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Sepsis, blood poisoning or septicaemia

Sepsis is a life-threatening illness caused when the body is overcome by infection. It is often

called septicaemia or blood poisoning when the body is fighting a severe infection that hasspread via the bloodstream.

This condition can develop either as a result of the body's own defence system or from toxic

substances made by the infecting agent (such as a bacteria, virus or fungus).

There are three stages of sepsis:

Uncomplicated sepsis is very common and usually does not need hospital treatment. When the infection starts to interfere with the organs of the body it is called severe sepsis. In severe sepsis, ifblood pressure drops to dangerous levels, organs are prevented from

getting enough oxygenated blood, and this is called septic shock.

People at risk of sepsis

People whose immune systems (the body's defence against microbes) are not functioningwell because of an illness (such as cancer or AIDS) or because of medical treatment

(such as chemotherapy for cancer or steroids for a number of medical conditions) that

weakens the immune system are more prone to develop sepsis. It is important toremember that even healthy people can suffer from sepsis.

Because their immune systems are not completely developed, very young babies may getsepsis if they become infected and are not treated in a timely manner. Often, if they

develop signs of an infection such as fever, infants have to receive antibiotics and beadmitted to hospital. Sepsis in the very young is often more difficult to diagnose because

the typical signs of sepsis (fever, change in behaviour) may not be present or may bemore difficult to ascertain.

The elderly population, especially those with other medical illnesses such as diabetes,may be at increased risk as well.

The number of people developing sepsis in the UK appears to be increasing with more than

30,000 cases of severe sepsis occurring each year.

There has been a large increase in sepsis because doctors have started treating cancerpatients and organ transplant patients, among others, with strong medications that weaken

the immune system.

Because of our ageing population, the number of elderly people with weak immunesystems has also grown.

Finally, because of the increased and often inappropriate use of antibiotics to treatillnesses caused by viruses and not bacteria, many strains of bacteria have becomeresistant to antibiotics, making the treatment of sepsis more difficult in some cases.

Sepsis causes

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Many different microbes can cause sepsis. Although bacteria are most commonly the cause,

viruses and fungi can also cause sepsis. Infections in the lungs ( pneumonia), bladder and

kidneys (urinary tract infections), skin ( cellulitis), abdomen (such as appendicitis), and otherorgans (such asmeningitis)can spread and lead to sepsis. Infections that develop after surgery

can also lead to sepsis

Sepsis, blood poisoning or septicaemia

(continued)

Who is at risk of sepsis?

Very young people and elderly people Anyone who is taking immunosuppressive medications (such as transplant recipients) People who are being treated with chemotherapy drugs or radiotherapy Patients who have no spleen Patients taking steroids (especially over the long-term) People with long-standing diabetes, AIDS or cirrhosis Someone who has very large burns or severe injuries People with infections such as the following:

o Pneumoniao Meningitiso Cellulitiso Urinary tract infectiono Ruptured appendix

Sepsis symptoms

If a patient has sepsis, they often will have fever. Sometimes, though, the bodytemperature may be normal or even low.

The patient may also have chills and severe shaking. The patient'sheart may be beating very fast and they may be breathing rapidly.

Symptoms of severe sepsis or septic shock include confusion, disorientation, agitation,dizziness

- particularly when standing up, decreased urination,diarrhoea,nausea and vomiting, cold, pale

and clammy skin

Some patients who have septicaemia develop a rash on their skin. The rash may be areddish discolouration or small dark red dots throughout the body.

The patient may also developpain in thejoints of their wrists, elbows, back, hips, kneesandankles.

A

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When to seek medical care

A person shouldseek medical adviceurgently if they or a loved one has signs and symptoms of

sepsis. Particular vigilance is required regarding possible sepsis symptoms if the patient:

Is being treated with chemotherapy or radiotherapy Has had an organ transplant Has diabetes Has AIDS Is concerned that he or she may have sepsis and develops fever or chills or any other

signs and symptoms.

When to go to hospital

If achildhas fever, lethargy, poor feeding, a change in normal behaviour or an unusualrash, and you think they may have severe sepsis or septic shock, call 999 and ask for an

ambulance. If you have a family member with confusion, dizziness, fast heartbeat, fast breathing,

fever, chills, rash or dizziness, and you think they may have severe sepsis or septic shock,

call 999 and ask for an ambulance.

Examinations and tests

In hospital, doctors may conduct various tests.

Blood tests may be done by inserting a needle into a vein in the patient's hand or arm anddrawing blood into several tubes. This blood may be analysed to see if the patient has an

elevation in the white blood cells. Blood may also be sent to the lab to be placed on a medium where bacteria will grow if

they are present in the blood. This is called a blood culture. Results from this test usuallytake more than 24 hours. Lab technicians may also look for bacteria in the blood under

the microscope on slides.

Samples may be taken of sputum (mucus), urine, spinal fluid orabscesscontents to lookfor the presence of infectious organisms.

o To obtain clean urine and to measure the amount of urine the patient produces aflexible rubber tube may be placed in their bladder (catheter).

o Spinal fluid may be obtained from the lower back, called a lumbar puncture orspinal tap. After the skin is cleaned and numbed, a hollow needle is placed

between the bones of the spine into the canal containing the spinal cord. Becausethe needle is placed lower than where the cord ends, there is little danger of

injuring the nerves of the spinal cord. Sometimes the patient may experienceelectrical sensations or jolts in their legs during this test because the needle tickles

the nerves as it goes in, but these sensations go away in a matter minutes in most

cases. When the needle is in the correct spot, the doctor will let the fluid drip intotubes. These tubes are sent to the lab for testing.

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o Other tests may include a chest X-ray to look for pneumonia or aCT scanto see ifthere is infection in the abdomen.

A dye might be injected into the patient's vein during a CT scan to helphighlight certain organs in the abdomen. During the injection of this dye,

the patient may feel a flushing or hot sensation or even become nauseated,

but again this feeling will last a very short time. The CT scan is a series of X-rays taken from different angles very quickly

and put together by the computer to show an image of the internal organs.

Usually a radiologist reads the results and notifies the patient's doctor.o In the hospital the patient may be placed on a cardiac monitor, which will show

the patient's heart rate and rhythm.

If the patient is a young child that is ill and being evaluated for sepsis, he or she will getsimilar tests and treatment.

Sepsis treatment: Self-care at home

Severe sepsis is a medical emergency. If a person has severe sepsis, treatment is usually given inthe hospital and often in an intensive care unit.

Medical treatment

The patient will probably be placed on oxygen, either through a tube that is placed near thenose or through a clear plastic mask.

Depending on the results of the tests, the doctor may recommend medications. Thesemedications may include antibiotics given into a vein (intravenous/IV). Initially the antibiotics

may be those that kill many different bacteria because the exact kind of infection the patient

has is not known. Once the blood culture results show the identity of the bacteria, your doctor

may select a different antibiotic that kills the specific microbe. The doctor may also order IV salt solution (saline) and medications to increase the patient's

blood pressure if it is too low.

The doctor will probably admit the patient to the hospital at least until the blood culture resultsare known. If the patient is very ill withlow blood pressure,the doctor may admit the patient to

the intensive care unit (ICU) and may consult other doctors to help in the management of the

patient's illness.

If results show an infection in the abdomen, either drainage of the infection by tubes or surgerymay be necessary.

Research to discover new treatments for sepsis has failed over the past 20-30 years. Many medications

that were thought to be helpful were proven to have no benefit in clinical trials. However, scientists are

working diligently to discover medications that will modify the body's aggressive immune response to

microbes, which leads to sepsis

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