subject: Septecemia Homeo Cure [print this page] Animals mount both local and systemic responses to microbes that traverse epithelial barriers and invade underlying tissues. Fever or hypothermia, leukocytosis or leukopenia, tachypnea, and tachycardia are the cardinal signs of the systemic response If infection is suspected or proven, a patient have sepsis .
When sepsis is associated with dysfunction of organs distant from the site of infection, the patient has severe sepsis. Severe sepsis may be accompanied by hypotension or evidence of hypo perfusion. When hypotension cannot be corrected by infusing fluids, the diagnosis is septic shock.
Sepsis is usually reversible, whereas patients with septic shock often succumb despite aggressive therapy.
Epidemiology
The septic response is a contributing factor in many deaths per year in the world. The incidence of severe sepsis and septic shock has increased over the past 20 years. Approximately two-thirds of the cases occur in patients with significant underlying illness. Sepsis-related incidence and mortality rates increase with age and preexisting comorbidity.
Etiology
Severe sepsis can be a response to any class of microorganism. Microbial invasion of the bloodstream is not essential for the development of severe sepsis, since local inflammation can also elicit distant organ dysfunction and hypotension. In fact, blood cultures yield bacteria or fungi in only 20-40% of cases of severe sepsis and 40-70% of cases of septic shock. Individual gram-negative or gram-positive bacteria account for 70% of these isolates.
In patients whose blood cultures are negative, the etiologic agent is often established by culture or microscopic examination of infected material from a local site.
In some case series, a majority of patients with a clinical picture of severe sepsis or septic shock have had negative microbiologic data.
Patho physiology
Most cases of severe sepsis are triggered by bacteria or fungi that do not ordinarily cause systemic disease in immuno competent hosts These microbes probably exploit deficiencies in innate host defenses to survive within the body. The septic response may also be induced by microbial exo toxins that act as super antigens.
Clinical Manifestations
Hyperventilation
Disorientation
Confusion
Encephalopathy may also develop early on, particularly in the elderly and in individuals with preexisting neurologic impairment.
Focal neurologic signs are uncommon, although preexisting focal deficits may become more prominent.
Hypotension
DIC (disseminated intravascular coagulation)
Cellulitis ,pustules, bullae, or hemorrhagic lesions may develop when hematogenous bacteria or fungi seed the skin or underlying soft tissue.
Bacterial toxins may also be distributed hematogenously and elicit diffuse cutaneous reactions.
A cutaneous lesion seen almost exclusively in neutropenic patients is ecthyma gangrenosum, usually caused by P. aeruginosa. It is a bullous lesion, surrounded by edema that undergoes central hemorrhage and necrosis
Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and ileus may suggest acute gastroenteritis.
Stress ulceration can lead to upper gastrointestinal bleeding.
Cholestatic jaundice, with elevated levels of serum bilirubin mostly conjugated and alkaline phosphatase, may precede other signs of sepsis.
Prolonged or severe hypotension may induce acute hepatic injury or ischemic bowel necrosis.
Blood lactate levels rise early because of increased glycolysis
The blood glucose concentration often increases, particularly in patients with diabetes, although impaired gluconeogenesis and excessive insulin release on occasion produce hypoglycemia.
Serum albumin levels decline as a result of decreased hepatic synthesis and the movement of albumin into interstitial spaces, which is promoted by arterial vasodilation.
Major Complications
Cardiopulmonary Complications
Sepsis-induced hypotension usually results initially from a generalized mal distribution of blood flow and blood volume and from hypovolemia.
Other factors that may decrease effective intravascular volume include dehydration from antecedent disease or insensible fluid losses, vomiting or diarrhea, and polyuria.
Renal Complications
Oliguria, azotemia, proteinuria, and nonspecific urinary casts are frequently found. Many patients are inappropriately polyuric; hyperglycemia may exacerbate this tendency.
Neurologic Complications
When the septic illness lasts for weeks or months, critical-illness polyneuropathy may prevent weaning from ventilatory support and produce distal motor weakness.
Homoeopathic approach:
Lachesis:
This remedy does its best work in localized pyaemia, traumatic
gangrene, and carbuncles.
The indications are blue skin, sensitive parts, great prostration and scanty discharges.
It has the prostration of Arsenicum but lacks its restlessness.
Rhus toxicodendron:
Produces a perfect picture of septicaemia, with redness and soreness
at the point of infection.
Chilliness, dry tongue, diarrhoea, restlessness.
Echinacea:
Pyaemia, dull aching in head and extremities.
Infections spreading from uterus, tympanitis, sensitive abdomen, foul discharges.
It seems to overcome to toxaemia of absorption.
Carbolic acid:
This, internally, is a neglected remedy in septicaemia.
Prostration, exhaustion to the point of collapse are indications.
The patient falls asleep from weariness and wakens un refreshed.
Arnica:
Anaemia and pyaemia, sore bruised sensations, loose stools, foul
odors.
A frequently indicated remedy in septic conditions.
Restlessness, anguish,local and general burning, vomiting and prostration.
