When sepsis strikes, it can be fatal. Death due to sepsis occurs as a result of poor blood flow and multi-organ failure. In India, 34% of people with sepsis die in the intensive care unit. Globally, sepsis is attributed to causing deaths greater than those caused by heart diseases and stroke combined. Despite these grave consequences, fewer individuals know about sepsis. Early detection of infection and timely treatment can save lives.

At a Glance:

What is sepsis or septicemia? 

Sepsis is the overactive, toxic response of the body to infection through an overdrive of immunoprotective chemicals. Sepsis is a life-threatening condition in response to infections which may progress to extensive damage to multiple organs and death. Sepsis is commonly noticed in infections such as pneumonia, urinary tract infections, and digestive infections. The initial septicemia (blood infection or blood poisoning) if not managed in time, may progress into a serious condition called sepsis which may further lead to septic shock (extremely low blood pressure). In normal conditions, the immune system or self-defense system of the human body efficiently fights microorganisms including bacteria, virus, and fungi. In other cases, the chemicals released to fight the infection cause widespread inflammation throughout the body, leading to a cascade of events that culminates into serious organ damage and sometimes even death.

What are the first signs and common symptoms of sepsis?

The symptoms of septicemia depend upon the primary site of infection. Initial symptoms of the disease should be identified, and immediate medical intervention is required for treating blood infection effectively. Early identification of these warning signs also reduces the risk of developing life-threatening septicemia. Sepsis, if not properly managed, in the early stages may assume a severe form which is characterized by reduced functioning of various vital organs such as lungs, kidney, and liver.

Some of the initial signs and symptoms of sepsis include: 

• Confusion
• Diarrhea
• Discolored skin due to reduced blood perfusion
• Disorientation
• Fast pulse
•  Very low temperature or Fever and chills
• Less than normal urination
• Mental decline
• Muscle pain
• Nausea and vomiting
• Rashes
• Shallow and rapid breathing

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What are the complications of sepsis? 

Septicemia and sepsis is a progressive condition and can be treated effectively with the administration of antibiotics and intravenous fluids. However, untreated sepsis may lead to a variety of complications, such as:

• Circulatory collapse: A reduced flow of blood which affects the functioning of various vital organs.
• Organ dysfunction: During sepsis, the permeability of the blood vessels increases leading to the reduced blood supply and an increased risk of clot formation. This leads to dysfunction and failure of the organs.
• Septic shock: Unmanaged sepsis leads to septic shock which is characterized by dangerously low blood pressure. A reduction in blood flow and low blood pressure leads to organ or tissue damage.
• Inflammation: Highly aggressive immune system against the bacteria causes inflammation throughout the body and can cause organ damage. Serious inflammation that may lead to organ damage is particularly seen in those patients with a chronic disease, as the immune system of such patients is compromised.
• Acute Respiratory distress syndrome: This is also a serious effect of blood infection as the reduced supply of oxygen to the lungs and brain gets reduced. In conditions with a reduced amount of oxygen, the patient may experience neurological symptoms.
• Blood clots: Blood infection may also cause the formation of blood clots in various parts of the body. As the blood clots block the blood flow in a tissue, the tissue starts to die. Prolonged obstruction of blood flow to an organ may lead to permanent damage and organ death, often needing amputation.
• Post-sepsis symptoms: It has been seen that even when the sepsis is completely treated, patient lives with post-sepsis symptoms for months. Some of the symptoms related to the condition “post-sepsis symptoms” includes
  • Cognitive Decline,
  • Fatigue
  • Insomnia

What are the causes of sepsis? 

Bacterial infections are the most common cause of sepsis. The infection may be caused primarily by bacteria, but the causative agent may also be fungi and virus. The infection may primarily occur in one of the following locations:

• Lung: Lung infection and pneumonia are said to be the primary source of a blood infection. As the blood passes through the pulmonary artery and veins, the infection spreads throughout the body through blood.
• Gastric-Intestinal tract: Gastrointestinal infections also result in sepsis. Gastrointestinal organs susceptible to infection are stomach, intestine, and colon.
• Urinary tract: As the blood circulates into the urinary tract for filtration infection in the kidney may lead to blood infection.
• Blood infections: Direct blood infection such as infection caused by the insect bite also causes sepsis.
• Post-surgical Infections:You may also get blood infection after surgery due to various reasons. Urinary tract infection is a common feature after surgery which can cause sepsis. Further, cuts on your body and your internal tissues are exposed to the environment. This may also cause infection and sepsis if adequate precautions are not taken.
• Meningitis:If you are suffering from meningitis i.e an inflammation of the membrane or covering of the brain, the risk is high.

Who is at higher risk for sepsis?

The risk of sepsis is high in individuals with a compromised immune system due to certain conditions such as a chronic disease or a recent surgery. People in these categories are at a higher risk:

• Very old or very young individuals.
• Recent surgery.
• Chronic diseases such as cancer, diabetes or hypertension.
• People diseases of the immune system like HIV/AIDS or those on immunosuppressant drugs.
• People undergoing care in high dependency units like the Intensive Care Unit (ICU).
• Infections by antibiotic-resistant bacteria.
• Pregnant women.

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How do newborn babies and children get affected by sepsis? 

Blood infection in children and newborn babies is due to their under-developed immune system. Some of the other reasons which make children and babies susceptible to septicemia include:

• Presence of infection in the amniotic fluid or in the birth canal.
• Hospital-acquired infections.
• Ill-developed organs in premature babies that make them susceptible to pneumonia, influenza and other infections.
• Infections from mother (group B streptococcus infection).
• Non-adherence to advised vaccination program.

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How do the elderly get affected by sepsis? 

‘Elderly or older persons’ are at higher risk for developing sepsis due to a weakened immune system. Further, the organ dysfunction and organ failure are relatively at a rapid pace in the elderly as compared to young individuals. The time between the sepsis and presentation of symptoms of complications is less, thus leading to high mortality. Elderly or older persons are more prone to chronic diseases such as diabetes and hypertension, which is one of the risk factors for getting sepsis.

Is sepsis contagious? Can a person suffering from sepsis spread it to others? 

Sepsis is a severe blood infection but is not contagious. It means that a person suffering from sepsis cannot transfer it to another person. Sepsis is a condition, the severity of which varies from person to person depending upon the immune system and associated risk factors. Sepsis itself is not contagious but since certain sepsis-causing types of bacteria, viruses, and occasionally, fungi and parasites called pathogens may be transferred. The transfer of the causative organism may or may not cause sepsis in the other person.

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How do doctors diagnose sepsis?

Apart from medical history and physical examination by the doctor, the primary test for diagnosis is the blood test to identify severe blood infection. Apart from the positive test for the presence of infection in the blood, other tests are also used to diagnose the disease. These tests include white blood cell count, PaCO2 (partial pressure of carbon dioxide) and procalcitonin levels. The primary site of infection also evaluated. For example, if the infection is believed to be in the lungs, the chest X-ray is advised while in case of urinary infection, comprehensive urine analysis should be done.

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What are the criteria for terming a condition as Sepsis?

Sepsis may sometimes be difficult to diagnose due to the similarity of its symptoms to other conditions. However, doctors usually term a person to have sepsis when the person meets at least two of the following criteria in addition to a physical exam and  a blood test for the presence of an infection according to the systemic inflammatory response syndrome (SIRS) definition for sepsis:

• An increased heart rate (> 90)
• An unusually high or low body temperature (>100.4 F or <98.6 F)
• A high respiratory rate (> 20 breaths per minute) or a decreased partial pressure of carbon dioxide (PaCO2) in arterial blood
• Abnormally high or low white blood cell count (WBC; >12,000 or < 4,000 cells/ul)

Individuals with septicemia require hospitalization and immediate treatment.

What is the treatment for sepsis? 

The treatment method in the initial phase follows the “sepsis six” strategy. This strategy involves three treatments and three tests.

The treatment includes the administration of

• Antibiotics
• Intravenous fluids
• Oxygen if the level of oxygen is low.

The tests done during this phase include:

• Identifying the causative bacteria
• Analysing the severity of the disease
• Evaluating the function of the kidney through kidney function tests.

Further treatment that may accompany the main treatment includes:

• Steroids for controlling inflammation.
• Blood transfusion, if required.
• Dialysis in case of poor kidney function.
• Breathing support such as mechanical ventilation.

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Can a person recover from sepsis? 

Recovery from sepsis depends upon a variety of factors. A primary factor is a rapid diagnosis and immediate initiation of the treatment. If the patient’s vital organs are damaged due to unmanaged sepsis, the recovery becomes difficult and the patient may suffer from lifelong disabilities. Sometimes aggressive treatment is required to make sure that there is a complete recovery. Recovery also depends upon the response of the patient towards treatment. Generally, in mild and moderate sepsis, there is a complete recovery.

How can sepsis be prevented? 

Sepsis is caused due to infection which is caused by bacteria, virus or fungus. Most of the times, the infection is caused by bacteria. Sepsis can be prevented by the elimination of risk factors like adhering to vaccination schedule, maintaining good hygiene and early diagnosis and treatment of primary infection, especially in high risk persons. Early treatment of infection is essential in order to prevent it from spreading in blood. Sepsis can be prevented in children by providing them with vaccinations for chicken pox, influenza, and hepatitis. Good hygiene includes taking good care of one’s health as well as activities like frequent hand washing. Further, any illness should be immediately attended and advice from a medical professional should be taken. Immunocompromised individuals and elderly should be provided with quality care and a healthy diet.

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Conclusion:

Sepsis or blood infection is characterized by an overwhelming response of the immune system against the pathogens. This leads to inflammation all over the body. Sepsis is generally caused due to delay in the diagnosis of infection and its treatment. Diagnosis of sepsis is done by a detailed medical history, physical examination and a blood test. Parameters such as body temperature, breathing rate, heart rate, and blood cell count are also taken into consideration for diagnosing sepsis.

Sepsis is a serious condition and it should not be ignored. Even in absence of signs of organ failure and a timely diagnosis, the chances of death may be as high as 15%-30% and in case of severe sepsis, the chances may even be as high as 40%-60%. Thus, in case of any signs or symptoms of any infectious disease like wound infections, pneumonia, meningitis immediate medical attention should be sought. Early treatment of infections can reduce the chance of developing sepsis, especially in high risk groups like children, elderly, & immunocompromised individuals.

References:

• Mayo Clinic. Sepsis. Available at: https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214. Accessed on January 7, 2019
• Sepsis Alliance. Risk Factors. Available at: https://www.sepsis.org/sepsis/risk-factors/. Accessed on January 7, 2019
• University of Rochester. Sepsis in the Newborn. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p02410. Accessed on January 7, 2019
• National Health Services. Sepsis. Available at: https://www.nhs.uk/conditions/sepsis/treatment/. Accessed on January 7, 2019
• National Health Services. Sepsis. Available at: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/sepsis. Accessed on January 7, 2019
• Sepsis Alliance. Sepsis and Prevention. Available at: https://www.sepsis.org/sepsis-and/prevention/. Accessed on January 7, 2019
• The death toll of sepsis in India. Ncholas Parry. Available at: https://www.healthissuesindia.com/2018/09/13/the-death-toll-of-sepsis-in-india/. Accessed on January 7, 2019