传染病学课件：septicemia

septicemia

TONGJIMEDICALCOLLEGE

HUAZHONGUNIVERSITYOFSCIENCE&TECHNOLOGYDefinitionBacteremia:

presenceofbacteriaintheblood,asevidencedbypositivebloodculture.It’stransientandrelativelymild.Septicemia:

aclinicalsituationduetotheinvasionandproliferationofmicrobesandthereleaseoftoxinsintheblood,it’saseverefatalblood-streaminfection.

SIRS

(Systemicinflammatoryresponsesyndrome)

twoormoreofthefollowingconditions

shouldbeincluded.

Fever>38℃orhypothermia＜36℃Heartrate>90bpmRespiration>24bpmorPaCO2＜4.3kPa(32mmHg)WBC>12×109/L,<4×109/L,or>10%immature"band"formsSepsis:clinicalevidencesuggestiveofinfection,plussignsofasystemicresponsetoinfectionorSIRScausedbyinfectionSeveresepsis:sepsiswithoneormoresignsoforgandysfunction,suchas:metabolicacidosis;acuteencephalopathy;oliguria;hypoxemia;DIC;hypotensionEarlysepticshock:clinicaldiagnosisofsepsissyndrom,asoutlinedabove,plushypotension<90mmHg(ora40-mmHgdecreasebelowbaseline)thatlastsfor<1handisresponsivetoconventionaltherapyRefractorysepticshock:clinicaldiagnosisofsepsisasabove,plushypotensionthatlastsfor>1hdespiteadequatetherapySepsissyndrom:

theaboveplusevidenceofalteredorganperfusion,oneormoreofthefollowing:

HypoxiaIncreasedplasmalactateOliguriaAlteredmentalstatus

BactrermiaMildSepticemiaSevereSepsisLife-threateningSepticshockAlmostirreversibleEtiology1.CommonpathogenicbacteriaG+coccobacteria（30%）

Staphylococcusaureus(S.aureus),e.g.:MRSA

Staphylococcusepidermidis(S.epidermidis)e.g.:MRSE

Streptococcuspneumoniae

hemolyticstreptococci

DgroupenterococcusstreptococcusEtiologyFeatures：

1.Anti-phagocytepolycosecaps

2.Hydrogendioxideinactivator,β-lactamase3.Induceabscess,metastaticfocusofinfection

4.Toxin

glyco-peptide（peptidepolyglucosan/teichoicacidcompound）enterotoxin

erythrogenictoxinEtiologyG-bacillus（60%）Fourtypes:

Escherichiacoli

,

Pseudononasaeruginosa,Klebsiella,AcinetobacterTwokindsofagents:

Endotoxin,LPS,LipideA

β-lactamase,ESBL,AmpCenzymeEtiologyAnaerobic（5%）Twotypes:

BacteroidesfragilispeptostreptococcusTwoagents:solubleexotoxin

HeparinaseEtiologyFungi（3%）Blastomyces(candida)albicans,Cryptococcus,Aspergillus

EtiologyFeaturesofpathogenicbacteria:

Conditionalpathogenicbacteria

MostarenormalflorainhumanbodyStrongresistance，mostareantibiotics-resistantbacteria

Dysbacteriaormicro-dysbiosis

occursFormingbacterialbiofilmEtiologyToxinsofpathogenicbacteria:Exotoxin—Gram-positivebacteria,proteinorenzyme,toleranttoheat,affectingnervoussystemEndotoxin—Gram-negativebacillus,bacterialcellwall,intoleranttoheat,strongtoxicity,inducingshockpathogenesisandpathology

Human

Bacteriacutaneousandmucosalbarrierstoxinshostresponsesenzymesiatrogenicfactors

cytokinesbasicaldiseasesinflammatorymediatorspathogenesisand

pathologyPathophysiologyLPS→mediatorsofinflammation→microcirculationdisturbanceoftargetorgans

pathogenesisand

pathologyPathologycelldegenerationandnecrosisofimportantorgansmetastasisexudativeinflammationofserouscavity

Micrangiumorbloodcapillaryhemorrhagemononuclearcyte-macrophageproliferationintumescence

ofliver,spleen,lymphnodeclinicalmanifestation1.Commonfeatures

toxemiasymptoms

skinlesions(rash)

jointinvolvement

hepatosplenomegaly

metastasisclinicalmanifestation2.Clinicalfeaturesofcommonsepticemia

staphylococcusaureussepticemia

metastasis

scalded-likerash

seawater-likediarrhea

SBE:subacutebacterialendocarditisTSS:toxicshocksyndromeclinicalmanifestationAnaerobesepticemia

hemolyticanemia

hyperbilirubinemia

thrombophlebitis

metastasis

stinking

subcutaneousgasclinicalmanifestation3.Othertypesofsepticemia

neonatalsepticemia

septicemiainseniors

postburn

septicemiasepticemiaingranulopenia

iatrogenicsepticemiaLaboratorytestsBlood-RTUrine-RTOthertestsmediatorsofinflammation,CRPEtiologybodyfluidculture,drugsensitivity

ImmunologytestDiagnosisPathogenicbacteriafrombloodorbonemarrowcultureareevidencesoffinaldiagnosis

ClinicaldiagnosisDifferentialDiagnosissubsepsisallergicamalignanthistocytosismalignantdiseasesofhematologicalsystemsuchasleukemiaconnectivetissuediseaseviralinfectionothers1939年10月28日，"冬季扫荡"的日寇疯狂抗日根据地。在孙家庄，哨兵催促正在做手术的白求恩大夫赶快撤离。白求恩却说："加快手术速度。"当时躺在手术床上的战士叫朱德士，大腿粉碎性骨折。白求恩为了与敌人抢时间，不慎刺破手指。他将手指伸进消毒液中，浸泡了一下，坚持缝完最后一针才转移。10分钟后，敌人冲进村庄。

白求恩的手指发炎了，炎症一天天加重。11月1日，又抢救一名丹毒合并蜂窝组织炎的伤员吴明。这是外科一种烈性传染病，发炎的手指第二次受到细菌致命的感染。后来，在手指疼痛的折磨中，他又连续做了13台手术，并写下了治疗疟疾病的讲课提纲。

11月7日，白求恩病情迅速恶化，左肘关节下发生转移性脓疡，领导强迫白求恩向后方医院转移。当到达南太平地时，白求恩听到前沿有枪声，便叫担架停下来，想到阵地看一看伤员。但此时他高烧已达40摄氏度，浑身瘫软。10日到达唐县黄石村，白求恩的病情已十分危险。大家很着急，白求恩却平静地说："我得了脓败血症，没有办法了……请转告毛主席，我相信中国人民一定会获得解放，遗憾的是我不能亲眼看到新中国诞生了……

11月12日清晨5点，白求恩大夫与世长辞，灵柩被秘密掩埋在村南青山秀水的狼山沟门。Treatment1.Fundamentaltreatmentandsymptomatictreatment2.Pathogentreatm