Pathogenetic variants of sepsis in oncologicy practice

Abstract

Introduction Over the past 30 years, sepsis has been an urgent interdisciplinary problem of modern medicine due to the increase in morbidity and a consistently high mortality rate. Patients of oncological hospitals have a high predisposition to the development of sepsis, both in the postoperative period and in the departments of chemo and radiation therapy. In addition, sepsis may be a complication of the postoperative period in patients undergoing surgical treatment. Of interest is not only the clinical and laboratory diagnosis of sepsis in this category of patients, but also the features of its morphological picture, due to uniform diagnostic criteria. The greatest difficulties arise in the study of autopsies, after antitumor chemotherapy, which causes a secondary immunodeficiency condition characterized by the absence of a classical morphological picture of sepsis. The use of modern antibacterial drugs, as well as pathogenetic therapy of sepsis also leads to its pathomorphosis, which also complicates diagnosis.The aim of the study is to systematize the literature data and the results of our own research on the features of morphological manifestations of sepsis in oncological pathology, depending on cancer treatment.Material and methods The search and selection of literary sources was carried out in PubMed, GoogleScholar, electronic library systems elibrary.ru, the search depth is 30 years.Results and Discussion Sepsis in cancer patients after surgical interventions is characterized by hyperergic type of tissue reactions with hyperplasia of lymphoid and myeloid tissue and classic manifestations of septicopyemia of varying severity of purulent metastatic process: from macroscopically distinguishable abscesses to mini-foci of purulent inflammation. Against the background of antibiotic therapy, there is a pathomorphosis of sepsis with a predominance of microcirculation disorders and small focal ulcers. In patients after chemotherapy, accompanied by leukopenia and agranulocytosis, with sepsis, hypoplasia of myeloid and lymphoid tissue is noted, and in the internal organs, along with microcirculation disorders, foci of necrosis, severe dystrophic changes with the absence of neutrophil infiltration are found.Conclusion Sepsis in cancer patients from pathogenetic positions is heterogeneous, depending on the characteristics of the body and the nature of treatment, it should be divided into hyper- and anergic. The diagnosis of sepsis is clinico-morphological, which requires not only the use of clinical and laboratory diagnostic scales, but also the definition of criteria for morphological diagnosis.