Sepsis – Clinical Features & Differential Diagnoses

Sepsis needs to be categorized as a clinical syndrome. Two of the systemic inflammatory response syndrome requirements must be met, together with an infection source, to be classified as sepsis.

Systemic Inflammatory Response Syndrome Criteria:

1. Temperature > 38°C (101.4°F) or < 36°C (96.8°F)

2. Heart rate > 90

3. Breathing rate > 20 or PaCo2 < 32 mm Hg

4. While blood cells > 12,000/μL or < 4,000/μL

Factors Predisposing to Sepsis

1. Extremes of age

2. Iatrogenic procedures (e.g., indwelling catheters, surgical or invasive diagnostic procedures).

3. Social factors (e.g., alcoholism, substance abuse, intravenous drug abuse)

4. Immunosuppression (e.g., neutropenia, complement deficiencies, hypo- or agammaglobulinemia, splenectomy, HIV infection).

5. Medical conditions (e.g., burns, cirrhosis, cancer, diabetes mellitus, multiple trauma, complicated pregnancy or delivery).

6. Malnutrition

CLINICAL FEATURES: Depending on whether the patient is in the early, moderate, or late stages of the illness, it varies significantly.

1. General symptoms and physical examination findings

a) Systemic findings may include chills, fever, rigors

b) Neuromuscular findings may include arthralgias and myalgias.

c) Neurologic findings may include a changed state of mind.

d) Cardiopulmonary findings may include arrhythmias, hypotension, hypertension, tachycardia, a widened pulse pressure, or tachypnea.

e) Dermatologic findings: Petechiae, embolic lesions, and ecthyma gangrenosum are cutaneous abnormalities that might raise clinical suspicion of sepsis.

2. Site-specific symptoms and physical examination findings

a) Skin: Findings that might be indicative of the initial focal source include a localized increase in temperature, erythema, induration, tenderness, lymphadenitis, and pus.

b) Heart or lungs: Findings may include a cough, chest pain, cyanosis, dyspnea, sputum, rales, or edema.

c) Urinary tract: Findings may include dysuria, Increased frequency, urinary urgency, tenesmus, flank pain, oliguria, or anuria.

d) Gastrointestinal tract: Findings may include abdominal pain, diarrhea, nausea, vomiting, constipation, or jaundice.

e) Central nervous system (CNS): Findings may include an altered sensorium, focal neurologic signs, headache, stiff neck, photophobia, retinal hemorrhages, cotton wool spots, conjunctival petechiae, endophthalmitis, or panophthalmitis.

DIFFERENTIAL DIAGNOSES include the following:

1. Endocrine diseases (e.g., adrenal insufficiency, thyroid storm).

2. Nonseptic causes of shock (e.g., anaphylaxis, cardiogenic shock, cardiac tamponade, hypovolemic shock, neurogenic shock, pulmonary embolism, dissecting aortic aneurysm).

3. Viral diseases (e.g., influenza, dengue fever, coxsackie B virus infection)

4. Spirochetal diseases (e.g., syphilitic Jarisch-Herxheimer reaction, leptospirosis, relapsing fever caused by Borrelia infection).

5. Rickettsial diseases (e.g., endemic typhus, Rocky Mountain spotted fever)

6. Protozoal diseases (e.g., Pneumocystis carinii infection, Plasmodium falciparum infection, Toxoplasma gondii infection, Trypanosoma cruzi infection)

7. Collagen vascular diseases

8. Vasculitides

9. Thrombocytic thrombocytopenic purpura/hemolytic–uremic syndrome