Sepsis: What You Need To Know

In the English language, the ill-defined terms sepsis, septicemia, and septic shock refer to a a condition of systemic inflammation that can cause whole organ systems to shut down.

For this article, we'll refer to all three conditions as "sepsis," which can refer to septicemia, a body-wide bacterial infection, systemic inflammatory response, a body-wide condition of inflammation, or both events occurring at the same time. Sepsis usually involves bacteria, but it can involve viruses, parasites, or fungi, and systemic inflammatory response can include pancreatitis, burns, and trauma.

What you need to know to survive these conditions is the same regardless of the cause.

The Symptoms Of Sepsis Are Insidious And Vague

The initial symptoms of sepsis are hard to diagnose because they are so non-specific.

The most common symptom of sepsis in older people is not something you will usually read about online in articles about sepsis. It's confusion. Someone in the early stages of sepsis may suddenly start acting as if she or he had Alzheimer's. Then there can be anxiety. Someone who has sepsis may not want to go to see the doctor or go to the emergency room, whether because the person is anxious or not taking the problem seriously.

Then as the problem progresses, there is no particular order in which organ systems will begin to run amok. There can be:

• Neurological symptoms. These can include a stiff neck, ear ache, sore throat, and "the worst headache ever," in addition to an altered mental status.
• Respiratory symptoms. Sepsis is more likely to cause a productive, "phlegmy" cough than a dry cough. There can be shortness of breath and difficulty breathing.
• Gastrointestinal symptoms. Diarrhea is not unusual in cases of sepsis. Neither is abdominal tenderness. Swelling can occur where it is not expected, in places such as the rectum.
• Bone and muscle symptoms. There can be joint pain, swollen muscles, and stiffness.
• Urogenital symptoms. Urination may be scanty of difficult, and the patient's urine may be dark. There can be flank (kidney) pain.
• Skin symptoms. The skin can appear bruised, either with tiny petecchiae or with larger blue and purple spots. It can blister.

The problem with getting a good diagnosis of sepsis is that any, all, or some of these symptoms can occur in any order — as well as that all of these symptoms can be caused by different medical problems. Sometimes all a patient will have to go on is the certain knowledge that "something is very wrong" and the only thing to do is to report to an emergency room.

READ The Five Signs Of Wound Infection

Sepsis Leads To Shock

Once sepsis has set in, multiple organ systems begin to malfunction, resulting in shock. Basically, shock is the body's loss of the ability to maintain circulation. The heart may work very hard but be unable to circulate blood because blood vessels are dilated. The kidneys may not get enough circulation to keep producing urine.

The skin may be pale, cool, and clammy, and the heart may beat fast (more than 90 beats per minute), breathing may be shallow but rapid (more than 20 breaths per minute), and the patient's body temperature may fluctuate, higher than 38°C (100.4°F) or lower than 36°C (96.8°F). All of these symptoms seem to result from an over-response of the immune system either to an infection, or to tissue injury and blood loss.

Who Is Most At Risk For Sepsis?

Sepsis, septicemia, and septic shock are a lot more common in older people (over 50, and especially over 60), than in younger people. These conditions are more common in men than in women. About twice as many men develop sepsis as women. In the United States, sepsis is particularly common among African-American men.

Black men have less access to health care, and get more infections that can "go septic." A distressingly common scenario is something like this. Non-cancerous prostate disease interferes with urination. A bladder infection gets trapped, and either an injury (a fall, for instance) or a medical procedure intended to diagnose the problem punctures the lining of the bladder. The infection spreads into the abdominal cavity, and because the man does not have ready access to health care, sepsis sets in and is not treated in a timely fashion. (This doesn't happen only to African-American men. My American friend Robert Rister's father, who was white, died of this kind of sepsis.)

African-Americans of both sexes are more likely to have diabetes and chronic kidney disease, which increase the likelihood of sepsis.

Is Sepsis Survivable?

Europeans die of sepsis more often than Americans, because they usually get treatment later. In Europe, about 50 percent of people admitted to hospital die of the disease. In the US, about 76 percent of sepsis patients survive. In Australia and New Zealand, survival rates are even better, over 80 percent. Sepsis is always a difficult disease, however, and hospital stays of months, not just weeks or days, are commonplace. What is more, people who have had sepsis remain at a higher risk of dying even once they are released from the hospital.

What Can You Do To Prevent Sepsis?

It is unusual for people under the age of 50 to develop sepsis, When this happens, usually there has been an infected wound.  Someone kayaking or canoeing who suffers a compound fracture (broken bone breaking through the skin) in bacteria-contaminated water, for example, might develop sepsis. Severe injuries under extremely unsanitary conditions can result in sepsis.

READ Osteomyelitis: Bone infection

For older persons, it is much easier to control the risk factors for sepsis.

• Contaminated catheters are a common cause of infection. Don't ever reuse catheters if you do not have to, and never reinsert a catheter that has fallen on the floor or, even worse, into dirt or debris. Older people who cannot remember why they have a catheter may need to be monitored constantly to ensure safety around this medical device.
• Bed sores are another common source of sepsis.  It is important to make sure that the patient changes position every two hours, twenty four hours a day. The prevention of bed sores is easier with pressure relieving mattress pads and by making sure the head of the bed is never raised so high (more than 30 degrees) that there is pressure on the buttocks.
• Incontinence has to be managed properly to prevent infection. Diapers have to be changed promptly, without gentle but thorough cleaning and drying before a new diaper is put on. Catheters must be changed as often as the doctor prescribes.
• Any medical breathing devices (CPAP, devices for taking COPD medications, and so on) must be kept as germ-free as possible to prevent sepsis, to the contrary these life-saving devices can become bringers of death.
• Preventing sepsis is not easy, but it is easier than treating sepsis. Make sure you or your loved one gets medical attention as quickly as possible at the first sign of possible symptoms.