Sepsis a disease in which the body has a severe and inflammatory response to bacteria or other microorganisms.
What are the symptoms of sepsis?
We can differentiate three stages in sepsis: sepsis, severe sepsis, and septic shock. It can appear while the patient is still in the hospital recovering from an intervention, but this is not always the case. It is important to seek immediate medical attention if you have any of the following symptoms. The sooner you seek treatment, the better your chances of survival.
Symptoms of sepsis include:
- fever above 101ºF (38ºC) or a temperature lower than 96.8ºF (36ºC);
- a heart rate higher than 90 beats by the minute;
- respiratory rate higher than 20 breaths by the minute, or
- a probable or confirmed infection.
You must have at least two of these symptoms before a doctor diagnoses you with sepsis. Severe sepsis occurs when a failure occurs in the body. You must experience one or more of the following signs for your doctor to diagnose this disease:
- discolouration spots on the skin;
- reduction in urine output;
- changes in mental capacity;
- thrombocytopenia (decrease in the number of platelets);
- respiratory problems;
- abnormal heart function;
- chills due to low body temperature;
- Unconsciousness, or
- extreme weakness
Septic shock symptoms of septic shock include the signs of severe sepsis and very low blood pressure.
What Causes Sepsis?
Any infection can lead to sepsis, but the following types of infections are more common:
- abdominal infection;
- kidney infection, or
- infection in the bloodstream.
According to the National Institute of Medical and General Sciences, the number of cases with sepsis is increasing each year in the United States. Possible reasons for this increase include:
- the ageing of the population, since sepsis is more frequent in the elderly;
- an increase in resistance to antibiotics, which occurs when an antibiotic loses the ability to resist or kill a bacteria, or
- an increase in the number of people with diseases that weaken their immune systems.
Who can get sepsis?
Although some people are at higher risk for infection, anyone can get this disease. Among the individuals most likely to find:
- young children and older people;
- people with weaker immune systems, such as those with HIV or those undergoing cancer treatment;
- to individuals who are in the Intensive Care Unit (ICU), or
- those who are exposed to invasive devices, such as IV catheters or breathing tubes.
New-borns and sepsis
Neonatal sepsis appears when a baby has an infection in the bloodstream in the first months of life. This disease is classified based on how long the infection lasts, depending on whether it was contracted during childbirth (early-onset) or after birth (late-onset). This helps the doctor decide what type of treatment to administer. Premature and low-birth-weight babies are more likely to develop late-onset sepsis because their immune systems have not matured. Although symptoms can be subtle or nonspecific, some signs include:
- abnormal breastfeeding;
- low body temperature;
- apnea (temporary suspension of breathing);
- poor blood circulation in the skin, which causes cooling in the extremities;
- abdominal swelling;
- yellowing of the skin and the whites of the eyes (jaundice), or
- eating disorders.
Neonatal sepsis still represents the leading cause of infant death, but with early diagnosis and treatment, the baby will make a full recovery and no other problems. Thanks to check-ups at the maternal stage and appropriate neonatal testing, the risk of neonatal sepsis has decreased significantly.
Older people and sepsis
How is sepsis diagnosed?
If you have symptoms related to sepsis, your doctor will do some tests to identify the problem and determine the severity of the infection. One of the first tests is blood. Patients’ blood is checked for complications such as:
- an infection;
- clotting problems;
- abnormal kidney or liver function;
- a decrease in the amount of oxygen, or
- an imbalance in minerals called electrolytes, which affect the amount of water in the body, as well as the acidity of the blood.
Depending on the patient’s symptoms and the results of the blood test, the doctor will order other tests, such as:
- a urinalysis (to check for bacteria present in it);
- a culture for wound drainage (to check for infection in an open wound), or
- a mucus discharge test (to identify the germs responsible for the infection).
If the doctor cannot determine the source of the infection using these tests, he or she may need to visualize the inside of your body using one of the following methods:
- X-ray to visualize the lungs;
- CT scan to view possible infections in the appendix, pancreas, or intestine;
- ultrasound to visualize infections in the gallbladder or ovaries, or
- MRI, which can identify soft tissue infections.
Methods for diagnosing sepsis
There are two methods that doctors use to determine the severity of the disease. One is the systemic inflammatory response syndrome (SIRS), which is defined when the patient has two or more of the following conditions:
- fever over 100.4 ° F (38 ° C) or less than 96.8 ° F (36 ° C);
- heart rate higher than 90 beats by the minute; <
- respiratory rate greater than 20 breaths per minute or partial pressure of carbon dioxide in arterial blood (PaCO2) less than 32 mm Hg, or
- abnormal white blood cell count.
Another method that is also used is the Sequential Organ Failure Assessment (qSOFA), which uses the results of three methods:
- low blood pressure reading;
- high breathing rate (greater than 22 breaths per minute), or
- Glasgow Coma Scale less than 15 (used to determine the level of consciousness).
A positive qSOFA determines whether two or more of the above measurements are abnormal. Some specialists prefer to use this evaluation, since, unlike the SIRS, it does not require tests in the laboratory. The results of either of these two tests will help your doctor determine treatment.
How is sepsis treated?
Sepsis can quickly lead to septic shock or death if left untreated. Doctors use a variety of medications to treat it, such as:
- intravenous antibiotics to fight infection;
- vasoactive drugs to increase blood pressure;
- insulin to stabilize blood sugar level;
- corticosteroids to reduce inflammation, or
Severe sepsis may also require large amounts of IV fluids and a ventilator. Dialysis may be necessary if a kidney condition has occurred. The kidneys help filter harmful wastes, salt, and excess water in the blood. In dialysis, a machine is in charge of performing these functions. In some cases, surgical intervention may be necessary to eliminate the source of the infection, for example, draining a liver abscess or removing infected tissue.
Recovery will depend on the severity of the disease and any pre-existing problems the patient may have. Many of the survivors will make a full recovery, although some may suffer some lasting effects. The UK Sepsis Trust states that it can take up to 18 months for patients who recover from sepsis to feel completely well. On the other hand, the Sepsis Alliance believes that 50 per cent of survivors will have to deal with post-sepsis syndrome (PSS). This association also believes that sepsis produces long-term side effects such as:
- organ damage;
- muscle and joint pain;
- poor concentration;
- the decrease in cognitive functioning, or
- low self-esteem.
- Severe cases of sepsis can lead to death.
It is important that you take steps to prevent the spread of an infection and thus reduce the risk of developing sepsis, such as:
- Staying up-to-date with vaccinations, meaning you need to get vaccinated against flu, pneumonia, and other infections.
- Have good hygiene, which means that you must take proper care of wounds and wash hands properly, as well as bathe regularly.
- Get immediate care if you develop signs of infection, as every minute counts in treating sepsis. The earlier you start treatment, the greater the result.