Septicemia

Causes and Risks:
Septicemia is a serious, rapidly progressive, life-threatening infection that may arise secondary to localized infections of the respiratory , genitourinary and gastrointestinal tract or from the skin. It may precede or coincide with infections of the bone ( osteomyelitis ), central nervous system ( meningitis ,) or other tissues. Septicemia can rapidly lead to septic shock and death. Septicemia associated with some organisms such a meningococci can lead to shock , adrenal collapse and disseminated intravascular coagulopathy , a condition called Waterhouse-Friderichsen syndrome .

Onset of septicemia is heralded by spiking fevers and chills, rapid breathing and heart rate, the outward appearance of being seriously ill (toxic) and a feeling of impending doom. These symptoms rapidly progress to shock with decreased body temperature (hypothermia), falling blood pressure, confusion or other changes in the mental status, and clotting abnormalities evidenced by hemorrhagic lesions in the skin (petechiae and ecchymosis).

Prevention:
Appropriate treatment of localized infections can prevent septicemia. HIB vaccine for children has already reduced the incidence of Hemophilus septicemia (and Hemophilus meningitis , epiglottitis , and periorbital cellulitis ) and is a routine part of the recommended childhood immunization schedule. Children who have had their spleen removed or who have diseases that damage the spleen (such as sickle cell anemia ) should receive pneumococcal vaccine. Pneumococcal vaccine is not part of the routine childhood immunization schedule.

Close contacts (parents, siblings, friends) of septic children with certain organisms such as pneumococcus, meningococcus, and Hemophilus may require preventive antibiotic therapy. This will be prescribed by the health care provider and the type of antibiotic will be determined by the organism involved.

Symptoms:
  • fever (sudden onset, often spiking)
  • chills
  • toxic looking (looks acutely ill)
  • changes in mental state

  • shock
    • cold
    • clammy
    • pale
    • cyanotic (blue)
    • unresponsive

  • skin signs associated with clotting abnormalities
    • petechiae
    • ecchymosis (often large, flat, purplish lesions that do not blanch when pressed)
    • gangrene (early changes in the extremities suggesting decreased or absent blood flow)

  • decreased or no urine output



Signs and Tests:
Physical examination may show:

Tests that confirm infection include:



Treatment:
This disorder must be treated in a hospital, usually with admission to an intensive care unit.

Intravenous (IV) fluids are given to maintain the blood pressure . Strong IV drugs called sympathomimetics are often needed to maintain the blood pressure. Oxygen therapy is begun to maintain oxygen saturation.

The infection is treated with broad spectrum antibiotics (those that are effective against a wide range of organisms) before the organism is identified. Once cultures have identified the specific organism that is responsible for the infection, antibiotics that are specific for that organism are begun.

Plasma or other treatment may be needed for correction of clotting abnormalities.

Prognosis:
Septic shock has a high death rate, exceeding 50%, depending on the type of organism involved. The organism involved and the immediacy of hospitalization will determine the outcome.

Complications:



Call Your Healthcare Provider:
Septicemia is not common but is devastating and early recognition may prevent progression to shock .

  • Any child with fever , shaking chills, and who looks acutely ill should be seen immediately as an emergency.
  • Any child with evidence of bleeding into his skin should be seen immediately as an emergency.
  • Any child who has been ill and has any changes in mental status should be seen immediately as an emergency.

Call your health care provider if your child is not current on vaccinations or has not had immunizations for Hemophilus influenza B , commonly referred to as a HIB shot. If your child has a damaged spleen from any disease process or has had it removed, schedule an appointment for an immunization against pneumococcal disease.


Necrosis can occur any time there is abnormal coagulation within the blood vessels. In this person, all circulation to the toes and front part of the foot has ceased and gangrene has developed in the toes. This condition in infants may follow infection with meningococci, generalized sepsis, and disseminated intravascular coagulation.



Purpura is a condition characterized by bleeding into the skin or other tissue. Purpura fulminans is a rapidly progressive form of purpura. It usually occurs in children and frequently results in death. This picture shows a critically ill child with purpura fulminans on the lower extremities.







Infection by the meningococcus organism causes damage to the blood vessels with subsequent clotting within the vessels. This causes loss of blood flow to tissue, which results in discoloration and tissue death.



Insufficient blood flow has caused tissue death (necrosis) and gangrene of the middle two toes, which have become black.



The red, slightly elevated skin lesion on this infant's left cheek resulted from septicemia caused by pseudomonas. This is a skin manifestation of widespread infection. The discharge from the nose contains pus (purulent).



This is a close-up picture of a skin lesion in a child with pseudomonas septicemia.



A close-up picture of a skin lesion on the chest of a child with pseudomonas septicemia.



Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. There is usually bleeding into the skin (petechiae and purpura), and the tissue in these areas may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring.



Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) may occur. The tissue in areas may die (become necrotic or gangrenous). If the person survives, the areas heal with scarring.



Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. There is usually bleeding into the skin (petechiae and purpura), and the tissue in these areas may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring. This picture demonstrates more hemorrhage and little tissue death.



Meningococcemia is a life-threatening infection that occurs when the bacteria, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) typically occurs and the tissue may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring.



This is a gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenza, one of the most common causes of childhood meningitis (prior to the widespread use of the H. influenza vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenza (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4 and 12 months.