As you know, inflammatory diseases can affect any organ. They are divided into 2 types: acute and chronic processes. Timely diagnosis and treatment of inflammatory pathologies often leads to a 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 unfavorable factors or in the absence of treatment, the process can spread. As a result, bacterial particles enter the bloodstream. This condition is called sepsis. Such a complication is quite dangerous, as it can lead to the development of shock and death.
Cryptogenic sepsis - what is it?
Several types of sepsis are distinguished depending on the location of the focus of primary inflammation. 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 cannot 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 had already entered the bloodstream and spread throughout 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 a blood poisoning by bacteria without an established primary inflammatory focus. Often, pathology occurs in premature infants, people with weak immunity. In most cases, the disease is severe. With timely started therapy, a complete cure is possible.
Causes of cryptogenic sepsis
If it is difficult to establish a primary inflammatory focus, and bacteria have already entered the bloodstream, then a diagnosis of cryptogenic sepsis is made. The causes of this disease can be different. Usually, the etiology is no different 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. Moreover, the time from the onset of the disease to the spread of infection (breakout of the outbreak) is reduced. In this case, the patient does not have time to understand what symptoms began to bother him in the first place. In most patients, the primary lesion can be detected after examination. If it is still not found, then the pathology is classified as cryptogenic sepsis. The causes of the disease:
- Bacterial infection. The causative agent of sepsis can be any microorganism. Most often these are staphylococci and streptococci, Proteus, Pseudomonas aeruginosa and Escherichia coli.
- Conditionally pathogenic microflora. As you know, in the body there are many bacteria that are present normally. With a decrease in immune defense, conditionally pathogenic microflora begins to grow, which leads to various diseases. As a result, cryptogenic sepsis may develop.
- Infections caused by pathogenic fungi (candidiasis).
- Primary and secondary immunodeficiencies (HIV).
- The period of prematurity, newborns with low body weight (up to 2 kg).
- Intrauterine infections.
The mechanism of sepsis
Cryptogenic sepsis - what is it? A similar diagnosis is made in the absence of a primary pathology that can lead to blood poisoning. Cryptogenic sepsis is also called primary, or idiopathic. It develops when pathogenic microorganisms enter the bloodstream. As a result, bacteria are spread throughout the body. As a result, inflammatory foci can be localized in several places at once. In addition, bacterial intoxication of the body 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 very dangerous and often fatal.
Classification of cryptogenic sepsis
Considering that the primary localization of the pathological focus is unknown, cryptogenic sepsis is not classified by etiological basis. Nevertheless, it is necessary to establish the pathogen of infection in order to conduct adequate antibacterial therapy. Like other types of sepsis, this variant of the pathology can occur in 2 forms. However, this classification does not affect the prognosis of the disease. Forms of cryptogenic blood poisoning:
- Septicemia. It implies the presence of bacterial or fungal microflora circulating throughout the body. However, pathogens do not form foci of infection.
- Septicopyemia. In addition to the presence of bacteria in the blood, their organs are seeded. Often, pathogens accumulate (settle) in the lungs, brain, and abdominal cavity. As a result, foci of purulent inflammation are formed in these areas.
According to the clinical course, lightning, acute and chronic sepsis are distinguished. In the first case, the disease develops already in the first day after the penetration of the pathogen and is characterized by severe violations of the functions of organs and systems. Acute sepsis lasts about 2-4 weeks. Chronic damage can last for several months or 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 checking the blood for sterility can we 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 body develops. Nevertheless, the doctor may suspect this disease on the basis of a characteristic clinical picture. First of all, a similar diagnosis is suggested only with the exclusion of other inflammatory pathologies. The following symptoms of sepsis are distinguished:
- Increased body temperature up to 39-40 degrees. Hyperthermia is accompanied by chills, sweating, and headache.
- Worsening condition. With sepsis, weakness, pain in muscles and joints without a certain localization, loss of appetite are observed.
- Tachycardia - increased heart rate.
- Lowering blood pressure.
- Increased respiratory rate.
- Impaired liver function. It is manifested by the development of jaundice, an increase in the size of the organ (hepatomegaly).
- The defeat of the digestive tract. Some patients have stool disorder (diarrhea), nausea and vomiting.
- The appearance of hemorrhages on the skin.
With the development of septicopyemia, other symptoms may be observed. They depend on the localization of inflammatory foci. Often develops endocarditis, pneumonia.
Diagnostic criteria for cryptogenic sepsis
Diagnostic criteria for sepsis include the clinical manifestations of this disease, as well as changes observed during laboratory and instrumental research methods. First of all, pay attention to the general condition of the patient. If it worsens over several days, despite antibiotic therapy, cryptogenic sepsis can be suspected. Signs that indicate this disease are an earthy (grayish) color of the skin, severe general weakness, fever and the appearance of skin hemorrhages. The characteristic clinical manifestations include the addition of jaundice and hepatomegaly. In the presence of these symptoms, it is necessary to urgently hospitalize the patient and conduct an examination.
Laboratory and instrumental diagnostics
With cryptogenic sepsis, significant changes in laboratory parameters are observed. Leukocytosis, thrombocytopenia and anemia, as well as an acceleration of ESR, are noted in the KLA. 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 microflora). Thanks to this study, you can determine the causative agent of the disease and prescribe treatment.
Instrumental diagnostics is carried out in order to detect foci of septic lesions. To do this, an x-ray of the chest, ultrasound of the abdominal cavity and pelvis. Often there is pneumonia in the lungs - pneumonia, enlarged liver - hepatomegaly.
Cryptogenic sepsis: ICD-10 code
Like any pathology, this disease has a certain code in the international classification. It is set depending on the pathogen that caused cryptogenic sepsis. ICD-10 is a special classification that operates throughout the world. In the medical history, the diagnosis itself is written first, and then its code. In the case of cryptogenic sepsis, the code will be A41.9 (unspecified septicemia). Having seen the ICD-10 code, a doctor of any medical organization in another country will understand what diagnosis was made to this patient.
Possible complications of sepsis
With the wrong approach to the treatment of sepsis, severe complications develop. Among them - a shock condition, pulmonary embolism, bacterial endocarditis, stroke, exhaustion and bleeding. Each of these conditions can cause the death of the patient. Therefore, when making this diagnosis, it is urgent to start antibacterial and symptomatic therapy.
Cryptogenic sepsis treatment
First of all, if this disease is detected, the patient should be hospitalized and bed rest should be prescribed. Also, these measures are necessary for suspected cryptogenic sepsis. Treatment begins immediately after diagnosis. The main group of drugs is antibiotics. A combination of 2-3 drugs is prescribed. The most commonly used drugs are Penicillin, Ceftriaxone, Gentamicin, Imipenem, etc. Since there is an intoxication of the body, infusion therapy is prescribed. Crystalloid and colloidal solutions are injected intravenously, according to indications, a blood transfusion is performed. Also shown are immunostimulants, antipyretic and analgesics. If a foci of infection is detected, surgical intervention is necessary. With the development of septic shock, vasopressors are prescribed (the drug "Dopamine"). Nutrition of patients is carried out parenterally or through a tube.
Prognosis for cryptogenic sepsis
The prognosis for cryptogenic sepsis depends on the general condition of the patient's body (immunity), age, timeliness of treatment. With adequate therapy and the absence of complications, a complete recovery is observed. The most favorable prognosis is subacute and chronic sepsis. In case of lightning fast, the disease often leads to death. Despite antibiotic therapy, mortality from this pathology is about 50% of cases.
Prevention of cryptogenic sepsis
Sepsis often develops in people suffering from chronic inflammatory diseases. Therefore, preventive measures include timely treatment of foci of infection, taking immunostimulating drugs and vitamins. To prevent the disease in newborns and young children, the expectant mother must exclude bad habits, taking medications, hypothermia.