傳染病學(xué)課件：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，"冬季掃蕩"的日寇瘋狂抗日根據(jù)地。在孫家莊，哨兵催促正在做手術(shù)的白求恩大夫趕快撤離。白求恩卻說："加快手術(shù)速度。"當(dāng)時(shí)躺在手術(shù)床上的戰(zhàn)士叫朱德士，大腿粉碎性骨折。白求恩為了與敵人搶時(shí)間，不慎刺破手指。他將手指伸進(jìn)消毒液中，浸泡了一下，堅(jiān)持縫完最后一針才轉(zhuǎn)移。10分鐘后，敵人沖進(jìn)村莊。

白求恩的手指發(fā)炎了，炎癥一天天加重。11月1日，又搶救一名丹毒合并蜂窩組織炎的傷員吳明。這是外科一種烈性傳染病，發(fā)炎的手指第二次受到細(xì)菌致命的感染。后來，在手指疼痛的折磨中，他又連續(xù)做了13臺(tái)手術(shù)，并寫下了治療瘧疾病的講課提綱。

11月7日，白求恩病情迅速惡化，左肘關(guān)節(jié)下發(fā)生轉(zhuǎn)移性膿瘍，領(lǐng)導(dǎo)強(qiáng)迫白求恩向后方醫(yī)院轉(zhuǎn)移。當(dāng)?shù)竭_(dá)南太平地時(shí)，白求恩聽到前沿有槍聲，便叫擔(dān)架停下來，想到陣地看一看傷員。但此時(shí)他高燒已達(dá)40攝氏度，渾身癱軟。10日到達(dá)唐縣黃石村，白求恩的病情已十分危險(xiǎn)。大家很著急，白求恩卻平靜地說："我得了膿敗血癥，沒有辦法了……請(qǐng)轉(zhuǎn)告毛主席，我相信中國人民一定會(huì)獲得解放，遺憾的是我不能親眼看到新中國誕生了……

11月12日清晨5點(diǎn)，白求恩大夫與世長辭，靈柩被秘密掩埋在村南青山秀水的狼山溝門。Treatment1.Fundamentaltreatmentandsymptomatictreatment2.Pathogentreatm