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SYSTEMIC MANIFESTATION OF SEPSIS

Dr Faiza Yasin

Consultant Neonatologist

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ORGANISMS

  • Bacterial – Ecoli, Klebsiella pneumoniae, acinetobacter baumannii, Serratia marcescens, Listeria monocytogenes, Group B streptococcus

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  • Viral - enterovirus, herpes simplex, cytomegalovirus, enterovirus, Epstein-Barr virus, HSV types 1 and 2, human herpes virus 6, varicella zoster, SARS CoV-2

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  • Fungal – candida, Cryptococcus neoformans/gattii �

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MENINGITIS COMPLICATIONS

  • Acute:
  • Cerebral edema (vasogenic and cytotoxic)
  • Ventriculitis
  • Cerebritis
  • Hydrocephalus
  • Brain abscess
  • Cerebral infarction, and subdural effusion or empyema.4

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  • Longterm: Moderate to severe neurodisabilities.

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VENTRICULITIS

- Inflammation of the ventricular fluid and lining of the ventricles

- sometimes obstruction to cerebrospinal fluid flow.

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- 5 to 10 percent of cases

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GASTROENTERITIS

  • Common presentation of sepsis- diarrhea, bloody diarhea, vomiting, poor feeding, dehydration, renal failure
  • Etiolgy- Gram negative bacteria esp.Ecoli, rota virus

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  • Breastfeeding, minimal exposure to water and contaminated food, passive maternal immunity
  • Rota virus vaccination

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Goal of treatment:

  • Rehydration
  • Correction of electrolyte imbalance, hypoglycemia
  • Infection
  • Maternal education for hygiene

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URINARY TRACT INFECTIONS

  • Urinary tract infection (UTI) - bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT).
  • Upper tract infections (ie, acute pyelonephritis) - kidney parenchymal scarring and chronic kidney disease.
  • More common in LOS (10-20%)
  • Etiology – gram negative bacteria esp Ecoli, gram positive CONS
  • Premature babies - candida

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CLINICAL MANIFESTATION

Fever, Irritability, Lethargy,

Poor feeding , Vomiting, Loose stools (3 to 5 percent)

Apnea (most common in preterm neonates)

Jaundice

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DIAGNOSIS

Urine dipstick

  • Pyuria >5/hpf
  • Leucocyte esterase
  • Nitrite

Urine culture

  • Catheter sample - 50,000cfu/ml
  • Supra pubic aspiration - 1000cfu/ml

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  • Imaging to detect CAKUT

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OSTEOMYELITIS

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  • Hematogenous seeding

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  • Etiology: Staph. Aureus, gram negative bacilli, GBS

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CLINICAL MANIFESTATION

Clinical scenario of sepsis

Surgical intervention

Trauma

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Localised signs including, swelling, redness, tenderness, reduced movement

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Blood culture

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Radiographic findings that are compatible with osteomyelitis include

- Evidence of periosteal new bone formation (periosteal reaction)

- Periosteal elevation (suggestive of periosteal abscess)

- Lytic lesions or sclerosis, indicating subacute/chronic infection

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