The infected Patient

Question 1

What are the symptoms of a patient with an infection?

Answer 1

• Pyrexia
• Rigors
• Sweats
• Pale face
• Dehydration
• Headache
• Pain
• Sore throat
• Runny nose

Question 2

What are the signs of a patient with infection?

Answer 2

• Tachycardia
• Rash
• Pus in lesion
• Lymphadenopathy
• Confusion

Question 3

What questions are important to ask in a travel history?

Answer 3

1. Travel departure & start dates. - specific areas of travel etc.
2. Purpose of travel? - farmer, health worker etc. and activities undertaken? - e.g. swimming in fresh water.
3. Degree of contact with local population - any known disease contact, unprotected intercourse.
4. known insect/animal bites, scratches or licks.
5. and injuries or illnesses.
6. vaccination history
7. diet whilst traveling

Question 4

What are the first line investigations for a febrile patient?

Answer 4

Full blood count 
ESR or C-reactive protein 
U + E 
Procalcitonin 
Liver enzymes

Question 5

What is Bacteraemia?

Answer 5

The presence of organisms in the blood, can occur in healthy people without causing any symptoms as a result of local infection of penetrating injury.. It can follow surgery, dental treatment and even tooth-brushing. It can occur from the bowel or bladder, especially in the presence of local inflammation. Unless a site of metastatic infection is established (such as the heart valves), most organisms are rapidly cleared from the blood.

Question 6

What is septicaemia?

Answer 6

Septicaemia (another name for blood poisoning) refers to a bacterial infection of the blood, whereas sepsis can also be caused by viral or fungal infections.

Question 7

What is sepsis?

Answer 7

Sepsis is the term used to describe the signs and symptoms of a systemic inflammatory response syndrome (SIRS) to a localized primary site of infection. Viral, bacterial, fungal and parasitic disease can all trigger the sepsis syndrome. SIRS is not unique to infection and may complicate a variety of events and conditions such as trauma, chronic inflammatory disease and malignancy (e.g. lymphoma).

Question 8

What is severe sepsis?

Answer 8

This is the presence of the sepsis syndrome (presence of either a positive blood culture or clinical features of fever, tachypnea, suspected infection), complicated by organ dysfunction, hypotension or hypoperfusion and manifested by low blood pressure, oliguria, hypoxia, acute confusion and lactic acidosis.

Question 9

What is septic shock?

Answer 9

Is defined as the sepsis syndrome plus organ dysfunction and hypotension unresponsive to adequate fluid replacement. Mortality rates often exceed 50%

Question 10

What are the common causes of sepsis in a previously healthy adult?

Answer 10

Skin - Staph aureaus and other gram positive cocci.
Urinary tract - E. coli and other aerobic gram negative rods.
Resp tract - streptococcus pneumoniae
Gall bladder or bowel - Enterococcus faecalis, E. coli and other gram negative rods, Bacteroids fragilis.
Pelvic organs - Neisseria gonorrhoeae, anaerobes.

Question 11

What are the common causes of sepsis in hospitalised patients?

Answer 11

Urinary catheter - E.coli, Klebiella spp, proteus spp, serratia spp, pseudomonas

Intravenous catheter - Staph aureus, staph epidermidis, klebsiella spp, pseudomonas spp, candida albicans

Post surgery

• wound infection: staph aureus, e.coli, anaerobes (depending on site)
• deep infection: Depends onf anatomical location

Burns - Gram positive cocci - pseudomonas spp, candida albicans

Immunocompromised - any of the above