Septic Shock
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2021 ◽  
Chao Wang ◽  
Xujin Liu ◽  
Fan Zhang

Abstract BackgroundNecrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentationA 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen, was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.MethodsA retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage.ResultsThe incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5–9 months), no recurrence of infection or incision rupture occurred.DiscussionAlthough prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.ConclusionsPrompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.

2021 ◽  
Vol 15 (7) ◽  
pp. e0009453
Sri Linuwih Menaldi ◽  
Anastasia Asylia Dinakrisma ◽  
Hok Bing Thio ◽  
Iris Rengganis ◽  
Salma Oktaria

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

Dipu Kallekkattu ◽  
Ramachandran Rameshkumar ◽  
Muthu Chidambaram ◽  
Kandamaran Krishnamurthy ◽  
Tamil Selvan ◽  

Takayuki Shinohara ◽  
Koh Okamoto ◽  
Saho Koyano ◽  
Amato Otani ◽  
Marie Yamashita ◽  

Abstract Plesiomonas shigelloides is a gram-negative bacillus that commonly causes self-limited diarrhea in humans. We present the case of P. shigelloides bacteremia in a 49-year-old man with alcoholic cirrhosis who developed septic shock a day after eating Dojo nabe (loach hotpot), a Japanese traditional dish.

2021 ◽  
Vol 11 (1) ◽  
Pedro Mendes de Azambuja Rodrigues ◽  
Richard Hemmi Valente ◽  
Giselle Villa Flor Brunoro ◽  
Helder Takashi Imoto Nakaya ◽  
Mariana Araújo-Pereira ◽  

AbstractSepsis results from a dyshomeostatic response to infection, which may lead to hyper or hypoimmune states. Monocytes are central regulators of the inflammatory response, but our understanding of their role in the genesis and resolution of sepsis is still limited. Here, we report a comprehensive exploration of monocyte molecular responses in a cohort of patients with septic shock via proteomic profiling. The acute stage of septic shock was associated with an impaired inflammatory phenotype, indicated by the down-regulation of MHC class II molecules and proinflammatory cytokine pathways. Simultaneously, there was an up-regulation of glycolysis enzymes and a decrease in proteins related to the citric acid cycle and oxidative phosphorylation. On the other hand, the restoration of immunocompetence was the hallmark of recovering patients, in which an upregulation of interferon signaling pathways was a notable feature. Our results provide insights into the immunopathology of sepsis and propose that, pending future studies, immunometabolism pathway components could serve as therapeutic targets in septic patients.

Elif Tükenmez Tigen ◽  
Alper Kepez ◽  
Murat Sünbül ◽  
Beste Özben ◽  
Buket Ertürk Şengel ◽  

Objectives: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p=0.05) and procalcitonin (p=0.03) besides BNP (p=0.01) and SOFA (p=0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p=0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p: 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

2021 ◽  
Vol 2021 ◽  
pp. 1-13
A. Blangy-Letheule ◽  
A. Persello ◽  
S. Michelland ◽  
V. Cunin ◽  
F. Souab ◽  

Introduction. Septic shock is a systemic inflammatory response syndrome associated with organ failures. Earlier clinical diagnosis would be of benefit to a decrease in the mortality rate. However, there is currently a lack of predictive biomarkers. The secretome is the set of proteins secreted by a cell, tissue, or organism at a given time and under certain conditions. The plasma secretome is easily accessible from biological fluids and represents a good opportunity to discover new biomarkers that can be studied with nontargeted “omic” strategies. Aims. To identify relevant deregulated proteins (DEP) in the secretome of a rat endotoxemic shock model. Methods. Endotoxemic shock was induced in rats by intravenous injection of lipopolysaccharides (LPS, S. enterica typhi, 0.5 mg/kg) and compared to controls (Ringer Lactate, iv). Under isoflurane anesthesia, carotid cannulation allowed mean arterial blood pressure (MAP) and heart rate (HR) monitoring and blood sampling at different time points (T0 and T50 or T0 and T90, with EDTA and protease inhibitor). Samples were prepared for large-scale tandem mass spectrometry (MS-MS) based on a label-free quantification to allow identification of the proteins deregulated upon endotoxemic conditions. A Gene Ontology (GO) analysis defined several clusters of biological processes (BP) in which the DEP are involved. Results. Ninety minutes after shock induction, the LPS group presents a reduction in MAP (-45%, p < 0.05 ) and increased lactate levels (+27.5%, p < 0.05 ) compared to the control group. Proteomic analyses revealed 10 and 33 DEP in the LPS group, respectively, at 50 and 90 minutes after LPS injection. At these time points, GO-BP showed alterations in pathways involved in oxidative stress response and coagulation. Conclusion. This study proposes an approach to identify relevant DEP in septic shock and brings new insights into the understanding of the secretome adaptations upon sepsis.

2021 ◽  
Vol 9 (1) ◽  
Wagner Luis Nedel ◽  
Afonso Kopczynski ◽  
Marcelo Salimen Rodolphi ◽  
Nathan Ryzewski Strogulski ◽  
Marco De Bastiani ◽  

Abstract Background Septic shock is a life-threatening condition that challenges immune cells to reprogram their mitochondrial metabolism towards to increase ATP synthesis for building an appropriate immunity. This could print metabolic signatures in mitochondria whose association with disease progression and clinical outcomes remain elusive. Method This is a single-center prospective cohort study performed in the ICU of one tertiary referral hospital in Brazil. Between November 2017 and July 2018, 90 consecutive patients, aged 18 years or older, admitted to the ICU with septic shock were enrolled. Seventy-five patients had Simplified Acute Physiology Score (SAPS 3) assessed at admission, and Sequential Organ Failure Assessment (SOFA) assessed on the first (D1) and third (D3) days after admission. Mitochondrial respiration linked to complexes I, II, V, and biochemical coupling efficiency (BCE) were assessed at D1 and D3 and Δ (D3–D1) in isolated lymphocytes. Clinical and mitochondrial endpoints were used to dichotomize the survival and death outcomes. Our primary outcome was 6-month mortality, and secondary outcomes were ICU and hospital ward mortality. Results The mean SAPS 3 and SOFA scores at septic shock diagnosis were 75.8 (± 12.9) and 8 (± 3) points, respectively. The cumulative ICU, hospital ward, and 6-month mortality were 32 (45%), 43 (57%), and 50 (66%), respectively. At the ICU, non-surviving patients presented elevated arterial lactate (2.8 mmol/L, IQR, 2–4), C-reactive protein (220 mg/L, IQR, 119–284), and capillary refill time (5.5 s, IQR, 3–8). Respiratory rates linked to CII at D1 and D3, and ΔCII were decreased in non-surviving patients. Also, the BCE at D1 and D3 and the ΔBCE discriminated patients who would evolve to death in the ICU, hospital ward, and 6 months after admission. After adjusting for possible confounders, the ΔBCE value but not SOFA scores was independently associated with 6-month mortality (RR 0.38, CI 95% 0.18–0.78; P = 0.009). At a cut-off of − 0.002, ΔBCE displayed 100% sensitivity and 73% specificity for predicting 6-month mortality Conclusions The ΔBCE signature in lymphocytes provided an earlier recognition of septic shock patients in the ICU at risk of long-term deterioration of health status.

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0251154
Fatma Mamdouh ◽  
Hafez Bazaraa ◽  
Ahmed Baz ◽  
HebatAllah Fadel Algebaly

Background and aim Hemodynamic monitoring and cardiac output (CO) assessment in the ICU have been trending toward less invasive methods. Carotid blood flow (CBF) was suggested as a candidate for CO assessment. The present study aimed to test the value of carotid artery ultrasound analysis in prediction of mortality in pediatric patients with septic shock. Methodology/Principal finding Forty children with septic shock were included in the study. Upon admission, patients were subjected to careful history taking and thorough clinical examination. The consciousness level was assessed by the Glasgow Coma Scale (GCS). Laboratory assessment included complete blood count, C-reactive protein, arterial blood gases, serum electrolytes, and liver and kidney function tests. Electrical cardiometry was used to evaluate hemodynamic parameters. Patients were also subjected to transthoracic 2-D echocardiography. CBF was evaluated using GE Vivid S5 ultrasound device through dedicated software. At the end of study, 14 patients (35.0%) died. It was found that survivors had significantly higher CBF when compared non-survivors [median (IQR): 166.0 (150.0–187.3) versus 141.0 (112.8–174.3), p = 0.033]. In addition, it was noted that survivors had longer ICU stay when compared with non-survivors [16.5 (9.8–31.5) versus 6.5 (3.0–19.5) days, p = 0.005]. ROC curve analysis showed that CBF could significantly distinguish survivors from non-survivors [AUC (95% CI): 0.3 (0.11–0.48), p = 0.035] (Fig 2). Univariate logistic regression analysis identified type of shock [OR (95% CI): 28.1 (4.9–162.4), p<0.001], CI [OR (95% CI): 0.6 (0.43–0.84), p = 0.003] and CBF [OR (95% CI): 0.98 (0.96–0.99), p = 0.031]. However, in multivariate analysis, only type of shock significantly predicted mortality. Conclusions CBF assessment may be a useful prognostic marker in children with septic shock.

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