ATYPICAL COURSE OF ACUTE SEPSIS AFTER MINOR SURGERY WITH MANIFESTATION IN THE FORM OF SECONDARY PURULENT-INFLAMMATORY GYNECOLOGICAL PATHOLOGY

  • Nataliia Matolinets Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • Volodymyr Pyda Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • Olesia Ilchyshyn Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Keywords: infection, inflammation, septicemia, early diagnosis

Abstract

Using the example of atypical variant of the septicаemic condition development with predominant affection of external genital organs in a 22-year-old woman, we established early diagnostic criteria for this complication in one-day surgery. Patient underwent dental extraction shortly before admission to hospital. On the second day from the moment of possible infection a purulent-resorptive fever was developed. On the fourth day patient status became more severe, hyperthermia to 38,5°С a large number of painful vesicles-pustular rash on the back skin, buttocks, lower limbs, foci of purulent inflammation in the genital area.

After clinical laboratory, bacteriological and instrument studies, consultations of related specialists, a clinical diagnosis was established: “Staphylococcal sepsis MRSA. Purulent-necrotic vulvovaginitis. Vesicular-papular (MRSA-staphylococcal) lesions of the skin of the trunk, lower extremities and oral mucosa”

According to international protocols of sepsis management, a schema of intensive pharmacological and local therapy was applied, as well as sanitation of foci with antiseptics. Patient in satisfactory condition was discharged from hospital after 30-days treatment.

Conclusions. A rapidly course and atypical clinical manifestation of purulent-septic complications can significantly impede their early diagnosis after minor surgical interventions. Rigorous anamnesis collection, comparison of all symptoms, that are not related at first glance, bacteriological examination serialization and consultations with related specialists, as well as intensive antibacterial and local therapies allow to make correct diagnostic on time and regress disease.

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References

Abraham E. New Definitions for Sepsis and Septic Shock Continuing Evolution but With Much Still to Be Done. JAMA. 2016,315(8):757-759. doi:10.1001/jama.2016.0290.

https://doi.org/10.1001/jama.2016.0290

Сhawla S, DeMuro JP. Current controversies in the support of sepsis. Curr. Opin. Crit. Care. 2014, 20(6): 681-684. https://doi.org/10.1097/MCC.0000000000000154

Dellinger R, Levy M, Rhodes A. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit. Care Med. 2013, 41(2): 580-637.

https://doi.org/10.1097/CCM.0b013e31827e83af

Drosatos K, Lymperopoulos A, Kennel PJ, Pollak N, Schulze PC, Goldberg IJ. Pathophysiology of Sepsis-Related Cardiac Dysfunction: Driven by Inflammation, Energy Mismanagement, or Both? Cur. Heart Fail. Rep. 2015,12(2):130-140.

https://doi.org/10.1007/s11897-014-0247-z

Duűnser M, Festic E, Dondorp A, Kissoon N, Ganbat T, Kwizera A, Haniffa R, Baker T, Schultz MJ. Recommendations for sepsis management in resource-limited settings. Intensive Care Med. 2012, 38(4): 557-574.

https://doi.org/10.1007/s00134-012-2468-5

Eachempati SR. Monitoring and Testing the Critical Care Patient. The Merck Manual for Health Care Professionals. 2017. Retrieved from: https://www.msdmanuals.com/professional/critical-care-medicine/approach-to-the-critically-ill-patient/monitoring-and-testing-the-critical-care-patient.

Heming N, Lamothe L, Ambrosi X, Annane D. Emerging drugs for the treatment of sepsis. Expert Opinion on Emerging Drugs. . 2016,21(1):27-37.

https://doi.org/10.1517/14728214.2016.1132700

Konovchuk VM, Andrushchak AV. Osoblyvosti rehulyatsiyi systemy krovoobihu u khvorykh na vazhkyy sepsis. Features of the regulation of the circulatory system in patients with severe sepsis. Medytsyna nevidkladnykh staniv. 2016,4 (75):46-52 (in Ukrainian).

Kursov SV, Nykonov VV. Rekomendatsiyi Rukhu za vyzhyvanistʹ pry sepsysi: evolyutsiya rannʹoyi tsilespryamovanoyi terapiyi. Recommendations for the Movement for Survival in Sepsis: Evolution of Early Targeted Therapy. Medytsyna nevidkladnykh staniv. 2018,4(91):35-43 (in Ukrainian).

Mal’tseva LA, Usenko LV, Mosentsev IF. Sepsis: etiologiya, epidemiologiya, patogenez, diagnostika, intensivnaya terapiya. Sepsis: etiology, epidemiology, pathogenesis, diagnosis, intensive therapy. Moskva: MEDpress-inform, 2005:176. (in Russian).

Marik PE. Early Management of Severe Sepsis. Chest. 2014, 145(6):1407-1418.

https://doi.org/10.1378/chest.13-2104

Marik PE, Desai H. Goal Directed Fluid Therapy. Current Pharmaceutical Design. 2012,18(38):6215-6224.

https://doi.org/10.2174/138161212803832399

Matolych UD, Horhota AI, Lapovetsʹ LYe, Horhota IM. Kliniko-laboratorni aspekty syndromu endohennoyi intoksykatsiyi u khvorykh na abstsesy ta flehmony shchelepnolytsevoyi dilyanky. Clinical and laboratory aspects of the syndrome of endogenous intoxication in patients with abscesses and phlegmones of the jaw-pulpit area. Novyny stomatolohiyi. 2013,4:16–20 (in Ukrainian).

Ob unifikacii mikrobiologicheskih (bakteriologicheskih) metodov issledovanija, primenjaemyh v klinikodiagnosticheskih laboratorijah lechebno-profilakticheskih uchrezhdenij. On the unification of microbiological (bacteriological) research methods used in clinical and diagnostic laboratories of medical institutions. Bakteriolohiya i virusolohiya: normatyvne vyrobnycho-praktychne vydannya, Kyiv, Medіnform. 2014:126-181.

Pallin DJ, Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA. Jr. Increased US emergency department visit for skins and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistan Staphylococcus aureus. Ann Emerg. Med. 2008,51 (3):291-298.

https://doi.org/10.1016/j.annemergmed.2007.12.004

Pinsky MR, Kalil A. 2018. Septic Shock. Medscape Reference. Drugs, Diseases & Procedures. Retrieved from: http://emedicine.medscape.com/article/168402-overview.

Rhodes А, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, et al. Surviving Sepsis Campaign: international guidelines for management of Sepsis and septic shock: 2016. Critical Care Medicine. 2017,45(3):486-553.

https://doi.org/10.1097/CCM.0000000000002255

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M., Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016,315(8):801-810.

https://doi.org/10.1001/jama.2016.0287


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Published
2018-12-28
How to Cite
1.
Matolinets N, Pyda V, Ilchyshyn O. ATYPICAL COURSE OF ACUTE SEPSIS AFTER MINOR SURGERY WITH MANIFESTATION IN THE FORM OF SECONDARY PURULENT-INFLAMMATORY GYNECOLOGICAL PATHOLOGY. Proc Shevchenko Sci Soc Med Sci [Internet]. 2018Dec.28 [cited 2024Mar.28];54(2):125-32. Available from: https://mspsss.org.ua/index.php/journal/article/view/167