Sepsis

Sepsis progresses through three stages: sepsis, severe sepsis, and septic shock. One can even develop 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 on 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

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

• The lungs: Lung infections such as pneumonia may lead to sepsis in some patients. Sepsis originating from the lungs can be fatal if not treated promptly.
• The abdomen: Infections in the appendix (appendicitis), abdominal cavity (peritonitis), gallbladder, liver, or bowel problems can lead to mild or severe sepsis.
• The urinary tract: Infections in the kidneys or bladder can also lead to sepsis. This type of blood infection occurs mostly in patients with a urinary catheter. Urosepsis may cause nausea, vomiting, pain in the lower spine, and an abnormal white blood cell count (either too high or too low). Urosepsis can be life-threatening if not treated promptly.
• The skin: Bacteria may penetrate the skin through open cuts or wounds. They can also enter through intravenous catheters when inserted to administer or drain fluids. Cellulitis, an inflammatory condition of the skin, can also lead to skin sepsis.

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

• Infancy: Infants are at high risk of developing sepsis due to various birth disorders.
• Old age: Older individuals are more susceptible to infections because of weakened immunity. Additionally, they often suffer from conditions such as diabetes or lower respiratory infections, which can lead to sepsis.
• A weak immune system: A compromised immune system, regardless of age or gender, can contribute to the development of sepsis. Cancer patients undergoing chemotherapy are particularly at risk due to their weakened immunity.
• Uncontrolled diabetes: Patients with diabetes mellitus are at a significantly higher risk of developing sepsis, as infections in these individuals can escalate rapidly.
• Chronic kidney or liver ailments: Individuals with chronic kidney disease who require regular dialysis are more prone to infections and subsequent sepsis.
• Hospitalized patients: Those with prolonged hospital stays or admissions to the intensive care unit are at increased risk of contracting infections that may progress to sepsis.
• Insertion of invasive devices: The use of breathing tubes or intravenous catheters can elevate the risk of infections, including healthcare-acquired infections (HAIs), which may lead to 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 assess evidence of an infection, 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.

Imaging Tests

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

• X-ray: Lung infections are identified through x-rays.
• 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.
• Computerized tomography (CT): This procedure provides cross-sectional images of the body's internal organs by taking x-ray images from various angles and combining them. It is an advanced form of testing that provides nearly perfect images of the liver, pancreas, and other abdominal organs to locate the source of the sepsis.
• 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 create images. MRI is utilized to identify sepsis in bones and soft tissues.

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Sepsis patients often have underlying health conditions that require frequent medical monitoring. Doctors can help prevent sepsis by educating patients about its signs and symptoms. For example, diabetic patients are at a higher risk of developing sepsis, so it is crucial for them to thoroughly check their feet for wounds that could lead to infections. To prevent sepsis, one should take the following steps:

• Get vaccinated: Approximately thirty percent of sepsis cases are caused by pneumonia. Annual flu shots can prevent respiratory infections that may lead to sepsis. Timely flu vaccinations can save many lives, especially among older adults.
• Clean open wounds properly: Open wounds can lead to skin sepsis, particularly in diabetic patients. It is essential to clean any dirt with soap and water and always cover open wounds. Diabetic patients should maintain foot hygiene to prevent foot infections.
• Avoid infections: Many patients develop sepsis while hospitalized, particularly in intensive care units. Healthcare providers must take steps to prevent these infections. Doctors, nurses, and visitors should maintain hygiene by washing their hands before touching patients.
• Know the symptoms: Recognizing the symptoms of sepsis is crucial to avoid complications. Sepsis is characterized by fever, chills, shortness of breath, diarrhea, vomiting, rash, pain, rapid heart rate, confusion, and disorientation.
• Do not delay: Sepsis is a life-threatening condition. If an infection or symptoms of sepsis persist and worsen, seek medical care immediately without delay.
• Get the right treatment: If infection is suspected to have progressed to septicemia, the medical team will identify the source of infection and initiate IV fluids and specific antibiotics.

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Immediate and aggressive treatment increases the chances of survival in sepsis. Timely intervention is essential to prevent 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:

• A. Antibiotics
  Broad-spectrum antibiotics are initially given as they are effective against a wide variety of bacteria. After conducting all relevant blood tests, antibiotics targeting specific bacteria causing the infection are administered. These antibiotics include:
  • 1. Ceftriaxone (Rocephin): Used to control several life-threatening bacterial infections such as pneumonia, meningitis, and E. coli. It is also given to prevent infection or sepsis after surgery.
  • 2. Meropenem (Merrem): An intravenous antibiotic used to treat sepsis arising from intra-abdominal infections.
  • 3. Cefotaxime (Claforan): An intravenous antibiotic used to treat sepsis that may arise from urinary tract infections, pneumonia, meningitis, or cellulitis.
  • 4. Ampicillin and sulbactam (Unasyn): This combination treats a wide spectrum of bacterial infections, including skin sepsis.
  • 5. Levofloxacin (Levaquin): Used to treat bacterial infections in the kidney and prostate, as well as 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 blood pressure does not increase even after intravenous fluids, vasopressor medications are initiated. Vasopressors function to constrict 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, mechanical ventilation to assist with breathing, and dialysis if the kidneys are adversely affected.
• E. Surgery
  Surgery may 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.

Sepsis is life-threatening for all age groups, but it is potentially dangerous for infants and older individuals. Sepsis can be treated with early diagnosis and proper treatment. However, it has several long-term side effects that 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 may be appointed.
2. Prevent infection from recurring at home
   Keep the surroundings clean. Personal hygiene should be maintained at all times, and wounds should be cleaned and covered. The site of the surgery should be cleaned and dressed regularly. Sepsis might lead to permanent side effects, which could cause loss of mobility or cognitive function. Some individuals might even lose limbs due to amputation. Therefore, appoint a caregiver if needed to help 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 use other tobacco products during the recovery period at home, as it can lead to reinfection and delayed recovery.
5. Eat a well-balanced diet
   A healthy diet is crucial for sepsis patients recovering at home. They should be provided with a nutritious diet as advised by the doctor. Foods such as nuts, soy, tofu, and fatty fish can aid in recovery. The doctor may also recommend restrictions on certain food items that must be avoided.

Sepsis can have serious complications, which include:

• 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. This could lead to complications like acute respiratory distress syndrome (ARDS).
• Thrombosis: Sepsis might lead to microvascular thrombosis (blockage of blood vessels by blood clots) and low blood pressure, impairing tissue oxygenation.
• Organ dysfunction/failure: Sepsis could lead to blockage of blood vessels because of microvascular thrombosis or blood clotting, potentially resulting in organ dysfunction or failure.
• Brain damage: The brain is the first organ that might be affected. During sepsis, the body produces nitric oxide, which impacts normal brain function.
• Endocarditis: A serious complication of sepsis is endocarditis, or damage to the heart valves, which could lead to heart failure.
• Gangrene: Sepsis might lead to gangrene or tissue death of the toes and fingers, which may require amputation.
• Weakened immune system: The immune system may become weakened, increasing the risk of reinfections.
• Septic shock: Symptoms of septic shock include all the symptoms of severe sepsis, with extremely low blood pressure, decreased urination, and clammy, sweaty skin. Septic shock can lead to respiratory or heart failure, stroke, or even death.

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 internal organs, including the lungs, kidneys, abdomen, brain, urinary tract, skin, and bones. Even surgical wounds may become infected and lead to septicemia. Home remedies for sepsis are not scientifically proven, but you can try the following 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:

• Vitamin C: Vitamin C strengthens the immune system and helps the body fight infections. Vitamin C (also known as ascorbic acid) is an essential nutrient that plays a critical role in several bodily functions.
• Turmeric (Haldi): Turmeric has been used since ancient times as an effective means to treat infections. Studies have shown that this remedy can play an important role in controlling sepsis. It is an anti-inflammatory agent that can reduce pain, redness, and swelling.
• Garlic (Lahsun): Garlic possesses extraordinary anti-inflammatory and antibacterial properties. It is rich in antifungal properties. Studies suggest that garlic can play an active role in recovery from sepsis.
• Honey (Shahad): Honey can strengthen the immune system. Honey and garlic make a great combination for boosting immunity and aiding recovery from infection.
• Lobelia and Slippery Elm: Lobelia and slippery elm can be applied externally to skin infections or wounds that may become infectious. These herbs are beneficial in treating bacterial infections. A paste of lobelia and slippery elm can be applied to wounds for quick recovery.
• Potato (Aloo): Potato juice can be applied externally to wounds to help control inflammation associated with sepsis.

Many survivors of sepsis are affected by post-sepsis syndrome (PSS). Patients may experience both physical and psychological side effects for an extended period. The physical effects of post-sepsis syndrome include:

• Fatigue or lethargy
• Difficulty in breathing
• Difficulty in sleeping
• 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 such as 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 recognize the symptoms of post-sepsis syndrome. Timely recognition leads to better treatment. Here are a few strategies to manage post-sepsis syndrome (PSS):

• Survivors experiencing psychological issues such as depression or reduced mental functioning should seek counseling, neuropsychiatric assessment, and cognitive behavioral therapy.
• If survivors suffer from physical side effects like reduced organ function or lack of sleep, they should pursue physical therapy and neurorehabilitation.
• Rest is essential for recovery. Survivors should take ample time to regain their strength and vitality, as the body endures significant stress during sepsis or septic shock.
• Survivors should avoid isolation during recovery. While it is advisable to stay away from crowded places to reduce the risk of infection, having someone to talk to, such as family or friends, is important.
• A nutritional diet is crucial for regaining strength. Survivors should follow a balanced diet according to their doctor's guidelines.
• Stay in contact with your doctor, especially in the initial weeks after recovery. Any discomfort related to post-sepsis syndrome symptoms should be promptly communicated to a healthcare professional.