Sepsis continues to be a critical problem in regards to morbidity and mortality in the clinical setting. Ranked as a top cause of morbidity and mortality, sepsis can be the result of a number of pathologies and can greatly complicate the care of patients in and out of the hospital setting [1]. Despite advances in the treatment of sepsis, 28 day in hospital mortality rates still range from 15 to 45% [2]. EpidemiologyInpatient expenses related to the treatment of sepsis infections are on the rise with annual costs estimated to be in excess of $20 billion [3]. This places sepsis as one of the most costly burdens on the health care system. Sepsis rates are on the rise (Table 1) [4]. The elderly population is at a greater risk for the development of sepsis and sepsis related complications. As a result this population makes up a significant amount of the total number of sepsis patients [1]. Similar to the general population, the elderly also have experienced dramatic increases in sepsis hospitalizations as shown in table 2 [3]. A more recent study has shown that sepsis likely contributed between 30 and 50% of mortality and had a large impact on healthcare costs in the US between 2010 and 2012 [4]. With the growing burden of sepsis on the healthcare system, there is a strong drive to develop more efficient mechanisms to detect and manage sepsis patients. PathophysiologySepsis and disease severity depend on various factors, ranging from the properties of the invading pathogen to the current immune status of the host [9]. Severe sepsis can develop following local infection and can stem from a number of sites including the abdomen, skin, soft tissue, urinary tract, lungs and is usually due to a primary Abstract Every physician has been trained early in their careers on how to recognize and manage sepsis. Although sepsis has been one of the most researched ailments in medicine, it also remains one of the deadliest diseases in the face of recent advances. In this current article, we review the diagnostic and management criteria for Systemic Inflammatory Response Syndrome (SIRS), sepsis, severe sepsis, septic shock, and Multi Organ Dysfunction Syndrome (MODS). We then examine the implications of the "surviving sepsis" campaign as well as explore the philosophy of Early Goal Directed Therapy (EGDT) and its role in the modern day management of sepsis. In addition, we sought to highlight potential new biomarkers and current available therapies in sepsis.
Introduction: Lemierre syndrome is a rare, potentially fatal, septic thrombophlebitis of the internal jugular vein. Treatment includes intravenous antibiotics for Fusobacterium necrophorum, the most common pathogen, as well as consideration for anticoagulation therapy. Case Report: A 27-year-old female presented with left-sided neck swelling and erythema. Computed tomography noted left anterior jugular vein thrombophlebitis and multiple cavitating foci, consistent with septic emboli. We report a rare case of Lemierre syndrome in which the thrombus was found in the anterior jugular vein, as opposed to the much larger internal jugular vein more traditionally associated with creating septic emboli. Conclusion: Based on an individual’s clinical symptoms, history, and radiologic findings, it is important for physicians to consider Lemierre syndrome in the differential diagnosis, as the condition may rapidly progress to septic shock and death if not treated promptly. The use of anticoagulation therapy remains controversial, and there is a lack of established standard care because the syndrome is so rare.
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