Cryptogenic sepsis: symptoms and treatment

As is known, inflammatory diseases can affect any organ. They are divided into 2 types: acute and chronic processes. Timely diagnosis and therapy of inflammatory pathologies often leads to complete cure or remission. If the body's immune system is weakened, the disease progresses. Regardless of location, the focus of inflammation is always delimited. Under the influence of adverse factors or in the absence of treatment, the process may spread. As a result, the bacterial particles enter the bloodstream. This condition is called sepsis. This complication is quite dangerous, since it can lead to shock and death.

Cryptogenic sepsis - what is it?

Depending on the localization of the focus of primary inflammation, several types of sepsis are distinguished. It is worth remembering that any disease can lead to the ingress of pathogenic microorganisms into the blood. Most often it is pneumonia, inflammatory processes of the skin, oral cavity, ENT organs. In some cases, the primary focus can not be established. Then the disease is called "cryptogenic sepsis". Such a diagnosis does not mean that there was no primary inflammatory focus. Nevertheless, at the time of the examination, the bacteria already got into the blood and spread through the body. Therefore, it is not possible to establish the cause of sepsis. This type of disease is less common than others. Cryptogenic sepsis is the infection of blood with bacteria without an established primary inflammatory focus. Often pathology occurs in premature newborns, people with weak immunity. In most cases, the disease is difficult. With timely-initiated therapy, a complete cure is possible.

Causes of Cryptogenic Sepsis

If the primary inflammatory focus is difficult to establish and the bacteria have already penetrated the blood, then a diagnosis of "cryptogenic sepsis" is made. The causes of this disease can be different. Usually the etiology does not differ from other types of sepsis. The difference is that the inflammation in some organ develops too quickly or the patient's immunity is significantly reduced. At the same time, the time from the onset of the disease to the spread of the infection (breakthrough of the focus) is reduced. In this case, the patient does not have time to understand which symptoms began to disturb him in the first place. In most patients, the primary focus can be detected after a survey. If it still does not find, then the pathology is classified as cryptogenic sepsis. Causes of the disease:

1. Bacterial infection. The causative agents of sepsis can be any microorganisms. Most often these are staphylococci and streptococci, Proteus, Pseudomonas and E. coli.
2. Conditionally pathogenic microflora. As is known, in the body there are many bacteria that are present in the norm. With a decrease in immune defense , the opportunistic microflora begins to grow, which leads to various diseases. As a result, cryptogenic sepsis may develop.
3. Infections caused by pathogenic fungi (candidiasis).
4. Primary and secondary immunodeficiencies (HIV).
5. Period of prematurity, newborns with low body weight (up to 2 kg).
6. Intrauterine infections.

Mechanism of sepsis development

Cryptogenic sepsis - what is it? A similar diagnosis is made in the absence of a primary pathology capable of leading to blood poisoning. Cryptogenic sepsis is also called primary, or idiopathic. It develops when pathogenic microorganisms enter the bloodstream. As a result, bacteria are carried throughout the body. As a result, inflammatory foci can be localized in several places at once. In addition, bacterial intoxication develops. In such cases, the immune system is not able to cope with a large number of pathogens. Often this condition leads to disruption of the cardiovascular system. As a result, bacterial shock develops. This complication is a great danger and often leads to death.

Classification of cryptogenic sepsis

Considering the fact that the primary localization of the pathological focus is unknown, cryptogenic sepsis is not classified by etiological trait. Nevertheless, it is necessary to establish an infectious agent for carrying out adequate antibiotic therapy. Like other types of sepsis, this variant pathology can occur in 2 forms. Nevertheless, this classification does not affect the prognosis of the disease. Forms of cryptogenic contamination of blood:

1. Septicemia. It implies the presence of a bacterial or fungal microflora that circulates throughout the body. Nevertheless, the pathogens do not form foci of infection.
2. Septicopyemia. In addition to the presence of bacteria in the blood, their organs are contaminated. Often, pathogens accumulate (settle) in the lungs, brain, abdominal cavity. As a result, foci of purulent inflammation form in these regions.

The clinical course distinguishes lightning, acute and chronic sepsis. In the first case, the disease develops already in the first day after the penetration of the pathogen and is characterized by severe impairment of the functions of organs and systems. Acute sepsis lasts about 2-4 weeks. Chronic lesions can last for several months and even years. It is characterized by the development of exacerbations and remissions. In some cases, a subacute variant of the course of sepsis is observed. Its duration is from 6 to 12 weeks.

Symptoms of cryptogenic sepsis

Only by testing blood for sterility, one can judge whether a person has cryptogenic sepsis. Symptoms of this disease can resemble many other pathologies. This is due to the fact that with all inflammatory processes, intoxication of the organism develops. Nevertheless, the doctor may suspect the disease on the basis of a characteristic clinical picture. First of all, such a diagnosis is assumed only with the exclusion of other inflammatory pathologies. There are following symptoms of sepsis:

1. Elevated body temperature up to 39-40 degrees. Hyperthermia is accompanied by chills, sweating and headache.
2. Deterioration of the condition. At a sepsis weakness, pains in muscles and joints without the certain localization, depression of appetite is observed.
3. Tachycardia is an increase in heart rate.
4. Reduced blood pressure.
5. Increased respiratory rate.
6. Violation of the functions of the liver. It is manifested by the development of jaundice, an increase in the size of the organ (hepatomegaly).
7. Lesion of the digestive tract. Some patients have a disorder of stool (diarrhea), nausea and vomiting.
8. The appearance of hemorrhage on the skin.

With the development of septicopyemia, there may be other symptoms. They depend on the localization of inflammatory foci. Endocarditis and pneumonia often develop.

Diagnostic criteria for cryptogenic sepsis

The diagnostic criteria of sepsis include the clinical manifestations of the disease, as well as the changes observed in the conduct of laboratory and instrumental research methods. First of all pay attention to the general condition of the patient. With its deterioration for several days, despite the implementation of antibiotic therapy, you can suspect cryptogenic sepsis. The signs that indicate this disease are the earthy (grayish) color of the skin, the general weakness, the increased temperature and the appearance of cutaneous hemorrhages. Also, the characteristic clinical manifestations include the attachment of jaundice and hepatomegaly. If you have these symptoms, you need to immediately hospitalize the patient and conduct a survey.

Laboratory and instrumental diagnostics

In cryptogenic sepsis, there are significant changes in laboratory parameters. In the OAB there is leukocytosis, thrombocytopenia and anemia, as well as acceleration of ESR. Bacteria can be present not only in the blood, but also in the urine. Changes are observed in biochemical parameters. These include the appearance of C-reactive protein, possibly an increase in the level of bilirubin, ALT, AST (with liver damage). The main marker of sepsis is a blood test for sterility (blood culture on the microflora). Thanks to this study, it is possible to identify the causative agent of the disease and prescribe a treatment.

Instrumental diagnostics is carried out with the purpose of detection of the centers of septic defeat. For this, chest X-ray, ultrasound of the abdominal cavity and small pelvis is performed. Often found inflammation in the lungs - pneumonia, liver enlargement - hepatomegaly.

Cryptogenic sepsis: ICD-10 code

Like any pathology, this disease has a certain code in the international classification. It is exposed depending on the pathogen causing cryptogenic sepsis. ICD-10 is a special classification that operates around the world. In the case history, the diagnosis is first written, and then its code. In the case of cryptogenic sepsis, the cipher will be A41.9 (septicemia, unspecified). Having seen the code of ICD-10, the doctor of any medical organization in another country will understand what diagnosis was made to this patient.

Possible complications of sepsis

With an incorrect approach to treating sepsis, severe complications develop. Among them - a shock state, thromboembolism of the pulmonary artery, bacterial endocarditis, ONMI, depletion of the body and bleeding. Each of these conditions can cause the death of the patient. Therefore, in the formulation of this diagnosis, it is urgent to start antibacterial and symptomatic therapy.

Treatment of cryptogenic sepsis

First of all, if this disease is found, the patient should be hospitalized and bed rest is prescribed. Also, these measures are necessary if there is a suspicion of cryptogenic sepsis. Treatment begins immediately after diagnosis. The main group of drugs is antibiotics. Assign a combination of 2-3 medications. The most commonly used drugs are Penicillin, Ceftriaxone, Gentamicin, Imipenem, etc. Since there is an intoxication of the body, infusion therapy is prescribed. Intravenously injected crystalloid and colloidal solutions, according to indications, hemotransfusion is performed. Immunostimulants, antipyretic and analgesic agents are also shown. If a foci of infection is identified, surgical intervention is necessary. With the development of septic shock, prescribe vasopressors (drug "Dopamine"). Nutrition of patients is performed parenterally or through a probe.

Forecast for cryptogenic sepsis

The prognosis for cryptogenic sepsis depends on the general condition of the patient's body (immunity), age, and timeliness of treatment. With adequate therapy and absence of complications, complete recovery is observed. The most favorable prognosis is subacute and chronic sepsis. With lightning-fast flow, the disease often leads to death. Despite antibacterial therapy, the mortality from this pathology is about 50% of cases.

Prevention of cryptogenic sepsis

Sepsis often develops in people with chronic inflammatory diseases. Therefore, preventive measures include the timely treatment of foci of infection, the use of immunostimulating drugs and vitamins. To prevent the disease in newborns and young children, the expectant mother must exclude bad habits, taking medications, hypothermia.