Sepsis and Septic Shock Quiz

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Questions and Answers

What is the primary difference between sepsis and severe sepsis?

Systemic inflammatory response

The presence of viable bacteria in blood

Organ dysfunction, hypoperfusion or hypotension (correct)

The presence of microorganisms in normally sterile host tissue

What is the definition of bacteremia?

An exaggerated systemic inflammatory response to a variety of severe clinical insults

The presence of viable bacteria in blood (correct)

The systemic response to infection

The presence of microorganisms in normally sterile host tissue

What is the key factor in differentiating septic shock from severe sepsis?

Systemic inflammatory response

Organ dysfunction

Hypotension despite adequate fluid resuscitation (correct)

Hypoperfusion

What is the recommended time frame for administering broad-spectrum IV antibiotics?

Within 1 hour (D) Signup and view all the answers

What is the purpose of obtaining cultures prior to administering antibiotics?

To identify the type of microorganism causing the infection (B) Signup and view all the answers

What is the definition of SIRS?

An exaggerated systemic inflammatory response to a variety of severe clinical insults (A) Signup and view all the answers

What is the recommended initial fluid resuscitation for hypotension or lactate >36 mg/dL?

30 mL/kg crystalloid (D) Signup and view all the answers

What is the criteria for SIRS?

Manifested by 2 or more of the following conditions (B) Signup and view all the answers

What is the indication for administering vasopressors?

MAP <65 mmHg (B) Signup and view all the answers

What is the preferred specimen for isolation of nontyphoidal Salmonella species?

Freshly passed stool (D) Signup and view all the answers

In patients who received antibiotic therapy prior to hospitalization, which specimen may still be positive for Salmonella?

Bone marrow aspirate (B) Signup and view all the answers

What is a common hematological finding in patients with typhoid fever?

Neutropenia (A) Signup and view all the answers

What is the significance of a high sedimentation rate in salmonellosis?

Abscess formation or osteomyelitis (A) Signup and view all the answers

What is the recommendation for antibiotic use in uncomplicated nontyphoidal Salmonella gastroenteritis?

Antibiotics are reserved for patients with severe disease or at high risk for invasive disease (B) Signup and view all the answers

What is the purpose of imaging studies in patients with salmonellosis?

To rule out concurrent vascular infections in patients older than 50 years (C) Signup and view all the answers

What is the significance of eosinophilia in patients with salmonellosis?

It suggests concurrent parasitic infection (C) Signup and view all the answers

What is the common liver function abnormality seen in salmonellosis?

Mild hepatocellular liver function abnormality (D) Signup and view all the answers

What is the preferred specimen for isolation of S. typhi or S. paratyphi?

Urine, gastric or intestinal secretions (C) Signup and view all the answers

What is the significance of thrombocytopenia in salmonellosis?

It is neither universal nor diagnostic (A) Signup and view all the answers

Study Notes

Infection

Infection is the presence of microorganisms in normally sterile host tissue.
Bacteremia is the presence of viable bacteria in the blood.

Spectrum of Infection

Sepsis is the systemic response to infection.
Severe sepsis is sepsis associated with organ dysfunction, hypoperfusion, or hypotension.
Septic shock is sepsis with hypotension despite adequate fluid resuscitation, and perfusion abnormalities.

SIRS (Systemic Inflammatory Response Syndrome)

SIRS is an exaggerated systemic inflammatory response to a variety of severe clinical insults.
It is manifested by 2 or more of the following conditions:
- Temperature >38 °C or <36 °C
- Heart rate >90 beats/min
- Respiratory rate >20 breaths/min
- White blood cell count (WBC) >12,000 (Leukocytosis) or <4,000
- Blood glucose >2 mmol/L

Management of Sepsis

Obtain cultures (blood, urine, sputum, etc.) prior to administration of antibiotics.
Administer broad-spectrum IV antibiotics within 1 hour.
Initial fluid resuscitation of 30 mL/kg crystalloid for hypotension or lactate >36 mg/dL (≥4 mmol/L).
Use vasopressors if Mean Arterial Pressure (MAP) is <65 mmHg.

Typhoid Fever

Typhoid fever can have varying clinical courses, ranging from mild to severe, with 10-15% of patients developing severe disease.
The incubation period is typically 10-14 days, and symptoms include prolonged low-grade fever, dull frontal headache, malaise, myalgia, dry cough, anorexia, and nausea.
The fever may progress in a stepwise manner to become persistent and high-grade by the end of the second week, lasting up to 4 weeks if left untreated.
Relative bradycardia at the peak of the fever is an indicator of typhoid fever, although this finding is not universal.
Rose spots develop on the back, arms, and legs in up to 25% of cases late in the first week of fever.
Other symptoms include coated tongue, alteration of bowel habits, tender abdomen, and hepatosplenomegaly.

Diagnosis

Blood culture is 80-100% accurate in detecting bacteremia.
Bacteria appear in the bloodstream within 14 days, facilitating secondary metastatic foci.
Gallbladder infection can lead to long-term carriage of S typhi or S paratyphi in bile and secretion to the stool.

Transmission

Salmonella is transmitted through consumption of contaminated foods, including beef, poultry, eggs, fruits, vegetables, dairy products, and shellfish.
Meat can become infected with Salmonella during production, when bacteria from animal intestines transfer onto meat due to careless processing or improper hygiene.

Causes

The 7 most commonly isolated Salmonella strains causing human disease reported to the CDC in 2007 include S enteritidis, S typhimurium, S enteritidis heidelberg, S enteritidis newport, S enterica serotype Javiana, S enterica serotype I 4,5,12:i:, and S enteritidis montevideo.
Enteric fever is caused by S typhi and S paratyphi.

Laboratory Diagnosis

Freshly passed stool is the preferred specimen for isolation of nontyphoidal Salmonella species.
PCR is performed, and bone marrow aspirate and culture are superior to blood culture.
In patients who received antibiotic therapy prior to hospitalization, bone marrow aspirate may still be positive for Salmonella even if blood culture results are negative.

Laboratory Findings

WBC count is usually within the reference range, but approximately one-fourth of patients with typhoid fever are leukopenic, neutropenic, or anemic.
Thrombocytopenia is neither universal nor diagnostic.
Eosinophilia should prompt a search for concomitant parasitic infection.
Mild hepatocellular liver function abnormality is common.

Imaging Studies

Radiologic findings in salmonellosis are nonspecific.
Patients older than 50 years with nontyphoid Salmonella bacteremia should undergo clinical assessments such as CT or MRI to rule out concurrent vascular infections.

Treatment

Salmonella gastroenteritis is usually a self-limiting disease.
Fluid and electrolyte replacement may be indicated in severe cases.
Antibiotics are not routinely used to treat uncomplicated nontyphoidal Salmonella gastroenteritis and are reserved for patients with severe disease or those who are at a high risk for invasive disease.

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Description

This quiz tests your knowledge on sepsis and septic shock, including the definition, spectrum, and clinical manifestations of infection.