Sepsis: What Everyone Needs to Know
“Overreaction most times leads to unfavorable consequences.” (Toni Payne)
Chances are you know of someone who died from the entity called sepsis. Perhaps it was a friend or family member, or someone in the news. (The website of the “Sepsis Alliance” lists dozens of celebrities and famous people who appear to have succumbed to sepsis—Paul Allen, Hugh Hefner, Christopher Reeve, Patty Duke, Jim Henson, Muhammad Ali, and Pope John-Paul II, to name a few.)
Exactly why sepsis recently emerged in the national consciousness is unclear to me. It could, however, relate in part to campaigns of the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Both organizations have prioritized increasing awareness of sepsis among healthcare professionals and the general public, alike. The CDC even has a new website dedicated to sepsis (just Google on CDC sepsis). Furthermore, the WHO estimates that sepsis affects 30 million people worldwide every year leading to 6 million deaths. So, when my daughter suggested that a blog on sepsis is in order, I agreed.
While the topic is complicated and highly interesting scientifically, I believe there are three things that everyone needs to know about sepsis: 1) What is it? 2) When should you suspect it? and 3) What should you do when you suspect it?
What is sepsis?
When I was training as an infectious diseases specialist more than four decades ago, most experts in the field thought the term sepsis should be abandoned because it was too vague and was defined differently by various authorities. While this was true, its meaning has gone through several iterations arriving at the current CDC definition: “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency.”
While virtually all educated people know that the body’s immune system provides defense against microbes that have breached physical barriers, such as, the skin or mucosa of the respiratory, gastrointestinal, or genitourinary tracts, most folks don’t realize that it is the reaction of cells of the immune system (macrophages, neutrophils, and lymphocytes) that both make us feel sick when we’re infected, and in some cases, can actually kill us. That is, many deaths from an infection, be it from pneumonia, cellulitis, intraabdominal or kidney infection, gastroenteritis, or infections of the heart or brain, are caused by an overreactive (or dysregulated) immune response. So, don’t necessarily blame the microbes. It is this overreaction to infection that the CDC is referring to as “the body’s extreme response to an infection.” And given sepsis high mortality rate, “It is a life-threatening medical emergency.”
When should you suspect sepsis?
This is where things get tricky. Because the immune system is activated in all infections, whether they are caused by bacteria, viruses, fungi, or parasites, we often see clinical manifestations of this aroused state. Common symptoms include fever, chills, loss of appetite (anorexia), lethargy, and a desire to go to bed. The immune system mediators, produced by activated macrophages, neutrophils, or lymphocytes, that are responsible for these clinical manifestations are proteins called cytokines.
Cytokines function as messenger molecules between immune cells as well as other types of cells in the body signaling for help to fight an infection. For example, cytokines, such as interleukin-1, target brain cells that trigger a myriad of biochemical reactions and behavioral responses resulting in an elevated body temperature, i.e., a fever.
Fever is generally a good thing; some microbes can’t stand the heat, and certain immune cell functions are increased when the temperature goes up. The reason you are deluded into thinking that you are “cold” when you have a fever is to steer you to bed, where you will ask for blankets thereby helping elevate your temperature.
But within the context of the entity called sepsis, the reactions of cells and the mediators they produce in response to an infection are extreme. (The term cytokine storm is often used to describe this condition.) When this happens, decreased blood flow to vital organs, such as, the brain, lungs and, kidneys occurs.
Tip offs that an infection has turned into sepsis all relate to a decreased blood flow to one or more vital organs. One of the most prominent symptoms, especially seen in older people, is confusion (“Grandma just isn’t herself.”), indicating that diminished blood flow to the brain has developed. Reduced blood flow to the lungs can lead to rapid breathing (tachypnea) or breathlessness, and when the kidneys aren’t receiving sufficient blood, decreased urine output occurs. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
While sepsis can occur in anyone with a serious infection, the risk is increased in certain groups: people over 65 years old, those with chronic medical conditions, such as diabetes, cancer, and heart, lung, or kidney disease, or an immune system disorder.
What should you do when you suspect sepsis?
If you or a loved one has what looks like an infection, and any of the symptoms mentioned above of decreased blood flow to a vital organ is present, call or go see a doctor. And ask, “Could this be sepsis?” They will take a history, perform a physical exam, and order blood and other tests to identify what kind of infection is present and to determine whether diminished blood flow to a vital organ is compromised.
When a blood culture yields a bacterium—a condition called bacteremia—the cause of the infection is found, and antibiotics are selected to target that bacterium. Infections that have spilled over into the bloodstream are particularly serious with an overall mortality rate of more than 20%. These infections can also lead to a markedly reduced blood pressure, or septic shock (when the systolic blood pressure is less than 90mm Hg), resulting in the death of over 50% of patients.
The key thing to remember is that successful treatment of sepsis is dependent upon early intervention. Better to get help too early, rather than too late. If you are experiencing or see in a loved one any of the above symptoms of sepsis, say something to a healthcare professional!