Septicemic

F19. Friedland, J. S Suputtamongkol, Y., Remick, D., Chaowagul, W., Strieer, R. M., Kunkel, S. L., White, N. J., and Griffing, G. E., Prolonged evaluation of interleukin-8 and interleukin-6 concentrations in plasma and of leukocyte interleukin-8 mRNA levels during septicemic and localized Pseudomonas pseudomallei infection. Infect. Immun. 60,2402-2408 (1992). 

Suggested Alternatives for Differential Diagnosis Plague and other septicemic diseases, acute pneumonia. 

Mortality Rate (untreated) <60% (bubonic) <100% (septicemic and pneumonic). 

Suggested Alternatives for Differential Diagnosis Hog cholera, salmonellosis, erysipelas, Glasser s disease, erysipelas, septicemic salmonellosis, pasteurellosis, Haemophilus suis infection, Streptococcus suis infection, eperythrozoonosis, porcine dermatitis and nephropathy syndrome, porcine reproductive and respiratory syndrome, pseudorabies, coumarin poisoning, and salt poisoning. 

For severe and/or septicemic disease, administer antibiotics as follows Ceftazidime, 120 mg/kg/day in three divided doses, combined with TMP/sulfa (TMP, eight mg per kg per day/sulfa, 40 mg per kg per day in four divided doses). Initially, administer parental therapy for two weeks, followed by oral therapy for six months. 

Symptoms Onset of symptoms may be either abrupt or gradual. Inhalational exposure produces fever commonly in excess of 102 degrees F, rigors, sweats, myalgias, headache, pleuritic chest pain, cervical adenopathy, hepatosplenomegaly, and generalized papular/ pustular eruptions. Acute pulmonary disease can progress and result in bacteremia and acute septicemic disease. 

Bubonic Plague Incubation period is from two to ten days. Malaise, high fever, and tender lymph nodes (buboes inflammatory swelling of one or more lymph nodes, usually in the groin the confluent mass of nodes usually suppurates and drains pus) may progress spontaneously to the septicemic form, with spread to the central nervous system (CNS), lungs, and elsewhere. 

Clinical Diagnosis A presumptive diagnosis can be made from by Gram or Wayson stain of lymph node aspirates, sputum, or cerebrospinal fluid. Plague can also be cultured. As for treatment, early administration of antibiotics is very effective. Supportive therapy for pneumonic and septicemic forms is required. 

Primary pneumonic plague occurs after inhalation of organisms, which may occur by aerosol transmission from a person or animal with secondary or primary pneumonic plague. Septicemic plague may evolve from any form of plague. It features the acute onset of bacteremia, septic shock, and thrombosis with or without antecedent lymphadenitis. Prognosis for both pneumonic and septicemic pneumonic plague is poor the fatality rate is 100 percent for untreated cases. 

Signs and Symptoms Ulceroglandular tularemia presents a local ulcer and regional lymphadenopathy (any disease process affecting a lymph node or lymph nodes), fever, chills, headache, and malaise. Typhoidal or septicemic tularemia presents fever, headache, malaise, substernal discomfort, prostration, weight loss and a non-productive cough. 

Lincomycin has found use in the treatment of diseases of the ear, throat, nose, respiratory tissue, skin and soft tissue, bone, joint, dental, and septicemic infections caused by staphylococci, pneumonococci, and streptococci (other than enterococci). It has also been used in the treatment of diphtheria and a variety of anaerobic infections, including actinomycosis. 

Nicand E, Buisson Y, Auzanneau G, Improvisi L, Dupont B Septicemic a Debaryomyces hansenii Candida famata), levure pathogene opportuniste. J Mycol Med 1993 4 242-244. Blaschke-Hellmessen R Standorte ffir Candida aus medizinisch-hygienischer Sicht. Mycoses 1999 42(suppl l) 22-29. 

Clinical trial data for this indication also are sparse. An observational study of the hemodynamic effects of DCLHb in 14 critically ill patients with septicemic shock or systemic inflammatory response syndrome suggested a beneficial effect. ° Likewise, patient stabilization and a decrease in the requirement for vasopressor therapy has been observed following the administration of PHP-Hb in volume-refractory, vasopressor-dependent shock patients. ... 

Children are also susceptible to opportunistic infection, notably Y. enterocolitica sepsis (142). In 10 children receiving intravenous deferoxamine (25 mg/kg) there were unexpected infections in four three had episodes of fever and S. aureus in blood cultures, and one had Y. enterocolitica sepsis (128). Because of the possibility of septicemic dissemination secondary to digestive Y. enterocolitica infection, the occurrence of febrile diarrhea in a child with thalassemia is a reason for immediate withdrawal of deferoxamine and the administration of antimicrobial therapy (co-trimoxazole) (142). 

Nouel O, Voisin PM, Vaucel J, Dartois-Hoguin M, Le Bris M. Association d une septicemic a Yersinia enterocolitica, d une hemochromatose idiopathique et d un traitement par deferoxamine. [Yersinia enterocolitica septicemia associated with idiopathic hemochromatosis and deferoxamine therapy. A case.] Presse Med 1991 20(31) 1494-6. 

A 50-year-old man with history of chronic hepatitis B had transient rises in serum transaminases after two successive episodes of autologous stem cell transplantation, with spontaneous resolution at that time PCR for hepatitis B virus was negative (76). Later he was given thalidomide and after 5 months suddenly experienced dizziness and jaundice. The concentration of hepatitis B virus DNA was 1641 pg/ml and serological tests for other viruses were negative. Despite conventional supportive care, he died of septicemic shock caused by Klebsiella pneumonia. Other hepatotoxic agents were excluded. 

Plagne remains a rare but reportable disease in the United States, with 390 cases reported from 1947 to 1996. Of these cases, 84% were bubonic, 13% septicemic, and 2% were pneumonic (23). Most hnman cases in the United States occur in two regions northern New Mexico, northern Arizona, and southern Colorado and California, southern Oregon, and far western Nevada (http //www.cdc.gov/ncidod/ dvbid/plague/epi.htm). Modes of transmission are known for 284 of 341 cases reported between 1970 and 1995 Flea bites were responsible for 222 (78%) cases, direct contact with an infected animal was responsible for 56 (20%) cases and inhalation of airborne materials snch as respiratory droplets from infected animals was responsible for 7 (2%) cases. Los Angeles was the site of the last person-to-person transmission in the United States in 1924 (23). 

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