Sepsis: The Silent Killer

Sepsis is one of the most common deadly diseases in the world. Previously almost unheard of in the Western world, more recent tragic cases like the deaths of eleven-year-old Rory Staunton from New York and one-year-old William Mead from Cornwall, England have raised the profile of this potentially-fatal disease.

Sepsis is one of the only diseases to strike both rich and poor, first world and third world, with equal ferocity. Sepsis is increasing in the developed world at an unprecedented rate, by 8 to 13 percent per year. Despite widespread access to antibiotics and modern medical care, it is still one of the primary causes of death by infection, killing 44,000 people every year in the UK alone.

That's more than the number of people who die from breast and bowel cancer combined!

In the developing world, the figures are even higher. Sepsis accounts for 60 to 80 percent of childhood deaths, killing more than 6 million babies and children every year on a global level.

What is sepsis?

Commonly known as "blood poisoning", sepsis is a life-threatening reaction to an infection. It can develop as a response to any infection, including skin infections, small wounds that become infected, pneumonia, a kidney infection, or appendicitis. However, sepsis can also occur following routine operations, such as Caesarean sections, or having a drip or a catheter inserted.

When you have an infection, germs enter the body, causing illness.

The body tries to fight the illness, but - in its attempt to protect us - our immune system causes widespread inflammation, leaky blood vessels and abnormal blood-clotting. This process damages the very organs that keep us alive. In severe cases of sepsis, there is an extreme drop in blood pressure, the patient experiences multiple organ failure and dies of septic shock within hours.

How quickly does that happen?

The process from sepsis to septic shock varies from person to person. Some patients become very ill very quickly, deteriorating rapidly and dying within a few hours of sepsis infection.

The best thing you can do is seek immediate medical attention if you experience symptoms.

What are the symptoms of sepsis?

There's no single sign of sepsis. However, if you get this combination of symptoms after an infection of any kind (whether viral, bacterial or fungal - though bacterial is most common), go see your doctor:

• Shivering, fever, or very cold
• Extreme pain or severe discomfort (especially the "worst ever")
• Pale or discolored skin
• Sleepy or confused
• I feel like I might die
• Shortness of breath

Who gets sepsis?

Anyone can get sepsis, although the potentially life-threatening medical condition is most common in the following vulnerable groups:

• Babies and young children
• Older people
• People with chronic illness: diabetes, AIDS, cancer, kidney and liver disease
• People with a severe burn or wound
• Pregnant women

How is Sepsis diagnosed?

Sepsis can be diagnosed by doctors after checking the patient's heart rate, respiratory rate, and examining the patient for fever. Your doctor will usually perform a blood test to see if you have an abnormally-high number of white blood cells, a sign of infection. Further blood tests and urinalysis may be used to find infectious agents. A CT scan may be performed to help find the initial site of infection.

Sepsis: Babies and Children And The Next Steps

Sepsis in Babies

If your babies and children under five have these symptoms, go straight to your nearest emergency medical care:

• High-pitched cries of distress
• Respiratory rate of more than 40-60 breaths per minute
• Heart rate of more than 140-160 beats per minute
• Rash or mottled skin
• Temperature of less than 36.C or more than 38.C
• Unresponsive - call an ambulance

Sepsis in Children

If you have a child aged 5 to 11, watch out for the following symptoms of sepsis:

• Altered behavior
• Complaining of feeling ill
• Respiratory rate of more than 25-29 breaths per minute
• Heart rate of more than 115 to 130 beats per minute

Aren't some of those sepsis symptoms...well, very general?

On the one hand, yes. Some of the symptoms that can point to sepsis might send you to the doctors for a check-up with every full-blown flu. But that's not necessarily a bad thing.

A recent study in The New England Journal of Medicine discovered that, under the old guidelines, known as SIRS, medical professionals missed up to one in eight severely septic patients. And, arguably, the SIRS guidelines were more even generalized than the new SEPSIS guidelines, advising medical professionals to watch for a fever of over 100.4F, a heartbeat above 90 per minute, and a respiratory rate above 20.

In addition to the symptoms that send us to the doctor (the new SEPSIS guidelines), our doctors are advised to look for (in older teens and adults):

• an altered mental state (for that reason, always try to see a doctor who knows you)
• a respiratory rate equal to or greater than 22
• a systolic blood pressure equal to or less than 100 mmHg.

One of the main problems with sepsis is that it initially resembles the normal response to infection in otherwise healthy people. As Dr Maureen Baker, chair of the Royal College of GPs, says: "The diagnosis of sepsis is a huge worry for GPs as initial symptoms can be similar to common viral illnesses."

How is sepsis treated?

Sepsis requires a high dose of antibiotics, usually delivered in a sterile intensive care unit.

The treatment of sepsis has three aims:

• Halt infection
• Protect the organs, which are at risk of failing
• Prevent a drop in blood pressure

Before the strain of bacteria that caused the sepsis can be identified, patients are treated with a broad-spectrum antibiotic (one that treats a wide variety of infections). When the infection is identified, a more specific antibiotic will usually be chosen, to target the infection.

Sometimes other treatment, such as kidney dialysis, may be required as a supportive treatment to keep the patient alive.

Long-term effects

Most people recover completely. However, some patients who were already weakened suffer long-term complications.

One common complication is permanent kidney damage in patients who already had some kidney impairment. This kidney damage may result in a need for lifelong dialysis.

What should I do if I think I have sepsis?

• Make an urgent appointment or go straight to the accident and emergency department/emergency room if you have/have had an infection and you have any signs of sepsis.

• Tell your doctor/healthcare provider, "I am concerned about Sepsis".

Also ask your doctor about sepsis if you have had surgery and you are feeling worse or are not feeling better a few days after surgery.