Sepsis – A Deadly Infection You May Not Know About
Word is spreading about the dangers of this deadly infection
Consider, if you will, the lowly paper cut. Painful, yes, but along with a stubbed toe, a paper cut doesn’t typically garner much attention. It is true that such minor injuries are usually more of a brief annoyance than a cause for alarm, but in the world of health care, sometimes even the seemingly trivial and insignificant have the potential to take on new and dangerous dimensions.
In the case of paper cuts, it comes down to this: Anything that can lead to an infection — even something as innocuous as a paper cut — can set off a reaction called sepsis, and if sepsis is severe enough, it can kill you.
Never heard of sepsis? You’re not alone. Although severe sepsis strikes about 750,000 people in the United States each year, according to the National Institute of General Medical Sciences, and kills an estimated 28 to 50 percent of those individuals, it remains a bit player, at best, in the general public’s consciousness. “It’s a pretty big health problem,” however, says Thomas Akey, MD, a pulmonologist and critical care provider at Concord Hospital.
Sepsis develops when the immune system essentially overreacts to an infection and creates a cascade effect that can include damaging fever and inflammation. It is not always serious; some cases of sepsis are mild, but sepsis can progress rapidly, and at its worst, sepsis can lead to “septic shock” and cause organ failure and death. “The more severe the infection is, the more likely it is that you’re going to have sepsis with it, and if you go down the spectrum from mild sepsis to severe sepsis to sepsis with shock, your mortality increases,” Akey says.
The top cause of sepsis, “far and away,” is pneumonia, says Kevin P. Desrosiers, MD, MPH, a critical care physician at Elliot Hospital. Sepsis also commonly stems from infections in the abdomen or in the urinary tract, he says. Although anyone can develop sepsis, it most often affects the very young, the elderly, those who have a weakened immune system, and those who suffer from chronic health trouble such as diabetes, lung or kidney disease, or cancer.
Patients suffering from sepsis usually exhibit an increase in heart rate, temperature, and respiratory rate. Based on the typical sepsis symptoms, quite a few people who go to the emergency room would meet the criteria for mild sepsis, says Akey, which bears watching, but what doctors really worry about, he says, is severe sepsis, when the immune system’s response to infection becomes overwhelming. “Once you get to that point, there’s a very high risk of death.”
It seems counterintuitive that our bodies would plot against us by releasing such a potentially damaging response from the immune system, but what happens with sepsis is mostly a case of an uneven checks-and-balances system, says Desrosiers. “The body in a sense recognizes that there’s an advantage to trying to fight this infection even at the expense of harming itself in some way, but it also tries to mitigate that damage by using other mechanisms,” he says. However, sustaining the equilibrium between the aggressive fighting of the infection and the prevention of self-harm can be “tricky for the body,” he says, and some patients are not able to maintain that balance, especially patients who were not all that healthy prior to developing sepsis.
Seeing the signs of sepsis
Because sepsis can progress quickly, early identification of it and prompt intervention can play a crucial role in patients’ ultimate outcome. Various medical societies and organizations have published initiatives in an effort to raise awareness among health professionals of sepsis and its potential seriousness, and in some hospitals, at least, “we consider it a medical emergency,” and treat it as such, Akey says. Early sepsis therapy typically includes antibiotics, intravenous fluids, and monitoring. “If patients meet the [sepsis] criteria — the list goes from mild to severe with shock — they have very easily identifiable signs,” and should be treated aggressively, he says.
Indeed, it is vitally important to recognize sepsis before it becomes severe and before the inflammatory cascade gathers too much steam, Desrosiers says. If a doctor suspects an infection in a patient and sees symptoms such as fever, elevated white blood cell count and blood pressure that is even a mere 10 or 20 percent lower than the person’s normal blood pressure, the individual “should be identified as having sepsis because the early treatment, particularly the early antibiotics and the early … intravenous fluids, can significantly impact the course of their disease and their ability to not only survive the hospitalization but to prevent the downstream effects of having sepsis.” If sepsis does progress and becomes severe, its effects can be long-lasting; although many people who experience severe sepsis recover completely, others suffer from ongoing physical, psychological, and cognitive problems, Desrosiers says.
As for preventive steps that patients can take, the best bet is to try to maintain good health and to speak up for the health of others. “If you have a loved one who has an infection and they look sick and they’re admitted to the hospital and they meet the definition of sepsis, [insist] that they be treated aggressively,” Akey says. More recognition of sepsis among people who are not medical providers would be helpful “because families could advocate for their loved ones if they get sick,” he says.
Diabetes and Sepsis
Because sepsis is more likely to occur in people who have chronic health conditions, individuals can at least make smart lifestyle choices to help optimize health, and to be vigilant regarding the dangers of sepsis. If you are diabetic, that can include paying attention to your feet and having annual foot exams. “Foot exams are done primarily to detect sensation,” since it’s not uncommon for diabetics to lose sensation in their feet, says Kevin P. Desrosiers, MD, MPH, a critical care physician at Elliot Hospital. Because of muted foot sensitivity, some diabetics wear poorly fitting shoes “that can lead to ulcers or other small infections in the feet that can significantly worsen to the point where patients can develop sepsis,” Desrosiers says. Even a particularly bad ingrown toenail that becomes infected can lead to sepsis, he says, although that is not a common occurrence.