Sepsis, Thrombophlebitis

Septic Shock



Sepsis, Thrombophlebitis Emergency Medicine LInks

See related handout on skin Thrombophlebitis soft tissue infectionswritten by the authors of this article. Skin and soft tissue infections result from microbial invasion of the skin and Thrombophlebitis supporting structures, Sepsis. Management is determined by the severity and location of the infection and by patient comorbidities.

Infections can be classified as simple uncomplicated or complicated necrotizing or nonnecrotizingor as suppurative or nonsuppurative, Sepsis.

Most community-acquired infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus.

Simple infections are usually monomicrobial and present with localized clinical findings. In contrast, complicated infections can be mono- or Sepsis and may present with systemic inflammatory response syndrome. The diagnosis is based on clinical evaluation. Laboratory testing may be required to confirm an uncertain diagnosis, evaluate for deep infections or sepsis, determine the need for inpatient care, and evaluate and treat comorbidities. Initial antimicrobial choice is empiric, Thrombophlebitis, and in simple infections should cover Staphylococcus and Streptococcus species.

Patients Thrombophlebitis complicated infections, including suspected necrotizing fasciitis Sepsis gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, Thrombophlebitis, and surgical consultation for debridement. Superficial and small abscesses respond well to drainage and seldom require antibiotics. Immunocompromised patients require early treatment and Sepsis coverage for possible atypical organisms. Skin and soft tissue infections SSTIs account for more than 14 million physician office visits each year in the United States, as well as emergency department visits and hospitalizations.

Blood cultures seldom change treatment and are not required in healthy immunocompetent patients with SSTIs. Uncomplicated purulent SSTIs in easily accessible areas without overlying cellulitis can be treated with incision and drainage only; antibiotic therapy does not improve outcomes. Inpatient treatment is recommended for patients with uncontrolled SSTIs despite adequate oral antibiotic therapy; those who cannot tolerate oral antibiotics; those who require surgery; those with initial severe or complicated SSTIs; and those with underlying unstable comorbid illnesses or signs Thrombophlebitis systemic sepsis, Sepsis.

Treatment of necrotizing fasciitis involves early recognition and surgical debridement of necrotic tissue, combined with high-dose broad-spectrum intravenous antibiotics. For information about the SORT evidence rating system, Thrombophlebitis, go to http: Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue Thrombophlebitis after successful incision and drainage and with adequate medical follow-up.

For more information on the Choosing Wisely Campaign, see http: For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http: SSTIs are classified as simple Thrombophlebitis or complicated necrotizing or nonnecrotizing and can involve the skin, subcutaneous fat, fascial layers, Sepsis, and musculotendinous structures, Thrombophlebitis.

Information from reference 3. Simple infections confined to the skin and underlying superficial soft Thrombophlebitis generally respond well to outpatient management.

Common simple SSTIs include cellulitis, erysipelas, Sepsis, impetigo, ecthyma, Sepsis, folliculitis, furuncles, Creme von Krampfadern tun abscesses, Sepsis, and trauma-related infections 6 Figures 1 through 3. Complicated infections extending into and involving the underlying deep tissues include deep abscesses, decubitus ulcers, necrotizing fasciitis, Fournier gangrene, and infections from human or animal bites 7 Figure 4.

These infections may present with features of systemic inflammatory response syndrome or Thrombophlebitis, and, occasionally, ischemic necrosis. Perianal infections, Thrombophlebitis, diabetic foot infections, infections in patients with significant comorbidities, and infections from resistant pathogens also represent complicated infections.

Older age, cardiopulmonary or hepatorenal disease, diabetes mellitus, debility, immunosenescence or immunocompromise, obesity, Thrombophlebitis arteriovenous or lymphatic insufficiency, Thrombophlebitis, and trauma are among the risk factors for SSTIs Table 2. Information from references 9 through Predisposing factors for SSTIs include reduced tissue vascularity and oxygenation, Thrombophlebitis, increased peripheral fluid stasis and risk of skin trauma, Thrombophlebitis, and decreased ability to combat infections.

For example, Thrombophlebitis, diabetes increases the risk of infection-associated complications fivefold, Thrombophlebitis. Staphylococcus aureusStreptococcusanaerobes often polymicrobial, Thrombophlebitis. Polymicrobial Bacteroides, Bartonella henselae, Capnocytophaga canimorsus, Eikenella corrodens, Pasteurella multocida, Peptostreptococcus, S. Traumatic or spontaneous; severe pain at injury site followed Sepsis skin changes e.

Beta-hemolytic streptococci, Haemophilus influenzae childrenS, Sepsis. Candida, dermatophytes, Pseudomonas aeruginosaThrombophlebitis, S. Infection or inflammation of the hair follicles; tends to occur in areas with increased sweating; associated with acne or steroid use; painful or painless Thrombophlebitis with underlying swelling, Thrombophlebitis.

Walled-off Sepsis of pus; painful, firm swelling; systemic features of infection; carbuncles are larger, deeper, Thrombophlebitis, and involve skin and subcutaneous tissue over thicker skin of neck, back, and lateral thighs, and drain through multiple pores, Thrombophlebitis.

Common in infants and children; affects skin of Thrombophlebitis, mouth, or limbs; Thrombophlebitis soreness, redness, Sepsis, vesicles, and crusting; may cause glomerulonephritis; vesicles may enlarge bullae ; may spread to lymph nodes, bone, Thrombophlebitis, joints, or lung. Mental status changes and hypotension suggest worsening sepsis and hemodynamic Sepsis. Information from references 5 and Most SSTIs occur de novo, or follow a breach in the protective skin barrier from trauma, surgery, Thrombophlebitis, or increased tissue tension secondary to fluid stasis.

The infection may also originate from an adjacent site or from embolic spread from a distant site. In one prospective study, beta-hemolytic streptococcus was found to cause nearly three-fourths of cases Thrombophlebitis diffuse Sepsis. Lymphatic and hematogenous dissemination causes septicemia and spread to other organs e. Diabetic lower limb infections, severe hospital-acquired infections, necrotizing infections, and head and hand infections pose higher risks of mortality and functional disability.

Patients with simple SSTIs present with erythema, warmth, edema, Sepsis, and pain over the affected site, Thrombophlebitis. Systemic features of infection may follow, their intensity reflecting the magnitude of infection. The lower extremities are most commonly involved. Patients with necrotizing fasciitis may have pain disproportionate to the physical Thrombophlebitis, rapid progression of infection, Sepsis, cutaneous anesthesia, hemorrhage or bullous changes, and crepitus indicating gas in the soft tissues, Thrombophlebitis.

The diagnosis of SSTIs is predominantly clinical, Sepsis. A complete blood count, C-reactive protein level, and liver and kidney function tests should be ordered for patients with severe Sepsis, and for Sepsis with comorbidities causing organ dysfunction. Maximum score is Scores of 6 or more are indicative of necrotizing fasciitis, and scores of 8 or more are highly predictive, Thrombophlebitis.

Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary, Sepsis. Sterile aspiration of infected tissue is another recommended sampling method, preferably before commencing antibiotic therapy, Sepsis.

Imaging studies are not indicated for simple SSTIs, and surgery Sepsis not be delayed for imaging. Plain radiography, Sepsis, ultrasonography, computed tomography, or magnetic resonance imaging may show soft tissue edema or fascial thickening, fluid collections, or soft tissue air. The management of SSTIs is determined primarily by their severity and location, and by the patient's comorbidities Figure 5, Thrombophlebitis.

According to guidelines from the Infectious Diseases Society of America, initial management is determined by the presence or absence of purulence, acuity, and type of infection. Initial management of skin and soft tissue infections. Children younger than 3 months and less than 40 kg 89 lb: For MSSA infections and human or animal bites. For MSSA infections, impetigo, Sepsis, and human or animal bites; twice-daily dosing is an option.

Doxycycline or minocycline Minocin. For MRSA infections and human or animal bites; Sepsis recommended for children younger than Sepsis years. Clostridium difficile colitis, Sepsis, hepatotoxicity, pseudotumor cerebri, Stevens-Johnson syndrome.

For human or animal bites; not useful in MRSA infections; not recommended for children, Sepsis. For MRSA impetigo and folliculitis; not recommended for children younger than 2 months.

For MSSA impetigo; not recommended for children younger than 9 months. For MRSA infections and human or animal bites; contraindicated in children younger than 2 months. Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone.

Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, Thrombophlebitis poor response to initial drainage; that involve specific sites e.

Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics Figure 6, Sepsis. Hospitalization is also indicated for patients who initially present with severe or complicated infections, unstable comorbid illnesses, or signs of systemic sepsis, or who need surgical intervention under anesthesia.

Intravenous antibiotics should be continued until the clinical picture improves, Sepsis, the patient can tolerate oral intake, and drainage or debridement is completed. The recommended duration Thrombophlebitis antibiotic therapy for hospitalized patients is seven to 14 days, Thrombophlebitis. Inpatient management of skin and soft tissue infections. Used with metronidazole Flagyl or clindamycin for initial treatment of polymicrobial necrotizing infections. Dose adjustment required in patients with renal impairment.

Useful in waterborne infections; used Thrombophlebitis doxycycline for Aeromonas hydrophila and Vibrio vulnificus infections. Adults and children 12 years and older: Children 8 years and older and less than 45 kg lb: Useful in waterborne infections; used with ciprofloxacin Sepsisceftriaxone, or cefotaxime in A. Used Sepsis cefotaxime for initial treatment of polymicrobial necrotizing infections.

For necrotizing fasciitis caused by sensitive staphylococci. Combined therapy for necrotizing fasciitis caused by streptococci; either drug is effective in clostridial infections. Rare adverse effects of clindamycin: First-line antimicrobial for treating polymicrobial necrotizing infections, Thrombophlebitis. For MRSA infections; increases mortality risk; considered medication of last resort, Thrombophlebitis.

Parenteral drug of choice for MRSA infections in patients allergic to penicillin; 7- to day course for skin and soft tissue infections; 6-week course for bacteremia; maintain trough levels at 10 to 20 mg per L. Treatment of Sepsis fasciitis involves early recognition and surgical consultation for debridement die Behandlung von venösen Geschwüren Möhren Sepsis tissue combined with empiric high-dose intravenous broad-spectrum antibiotics.

Monomicrobial necrotizing fasciitis caused by streptococcal and clostridial infections is treated with penicillin G and clindamycin; S, Sepsis. Antibiotic therapy should be continued until features of sepsis have resolved and surgery is completed.

Patients may require repeated surgery until debridement and drainage are complete and healing has commenced. Immunocompromised patients are more prone to SSTIs and may not demonstrate classic clinical features and laboratory findings because of their attenuated inflammatory response.

Diagnostic testing should be performed early to identify the causative organism and evaluate the extent of involvement, and antibiotic therapy should be commenced to cover possible pathogens, Sepsis, including atypical organisms that can cause serious infections e.


Sepsis with gonococcal septicemia; Sepsis without acute organ dysfunction due to gonococcus; Septic shock with acute organ dysfunction; Septic shock with acute organ.

Lemierre's syndrome or Lemierre's diseasealso known as postanginal shock including sepsis and human necrobacillosis refers to infectious thrombophlebitis of the internal jugular vein, Sepsis.

The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli. Lemierre's syndrome occurs most often when Sepsis bacterial e. Deep in the abscess, anaerobic bacteria can flourish. When the abscess wall ruptures internally, Thrombophlebitis, the drainage carrying bacteria seeps through the soft tissue and infects the nearby structures. Spread of infection to the nearby internal jugular vein provides a gateway for the spread of bacteria through the bloodstream.

The inflammation surrounding the Thrombophlebitis and compression of the vein trophischen Geschwüren Sulfargin lead to blood clot formation. Pieces of the potentially infected clot can break off and travel through the right heart into the lungs as emboli, blocking branches of the pulmonary artery that carry blood with little Sepsis from the right side of the heart to the lungs.

Sepsis following a throat infection was described by Schottmuller in The signs and symptoms of Lemierre's syndrome vary, Thrombophlebitis, but usually start with a sore throat, fever, and general Sepsis weakness.

These are followed by extreme lethargy, spiked fevers, Thrombophlebitis, rigors, swollen cervical lymph nodesand a swollen, Sepsis, tender or painful neck. Often there is abdominal pain, diarrhea, nausea and vomiting during this phase. These signs and symptoms usually occur several days to 2 weeks after the initial symptoms, Thrombophlebitis. Symptoms of pulmonary involvement can be shortness of breath, cough and painful breathing pleuritic chest pain.

Rarely, Thrombophlebitis, blood is coughed up. Painful or inflamed joints can occur when the joints are involved, Thrombophlebitis. Septic shock can also arise, Thrombophlebitis. This presents with low blood pressureincreased heart ratedecreased urine output and an increased rate of breathing, Sepsis.

Some cases will also present with meningitiswhich will typically Sepsis as neck stiffnessSepsis, headache and sensitivity of the eyes to light, Thrombophlebitis. Liver enlargement and spleen enlargement can be found, Sepsis, but are not always associated with liver or spleen abscesses. The bacteria causing the thrombophlebitis are anaerobic bacteria that are typically normal components of the microorganisms that inhabit the mouth and throat.

Species of Fusobacteriumspecifically Fusobacterium necrophorumThrombophlebitis most commonly the causative bacteria, but Thrombophlebitis bacteria have been implicated, Sepsis.

Lemierre's syndrome begins with an infection of the head and Thrombophlebitis region. Usually this infection is a pharyngitis which occurred in During the primary infection, F. Thrombophlebitis bacteria then invade the peritonsillar blood vessels where they can spread to the internal jugular vein.

Furthermore, Sepsis, the internal jugular vein becomes inflamed. This septic thrombophlebitis can give rise to septic microemboli [9] that disseminate to other parts of the body where they can form abscesses and septic infarctions. The first capillaries that the emboli encounter where they can nestle themselves are the pulmonary capillaries, Sepsis.

As a consequence, Thrombophlebitis, the most frequently involved site of septic metastases are the lungs, followed by the joints knee, hip, Sepsis, sternoclavicular jointshoulder and elbow [10]. In the lungs, the bacteria cause abscesses, nodulary and cavitary lesions, Sepsis. Pleural effusion is often Sepsis. Production of bacterial toxins such as lipopolysaccharide leads to secretion of cytokines by white blood cells which then both lead to Sepsis of sepsis.

Diagnosis and the imaging and laboratory studies to be ordered largely depend on the patient history, signs and symptoms. If a persistent sore throat with signs of sepsis are found, physicians are cautioned to screen for Lemierre's syndrome. Laboratory investigations reveal signs of a bacterial infection with elevated C-reactive proteinerythrocyte sedimentation rate and white blood cells notably neutrophils. Platelet count can be Thrombophlebitis or high. Liver and kidney function tests are often abnormal, Thrombophlebitis.

Thrombosis of the internal jugular vein can be displayed with sonography. Thrombi that have developed recently have low echogenicity or echogenicity similar to the flowing blood, Sepsis, and in such cases pressure with the ultrasound probe show a non-compressible jugular vein - a sure sign of thrombosis.

Also color or power Doppler ultrasound identify a low echogenicity blood clot. A CT scan or an MRI scan is more sensitive in displaying the thrombus of the intra-thoracic retrosternal veins, but are rarely needed. Chest Sepsis and chest CT may show pleural effusion, nodules, Sepsis, infiltrates, abscesses and cavitations. Bacterial cultures taken from the blood, joint aspirates or other sites can identify the causative agent Sepsis the disease, Thrombophlebitis.

Other illnesses that can be included in the differential diagnosis are:. Lemierre's syndrome is primarily treated with antibiotics given intravenously. Fusobacterium necrophorum is generally highly susceptible to beta-lactam antibioticsmetronidazoleclindamycin and third generation cephalosporins while the other fusobacteria have varying degrees of resistance to beta-lactams and clindamycin, Thrombophlebitis. Thrombophlebitis these reasons is often advised not to use monotherapy in treating Lemierre's syndrome, Thrombophlebitis.

Penicillin and penicillin-derived antibiotics can thus be combined with a beta-lactamase inhibitor such as clavulanic acid or with metronidazole, Sepsis. There is no evidence to opt for or against the use of anticoagulation therapy, Sepsis. The low incidence of Lemierre's Sepsis has not made it possible to set up clinical trials to study the disease. The disease can often be untreatable, Sepsis, especially if other negative factors occur, i.

When properly diagnosed, the mortality of Lemierre's syndrome is about 4. Lemierre's Thrombophlebitis is currently rare, but was more common in the early 20th century before the discovery of penicillin, Thrombophlebitis. The reduced use of antibiotics for sore throats may have increased the risk of this disease, with 19 cases in and 34 cases in reported in Thrombophlebitis UK. The disease is becoming less rare with many cases being reported, Sepsis, however it is still known as "the forgotten disease" as many doctors are unaware of its existence, Thrombophlebitis, Sepsis often not even diagnosed which might considerably change the above-mentioned statistics, Thrombophlebitis.

Sepsis following from a throat infection was described by Scottmuller in From Wikipedia, the free encyclopedia. Lemierre's syndrome Synonyms Septic phlebitis of the internal jugular vein,Postanginal sepsis secondary to orophyngeal infection Classification and external resources Specialty infectious disease ICD - 10 ICD Dtsch Med Wochenschr in German, Thrombophlebitis.

American Journal of Emergency Medicine. Radiological Society of North America. European Journal of Pediatrics. Medical Microbiology and Immunology. Case report and review of the pediatric literature". Pediatric Critical Care Medicine. Annals of Emergency Medicine. Infectious diseases Bacterial diseases: BV4 non- proteobacterial G- primarily A00—A79—, — Chlamydophila psittaci Psittacosis Chlamydophila pneumoniae, Thrombophlebitis.

Chlamydia trachomatis Chlamydia Lymphogranuloma venereum Trachoma, Sepsis. Bacteroides fragilis Tannerella forsythia Capnocytophaga canimorsus Porphyromonas gingivalis Prevotella intermedia. Retrieved from " https: Bacterial Sepsis Rare diseases Syndromes caused by microbes. Views Read Edit View history. This page Sepsis last Thrombophlebitis on 5 NovemberSepsis, at By using this site, you agree to the Sepsis of Use and Privacy Policy.

Septic phlebitis of the internal Sepsis vein,Postanginal sepsis secondary to orophyngeal infection.

Leptospira Leptospira interrogans Leptospirosis. Chlamydophila Chlamydophila psittaci Psittacosis Chlamydophila pneumoniae.


What Are The Causes Of Puerperal Sepsis?

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Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the.
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Sepsis with gonococcal septicemia; Sepsis without acute organ dysfunction due to gonococcus; Septic shock with acute organ dysfunction; Septic shock with acute organ.
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