5 Jun 2012
A minor infection can aggravate into a life-threatening ‘sepsis’. Here’s how to tackle it
Do not take an infection for granted. A recent survey has found that every year, more than 90,000 people in India die due to sepsis. What may seem at first like an innocuous bruise or a cut can speedily progressintoaninfection,whichifuntreated,may lead to a life-threatening, full-body inflammatory state called sepsis, also known as Systemic
Inflammatory Response Syndrome (SIRS).
Dr Dilip R Karnad says sepsis is a medical condition triggered due to the body’s response to an infection. “It is caused by microorganisms invading the body, either limited to a specific body part or widespread in the bloodstream,” he says.
Infections of the bowel, kidneys, the lining of the brain (meningitis), the liver or the gall bladder, lungs, skin, soft tissue and urinary tract are the most prone to sepsis. This condition can also occur among children suffering from an infection of the bone (osteomyelitis). In patients who have been hospitalised, common places of developing an infection, include intravenous lines, surgical wounds and the site of skin breakdown known as bedsores. Laparoscopic surgeon Dr Ramesh Punjani says that the human body fights infection in its own way. “If treated incorrectly, belatedly or if the infection has bacteria that have developed resistancetothemedication,thenthebacteriawillspiral out of control and enter the blood stream, eventually leading to septicemia and then sepsis.”
KNOW THE CAUSE
Many a time during organ transplants and other surgical procedures that require suppressing the patient’s immune system, antibiotics are indiscriminately used to treat infections, leading to the development of drug-resistant bacteria. The outcome of patients with sepsis is related to the severityorstageofillnessaswellastothepatient’sunderlying health status. Those with severe sepsis or septic shock have a mortality rate of about 40 to 60 per cent, with the elderly being at the highest risk. Since diabetics and alcoholics tend to have poor immunity, they must be extra careful in treating infections.
IDENTIFY THE SYMPTOMS
But how does one know that the infection has aggravated into a grave situation? In sepsis, the body temperature drops and the blood pressure starts falling, sometimes resulting in shock. A change in mental status, fever, hypothermia (low body temperature) and hyperventilation may be the earliest signs of sepsis. Other symptoms include chills, confusion,delirium,decreasedurineoutput,rapid heartbeat, shivering, skin rash and giddiness due to low blood pressure. You have to be very quick in treating septicaemia, else it can lead to sepsis or SIRS. If untreated, it may lead to Multiple Organ Dysfunction Syndrome (MODS) wherein major organs such as kidneys, liver, lungs, and central nervous system may stop functioning properly. In extreme conditions, this leads to death.
A blood test is the simplest way of confirming if these symptoms are related to your worst fears. However, a blood test may not reveal infection in people who are on antibiotics. Dr Punjani says, “You can’t entirely rely upon a blood test. Only a thorough examination followed by a multiple bloodtest,bloodculturereportandchestX-raycan confirm sepsis.” In some cases, doctors may also recommend blood gases, kidney and liver function test.
Patients with sepsis need to be hospitalised immediately and must be monitored under intensive care. However, there is no specific treatment to control the inflammation. There is no primary therapyavailabletocontroltheseriesofinflammatory events induced by multiple infections. The therapies available are for achieving the secondary goals of sepsis management where antibiotics are prescribed to control the infection and fluid therapy to stabilise the patient’s condition. Therefore, the only way to prevent being under attack from sepsisisbynippingtheinfectioninthebud,rightat the outset.