Piremia is a particularly severe form of blood poisoning (sepsis) in which the pathogens carried by the blood flow secondarily affect other organs. The prognosis is generally even less favorable than in ordinary sepsis.
What is pyemia?
Piremia is also called metastatic general infection because masses of pathogens infect other organs through the bloodstream. The pathogens spread through the bloodstream in a similar way to cancer cells in a cancerous tumor. In this sense, pyemia can be considered a particularly severe form of sepsis. Even ordinary sepsis represents a serious clinical picture. It is characterized by complex systemic inflammatory reactions due to massive infection with bacteria, bacterial toxins and fungi. In the case of pyemia, however, pathogens also enter the lungs, heart, spleen, liver, kidneys, joints or brain via the blood in the course of embolic transport. There, foci of infection also form, which in turn can spread and exacerbate the entire disease process. Abscesses form everywhere in the body. A typical example of pyemia is puerperal fever. In puerperal fever, various pathogens enter the organism through a large wound area in the placenta and cause inflammation in the peritoneum, uterus, intestines and other organs. In this context, it should be noted that the discoverer of puerperal fever, the Hungarian physician Ignaz Philipp Semmelweis, himself died of pyemia in 1865.
Causes
Pyemia is caused by the massive entry of pathogens such as Streptococcus pyogenes, Staphylococcus pyogenes, Staphylococcus aureus, or Neisseria into the bloodstream. These spread throughout the organism and cause the symptoms of sepsis, which is accompanied by additional infection of other organs. Thus, in pyemia, the organism is affected both by the systemic inflammatory reactions and by the additional infection of other organs with pathogens. In puerperal fever, for example, these pathogens enter through the cervix, which has been opened by the birth process. There is a direct connection from the vagina to the uterus via the cervix. Even under good hygienic conditions, it is easy for the pathogens to infect the uterus. However, the postpartum flow normally ensures that the germs are transported back. However, this is not the case if the postpartum flow is too weak. Other forms of pyemia are also transmitted through wounds. Both the development of sepsis and pyemia depend on three factors. These factors include the virulence of the germs, the state of the immune system, and the nature of the organism’s response. Where and how the pathogens enter the organism also plays a role. They immediately enter the blood via wounds. Organs such as the brain, lungs or abdominal cavity are poorly protected even in the case of harmless infections, so that the germs can spread there quickly. People with weakened immune systems naturally have a higher risk of developing sepsis or even pyemia. However, when a large number of pathogens enter the bloodstream, often even a strong immune system is no longer helpful in averting pyemia.
Symptoms, complaints, and signs
Like sepsis, piremia is characterized by high intermittent fever, increased respiratory rate, severe impaired consciousness, diarrhea, nausea, vomiting, chills, high heart rate, very low blood pressure, and possibly septic shock. Abscesses form throughout the body. If left untreated, pyemia invariably leads to death.
Diagnosis and course of the disease
In diagnosis, testing for the causative pathogens and the origin of the infection is particularly important. Blood cultures are grown to determine the pathogens. Furthermore, the preparation of a blood count is necessary. In the course of a blood gas analysis, statements can be made about the gas distribution of carbon dioxide and oxygen as well as the acid-base balance. During the course of the pyemia, it is necessary to monitor various parameters. These include regular examinations of blood cultures, blood pressure checks, determinations of blood gases, lung function tests and much more.
Complications
In the worst case, pyemia can result in the death of the affected person. However, this usually occurs if the disease is not treated. In this case, the internal organs are attacked by the pathogens and can thus be irreversibly damaged. The patients suffer from a very high fever due to the pyemia. The fever does not subside even with the help of medication. It is also not uncommon for the respiratory rate of those affected to be disturbed in pyemia, and this leads to disturbances in consciousness and possibly also to a loss of consciousness. In most cases, the affected person also suffers from nausea or vomiting. In addition to fever, shivering also occurs and affected individuals suffer from hypertension. Without treatment, pyemia usually leads to the death of the patient. There are usually no particular complications associated with the treatment of pyemia. The disease can be treated relatively well with the help of antibiotics. The earlier the disease is diagnosed and treated, the better the prospects for complete recovery of the patient. In severe cases, organ transplants may be necessary.
Treatment and therapy
Because pyemia is an emergency situation, treatment must be started before the pathogens are fully identified. The earlier therapy begins, the greater the likelihood of survival. Thus, a wide range of antibiotics must be administered first to reach the entire spectrum of pathogens. After resistance testing, it is then possible to switch to the specifically adapted antibiotic. The focus of infection must also be surgically sanitized. This also applies to the removal of abscesses in the other organs. Furthermore, it is necessary to adjust the central venous pressure and the arterial mean pressure by infusions. Other treatment methods also include the administration of erythrocytes and pulmonary ventilation. Often, further organ-supporting measures have to be carried out. Despite the most intensive therapy, more than 30 percent of those with the disease die.
Prevention
To prevent pyemia, the risks of infection should be reduced. To do this, it is important to strengthen the immune system in general to protect against infectious diseases. To do this, a healthy lifestyle with a balanced diet, plenty of exercise, and low stress are recommended. Alcohol consumption and smoking should also be limited. Furthermore, compliance with hygienic standards such as hand washing and disinfection is very important. This is especially true when coming into contact with people who are seriously ill. To prevent puerperal fever, among other things, births should always take place under medical supervision.
Aftercare
If pyemia has been treated successfully, good aftercare is important to prevent recurrence of pyemia or sepsis (blood poisoning) and secondary diseases such as organ damage. The organs that were affected by the pyemia should be examined regularly. Depending on the organ, this is done with imaging techniques such as ultrasound, MRI, CT and X-ray. However, this can only detect external organ damage and monitor the healing of the damage caused by the pyemia. Organ function should also be monitored, however, as limitations are possible in the long term as a result of the pyemia. This is done through regular checks of organ levels in the blood. If the brain has been affected by the pyemia, long-term sequelae often cannot be detected via blood checks. The development of neurological symptoms such as new types of headaches that occur for no apparent reason, muscle tremors or signs of paralysis can be a late consequence of the pyemia and should be clarified with the attending physician immediately after the first occurrence. Organ damage that has already occurred must be treated separately, even after treatment of the pyemia. If an inflammatory skin disease is present as the underlying disease, it must be treated dermatologically on a long-term basis. If such an underlying disease is present, a high standard of hygiene should also be maintained to prevent the spread of bacteria on the skin.
