Clinical Case Database / Category: Patient Management

A case of reduced GCS in an immunocomprimised patient

Publication details

Lisa Gemmell, ST6, Ailsa Gemmell, FY1, Valerie Cunningham
Foundation Years Journal, volume 9, issue 8, p.6 (123Doc Education, London, September 2015)


The ability to recognise the acutely ill patient is a skill that all foundation doctors should have and guidelines from NICE and surviving sepsis prompt this. Severe sepsis is a major cause of morbidity and mortality, with an annual mortality rate of 35% (1). The surviving sepsis guidelines implementation in hospital has been shown to reduce mortality, decrease length of stay and reduce intensive care bed days (2,3).
The prompt assessment, institution of appropriate investigations and management and involvement of senior doctors has been shown to reduce mortality in this patient group. Sepsis Six is the name given to the bundle of medical therapies designed to reduce the mortality of patients with sepsis. These simple measure can save lives. All foundation doctors who will work in an acute receiving unit should possess these skills.
Source control is fundamental to the treatment of sepsis and vital for overall morbidity and mortality. We present a rare case of reduced GCS in an immunocomprimised patient. Invasive fungal infections are rare, but should be considered in patients who are immunocomprimised, those with solid organ transplants taking immunosuppressants and those with haematological malignancies.

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Lisa Gemmell, ST6 (Corresponding author)

Glasgow Royal Infirmary
84 Castle Street, Glasgow G4 0SF

Ailsa Gemmell, FY1

Hairmyres Hospital
Eaglesham Road, East Kilbride, G75 8RG

Valerie Cunningham

Consultant Anaesthetist
Institute for Neurological Sciences
Southern General Hospital
Govan Road, Glasgow


1. Linde-Zwirble WT, Angus DS: Severe sepsis epidemiology: Sampling, selection and society Crit Care 2004; 8:222-226
2. Surviving Sepsis Guideline:
3. Ron Daniels et al : Surviving the 1st hours of sepsis: getting the basics right. Journal of Antimicrobial chemotherapy 2011; 66 supplement 2
4. A systemic approach to the acutely ill patient (ABCDE approach) –
5. National Institute for Health and Clinical Excellent. Acutely Ill patients in hospital: recognition of and response to acute illness in adults in hospital.
6. Verpula et al: Haemodynamic variables related to outcome in septic shock. Intensive Care Medicine 2006; 31:1066-1071
7 E.Dodds Ashley: Fungal infections in the ICU
8. Invasive pulmonary and CNS aspergillosis. Critical Care Medicine 2010 14:442
9. Limper et al. An official American Thoriacic Society: treatment of fungal infections in adult pulmonary and critical care patients. Am Journal Respiratory Critical Care Medicine 2011; 183;96
10. Marr et al. Combination antifungal therapy for invasive aspergillosis: a randomised trial. Annual Internal Medicine 2015; 162:81
11.. Collins JA. Problems associated with the massive transfusion of stored blood. Surgery 1974; 74:274


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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