Septicemia (alternative UK spelling Septicaemia) is a serious, potentially life-threatening blood infection in which the body’s immune system is overwhelmed by the presence of poisons in the circulatory system. These poisons are usually bacteria and/or the toxins produced by them but can occasionally be due to fungal or viral infections. The term “blood poisoning” has been used for many years but has now fallen into disuse. “Bacteremia” more accurately describes the bacterial form of this condition. The most dangerous aspect of this condition is that it develops into sepsis which in severe cases can result in reduced blood supply to the vital organs, septic shock, multiple organ failure and ultimately death. Although sepsis can occur without septicemia, the two are so closely interconnected that they are now considered synonymous and the medical profession almost invariably uses the former descriptor.
This is a major cause of death with recent statistics revealing that in one year in the UK approximately 150,000 cases were recorded resulting in 44,000 deaths. The charity Sepsis Trust points out that this total is greater than the number of deaths attributable to breast, bowel and prostate cancer combined.
There is no single cause for this condition and any primary infection may develop into a blood poisoning scenario. These infections may be obvious such as cellulitis, infected wounds or ulcers but are just as likely to occur within the body such as with bacterial pneumonia or urinary tract infection. They can even originate from something as apparently innocuous as an insect bite. Pressure sores can also become seriously infected so great care is needed when caring for the immobile. The body’s immune system is capable of dealing with most infections but in this case the sheer size of the infection necessitates it going into overdrive. Anyone considered to be immuno-compromised is at much greater risk so the very young, frail or old may be more susceptible as are those whose immune system may be suppressed due to genetics, disease such as HIV infection, or because of medication such as steroids or chemotherapy. Any procedure which compromises the integrity of the skin may increase the risk of such infections as can procedures involving catheters and fistulas. Surgery poses many risks both from the procedure being carried out, such as bowel surgery, and from the wounds themselves and, in cases of post-operative infections, further surgery may be required.
One of the greatest problems in dealing this type of blood infection is that, in the initial period, sepsis symptoms are fairly non-specific resulting in a delay in obtaining medical treatment and, as the condition rapidly progresses to the acute stage, speed is of the essence and can be a matter of life or death. Like many illnesses, a general feeling of being unwell is the first sign followed by some of the early symptoms which include confusion and slurred speech, muscle pain and shivering, severe breathlessness, no passing of urine for 18 hours or more, mottled bluish or very pale skin and a feeling that “Something is very wrong”. If such symptoms are present, no time should be lost in seeking medical attention. This is a real emergency requiring hospital treatment. Septicemia symptoms may not be immediately recognised by health care professionals and so it may be necessary to inform them that this condition is suspected. Sepsis symptoms can then be evaluated in order to establish whether this form of blood poisoning is actually present to enable treatment to commence without delay.
Septic shock occurs when the infection causes damage to the small blood vessels causing them to leak. This causes a drop in blood pressure (hypotension) which can reduce the supply of oxygen to the vital organs. In worst cases this can lead to organ failure and death. The most recent definition qualifies this condition as being present when, after adequate fluid resuscitation, the administration of vasopressors or vasoactive medication is required to maintain a mean arterial blood pressure of 65 mm Hg or higher together with the presence of high lactate (more than 2 mmol/L).
The first thing to stress is that this is not a condition which can be treated by home remedies. All types of blood poisoning symptoms require treatment by healthcare experts and although the original fairly vague symptoms may give a fairly good indication of the likelihood of sepsis infection, specialists will follow a very specific assessment procedure. There may be minor variations but the traditional form of assessment begins by testing whether the patient is suffering from systemic inflammatory response syndrome (SIRS). Such tests will check such things as temperature, heart rate, respiration rate, blood tests (especially white cell count and glucose) and assessing any altered mental state. If SIRS is confirmed, the second part of the sepsis criteria tests involves specific tests to establish whether this is likely to be due to sepsis infection. These more detailed tests are known as Sequential Organ Failure Assessment (SOFA).
Recent developments published in February 2016 at the Society of Critical Care’s 45th
Congress, have given full recognition to the essential need for speedy assessment and have devised much simpler assessment criteria where only three parameters are considered being: Hypotension, Altered Mental State and Tachypnea. This may be referred to as the Sepsis-Three or simply be known by the acronym “HAT”. A positive assessment is produced when two or more of the descriptors are present. These are: Systolic Hypotension of less than 100 mm Hg, Tachypnea of at least 22 breaths/min and an Altered Mental State. This simplified assessment does not call for any blood tests or other time consuming procedures at this stage. It bypasses the previously used SIRS and SOFA assessments in favour of speed but further in-depth tests will of course be carried out at a later stage.
The confirmation of such blood poisoning symptoms calls for immediate treatment which should be carried out within one hour. Sepsis treatment will typically involve the administration of intravenous antibiotics and fluids and the common practice is to opt for a wide spectrum drug which is effective for most commonly encountered bacteria even though the choice of antibiotic may be reassessed and changed later when detailed results are available identifying the causative organism. The patient may be administered with high-flow oxygen and measurements taken of urine output and blood lactates. This very regimented septicemia treatment procedure involves six different parameters and is often referred to as the “Sepsis-Six”. Again it must be stressed that this is a procedure which requires expert supervision. It is currently only recommended in severe cases meaning that a precise evaluation of the condition is a prerequisite.
So sepsis treatment is fairly straightforward and involves supporting the body systems until the infection is controlled. A major factor is in maintaining adequate blood pressure. In some acute cases it may be necessary to offer organ support such as dialysis or mechanical ventilation until the body recovers. One particular concern however is the existence of the so-called superbugs such as MRSA which are resistant to many antibiotics meaning that some infections may be difficult to control. It is generally acknowledged that the very high mortality rate associated with this condition is not due to any lack of medical expertise but is mainly due to the failure in obtaining early treatment. The latest thinking is that a campaign raising public awareness is needed in an attempt to overcome this problem.
Surviving this condition is certainly a life-changing event but for many people full recovery involves much more than simply leaving hospital and returning home. The ravages of the infection can cause damage throughout the body and there are many long-lasting side effects both physical and mental some of which are listed below:
(1)Lethargy and Tiredness:- This can have both physical and mental causes and can even constitute the disabling condition Chronic Fatigue Syndrome (CFS).
(2)Mobility Problems:- Muscle weakness.
(4)Swollen Limbs (edema):- The accumulation of body fluids can result in swelling and mobility problems.
(6)Insomnia: Both due to pain and breathing problems and psychological reasons.
(8)Dry Skin and Nail Problems
(9)Changes in Taste Sensations
(11)Changes in Vision
(12)Changes in Sensations in Limbs
(14)Short-Term Memory Loss
(16)Post Traumatic Stress Disorder
From the above it is apparent that full recovery is unlikely to be rapid and generally speaking many patients only feel that they are getting back to normal after a prolonged period typically around eighteen months to two years. Some people find that they suffer a series of recurring infections each requiring antibiotic treatment while others may go on to make a full and rapid recovery.
From a medical perspective this is not an incurable disease. There are no high profile research programmes seeking a cure and we are unlikely to ever see effective inoculation against it, with the possible exception of bacterial meningitis, but there is certainly scope for improvements in its recognition both by the general public and health care professionals alike to enable everyone to have access to the best possible treatment. As with many critical conditions, the secret is to spot the symptoms and act quickly. 44,000 deaths per year in the UK alone is a figure which is hard to comprehend but many lives can be saved simply by increasing awareness and any scheme to this end is to be welcomed.
[Misspellings of septicemia include: septicaemia, septecimia, septocemia, septecima, septemia, septocemia, septisimia, septesemia]