Sepsis

Symptoms Of Sepsis

Sepsis progresses through three stages, sepsis, severe sepsis and septic shock. One can even get sepsis while recovering from an illness in the hospital. The symptoms depending on the stage include:

Symptoms of sepsis

• Fever above 101 F

• Increased heart rate 

• A confirmed infection in the body

• Increased breathing rate of more than twenty breaths per minute

Symptoms of severe sepsis

• Organ failure due to tissue damage

• Discolored skin or a hemorrhagic rash in the skin

• Bone marrow suppression leading to decreased platelet counts

• Difficulty in breathing

• Abnormal heart functions causing cardiomyopathy (heart disease leading to difficulty in pumping blood to the body)

• Reduced body temperature leading to chills

• Weakness and dizziness

• Confusion or disorientation

• Slurred speech 

Symptoms of septic shock 

• Decreased urination

• Clammy and sweaty skin

• Respiratory failure

• Heart failure

• Stroke

• Death

Causes Of Sepsis

The most common cause of sepsis or septicemia is a bacterial infection. Other common causes of sepsis are fungal, viral, or parasitic infections in your body. The infection might occur anywhere in the body, but some of the common sites where infection could lead to sepsis include:

The lungs: Lung infections such as pneumonia might lead to sepsis in some patients. Sepsis through the lungs can be fatal if not treated on time.

The abdomen: An infection in the appendix (appendicitis), infection of the abdominal cavity (peritonitis), gallbladder infections, liver infections, or bowel problems might lead to mild or severe sepsis.

The urinary tract: An infection in the kidneys or bladder can also lead to sepsis. This kind of blood infection occurs mostly in patients who have a urinary catheter to drain urine. Urosepsis might cause nausea, vomiting, pain in your lower spine, and abnormal white blood cell count (either too high or too low). Urosepsis can be life-threatening if not treated on time. 

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The skin: Sometimes bacteria might penetrate the skin through open cuts or wounds. They can also enter through intravenous catheters when they are inserted into the body to give or drain fluids. Cellulitis, which is an inflammatory condition of the skin, can also lead to skin sepsis.

Risk Factors For Sepsis

Several factors increase the risk of sepsis, some of which include:

1. Infancy: Infants are at high risk of developing sepsis because of infantile birth disorders.

2. Old age: Older people are more susceptible to infections because of weaker immunity. Moreover, older people commonly suffer from diseases such as diabetes or lower respiratory infections, leading to sepsis.

3. A weak immune system: A weak immune system, irrespective of age or gender can also lead to the development of sepsis. Cancer patients who take chemotherapy have a weakened immune system which increases their chances of developing sepsis.

4. Uncontrolled diabetes: Patients who suffer from diabetes mellitus are at a high risk of developing sepsis. Infections are prone to get severe in these patients.

5. Chronic kidney or liver ailments: Patients with chronic kidney disease who undergo regular dialysis are more likely to develop infections and sepsis.

6. Hospitalized patients: Patients with extended hospital stays or who get admitted to the intensive care unit are prone to contracting an infection that might turn into sepsis.

7. Insertion of invasive devices: Breathing tubes or intravenous catheters can potentially increase the risk for infection, including healthcare-acquired infections (HAIs), which can lead to sepsis.

Diagnosis Of Sepsis

The doctor will conduct several tests to diagnose the actual cause of sepsis when the body exhibits symptoms of an infection. These diagnostic tests include:

Blood tests

Blood tests are conducted to test the evidence of an infection, any blood clots, electrolyte imbalance, impaired liver or kidney function, and lower oxygen levels. These include:

• Complete blood count (CBC)

• Serum concentrations of electrolytes

• Liver function test

• Kidney function test

Lab tests

Certain lab tests are conducted by collecting samples of urine, respiratory secretions, and wound secretions.

Detection of procalcitonin in the blood is used to diagnose sepsis at an early stage. Procalcitonin is a protein produced by the thyroid gland under normal conditions. Its level rises in the blood in response to microbial infection or an injury to the body. 
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Imaging tests

The following imaging tests are done to locate the exact source of the blood infection:

1. X-ray: Lung infections are identified through x-rays.

2. Ultrasound: Infections in the gallbladder and kidney are identified through ultrasound images. This procedure uses sound waves to create images of the organs on the monitor.

3. Computerized tomography (CT): This procedure gives cross-sectional images of the body's internal organs. It works by taking x-ray images from various angles and then combining them. It is an advanced form of testing and gives almost perfect images of liver, pancreas, and other abdominal organs to locate the source of the sepsis.

4. Magnetic resonance imaging (MRI): This procedure is used to produce 3D images of the body's internal organs. The technology uses sound waves and a magnet to produce images. MRI is used to identify sepsis in bones and soft tissues. 

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Prevention Of Sepsis

Sepsis patients mostly have some underlying health condition that needs frequent medical monitoring. Doctors can prevent the occurrence of sepsis by educating the patients and warning them about the signs of sepsis. For eg. diabetic patients are at a high risk of developing sepsis, therefore doctors should make it a point to ensure that diabetic patients thoroughly check their feet for wounds that could cause infections. One should also take the following steps as prevention against sepsis:

1. Get vaccinated

Around thirty percent of sepsis cases are caused by pneumonia. Therefore, annual flu shots can prevent respiratory infections, which lead to sepsis. Many deaths can be prevented if older adults get their annual flu shots on time.

2. Clean open wounds properly

Open wounds can lead to skin sepsis, especially in diabetic patients. Therefore, it is essential to clean any dirt with soap and water and always cover open wounds. Diabetic patients need to maintain foot hygiene and prevent any foot infections.

3. Avoid infections

Many patients develop sepsis in the hospital while staying in the intensive care unit. Therefore, doctors or healthcare providers must take steps to prevent the occurrence of any such infections. Doctors, nurses, and visitors should maintain hygiene, like washing their hands before touching the patient to avoid any kind of infection.

4. Know the symptoms

One must know the symptoms of sepsis to avoid any complications. Sepsis is characterized by fever, chills, shortness of breath, diarrhea, vomiting, rash, pain, rapid heart rate, confusion, and disorientation. 

5. Do not delay

Sepsis is a life-threatening condition. If an infection or symptoms of sepsis persist and are getting worse, act fast. Get medical care immediately without any delay. 

6. Get the right treatment

If it is suspected that infection has turned into septicemia, the medical team will try to identify the source of infection and start IV fluids and specific antibiotics.

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Specialist To Visit

Sepsis is a life-threatening disease. It cannot be treated at home and requires immediate hospitalization and life support systems such as breathing machines and oxygen cylinders. Therefore, in case of any symptoms of sepsis, one should visit the hospital immediately.

Specialists who help to manage sepsis are:

• Primary care provider (PCP)

• Emergency medicine doctor 

• Infectious disease specialists 

Primary care providers (PCP) prevent, diagnose, and treat diseases. An emergency medicine doctor treats patients admitted to the emergency department. Infectious disease specialists are doctors who treat severe sepsis or septic shock.

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Treatment Of Sepsis

Immediate and aggressive treatment increases the chances of survival in sepsis. Treatment in time is essential to prevent a septic shock. Patients with sepsis require lifesaving measures such as oxygen and breathing machines. The following treatment options are adopted to stabilize patients with sepsis symptoms. They include:

A. Antibiotics 

Broad-spectrum antibiotics are initially given as they are effective against a wide variety of bacteria. After conducting all the relevant blood tests, antibiotics targeting particular bacterias that are causing the infection are given. These antibiotics include:

1. Ceftriaxone (Rocephin): It is used to control several life-threatening bacterial infections such as pneumonia, meningitis, and E. coli. It is also given to prevention of infection or sepsis after surgery.

2. Meropenem (Merrem): It is an intravenous antibiotic used to treat sepsis arising out of intra-abdominal infections.

3. Cefotaxime (Claforan): It is an intravenous antibiotic used to treat sepsis that may arise from a urinary tract infection, pneumonia, meningitis, or cellulitis. 

4. Ampicillin and sulbactam (Unasyn): This combination treats a wide spectrum of bacterial infections that might include skin sepsis.

5. Levofloxacin (Levaquin): This antibiotic is used to treat bacterial infections in the kidney and prostate. It is also used to treat skin infections and pneumonia.

B. Intravenous fluids

Intravenous fluids are administered as soon as possible to prevent severe sepsis or septic shock. Crystalloid fluids are the most commonly used intravenous solutions given to patients with sepsis and septic shock.

C. Vasopressors

If the blood pressure doesn’t increase even after intravenous fluids, vasopressor medications are started. The function of vasopressors is to constrict the blood vessels to increase blood pressure. Norepinephrine and dopamine are the most preferred vasopressors used in the treatment of sepsis or septic shock.

D. Supportive care

Supportive care includes oxygen, a machine to help breathe properly, and dialysis if the kidneys are adversely affected.

E. Surgery

Surgery might be considered if the source of the infection is pus (abscesses), dead tissues (gangrene), or infected tissues. If there is a soft tissue abscess leading to sepsis, it should be drained as soon as possible. 

Home-Care For Sepsis 

Sepsis is life-threatening for all age groups, but it is potentially dangerous for infants and older people. Sepsis can be treated with early diagnosis and proper treatment. But sepsis has several long-term side effects, which require special care even after discharge from the hospital. Therefore, home care is an important part of the recovery from sepsis. Follow certain measures to look after your loved one at home:

1. Complete the antibiotic course

Do not miss antibiotics and consume them as directed by your doctor. An incomplete antibiotic course could lead to reinfection. A professional caregiver who can look after the patient at all times can be appointed.

2. Prevent infection from recurring at home

Keep the surroundings clean. Personal hygiene should be maintained at all costs, and wounds should be cleaned and covered at all times. The site of the surgery should be cleaned and dressed regularly.

Sepsis might lead to permanent side effects, which might cause loss of mobility or cognitive function. Some people might even lose arms, hands, or legs because of limb amputation. Therefore, appoint a caregiver if needed to help the sepsis patients get around and carry on with daily activities.

3. Stay hydrated

Sepsis patients should consume plenty of fluids to avoid dehydration.

4. Stop smoking

Sepsis patients should not smoke or consume other tobacco products in the recovery period at home as it can lead to reinfection and delayed recovery.

5. Eat a well-balanced diet

A healthy diet is very important for sepsis patients recovering at home. They should be given a nutritious diet as advised by the doctor. Foods such as nuts, soy, tofu, fatty fish, etc can be consumed for quick recovery. The doctor might advise restrictions on certain food items, which must be avoided at all costs.

Complications Of Sepsis

Sepsis can have serious complications, which include:

1. Acute respiratory distress syndrome (ARDS): If sepsis occurs from respiratory infections, respiratory organ dysfunction may be caused due to the lack of oxygen flow to the lungs. It could lead to complications like acute respiratory distress syndrome (ARDS). 

2. Thrombosis: Sepsis might lead to microvascular thrombosis (blockage of blood vessels by blood clots) and low blood pressure. As a result, tissue oxygenation is impaired.

3. Organs dysfunction/failure: Sepsis could lead to blockage of blood vessels because of microvascular thrombosis or blood clotting which might lead to organ dysfunction or even failure.

4. Brain damage: The brain is the first organ that might get affected. During sepsis, the body produces nitric oxide, which affects the normal functioning of the brain.

5. Endocarditis: A serious complication of sepsis is endocarditis or damage to the valves of the heart. It could also lead to heart failure.

6. Gangrene: Sepsis might lead to gangrene or tissue death of toes and fingers, which might require amputation.

7. Weakened immune system: The immune system might become weak, which raises the risk of reinfections.

8. Septic shock: Symptoms of septic shock include all the symptoms of severe sepsis with extremely low blood pressure levels along with decreased urination and clammy, sweaty skin. Septic shock leads to respiratory or heart failure, stroke or even death.

Alternative Therapies For Sepsis

Sepsis is a life-threatening condition. It requires immediate hospitalization and, in severe cases, life support systems like oxygen and breathing machines. Sepsis can affect all your internal organs such as the lungs, kidneys, abdomen, brain, urinary tract, and even skin and bones. Even wounds from surgery might turn infectious and lead to septicemia. 

Home remedies for sepsis are not scientifically proven, but you can try the following home remedies to prevent the initial spread of infection or after discharge from the hospital. It is always advisable to consult your healthcare provider before using any home remedies:

1. Vitamin C: Vitamin C strengthens the immune system and helps the body to fight against infections. 

Vitamin C (also known as ascorbic acid) is an essential nutrient that  plays a critical role in several bodily functions in a lot of constructive ways.
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2. Turmeric (Haldi): Turmeric has been used since ancient times as an effective means to treat infections. Studies have shown that this home remedy can play an important role in controlling sepsis. It is an anti-inflammatory agent which can reduce pain, redness, and swelling. 

3. Garlic (Lahsun): Garlic has extraordinary anti-inflammatory and anti-bacterial properties. It is a storehouse of anti-fungal properties. Studies suggest garlic can play an active role in recovering from sepsis.

4. Honey (Shahad): Honey can strengthen the immune system. Honey and garlic are a great combination for boosting immunity and recovering from an infection.

5. Lobelia and slippery elm: Lobelia and slippery elm can be applied externally to skin infections or wounds which can turn infectious. These herbs are beneficial in treating bacterial infections. A paste of lobelia and slippery elm can be applied to the wound for quick recovery.

6. Potato (Aloo): Potato juice can be applied externally to wounds to control inflammation from sepsis. 

Living With Sepsis

Many survivors of sepsis are affected with post sepsis syndrome or PSS. The patients suffer from physical and psychological side effects for quite a long term.

The physical effects of post-sepsis syndrome include:

• Fatigue or lethargy

• Difficulty in breathing

• Difficulty in sleeping

• There might be reinfections within the first few weeks of recovery from sepsis

• Poor or reduced appetite

• Hair loss

• Skin rash

• Swelling of limbs

• Reduced function of organs like the kidney, heart, and liver.

The psychological effects of post-sepsis syndrome include:

• Panic attacks

• Depression

• Memory loss

• Hallucinations

• Flashbacks

• Concentration problems

• Reduced mental functioning

• Post-traumatic stress disorder (PTSD)

Doctors and healthcare professionals must be able to recognize the symptoms of post-sepsis syndrome. Timely recognition of symptoms leads to better treatment. Here are a few things that can help you to manage post sepsis syndrome or PSS:

• Survivors of sepsis who are undergoing psychological problems like depression or reduced mental functioning should seek counseling, neuropsychiatric assessment, and cognitive behavioral therapy.

• If sepsis survivors suffer from physical side effects such as reduced organ functioning or lack of sleep, they should seek physical therapy and neurorehabilitation.

• Rest is the best medicine for all ailments. Survivors of sepsis should take ample rest to regain their lost strength and vitality. The body undergoes a lot of pain during a sepsis or septic shock. Therefore, it will take time to regain normalcy.

• Survivors should not isolate themselves in the recovery period. They should not stay in crowded places as it increases the risk of infection. But they should always have someone to talk to, like family or friends.

• To regain strength, the body needs a nutritional diet. A balanced diet should be given to survivors of sepsis, but according to the doctor's guidelines.

Always remember to stay in touch with the doctor, especially in the initial few weeks after recovery. Any kind of discomfort of post sepsis syndrome symptoms should be immediately conveyed to the doctor or healthcare professional.