Septicarmia & Sepsis, 5TH MBBS, ESUCOM By Dr. Okpara T.C. & Dr. Okorie G.O., M2

Combined Summary: Septicaemia & Sepsis Septicaemia (Dr. Okpara T.C.) Septicaemia = bacterial infection of the blood (bacteraemia). Dangerous because bacteria and toxins spread systemically. Trigger: inflammation → blood clots → organ failure. Septic shock = sepsis + extremely low BP → often fatal. Common causes: UTI, pneumonia, pyelonephritis. Risk factors: severe wounds/burns, very young/old, immunocompromised, indwelling catheters, chemotherapy, steroids. Symptoms: chills, fever, tachypnoea, tachycardia, confusion, nausea/vomiting, DIC (bleeding into skin), oliguria, shock. Diagnosis: FBC, platelets, clotting time, pan-culture (urine, blood, sputum, wound swabs), X-ray, USS. Treatment: IV fluids, broad-spectrum IV antibiotics (then targeted), oxygen, blood transfusion. Sepsis (Dr. Okorie G.O.) Sepsis = life-threatening organ dysfunction due to dysregulated host response to infection (Sepsis-3, 2016). Old term SIRS (temp >38/<36, HR >90, RR >20, WBC abnormal) is now less emphasised. Sepsis subsets (old) : Sepsis = SIRS + infection; Severe sepsis = organ dysfunction; Septic shock = persistent hypotension despite fluids, requiring vasopressors. Epidemiology: ~49 million cases/11 million deaths globally (2017). Highest burden: sub-Saharan Africa, Oceania, SE Asia. Most common cause of in-hospital death in USA. Pathophysiology: Local infection → dysregulated inflammation → cytokine release (IL-2, IL-6, TNFα) → vasodilation, capillary leak, endothelial damage → coagulation activation → microthrombi → tissue hypoxia → organ failure. Risk factors: age (elderly 60-85%), immunosuppression (HIV, DM, cancer, steroids, malnutrition), invasive procedures/catheters. Clinical features: fever (not always), breathlessness, confusion, tachycardia, tachypnoea, hypotension, warm peripheries, bounding pulse, oliguria. Investigations: cultures (gold standard), procalcitonin, CRP, lactate, FBC, EUCr, LFTs, clotting profile, imaging. Treatment – SEPSIS SIX: (1) high-flow O2, (2) blood cultures, (3) IV antibiotics, (4) lactate + FBC, (5) IV fluids, (6) accurate urine output. Other: haemodynamic support (vasopressors, transfusion), mechanical ventilation, dialysis, stress ulcer prophylaxis. Complications: AKI, DIC, respiratory failure, brain death, liver failure. Prognosis: poor in resource-poor countries; early intervention improves outcome.