Sepsis: Causes, Symptoms, Effects, Diagnosis And Treatment

The first origin of the term Sepsis appeared in Egyptian papyri which was 3500 years ago. The origin of the term Sepsis [σηψις] was first attributed by the Greek for decomposition of animal. It was used in this context before Hippocrates around 400 BC. ^[1] The Greek referred the term to describe putrefaction. The word sepsis has been used for more than 2500 years. Several centuries later, the signs of inflammation and organ dysfunction were referred by the term sepsis.

What Is Sepsis

Sepsis is a life-threatening complication that occurs when the bacteria from another infection enters the blood and spreads throughout the body, especially the bloodstream. This would lead to organ dysfunction, which is caused by the dysregulated host response to infection. Sepsis develops when the body releases chemicals into the bloodstream in order to fight infection; however, this process fails and generates widespread inflammation. ^[1] .

Timely diagnosis and therapy are imperative in order to prevent the patient from morbidity and mortality. Sepsis usually occurs when the body's response to the chemicals goes out of balance, which then can damage multiple organ systems. ^[2]

Sepsis is encompassed of three stages, which begins with sepsis and then develops into severe sepsis and septic shock.

Severe sepsis: It is associated with organ dysfunction, hypoperfusion abnormality (acute alteration of mental status) or sepsis-induced hypotension or organ dysfunction.

Septic shock: It is a subset of severe sepsis. The term is defined as sepsis-induced hypotension, persisting despite adequate fluid resuscitation along with the presence of hypoperfusion abnormalities ^[3]

Symptoms Of Sepsis

Sepsis syndrome generated by pathogens can be the primary cause of death due to infection. ^[4] Without a periodic treatment, sepsis can lead to multiple organ failure and death.

The early symptoms of sepsis may include:

• high or low body temperature,
• fast breathing,
• vomiting, diarrhoea,
• rapid heartbeats,
• chills and shivering and
• drop in blood pressure.

There are several symptoms of sepsis that are also associated with meningitis which includes

• fever,
• headache and
• vomiting.

Symptoms Of Severe Sepsis

• Dizziness
• Rapid breathing
• Discolouration of lips (lips turn bluish)
• Symptoms of septic shock
• Low blood pressure
• Internal organs receive less blood and eventually malfunction ^[5]
• Dizziness
• Low/absent urine output
• rapid heart rate
• shortness of breathing
• low or high body temperature ^[5]

Causes Of Sepsis

One-third of patients diagnosed with septic shock usually die. Sepsis can become complicated when it is a result of an infection [7] . The common symptoms include anxiety, confusion and difficulty in breathing, unusual skin colour, low urine output and feeling severe lethargy ^[7] .

Sepsis is usually caused by bacterial infections yet it does occur due to other pathogens like viruses, parasites and fungi. Infections that most often lead to septic shock are UTI, pneumonia, bone infections and heart infections.

Pneumonia

The most common types of infections that can cause sepsis in adults and senior are pneumonia or genitourinary infections. Usually, one-third of people die of sepsis. Mostly the common source of infection that the seniors get affected is the lungs ^[8] . If the person is suffering from pneumonia, oxygen will have trouble in reaching the blood.

Moreover, if there is less oxygen in your blood there is the possibility of your body cells not working properly. Sepsis happens when the immune system's inflammatory response is dysregulated in reaction to an infection which eventually leads to pneumonia or meningitis ^[8] .

UTI

A urinary tract infection is an infection in the urinary tract which then moves from your kidney, through the ureters, urinary bladder and then out through the urethra. When you have UTI, your body would be working really hard to battle the infection. If there is an infection it would generally cascade into a case of sepsis ^[9] .

Skin infections

Sepsis will occur when an invading organism enters the bloodstream and tries to cause a devastating reaction from the immune system ^[9] . There are several cases of sepsis that often result from the infection spreading throughout the bloodstream (due to medical procedures after inserting a tube into a vein sometimes the bacteria try to invade the bloodstream and be the cause of this condition).

Sepsis can also be an infection that is confined to certain parts of the body like lungs, urinary tract, skin or abdomen (which includes the appendix) ^[10] .

Effects Of Sepsis

Sepsis can exacerbate the blood flow to the vital organs. The brain, heart and kidney can become impaired. Sepsis has the possibility to cause blood clots in certain organs as well as in the legs, arms, fingers and even toes. It is easier to recover from mild sepsis; on the other hand, average mortality rate for septic shock is around 50% ^[5] .

People with sepsis will have complications when they have a weakened immune system, chronic illness such as diabetes, kidney or liver disease or cancer. Even having several wounds or burns can be taken as a risk factor. Seniors are more at risk because of the effects of immunity. Medical research proves that fungal infection induced sepsis is on the rise ^[5] .

Those having septic shock will have small blood clots throughout the body. Some of the blood clots can block the flow of blood and oxygen to other parts of the body ^[6] . Having high levels of lactic acid can be a cause of concern especially when the blood shows that your cells aren't using the required oxygen properly.

Complications Of Sepsis

• Tachypnea (abnormally rapid breathing)
• Elevated cardiac output, low systematic vascular resistance
• Increased cellular metabolism, elevated oxygen consumption
• Increased insulin requirements
• Respiratory alkalosis
• Oedema
• Increased WBC (certain times decreased)
• Elevated C-Reactive Protein (CRP)
• Raised procalcitonin
• Hypoxemia
• Hyperglycemia
• Thrombocytopenia (severe sepsis and septic shock)
• Disseminated intravascular coagulation (severe sepsis and septic shock)
• Acute respiratory failure
• Acute renal failure

Patients having a fever with or without hypotension or with the kinds of infections limited to certain organ systems are more likely to get sepsis. The infections include the gastrointestinal tract, hepatobiliary system, pelvis and genitourinary tract.

Risk Factors Of Sepsis

The people most at risk of sepsis are the young and old. In addition to this, people with the following are at an increased risk of suffering from sepsis:

• Weak immune system
• Chronic illness (such as diabetes, liver disease, AIDS or cancer)
• Wounds that are severe in nature (severe burns)

People are becoming more vulnerable to sepsis because of the following:

• Infections turning complicated as more people opt for invasive procedures and organ transplants.
• Infections becoming complicated when more people take immunosuppressive drugs and chemotherapies.
• A rise in antibiotic resistance (microbes are turning immune to drugs)

Diagnosis Of Sepsis

A sepsis patient must be treated without delay. Traditional methods for diagnosis will be employed ^[11] , which is based on the clinical finding, epidemiological history and predisposing conditions. Doctors usually run tests to find out if it was due to bacteria in the blood or other body fluids and to check for high or low white blood cell count, low blood pressure or to check the liver function.

The physician would examine the test through X-ray, CT scan or magnetic resonance imaging or ultrasound. If you have sepsis you would be put in an intensive care unit to stop the infection and to regulate the blood pressure ^{[11] [12] [13]} .

Treatment Of Sepsis

Those having sepsis would be closely monitored and are treated in an intensive care unit. There are a number of medications prescribed for treating sepsis, which includes broad-spectrum antibiotics. The medication is administered intravenously.

If your blood pressure is abnormally low even after intravenous fluids then you would be administered vasopressor medication which constricts blood vessels and would increase blood pressure. If the kidneys are affected then you need to undergo dialysis ^[14] . Other treatments include corticosteroids and mechanical ventilation, to help the patient to breathe ^[15] .

Prevention Of Sepsis

People should get regular vaccinations against flu, pneumonia, chickenpox and HIV as they can lead to sepsis ^[14] . It is necessary to practice basic hygiene which includes, everyday bathing and changing clothes after you come back from work. Those having pets need to wash their hands frequently to keep the infection at bay.

If you are regularly suffering from bacterial infection then take prescribed antibiotics. It is essential to treat certain parasitic infections with the help of medications, which will stump their growth.