Abstract

There is a clinico-pathological continuum of infection-driven sepsis syndromes, the most severe being septic shock with multi-organ failure. The organ dysfunctions are due to inflammatory cytokines from remote sources (the site of infection) and constitute the systemic inflammatory response syndrome (SIRS). The common causes are Gram-positive and Gram-negative infections; the common infection sites are (in descending frequency) lung, blood stream, intra-abdominal disease, urological sepsis and surgical wounds; the commonest organ dysfunctions are systemic shock, kidney, lung, and heart. The differential diagnosis of severe sepsis includes disseminated malignancy, atherosclerosis, and haemophagocytic syndrome. New treatments for severe sepsis are being trialled to raise the poor survival rates in intensive care. The role of the autopsy is to describe carefully the organ lesions, provide microbiological evidence of infection, and to correlate these with the clinical features and therapeutic variables.

Highlights

  • Sepsis is defined as infection plus systemic manifestations of infection (Dellinger.R.P. et al 2008)

  • It is possible to immunostain for these (Fig 1) and at least one author holds that positive ICAM-1 staining of alveolar capillary endothelial cells indicates septic shock with high sensitivity and specificity (Tsokos 2003)

  • 10.3 Lung Lung dysfunction at the commencement of severe sepsis is present in about 20% of such patients (Munford 2005).The clinical diagnosis of acute lung injury is made when there arterial hypoxaemia (PaO2/FiO2

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Summary

Introduction

Sepsis is defined as infection plus systemic manifestations of infection (Dellinger.R.P. et al 2008). Autopsy pathologists not infrequently use the term ‘septicaemia’ (implying blood infection) as the final process causing death, implying that there was bacteraemia – hopefully proven but sometimes assumed – associated with one or more organ failures This is an uneasy combination of clinical, laboratory and gross pathological features, because: 1. A British study (Perkins et al 2003) noted that only 7.7% of ICU deaths underwent autopsy, and found similar discrepancy patterns to the French study What few of these studies address is the precise contribution of sepsis and its management to death, severe sepsis is noted to be both under- and over-diagnosed pre-mortem (Blosser, Zimmerman, & Stauffer 1998) (Perkins, McAuley, Davies, & Gao 2003).

Epidemiology
Clinical case definitions
Infections causing sepsis
Pathogenesis of the sepsis syndromes
Autopsy protocols
Microbiology sampling
Non-microbiological means of identifying severe sepsis
Simulators of septic shock
10. Specific organs at autopsy
11. Haemophagocytic syndromes
12. Thrombotic microangiopathy syndromes
14. Outcomes and co-morbidities
15. The treatment of sepsis
16. Conclusion
Findings
17. References

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