Endotoxemia

Introduction Endotoxemia is a pathophysiological manifestation caused by bacteria in the blood or bacteria in the lesion releasing a large amount of endotoxin to the blood, or by injecting a large amount of liquid contaminated by endotoxin. Endotoxemia is divided into two categories: endogenous and exogenous.

Cause

In severe stress, infection and other stress conditions can occur:

The systemic reticular endothelial system is dysfunctional, the immune function is reduced, and the endotoxin absorbed by the intestine is excessive and exceeds the body's ability to clear.

Gastrointestinal mucosal ischemia, necrosis, barrier destruction, a large amount of endotoxin released into the blood.

The endotoxin absorbed by the intestine is directly in the systemic circulation due to liver dysfunction.

Infection of certain tissues and organs causes exogenous endotoxin to enter the blood.

an examination

Related inspection

Bacterial endotoxin test

(1) Clinical manifestations of chills, chills, hyperthermia, white blood cells and neutrophils. There is no restriction on a system that tends to or find multiple systems with migratory inflammation and multiple organ dysfunction. There is often a history of infection before the disease. In particular, those who have a basic disease that seriously affects the body's defense function, and who cannot control fever and other signs of systemic infection with general antibacterial drugs, should consider the possibility of endotoxemia. If there are defects or ecchymoses in the skin and mucous membranes, or complicated with septic shock, the clinical diagnosis of endotoxemia is basically established.

(2) Laboratory data The white blood cells and neutrophils are significantly increased, and the diagnosis is to obtain positive blood or bone marrow bacteria culture. For example, the detection of bacteria in specimens such as pus, pleural effusion, and cerebrospinal fluid has reference value. Judging the conditional pathogen: It is best to obtain the same kind of bacteria in multiple blood cultures, or the blood culture is consistent with the culture results of pleural effusion, cerebrospinal fluid, urine, pus, etc., for self-bacterial serum agglutination test, if positive is helpful for diagnosis .

Differential diagnosis

(1) Typhoid fever, toxemia, splenomegaly and normal or low white blood cell count are easily confused with Gram-negative bacillus endotoxemia, but typhoid fever is slow, and may have relatively slow pulse, rose rash, hearing Decreased, no desire, fatda reaction positive, blood culture may have typhoid or paratyphoid bacillus growth.

(B) miliary tuberculosis can have high fever, toxemia, splenomegaly, similar to endotoxemia, but patients with slower onset, have night sweats, weight loss and other symptoms of tuberculosis, negative blood culture, two weeks after the disease X The chest radiograph can be shaded by two lungs.

(C) allergic subsepticemia may have fever, rash, joint pain, splenomegaly and increased total white blood cells, clinically similar to endotoxemia. However, the toxemia is not obvious, and the fever and remission period alternate, and the disease occurs repeatedly for several months to several years. Negative blood culture, various antibacterial drugs are not effective, but effective for adrenocortical hormone.

(4) Malignant histiocytosis has irregular fever, and the total number of splenomegaly and white blood cells is reduced, which is similar to endotoxin in Gram-negative bacilli. However, patients with this disease have weight loss, exhaustion, bleeding tendency, hepatosplenomegaly, and endotoxemia. In addition to leukopenia in blood, there are progressive anemia, thrombocytopenia, bone marrow smear and lymph node biopsy showing abnormal tissue cells.

(5) Others must be differentiated from diseases such as falciparum malaria, lymphoma, and rheumatic fever.

(1) Clinical manifestations of chills, chills, hyperthermia, white blood cells and neutrophils. There is no restriction on a system that tends to or find multiple systems with migratory inflammation and multiple organ dysfunction. There is often a history of infection before the disease. In particular, those who have a basic disease that seriously affects the body's defense function, and who cannot control fever and other signs of systemic infection with general antibacterial drugs, should consider the possibility of endotoxemia. If there are defects or ecchymoses in the skin and mucous membranes, or complicated with septic shock, the clinical diagnosis of endotoxemia is basically established.

(2) Laboratory data The white blood cells and neutrophils are significantly increased, and the diagnosis is to obtain positive blood or bone marrow bacteria culture. For example, the detection of bacteria in specimens such as pus, pleural effusion, and cerebrospinal fluid has reference value. Judging the conditional pathogen: It is best to obtain the same kind of bacteria in multiple blood cultures, or the blood culture is consistent with the culture results of pleural effusion, cerebrospinal fluid, urine, pus, etc., for self-bacterial serum agglutination test, if positive is helpful for diagnosis .

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