, oligosymptomatic course (alternating periods of deterioration and improvement).

Early symptoms are:

anorexia, stopping or insufficient weight gain (at the 2nd week of life);

from the 3rd week, more pronounced symptoms of the disease: regurgitation, vomiting, unstable stools, weight loss;

increased (high, subfebrile) temperature. In 20% of patients with umbilical sepsis, normal and subnormal temperature with an irregular curve;

grayish-yellow color of the skin with pustular and hemorrhagic rashes;

rapid shallow breathing, often focal or interstitial pneumonia with shortness of breath and cyanosis;

lowering blood pressure (especially minimum), increased heart rate;

enlargement of the liver and spleen;

changes in the blood in the form of moderate leukocytosis with neutrophilia, less often leukopenia;

slight albuminuria, pyuria, microhematuria;

poor sleep, anxiety, sometimes cramps;

poor healing of the umbilical wound with purulent, bloody discharge, the skin around the navel with a pronounced venous network, not hyperemic, infiltrated, not always edematous;

sometimes swelling and slight tension of the abdominal wall.

The second variant of umbilical sepsis (less often) proceeds in the form of an acute severe process with high fever, many metastatic purulent foci, anemia, and high leukocytosis.

The most important is the differentiation of umbilical sepsis with infectious-toxic diseases (for epidemiological and therapeutic reasons). The main differences between infectious and toxic diseases:

significantly pronounced dyspeptic symptoms;

dehydration and toxicosis;

normal or slightly elevated temperature;

epidemiological history.

Otogenic sepsis ... It is a severe complication of purulent otitis media, the causative agents of which can be staphylococci, streptococci, pneumococci and other microbes, and purulent otitis media can be a primary disease or represent a metastatic focus.

Symptoms:

fever of a persistent or abnormal character with anxiety;

often pain and infiltration in the posterior mastoid process;

the presence of a painful cord along the jugular vein (a sign of lymphangitis in this area);

slight stiffness of the occipital muscles;

twitching of the face;

often slight icterus of the skin, sweat;

rapid pulse of weak filling;

enlargement of the liver and spleen.

Treatment of sepsis in a hospital should be comprehensive and include antibiotic therapy, the fight against toxicosis (in the initial phase), the impact on the macroorganism and the sanitation of purulent foci (primary and secondary):

targeted antibiotic therapy. In view of the predominant importance of staphylococcus in the etiology of sepsis, the use of oleandomycin, erythromycin, oletthrin (sigmamycin), semi-synthetic penicillins - methicillin, oxacillin as antibiotics active against staphylococcus is indicated before determining the sensitivity to antibiotics. With colibacillary sepsis, neomycin (mycerin, colimycin) is administered. When combining antibiotics, correct use is necessary (penicillin with streptomycin or monomycin, tetracycline with chloramphenicol, streptomycin with chloramphenicol). The daily dose should be administered in 3-4 doses (neomycin in 2 doses), after 7-10 days, replace antibiotics with others, prescribe nystatin. An individual approach to the duration of treatment is required (doses are the highest, age-related);

in case of toxicosis, inject intravenous plasma (10-15 ml per 1 kg of body weight), 5% glucose solution, physiological and Ringer's solutions (see dehydration);

stimulating therapy. Blood transfusion at the rate of 5-8 ml per 1 kg of body weight. Re-introduction of 3 ml of gamma globulin every other day (alternating with the introduction of plasma), pentoxil, sodium nucleic acid, dibazol (1 mg once a day for up to 10 days), vitamin B12;

treatment with vitamins A, C, complex B;

cardiotonic drugs according to indications;

local treatment of purulent foci;

aeration, oxygen therapy, good nutrition, hygiene regimen.

Acute hematogenous osteomyelitis ... Acute purulent inflammation of the bone marrow with simultaneous damage to the compact and cancellous bone (osteitis) and periosteum (periostitis). It is a form of sepsis (septicopyemia) with metastasis to the bone marrow. A frequent causative agent is staphylococcus, less often streptococcus and other microbes. The most affected age is from 5 to 15 years. Less commonly, the disease occurs in children during the first months and weeks of life. The pathogenesis has not been precisely clarified; instead of the vascular-embolic theory, the theory of autoinfection in a sensitized organism has recently been put forward. The clinical picture is diverse.

There are 3 main forms: toxic (adynamic), the most common septicopyemic (with a severe course) and a local form (with a mild course). Usually one bone is affected, only 20% have multiple bone lesions. Mostly the place (the primary focus of the lesion) of settling of microbes is the most vascularized parts (places of the most intensive growth): the lower metaphysis of the thigh, the upper metaphysis of the tibia and shoulder; the lower metaphysis of the tibia, less often other tubular bones and flat bones.

Features of hematogenous osteomyelitis in children of the neonatal period:

predominantly epiphyseal osteomyelitis;

frequent multiple lesions;

a pronounced general reaction;

rapid progression of the inflammatory process with extensive destructive changes.

Symptoms:

a sudden acute onset with a high fever in the first days, later replaced by an intermittent temperature, often chills;

general infectious symptoms: anxiety, anorexia, dyspeptic symptoms, with a toxic form, weakness, darkened consciousness, convulsions;

pale gray dry skin, sometimes with an icteric tinge, dry mucous membranes, sometimes hemorrhagic rashes;

muffled heart sounds, rapid pulse, shortness of breath;

local edema and tissue infiltration (after 1-2 days), local severe pain from the 2nd day. In young children, general anxiety with sparing the affected limb, crying when shifting, swaddling (pain has to be determined by palpation), the appearance of an enlarged venous network and an increase in local skin temperature in the area of the affected bone area, skin hyperemia, deep fluctuation (subcutaneous abscess or intermuscular phlegmon) ;

painful contracture and effusion in the joint with epiphyseal osteomyelitis; forced position of the limb, sharply limited and painful movements of the limb (in a toxic form, the death of a child may occur before obvious changes in the bone are detected);

leukocytosis in the blood with a sharp left shift, toxic granularity of neutrophils, accelerated ROE; often a positive blood culture (in the early days);

radiographs show fuzzy changes in the bone not earlier than 3-5 days. Only by the 10th day are small-spotted foci of enlightenment visible.

Differential diagnosis:

with rheumatism with affection of several joints. Rheumatism is indicated by the volatility of pain and its localization in the joint itself (in the soft tissues of the joint), and not near the joint, the rapid effectiveness of the treatment with salicylate and pyramidon;

with post-infectious arthritis (influenza, etc.). The difference is that the greatest pain in arthritis occurs in the joint, and not in the limb, and there are no severe general phenomena;

with scurvy, with Meller-Barlov's disease. In these diseases, fever, painful swelling of the limb and subperiosteal hemorrhage are also noted. With scurvy and Barlov's disease, symmetrical lesions of the limbs, the absence of spontaneous pain, bleeding of the gums, skin rashes in the form of small hemorrhages and a sharp improvement in 1-2 days under the influence of large doses of ascorbic acid are observed.

The prognosis depends on the form of the disease and the timing of the start of the specific treatment.

Treatment

Transportation in a recumbent position with transport immobilization. In the hospital:

antibiotic therapy. In view of the predominant value of staphylococcus, erythromycin, oleandomycin, oletetrin (sigmamycin), semisynthetic penicillins (methicillin, oxacillin) are shown (before the result of the antibioticogram). Treatment is long-term, at least 3 weeks. For the prevention of candidiasis, nystatin should be prescribed. With streptococcal etiology of osteomyelitis, penicillin in large doses - up to 10,000,000 units per day;

vitamins A, B, Bg, B12, C, P;

stimulating therapy: repeated hematransfusions, injections of gamma globulin;

cardiotonic drugs according to indications (all named drugs in age doses);

good nutrition;

opening of intermuscular phlegmon, subcutaneous abscess, immobilization of the affected limb.

Sepsis as a medical term has several interpretations, but by and large it is characterized as a systemic inflammatory process, which is based on a proven or suspected infection. It may have the following origins:

It can be considered as a serious condition in which an infection occurs with the pathogen of the blood of a child or an adult. There is a certain risk of this phenomenon in premature babies, which is especially dangerous
for their life.

In the past 10-15 years, the diagnosis of this disease has reached certain heights, and now the clinical guidelines are about careful consideration of the threshold values of SSIR (systemic inflammatory response syndrome). Statistics have noted that the risk of sepsis in children with concomitant diseases is almost twice as high as in the adult population. In particular, this concerns the presence of problems with immunity. In any case, the disease is classified as life-threatening and requires immediate treatment.

The main risk factors for development can be:

The presence of HIV infection, which causes pneumococcal sepsis.
Low level of hemoglobin indicators.
Congenital heart disease in children gives rise to the development of such a variety as urosepsis.
Burns received (large areas of the body).
Spleen dysfunction.
Different forms of cancer.
Unsuccessful prosthetics process.
The process of treatment with a course of intensive therapy, accompanied by a decrease in immunity.

In terms of epidemiological data, it is characterized as one of the causes of death in infants and children under 3 years of age. Active development is noted in developing countries with a low level of medical care. The risk of disease occurrence is inversely related to the patient's age. The older he is, the less likely he is to get this ailment.

The symptoms of sepsis are as follows:

there is a sharp increase in temperature with a febrile state;
pallor of the skin up to earthy shades;
breathing becomes rapid and sometimes difficult;
when breathing, there is a significant inflation of the wings of the nose;
tongue dry and coated with a specific coating;
attacks of nausea and vomiting may occur;
partial diarrhea;
decreased appetite and gradual weight loss;
the occurrence of headaches, mainly from one part;
the development of anemia;
the risk of thrombosis, both compensated and uncompensated, increases.

The need for diagnosis and options for therapeutic intervention

Timely diagnosis is a criterion for the effectiveness of subsequent treatment. To obtain full results, the following diagnostic measures will be required:

Clinical analyzes of blood, urine + serological examination.
Chest X-ray.
CT and MRI, in some cases the use of echocardiography.
Lumbar puncture.

It is also necessary to use differential diagnostic methods to detect bacteria, streptococcal or enterococcal infection, necrotizing enterocolitis, candidiasis, meningitis (aseptic or bacterial), adrenal insufficiency, E. coli, fungal endocarditis, influenza, viral herpes and infectious pericarditis, metabolic acidosis, rheumatism or tuberculosis ...

The treatment process is based on the results of the research obtained and the different methods of therapy. Intensive therapy with antibiotics is an important component of healing. It is the use of adequate empirical antibiotic therapy that can reduce the percentage of complications and the possibility of death. The course of these drugs is prescribed individually, taking into account the level of sensitivity to the patient's microflora.

Surgical treatment is a mandatory step (if indicated). Often, drainage of purulent foci that caused the development of sepsis is carried out.

A therapeutic course may contain:

carrying out the procedure for artificial ventilation;
aggressive fluid therapy;
correction of metabolic and physiological processes with drugs;
monitoring of the state and functioning of the vital systems of the body and its individual organs.

Modern medicine is developing rapidly, but despite this, problems remain that cannot be solved with the help of scientific achievements and new technologies. One of them is sepsis in children. Symptoms of this pathological process are detected in 0.8% of newborn babies. However, it is worth noting that in full-term infants, sepsis develops in 0.1% of cases, in premature babies - in 1% of cases. This pathology is even more common - in 30-33% of cases. What is sepsis, symptoms in children, photos of this process?

What is sepsis?

Mankind has known about this state since ancient times. Hippocrates mentioned sepsis in his writings. Then this word was understood as rotting blood. Currently, the term "sepsis" experts designate a pathological process, which is based on a systemic inflammatory response to an infection of a viral, fungal or bacterial nature.

A baby can be infected with sepsis during the antenatal (during fetal development), intrapartum (during childbirth) and postnatal (postpartum) periods. Before birth, the infection is transmitted to the fetus from the woman. During childbirth and in the postnatal period, the sources of infection are the mother, medical personnel, and the environment.

Causes and factors causing the pathological process

Sepsis in children, the symptoms of this serious condition occur due to the ingress of bacteria, fungi, viruses and protozoa into the body. In most cases, bacterial sepsis is observed. It is diagnosed in 85-90% of cases. Sometimes a combination of several different pathogens is detected. Statistics show that this is typical for 10-50% of cases.

Sepsis in children, the symptoms of which are varied, are caused by several factors. These include:

inadequate antibiotic treatment;
the use of drugs leading to a decrease in the immune response;
long-term full parenteral nutrition;
the use of invasive methods of diagnosis and treatment;
immunodeficiency states and severe premorbid background.

Classification of sepsis

Depending on the time of the onset of clinical symptoms, congenital and late sepsis are distinguished. The first type of pathological process is characterized by the appearance of signs in the first 72 hours after birth. As a rule, with early sepsis, infection occurs in utero. The primary focus of infection is absent. Late sepsis appears after 3 days of life. Infection with this type of serious condition occurs during or after childbirth. Possible reasons for the appearance of infection are pneumonia, meningitis, peritonitis, etc., because. with these diseases, foci of reproduction of pathogens and their development are noted.

Along the course, sepsis is fulminant, acute and subacute. There is also a classification based on the division of a serious condition into types according to the primary or leading focus of infection:

umbilical sepsis;
cerebral;
pulmonary;
intestinal;
cutaneous.

Clinical picture

The manifestations of the pathological process can be varied. The list below includes the early and late symptoms of sepsis in a newborn baby:

severe general condition;
(in term babies, fever occurs, and in premature babies, progressive hypothermia);
discoloration of the skin (the body becomes a dirty gray or dirty pale shade);
violation of the functional state of the central nervous system;
spontaneous bleeding;
rapidly growing jaundice;
respiratory failure (in the absence of inflammatory changes on the x-ray);
dysfunction of the gastrointestinal tract, deviation of the size of the liver and spleen from the norm upwards.

In newborns with sepsis, symptoms such as vomiting, diarrhea are also observed. Babies refuse to breast, rapidly lose weight. Often suppuration in the navel is determined, abscesses of various localization are found.

Diagnosis of sepsis

Sepsis, symptoms in children (photos of this pathology do not give a complete picture of the disease) are not the only topics that require consideration. Attention deserves the diagnosis of a serious condition - the conduct of emergency research. They include:

complete blood count with platelets;
coagulogram (a set of indicators by which blood clotting can be assessed);
determination of blood group and Rh-factor;
blood chemistry;
(CBS: pH and arterial blood gases);
X-ray of the internal organs of the chest;
electrocardiography;
microscopy and seeding of biological material (feces, urine, oropharyngeal mucosa washout);
sowing blood.

The emerging signs of sepsis in children may be inherent in other diseases. That is why differential diagnosis is important. Sepsis must be distinguished from bacterial infections. The diagnosis will be determined by prophylactic and specific antibiotic therapy. Differential diagnosis of sepsis and generalized forms of viral infections is also required. Upon confirmation of their presence, specific antiviral therapy is performed.

Tasks and methods of treating sepsis

This serious condition that occurs in children requires immediate treatment, because it is very dangerous and leads to death during progression. Therapy for sepsis is carried out simultaneously in 2 directions. One of them is etiotropic treatment. It includes debridement and antibiotic therapy.

The next direction in the treatment of sepsis is pathogenetic therapy. Its tasks are to restore changes in homeostasis (including the correction of immune disorders and organ disorders).

Etiotropic therapy

The most important action in the treatment of sepsis is the debridement of the septic focus. Only thanks to this measure, therapy carried out in a serious condition becomes effective. At this stage, specialists perform surgical intervention - they do an autopsy or puncture and drainage of purulent cavities, necrotomy, etc.

If symptoms of sepsis are observed in children, antibiotic therapy is prescribed (until the pathogen is identified). The doctor chooses the medicines. When selecting drugs, the time of occurrence of the condition (during intrauterine development, during childbirth or after birth), conditions of occurrence (hospital or community-acquired), localization of the septic focus are taken into account. All this information suggests the causative agent of the sepsis. After clarifying the nature of the microflora, antibacterial therapy is adjusted. If necessary, the drug used is replaced by another.

Some treatment regimens

Unfortunately, there is no specific medicine that could eliminate sepsis in children, the symptoms of this pathological process. However, there are recommended treatment regimens. For example, antibiotic therapy for congenital neonatal sepsis may be as follows:

"Ampicillin" in combination with aminoglycosides (or "Amikacin", or "Gentamicin", or "Netilmicin");
III generation cephalosporins (or "Ceftriaxone" or "Cefotaxime") in combination with aminoglycosides.

In late neonatal sepsis, one of the antibiotic therapy regimens is similar to the latter (a combination of third generation cephalosporins with aminoglycosides). In the pulmonary form, "Vancomycin" and aminoglycosides are prescribed. For catheterization sepsis, "Vancomycin" is used. An alternative treatment regimen is Linezolid.

Use of probiotics and antifungal drugs

Antibiotic therapy is quite long in this pathological process. Such a long and intensive treatment of sepsis in children can provoke dysbiosis. For its prevention, together with antibiotics, probiotics (Linex, Bifiform, Bifidumbacterin) and Fluconazole are prescribed.

Proper feeding is important. Young children should be fed with breast milk. In its absence, pediatricians recommend using special mixtures that contain bifidobacteria or probiotics.

Pathogenetic therapy

The named direction in the treatment of sepsis includes several elements:

immunocorrective therapy;
restoration of electrolyte and water balances and correction of acid-base disorders;
detoxification therapy;
anti-shock therapy;
restoration of the functions of the affected systems and organs.

The measures included in pathogenetic therapy are as follows.

Immunocorrective therapy	Means and methods of immunocorrection are varied. They include: exchange blood transfusion; hemosorption; plasmapheresis. Currently, during antibiotic therapy, children are injected with IgG preparations. They are effective at the onset of sepsis. At the 3-5th week of the pathological condition, these drugs no longer give the expected result.
Restoration of electrolyte and water balances, correction of acid-base disorders and detoxification therapy	Correction is provided by the use of oxygen therapy. Detoxification treatment includes infusion therapy using glucose-saline solutions and fresh frozen plasma, albumin
Anti-shock therapy	Speaking about how sepsis manifests itself in children, it is worth noting that septic shock is a serious consequence of this pathological process. To reduce the likelihood of its occurrence, anti-shock therapy is performed. It includes the introduction of Ig, "Hydrocortisone". Anti-shock therapy includes daily transfusions of fresh frozen plasma in combination with "Heparin"
Correction of cardiovascular disorders	In case of systemic arterial hypotension, cardiotonics are prescribed (or "Dopamine", or "Dobutamine"). With a decrease in cardiac output, children are injected with a cardiac glycoside ("Digoxin")

Evaluation of the effectiveness of treatment

Antibiotic therapy plays a major role in the treatment of sepsis. Thanks to her, pathogens of the pathological process die in the body. That is why experts assess the effectiveness of treatment. Antibiotic therapy is considered effective if, after 72 hours from the start of the drug intake:

the general condition of the child improves;
body temperature normalizes or decreases;
decreases tachycardia;
shortness of breath decreases;
laboratory parameters are normalized.

Antibiotic therapy, which is effective, lasts for 3 weeks (minimum). Then it is canceled by a specialist. After 4-6 weeks from the start of treatment, the functions of internal organs and systems are fully restored, the pallor of the skin disappears.

In conclusion, it is worth noting that sepsis (photos in children of this pathological process do not give a complete picture of this disease) is a dangerous condition that can occur in any newborn baby. Despite the rapid development of medicine, children continue to die from sepsis. Statistics show that out of 1,000 newborns, 4-5 babies die from this pathology.

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The condition, which in the medical community is called sepsis, is considered one of the most dangerous pathologies. Blood infection affects absolutely the entire body, including mucous membranes, soft tissues and biological fluids. As a result, the inflammatory process spreads with lightning speed, and its pathogens release toxic substances that can even lead to death.

The first signs of blood poisoning in humans

The main characteristic symptoms of sepsis at the very beginning of infection:

chills turning into a febrile state;
skin rash, usually hemorrhagic, but sometimes papular;
aching joints and bones ();
muscle weakness, lethargy;
general tiredness, drowsiness.

It is worth noting that early clinical manifestations directly depend on the causative agent of sepsis. In some cases, the signs are practically absent, and sometimes they appear and progress very quickly, within 24-48 hours.

How is general blood poisoning manifested?

The further development of infection of the biological fluid is characterized by the following symptoms:

an increase in the size of the spleen and liver;
a sharp increase in body temperature up to 40 degrees and above;
increased sweat separation;
stool disorders;
lack of appetite, fasting or;
a decrease in the intensity of contraction of all muscles in the body (physical inactivity);
the formation of large abscesses in the tissues;
diarrhea and vomiting, leading to dehydration, other dyspeptic disorders;
feeling thirsty;
instability of the mental state (apathy and depression, turning into joyful excitement, euphoria);
hyperemia of the skin of the face;
sunken cheeks;
the appearance of red spots or stripes on the shoulders, forearms (due to petechial hemorrhages);
bleeding of the mucous membranes, especially in the mouth;
herpetic lesions of the lips;
difficulty breathing;
fever with delusional states.

These clinical manifestations arise due to the complete intoxication of the body with harmful substances that release pathogenic bacteria in the process of life. Poisons and toxins, once in the blood and lymph, are instantly spread throughout the body, penetrating into soft tissues, mucous membranes, internal organs and even joints and bones.

Consequences of blood poisoning

In the absence of adequate antibiotic therapy, the outcome of the disease is disappointing - the activity of all body systems is disrupted, signs of peritonitis, pneumonia are revealed. Further, there is hypotension, dysfunction of many organs, hypoperfusion. With a decrease in the blood supply to the tissues, septic shock develops, after which death occurs.

Can blood poisoning be treated?

Sepsis therapy is necessarily carried out in a hospital setting, and in an intensive unit. The combined treatment regimen includes:

If there are open infected wounds or purulent foci, local treatment is also recommended, in some cases - surgical intervention with excision of the affected dead tissue, antiseptic treatment, drainage, suturing or the use of plastic techniques.