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Can Sepsis Cause Brain Damage

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How Are Neonatal Sepsis And Meningitis Diagnosed And Treated

Survivors of sepsis face long-term problems, says U-M physician

It is very important that neonatal sepsis and meningitis are diagnosed and treated promptly to avoid significant injury, brain damage, or death. Because the associated injuries are so severe, doctors should begin treatment even if they only suspect the presence of neonatal sepsis or meningitis.

The only true way to diagnose neonatal sepsis or meningitis is through blood testing, but often times the results of the blood tests are slow and unreliable. For this reason, physicians must do clinical assessments and lab tests to determine if the baby is at risk of developing neonatal sepsis or meningitis. If the baby is at risk, physicians must initiate treatment while waiting for the test results. If a babys blood culture is negative for sepsis and meningitis but doctors suspect presence of infection, tests should continue and the physician should prescribe antibiotics. Since the signs and symptoms of sepsis can be subtle, any abnormalities in a babys behavior should be used as potential indicators of neonatal sepsis or meningitis.

Other ways to test for neonatal sepsis and meningitis include:

  • Testing cerebral spine fluid
  • Testing for inflammatory markers
  • Urine culture

Consequences Of Cerebral Immune Activation

There is a body of evidence that NO, cytokines and prostaglandins modulate brain neurotransmission , especially the -adrenergic system, the production and release of CRF, ACTH and vasopressin, as well as medullary autonomic centre output . Inversely, neurotransmitters and neurohormones also modulate cerebral expression of inflammatory mediators . These effects have been described elsewhere . The final neuroendocrine and autonomic response is variable because it depends on a highly complex and spatiotemporally changing process that involves both stimulatory and inhibitory factors, which themselves depend on interactions between glial, endothelial and neuronal cells. Disturbances in these relationships may lead to maladaptive responses, as illustrated by a recent experimental study that showed that heart failure associated sympathetic hyperactivity was linked to decreased NO production in the paraventricular nucleus. The opposite phenomenon may occur in septic shock, which is associated with reduced sympathetic output .

What Is The Prognosis For These Infections

Outcome generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild encephalitis or meningitis can make a full recovery, although the process may be slow.

Individuals who experience only headache, fever, and stiff neck may recover in 2-4 weeks. Individuals with bacterial meningitis typically show some relief 48-72 hours following initial treatment but are more likely to experience complications caused by the disease. In more serious cases, these diseases can cause hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. These individuals may need long-term therapy, medication, and supportive care.

The recovery from encephalitis is variable depending on the cause of the disease and extent of brain inflammation.

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How Is Sepsis Treated

Sepsis is treated in the hospital, where doctors can closely watch the patient. Some kids must be in the pediatric intensive care unit for extra monitoring and treatment.

Monitors like a cardiorespiratory monitor and pulse oximetry watch the heart and breathing. Doctors watch the child’s blood pressure closely. Sometimes a special monitor, called an arterial line , measures blood pressure constantly from inside the arteries.

Antibiotics to fight the infection are given through an line, which is a small tube put into a vein. Usually, doctors start right away even before the diagnosis of sepsis is proven.

Kids also will get fluids through the IV and, if needed, blood pressure medicines called vasopressors to keep the heart working well. Some kids with sepsis might need extra blood or to get some parts of blood through the IV. This is called a transfusion and can help the blood make clots or carry oxygen better.

Sometimes, a child needs a special IV called a central line. This bigger IV line goes into a larger vein that can carry the needed medicines and fluids faster.

Kids with sepsis could need help breathing. If so, doctors give oxygen or might place a breathing tube and use a ventilator . If the heart and lungs are too sick to get enough oxygen to the body, the medical team may use a treatment called ECMO where a machine takes over for the heart and lungs so the body can heal.

When Is A Tooth Infection An Emergency

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A dental abscess infection is always considered a dental emergency. Any visible gum swelling can be life-threatening if not treated quickly.

During emergency treatment for a dental abscess, the surgeon will open up the abscess and drain it. This will relieve pressure and reduce any pain associated with the infection. You will also receive prescription antibiotics to help clear the infection.

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Outcomes Of Neonatal Sepsis

If given prompt and proper treatment, babies with neonatal sepsis will likely recover with no lasting health issues . However, there are several very serious birth injuries/complications that may result from neonatal sepsis. These issues are more likely to arise when sepsis goes undiagnosed or is improperly treated :

  • Infant death: in term and late preterm infants, the rate of mortality from neonatal sepsis has been estimated at around two to four percent

Pss Letters For Healthcare Professionals And Others

Some people who believe they have signs of PSS might find it difficult to speak to healthcare professionals about their problems. This letter, addressed to people who work in the healthcare field, helps explain some of the issues involved in PSS. If you feel this letter would be helpful, please feel free to print it out and bring it to your doctors appointments.

To help explain post-sepsis issues to others, Sepsis Alliance has letters that explain sepsis and PSS to:

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Who Is Most At Risk For Sepsis Or Septic Shock

Some patients are more susceptible than others, including those who:

  • Are very young or very old
  • Are suffering from a chronic illness or a drug-resistant bacterial infection
  • Have weakened immune systems from HIV, cancer treatments, transplant drugs, diabetes or major trauma
  • Have underlying illnesses that would make them eligible for hospice care, including advanced cancer, heart failure, advanced lung disease , and dementia accompanied by any difficulty with activities of daily living
  • Rely on invasive devices, including intravenous catheters, breathing tubes or ventricular assist devices for the heart

Can Meningitis And Encephalitis Be Prevented

Sepsis and Septic Shock, Animation.

People should avoid sharing food, utensils, glasses, and other objects with someone who may be exposed to or have the infection. People should wash their hands often with soap and rinse under running water.

Effective vaccines are available to prevent Haemophilus influenza, pneumococcal and meningococcal meningitis.

People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure.

To lessen the risk of being bitten by an infected mosquito or other arthropod, people should limit outdoor activities at night, wear long-sleeved clothing when outdoors, use insect repellents that are most effective for that particular region of the country, and rid lawn and outdoor areas of free-standing pools of water, in which mosquitoes breed. Repellants should not be over-applied, particularly on young children and especially infants, as chemicals such as DEET may be absorbed through the skin.

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What Are The Signs And Symptoms Of Neonatal Sepsis And Meningitis

  • Jaundice
  • Respiratory distress: Breathing problems including fast breathing, respiratory failure, failure to breathe when on a ventilator, or periods of apnea . These conditions will often cause cooling and a bluish tint to the extremities.
  • Bradycardia
  • Neurological changes: Irritability, lethargy, and non-responsiveness
  • Low urine output
  • Lethargy and hypotonia

Meningitis:

  • Failure to respond to antibiotic therapy
  • Respiratory depression
  • Growth of a soft spot
  • Fast head growth
  • Weakness on one side of the body
  • Seizures

What Can I Do To Help Myself Recover

Set small, achievable goals for yourself each week, such as taking a bath, dressing yourself, or walking up the stairs. Here are some things you can do:

  • Rest and rebuild your strength
  • Talk about what you are feeling with family and friends
  • Record your thoughts, struggles, and milestones in a journal
  • Learn about sepsis to understand what happened
  • Ask your family to fill in any gaps you may have in your memory about what happened to you
  • Eat a balanced diet
  • Exercise if you feel up to it
  • Make a list of questions to ask your doctor when you go for a check up

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Demographic And Clinical Characteristics

Of the 658 consecutive patients admitted in ICU, a total of 80 patients had severe sepsis or septic shock during the study period, 33 patients were initially identified as eligible and were evaluated within 24h after ICU discharge. Sixteen of them were re-evaluated around one year of discharge . The reasons for non-inclusion are reported in Fig. , and included: absence of severe sepsis or septic shock during ICU stay, death before ICU discharge, tracheostomy, prior or current neurological diseases. Comparison of demographic and clinical characteristics between patients re-evaluated and not re-evaluated in one year follow-up showed that these groups do not present significant differences in their baseline characteristics .

Figure 1

Infection Through The Bloodstream

Sepsis can cause long

Infections spread through the blood are thought to account for around 1 in 4 cases of brain abscesses.

People with a weakened immune system have a higher risk of developing a brain abscess from a blood-borne infection. This is because their immune system may not be capable of fighting off the initial infection.

You may have a weakened immune system if you:

  • have a medical condition that weakens your immune system such as HIV or AIDS
  • receive medical treatment known to weaken the immune system such as chemotherapy
  • have an organ transplant and take immunosuppressant medicines to prevent your body rejecting the new organ

The most commonly reported infections and health conditions that may cause a brain abscess are:

  • cyanotic heart disease a type of congenital heart disease where the heart is unable to carry enough oxygen around the body this lack of a regular oxygen supply makes the body more vulnerable to infection
  • pulmonary arteriovenous fistula a rare condition in which abnormal connections develop between blood vessels inside the lungs this can allow bacteria to get into the blood and, eventually, the brain

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Symptoms Of A Brain Abscess

The symptoms of a brain abscess may develop quickly or slowly but can include:

  • headache which is often severe, located in a single section of the head and cannot be relieved with painkillers
  • changes in mental state such as confusion or irritability
  • problems with nerve function such as muscle weakness, slurred speech or paralysis on one side of the body
  • a high temperature
  • being sick
  • stiff neck
  • changes in vision such as blurring, greying of vision or double vision

Who Is At Risk For Sepsis

  • The very old or very young or pregnant women
  • People with pre-existing infections or medical conditions such as diabetes, lung disease, cancer and kidney disease
  • People with weakened immune systems
  • Patients who are in the hospital
  • People with severe injuries, such as large burns or wounds
  • Patients with catheters or a breathing tube

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What Are The Risk Factors For Neonatal Sepsis And Meningitis

The following factors predispose a baby to neonatal infections like sepsis and meningitis:

  • Hypoxic ischemic encephalopathy : Insufficient flow of oxygen to the babys brain may result in infection.
  • Prematurity: Younger babies are likelier to become infected.
  • Low birth weight: Smaller babies cannot fight off infection like more developed babies.
  • Premature rupture of the membranes : If the amniotic sac breaks open early, a baby risks contracting an infection.
  • Urinary tract abnormalities in the mother
  • Maternal galactosemia: A genetic disorder that makes it difficult to break down sugars.

How Do You Get Sepsis Or Septic Shock

Concussion: Pathophysiology, Causes, Symptoms and Treatment, Animation

Patients develop sepsis when their body is unable to fight off an infection, usually because of underlying health conditions or chronic diseases that weaken the immune system. In about 73% of sepsis cases, patients already have sepsis when they enter the hospital, and another 26% develop it during their hospital stay.1

Before sepsis develops, vulnerable patients are already likely to be compromised because of other diseases or illness, especially cancer, dementia, stroke, and chronic lung, heart, liver, or kidney disease.1 Factors such as poor nutrition, declining functional or cognitive status, or uncontrolled symptoms can make it difficult for the body to fight off the infection that leads to sepsis.

To diagnose sepsis and identify the source of infection, doctors rely on a variety of factors and tests, including temperature, heart rate, respiratory rate, blood/platelet counts, biomarker analysis, and other cultures/tests.

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Neuroendocrine Dysfunction And Autonomic Failure

The endocrine response to sepsis is complex, and in this review we focus only on the hypothalamicpituitaryadrenal axis and on vasopressin. Briefly, disruption of the hypothalamicpituitaryadrenal axis is a common feature in severe sepsis and may be unmasked by a short Synacten test, when cortisol level increases by less than 9 g/dl after an intravenous bolus of 250 g corticotrophin . It is now recognized that, in sepsis, adrenal insufficiency partly accounts for reduced vascular sensitivity to vasopressors and an increased risk for death . Moreover, in septic shock, correcting this disorder by cortisol replacement therapy improves haemodynamic status and survival .

Keeping this in mind, it is noteworthy that, in patients with septic shock and adrenal insufficiency, plasma vasopressin levels were significantly higher in nonsurvivors . It is therefore plausible that secretion of vasopressin, which is known to modulate ACTH release and to be regulated by circulating cortisol , was adapted to adrenal function. In addition, this observation may also suggest that plasma vasopressin deficiency is not associated with poorer outcomes. So, why should plasma vasopressin be normalized?

Autonomic failure was initially described in endotoxin challenged animals before it was documented in patients with septic shock, particularly by using spectral analysis of heart rate variability . Impaired autonomic function is associated with an increased risk for death from critical illness .

Deficit In Cholinergic Function And Alteration Of Neurotransmission

Deficits in cholinergic function have been postulated to cause delirium and cognitive decline . Global hypocholinergia result from several mechanisms, including impaired acetylcholine synthesis and cholinergic synaptic dysfunction . Nicotinic receptors within the brain bind acetylcholine to modulate cognitive functioning, arousal learning, and memory. Use of anesthetic drugs that decrease acetylcholine release may impact on cognitive function after surgery . Anticholinergic medications and their metabolites also may induce delirium through competitive antagonism of postsynaptic muscarinic receptors that are more widely distributed throughout the brain. It was recently demonstrated that chronic cholinergic hypoactivity in the basal forebrain represents a major factor of acute brain dysfunction under systemic inflammation .

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What Patients And Families Should Know About Sepsis And How Hospicecan Help

Patients are eligible for hospice care when a physician makes a clinicaldetermination that life expectancy is six months or less if the conditionor disease runs its expected course.

Many sepsis infections, however, occur in patients who are alreadyseriously ill, hospitalized, in the intensive care unit or recoveringfrom a hospital procedure. However, elderly or debilitated patients may besuccessfully managed and discharged to outpatient care to only begin apersistent and progressive decline from the latent effects of thisinsidious disease. Ideally, patients who develop sepsis and have survivedthe initial hospitalization from sepsis, but are now experiencing decline,should be evaluated for participation in goals-of-care conversations. Theseconversations serve to identify their preferences for end-of-life care. Ifeligible, hospice care is the most care these individuals can receive athome.

Hospice admissions personnel should be contacted immediately when severeprogressive sepsis is diagnosed, because time is of the essence when apotentially rapid, progressive infection occurs late in the diseaseprogress or in patients whose health is already unstable or compromised. Ifsepsis does not result in the patients death, hospice care may be the bestoption to manage long-term symptoms, address pain and support the patientand family.

Diagnosing A Brain Abscess

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If a brain abscess is suspected, an initial assessment will be made based on your symptoms, medical history and whether you’ve had a recent infection or a weakened immune system.

Blood tests can also be carried out to check for an infection.

If you’re referred to hospital for further tests, you may have either:

  • a CT scan a series of X-rays are used to produce a detailed image of the inside of your body
  • an MRI scan which uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.

If an abscess is found, a procedure known as CT-guided aspiration may be used to remove a sample of pus for testing. This involves using a CT scan to guide a needle to the site of the abscess.

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What Are The Signs & Symptoms Of Sepsis

Sepsis can be very hard to identify. Many of its signs are also common in routine childhood illness. But trust your instincts. If your child seems sicker than usual or something just doesn’t seem right, call the doctor or get emergency medical care immediately.

Having one of these signs alone doesn’t mean a child has sepsis. But when a few of these things happen together, that’s a clue that sepsis is possible:

  • fever, shivering, or a very low temperature
  • fast breathing
  • extra sleepiness, trouble waking up, or confusion
  • complaining of bad pain

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