Sepsis is an acute systemic infection caused by pathogenic or opportunistic bacteria invading the bloodstream, where they multiply and produce toxins and other metabolites. Clinically, it is characterized by shivering, high fever, rash, arthralgia, and hepatosplenomegaly. Some cases may present with septic shock and metastatic sexually transmitted disease lesions.

bubble_chart Etiology

Human factors:

1. When the skin or mucous membranes are damaged or have suppurative inflammation, bacteria can easily invade the body.
2. The human immune response can be divided into non-specific immune responses and specific immune responses, with the latter further categorized into cellular immunity and humoral immunity. When the body's immune function declines, its ability to phagocytose and eliminate bacteria is impaired, allowing even a small number of less virulent bacteria to cause septicemia.
3. Nosocomial infections caused by opportunistic pathogens are also gradually increasing.

These are primarily related to the virulence and quantity of the pathogens. The likelihood of septicemia increases when highly virulent or large numbers of pathogenic bacteria enter the body.

bubble_chart Clinical Manifestations

1. Primary inflammation: The primary inflammation caused by various pathogenic bacteria is related to their distribution sites in the human body. The characteristics of primary inflammation include local redness, swelling, heat, pain, and dysfunction.
2. Toxemia symptoms: The onset is often abrupt. Common symptoms include shivering, high fever, fever which is mostly remittent or intermittent, but may also be continuous, irregular, or biphasic—the latter often caused by gram-negative bacilli septicemia. Fever is accompanied by varying degrees of toxemia symptoms, such as headache, nausea, vomiting, abdominal distension and fullness, abdominal pain, general malaise, and muscle and joint pain.
3. Rash: Seen in some patients, with petechiae being the most common, mostly distributed on the trunk, limbs, conjunctiva, and oral mucosa, and usually few in number.
4. Joint symptoms: Large joints may exhibit redness, swelling, heat, pain, and limited movement, and may even develop joint effusion or empyema. These symptoms are more common in the course of septicemia caused by gram-positive cocci, meningococci, or Alcaligenes bacteria.
5. Septic shock: Seen in about 1/5 to 1/3 of septicemia patients, manifesting as restlessness, rapid and thready pulse, cold extremities, mottled skin, reduced urine output, and hypotension. DIC may also occur due to severe toxemia.
6. Hepatosplenomegaly: Generally only grade I enlargement.

bubble_chart Auxiliary Examination

1. Blood picture: The total white blood cell count is mostly significantly increased.
2. Etiological examination:
   1. Bacterial culture.
   2. Bacterial smear: Direct smear examination of pus, cerebrospinal fluid, pleural ascites, petechiae, etc., can also detect pathogenic bacteria, which has certain reference value for the rapid diagnosis of septicemia.

bubble_chart Treatment Measures

1. General and symptomatic treatment: Bed rest, enhanced nutrition, and supplementation with appropriate vitamins. Maintain water, electrolyte, and acid-base balance. Transfusions of blood, plasma, albumin, and gamma globulin may be administered when necessary. Physical cooling measures can be used for high fever, and sedatives may be given for dysphoria.
2. Pathogenic treatment: Timely selection of appropriate antibacterial drugs is key to treatment. Emphasis should be placed on early and sufficient administration, primarily using bactericidal agents. Generally, two antibacterial drugs are combined and administered intravenously. The initial dose should be relatively large, with attention paid to the drug's half-life and divided dosing. The treatment course should not be too short, typically lasting more than three weeks, or medication may be discontinued 7–10 days after fever subsides, depending on the situation.
3. Management of local lesions: For purulent sexually transmitted disease lesions, whether primary or metastatic, appropriate and sufficient antibiotics should be used as a foundation, along with seasonal epidemic puncture or incision and drainage. For purulent pleuritis or joint abscesses, antibacterial drugs may be locally injected after puncture and drainage. Surgical intervention should be considered for biliary tract or urinary tract infections with obstruction.