Is sepsis always life-threatening?

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 causes more deaths than heart disease and stroke combined. Despite these grave consequences, few 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 body’s overactive, toxic response to infection caused by an overdrive of immunoprotective chemicals. Sepsis is a life-threatening condition in response to infections that 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, viruses, 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 in serious organ damage and sometimes even death.

What are the first signs and common symptoms of sepsis?

The symptoms of septicemia depend on the primary site of infection. Initial symptoms of the disease should be identified, and immediate medical intervention is required for treating blood infections 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 that is characterized by reduced functioning of various vital organs such as the lungs, kidneys, 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 are progressive conditions that 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 that affects the functioning of various vital organs.
• Organ dysfunction: During sepsis, the permeability of the blood vessels increases, leading to a 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 lead to organ or tissue damage.
• Inflammation: A highly aggressive immune system against 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 chronic diseases, as their immune systems are compromised.
• Acute Respiratory Distress Syndrome: This is also a serious effect of a 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: A 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 necessitating amputation.
• Post-sepsis symptoms: It has been seen that even when the sepsis is completely treated, the patient lives with post-sepsis symptoms for months. Some of the symptoms related to the condition “post-sepsis symptoms” include
  • 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 agents may also be fungi and viruses. The infection may primarily occur in one of the following locations:

• Lung: Lung infection and pneumonia are said to be the primary sources of a blood infection. As the blood passes through the pulmonary artery and veins, the infection spreads throughout the body through the blood.
• Gastric-Intestinal Tract: Gastrointestinal infections also result in sepsis. Gastrointestinal organs susceptible to infection are the stomach, intestine, and colon.
• Urinary tract: As the blood circulates into the urinary tract for filtration, infection in the kidney may lead to a blood infection.
• Blood infections: A direct blood infection, such as an infection caused by an insect bite, also causes sepsis.
• Post-surgical Infections: You may also get a blood infection after surgery due to various reasons. Urinary tract infection is a common feature after surgery and 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 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 have diseases of the immune system like HIV/AIDS or those on immunosuppressant drugs.
• People are 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 underdeveloped immune systems. Some of the other reasons that 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 make them susceptible to pneumonia, influenza, and other infections.
• Infections from the mother (group B streptococcus infection).
• Non-adherence to the 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, organ dysfunction and organ failure are occurring at a relatively rapid pace in the elderly as compared to young individuals. The time between sepsis and the presentation of symptoms of complications is shorter, 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 that is not contagious. It means that a person suffering from sepsis cannot transfer it to another person. Sepsis is a condition whose severity varies from person to person depending on the immune system and associated risk factors. Sepsis itself is not contagious, but 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 the medical history and physical examination by the doctor, the primary test for diagnosis is the blood test to identify a 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 was also evaluated. For example, if the infection is believed to be in the lungs, a chest X-ray is advised, while in cases of urinary infection, a 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 those of other conditions. However, sepsis specialists usually diagnose a person with sepsis when the individual 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 the following:

• Identifying the causative bacteria
• Analyzing 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 cases of poor kidney function.
• Breathing support such as mechanical ventilation.

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Can a person recover from sepsis? 

Recovery from sepsis depends on a variety of factors. A primary factor is a rapid diagnosis and the immediate initiation of 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 on the patient’s response to treatment. Generally, in mild and moderate sepsis, there is a complete recovery.

How can sepsis be prevented? 

Sepsis is caused by an infection that is caused by bacteria, viruses, or fungi. Most of the time, the infection is caused by bacteria. Sepsis can be prevented by eliminating risk factors like adhering to vaccination schedules, maintaining good hygiene, and early diagnosis and treatment of primary infections, especially in high-risk individuals. Early treatment of an infection is essential in order to prevent it from spreading in the blood. Sepsis can be prevented in children by providing them with vaccinations for chickenpox, 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 to, and advice from a medical professional should be taken. Immunocompromised individuals and the 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 by a delay in the diagnosis of the infection and its treatment. The diagnosis of sepsis is determined by a detailed medical history, a 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 the absence of signs of organ failure and a timely diagnosis, the chances of death may be as high as 15%–30%, and in the case of severe sepsis, the chances may even be as high as 40%–60%. Thus, in the event of any signs or symptoms of any infectious disease, like wound infections, pneumonia, or 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, the elderly, and 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