Bacteremia may present with a lot of signs and symptoms depending on the site of the primary infection, comorbid events and stage of the disease.
The following system-wise presentation are eminent in the majority of bacteremia cases:
General Appearance: Patients in severe bacteremia may present with pallor and lethargy due to blood coagulation and destruction. Oxygen desaturation during fulminant disease may present with cyanosis.
Systemic response: Fever is the most common heralding sign of infection and bacteremia in both children and adults due to a set point resetting which may lead to diaphoresis (excessive sweating). Older people may present with hypothermia due to incompetent immune response.
Head and Neck: Micro-hemorrhages of the conjunctiva may occur with DIC.
Chest and Heart: Patients will appear frequent and shallow breathing with severe bacteremia due to metabolic acidosis that decreases the blood pH. Heart murmurs are accentuated with bacterial endocarditis.
Abdomen: Enlargement and hardening of the abdomen may be observable if bacteremia complicates to peritonitis. Bleeding via the anus may be observed with blood coagulation complications
Extremities: Extremities may appear cold and clammy due to vasodilation with cytokine proliferation. Pulses may be less palpable due to late signs of septic shock.
The following laboratory workups are used in occult and persistent bacteremia:
In non-complicated bacteremia, the symptom of fever may be treated with acetaminophen. In general, bacteremia may clinically be treated with empiric doses of antibiotics and antifungal to shorten its clinical course and reduce complication.
Empiric treatments should always be reassessed with periodic blood cultures to rule out bacterial resistance to the treatment [9].
In meningitis, parenteral antibiotics were found to be more effective than oral antibiotics for treatment and in reducing its sequelae [10].
Complication of metabolic acidosis with sepsis should be controlled by altering it with parenteral sodium bicarbonate. Uncontrolled systemic inflammation may be allayed by the introduction of hydrocortisone in the blood stream.
Those in shock may be stabilized by the use of plasma expanders and intravenous fluids.
Occult bacteremia is arbitrarily self-limiting to all patient. In severe bacteremia cases however, risk were significantly higher in the age group below 3 months and beyond 55 years old. The absence of prior immunizations worsens the prognosis.
Morbidity state of children and adults will also be an indispensable predictor of bacteremia prognosis. The nature of the invading bacteria may influence the outcome of bacteremia. The World Health Organization (WHO) has conveyed that more than 6 million children die from pneumococcal infections presenting in either bacteremia, meningitis or pneumonia in developing countries worldwide [7].
Complications
Patients may present with the following complications with persistent and severe bacteremia:
Bacteremia may be occult or persistent (overwhelming) in nature. It may arise from any infections of the body like the lungs, abdomen, skin or urinary system.
Bacteremia may also incite infections of susceptible organs and may coexist with these primary infections of the bones (osteomyelitis), brain (meningitis) and the heart (endocarditis).
In the same way, bacteremia may stand as a complication of a primary diseases like typhoid fever, staphylococcal skin infections, and streptococcal pneumonia.
The incidence of isolated bacteremia may be challenging because of the existence of comorbid illnesses that disrupts the clinical presentation. With this regard, cohort studies tag bacteremia with common signs of significant temperature elevation, clinical appearance, associated risk factors and laboratory criteria.
In a United States study, incidence of bacteremia in children less than 3 months old without prior Haemophilus influenza type B (HiB) immunization were noted to be 1-2.2% for non-toxic infants, and 10-11% in infants that are toxic [1]. However, in age group 3-36 months old, the risk of serious bacteremia climbs to 10-90% [2]. The most common causative agent in infants less than 3 months old is Eschericha coli at 42% of cases while group B Streptococcus at 23% of cases [3]. Infants and children with concurrent immunization lowers the risk of bacteremia to 0.5% incidence [4].
Bacterial or viral invasion may triggers an immune response by releasing cytokines in the plasma. The assimilation of the cytokines causes a resetting of the thermoregulatory centers of the hypothalamus manifesting as fever (or increased of body temperature) [5]. The fidelity of the immune system dictates whether bacteremia is spontaneously resolved or whether it overwhelms the host.
Young children with immature immune system are unable to mount efficient immunoglobulin G (IgG) to combat encapsulated bacterial pathogens. Their opsonin and macrophage surface defense may also be underdeveloped to prevent bloodstream invasion [6]. Adult and child patients with immune-compromised states like those in antineoplastic drugs and those with inherent antibody defects may be a predictive sign for severe bacteremia. Prior immunizations with specific antigens may influence the type of invading organism in bacteremia among children.
Routine multiple immunization at an early age may significantly reduce the risk of persistent bacteremia and may directly influence patient morbidity and mortality. High risk patients for endocarditis like those with cardiac implants and those undergoing dental procedures should be given prophylactic antibiotics to prevent fulminant bacteremia.
Dirty wounds and surgical wounds should be dressed with antiseptics liberally to prevent pathogens from invading the bloodstream. Inserted bladder catheters and nasogastric tubes should be done aseptically to reduce the risk of bacteria translocation leading to iatrogenic bacteremia.
Bacteremia is a clinical condition where there is transient proliferation of bacteria in the bloodstream. Majority of cases of bacteremia may result from tooth brushing, dental procedures, and simple medical procedures which may spontaneously resolve.
However, persistent bacteremia may develop from serious infections like pneumonia and osteomyelitis to cause life-threatening scenarios. Persistent bacteremia especially in an immune-compromised host may lead to a system-wide response referred to as sepsis.
Innocent fever in both children and adults should always be taken as a sign of impending disease and should be brought to medical attention to avoid untoward complications.
Self-medication with antibiotics should never be an option for other medicines may damage the kidneys or the liver if taken for the incorrect indication. Compliance to medications in bacteremia is of paramount importance to ensure recovery and prevent the immergence of resistant strains of bacteria.