Infectious Disease Emergencies




(1)
Royal Free NHS Foundation Trust, London, UK

 




Sepsis definitions

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME



  • CRITERIA: Requires two or more of the following:



    • Temperature >38 C or <36 degrees Centigrade


    • Heart rate >90 beats/minute in the absence of beta-blocker


    • Respiratory rate >20 breaths/minute or paCO2<4.2 kPa (32 mmHg)


    • White blood cell count >12,000/cu.mm, <4000/cu mm or >10% immature forms (left shift)


  • SEPSIS



    • SIRS in a patient with a confirmed source of infection


  • SEVERE SEPSIS



    • Sepsis in the presence of organ dysfunction and hypotension (<90 mmHg or 40 mmHg reduction from normal blood pressure in the absence of other causes of hypotension)


  • SEPTIC SHOCK

    Sepsis (SIRS + infection) with a systolic blood pressure <90 mmHg or a drop of

    >30 mmHg, despite adequate resuscitation and signs of perfusion deficits (i.e. lactic acidosis, oliguria, depressed mental status)

    May not be hypotensive if vasopressors or inotropes are being used.


Causes of fever of unknown origin





  • Infection



    • Bacterial: tuberculosis; infective endocarditis; liver abscess; perinephric abscess; subphrenic abscess; bone and joint infections


    • Viral: Epstein Barr virus; AIDS


    • Chlamydial


    • Rickettsial


    • Fungal


    • Protozoal: amoebic liver abscess


  • Connective tissue disease: polyarteritis nodosa; systemic lupus erythematosus; Still’s disease; polymyalgia rheumatica; temporal arteritis


  • Malignancy: lymphoma; leukaemia; solid tumours: renal cell carcinoma; hepatocellular carcinoma


  • Inflammatory bowel disease


  • Drug fever


  • Factitious fever (failure of temperature to follow normal diurnal cycle; health care professional; normal pulse and respiratory rate with fever, rapid defervescence without sweating; very high temperature 106 F or greater)


Fever check list





  • Localising symptoms


  • Pattern and duration of fever


  • Temperature-pulse relationship (relative bradycardia)


  • Drug history, including intravenous drug use


  • Travel history


  • Sexual history


  • Sick contacts


  • Animal contacts


  • Occupational history


  • Immunisation history


  • Implanted medical devices and prostheses


  • Past history of serious, protracted, unusual recurrent infections


Sources of infection in sepsis



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Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Infectious Disease Emergencies

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