Septic phenomena. Sepsis: Understanding the Life-Threatening Response to Infection

21.09.202326.06.2023 by alexxlab

What is sepsis and how does it affect the body. How can pneumonia lead to sepsis. What are the risk factors for developing sepsis. How is sepsis diagnosed and treated. What are the long-term effects of surviving sepsis. How can sepsis be prevented. Why is early recognition of sepsis crucial for survival.

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The Silent Killer: Unmasking Sepsis and Its Devastating Impact

Sepsis, once commonly referred to as blood poisoning, is a life-threatening medical emergency that demands immediate attention and treatment. This condition arises when the body’s response to infection spirals out of control, potentially leading to organ failure and death if left unchecked.

The gravity of sepsis cannot be overstated. Worldwide, one-third of individuals who develop sepsis succumb to the condition. Even those who survive often face life-altering consequences, including:

Post-traumatic stress disorder (PTSD)
Chronic pain and fatigue
Organ dysfunction
Amputations

Given its severity, understanding sepsis is crucial for early recognition and prompt treatment. But what exactly triggers this potentially fatal condition?

From Infection to Crisis: How Sepsis Develops in the Body

Sepsis can stem from infections anywhere in the body. While the lungs are the most common source of infection in adults, other frequent culprits include:

Influenza
Urinary tract infections
Skin infections
Abdominal infections

When the body detects an infection, it launches an immune response to combat the invading pathogens. In sepsis, this response becomes dysregulated, leading to widespread inflammation that can damage tissues and organs throughout the body.

Why does the immune system sometimes overreact in this way? The exact mechanisms are not fully understood, but factors such as the type and severity of the infection, as well as the individual’s overall health and genetic predisposition, may play a role.

Pneumonia: A Common Precursor to Sepsis

Among the various infections that can lead to sepsis, pneumonia stands out as a particularly significant risk factor. Pneumonia is an infection that affects the lungs, causing inflammation in the air sacs (alveoli) and potentially leading to fluid accumulation.

There are several types of pneumonia, classified based on their cause:

Bacterial pneumonia
Viral pneumonia
Fungal pneumonia

Each type requires different treatment approaches. Bacterial pneumonia, for instance, responds to antibiotics, while viral pneumonia generally does not. Fungal pneumonia necessitates antifungal medications.

How does pneumonia progress to sepsis? When the infection in the lungs becomes severe or spreads to the bloodstream, it can trigger the systemic inflammatory response characteristic of sepsis. This progression underscores the importance of prompt and appropriate treatment for pneumonia.

Recognizing Pneumonia: Key Symptoms to Watch For

Identifying pneumonia early can be crucial in preventing its progression to sepsis. While some individuals may have pneumonia without realizing it, common symptoms include:

Fever
Cough with phlegm
Shortness of breath
Sweating and shaking chills
Chest pain when breathing
Fatigue and muscle pain

It’s important to note that not all symptoms need to be present for pneumonia to be diagnosed. If you suspect you might have pneumonia, seeking medical attention promptly is crucial.

At-Risk Populations: Who is More Susceptible to Sepsis?

While sepsis can affect anyone, certain groups are at higher risk of developing this life-threatening condition. Understanding these risk factors can help in early identification and prevention efforts.

Who faces an elevated risk of sepsis? Key groups include:

The elderly
Infants and young children
Individuals with weakened immune systems
People with chronic medical conditions (e.g., diabetes, kidney disease)
Recent surgery patients
Individuals with invasive medical devices (e.g., catheters, breathing tubes)

Why are these groups more vulnerable? Factors such as compromised immune function, underlying health conditions, and increased exposure to potential pathogens contribute to their heightened risk.

Healthcare-Associated Infections: A Hidden Danger

An often-overlooked risk factor for sepsis is healthcare-associated infections (HAIs). These are infections that patients acquire while receiving treatment for other conditions in healthcare settings. Alarmingly, HAIs affect approximately 1.7 million hospitalizations in the United States annually.

How do HAIs occur? Common causes include:

Inadequate hand hygiene among healthcare workers
Improper sterilization of medical equipment
Overuse of antibiotics leading to resistant bacteria
Prolonged use of invasive devices like catheters

Preventing HAIs is crucial in reducing the incidence of sepsis in healthcare settings. This requires a multifaceted approach involving strict hygiene protocols, judicious use of antibiotics, and ongoing education for healthcare providers.

Diagnosing Sepsis: The Race Against Time

Early diagnosis of sepsis is critical for improving outcomes. However, identifying sepsis can be challenging as its symptoms often mimic those of other conditions. What are the key indicators that healthcare providers look for when diagnosing sepsis?

The Sepsis-3 definition, established in 2016, uses the following criteria:

Suspected or confirmed infection
Organ dysfunction as indicated by a change in the Sequential Organ Failure Assessment (SOFA) score

Additionally, the quick SOFA (qSOFA) score can be used for rapid assessment outside of intensive care units. It considers three criteria:

Altered mental status
Respiratory rate ≥ 22 breaths per minute
Systolic blood pressure ≤ 100 mmHg

Why is rapid diagnosis so crucial? Every hour of delay in administering appropriate antibiotics increases mortality risk by about 7-8%. This underscores the importance of healthcare providers maintaining a high index of suspicion for sepsis, especially in at-risk populations.

Treatment Approaches: Battling Sepsis on Multiple Fronts

Once sepsis is diagnosed, immediate and aggressive treatment is essential. The cornerstone of sepsis management involves a multi-pronged approach aimed at controlling the infection, supporting organ function, and modulating the immune response.

What are the key components of sepsis treatment?

Antimicrobial therapy: Broad-spectrum antibiotics are administered immediately, often before the specific pathogen is identified. As culture results become available, therapy may be tailored to target the specific organism.
Fluid resuscitation: Large volumes of intravenous fluids are given to support blood pressure and organ perfusion.
Vasopressors: If fluid therapy alone is insufficient to maintain adequate blood pressure, medications to constrict blood vessels may be used.
Supportive care: This may include mechanical ventilation for respiratory support, dialysis for kidney failure, or other interventions based on the affected organs.
Source control: If a specific site of infection is identified (e.g., an abscess), interventions to control or remove the source may be necessary.

Why is a multifaceted approach necessary? Sepsis affects multiple organ systems simultaneously, necessitating a comprehensive treatment strategy to address both the underlying infection and its systemic effects.

The Sepsis Bundle: A Standardized Approach to Care

To streamline and standardize sepsis treatment, many healthcare facilities implement what’s known as the “sepsis bundle.” This is a set of evidence-based interventions that, when performed together, have been shown to improve outcomes in sepsis patients.

What does the sepsis bundle typically include?

Measure lactate level
Obtain blood cultures before administering antibiotics
Administer broad-spectrum antibiotics
Begin rapid administration of intravenous fluids
Apply vasopressors if hypotension persists despite fluid resuscitation

The implementation of sepsis bundles has been associated with significant reductions in mortality rates, highlighting the importance of standardized, protocol-driven care in managing this complex condition.

Long-Term Consequences: Life After Sepsis

While surviving sepsis is a significant victory, many patients face ongoing challenges in the aftermath of their illness. The long-term effects of sepsis, often referred to as post-sepsis syndrome, can be profound and long-lasting.

What are some of the common long-term consequences of sepsis?

Cognitive impairment: Many survivors experience difficulties with memory, attention, and problem-solving.
Physical weakness and fatigue: Prolonged muscle weakness and debilitating fatigue are common.
Organ dysfunction: Kidneys, lungs, and other organs may have lasting damage.
Psychological effects: PTSD, anxiety, and depression are frequently reported.
Increased susceptibility to infections: The immune system may be compromised, leading to recurrent infections.
Chronic pain: Persistent pain, often neuropathic in nature, can significantly impact quality of life.

Why do these effects persist long after the acute infection has resolved? The systemic inflammation and organ damage that occur during sepsis can have far-reaching consequences, affecting multiple body systems. Additionally, the physical deconditioning that occurs during prolonged hospitalization can contribute to ongoing weakness and functional limitations.

Rehabilitation and Recovery: The Road Back to Health

Given the potentially devastating effects of sepsis, comprehensive rehabilitation is often necessary to support recovery. This may involve:

Physical therapy to rebuild strength and endurance
Occupational therapy to regain independence in daily activities
Cognitive rehabilitation to address memory and attention deficits
Psychological support to manage PTSD and other mental health issues
Nutritional counseling to address malnutrition and support overall recovery

The recovery process can be lengthy, often extending months or even years beyond the initial hospitalization. This underscores the importance of viewing sepsis not just as an acute medical emergency, but as a condition with potential lifelong implications.

Prevention Strategies: Reducing the Burden of Sepsis

Given the significant morbidity and mortality associated with sepsis, prevention is paramount. While it’s not always possible to prevent sepsis entirely, several strategies can reduce the risk of developing this life-threatening condition.

What are some key approaches to sepsis prevention?

Vaccination: Immunizations against common infectious diseases like influenza and pneumococcal pneumonia can significantly reduce the risk of infections that may lead to sepsis.
Proper wound care: Cleaning and caring for wounds promptly and thoroughly can prevent infection and potential progression to sepsis.
Hand hygiene: Regular handwashing, particularly in healthcare settings, is crucial in preventing the spread of infectious agents.
Antibiotic stewardship: Appropriate use of antibiotics helps prevent the development of antibiotic-resistant bacteria, which can be particularly challenging to treat if they cause sepsis.
Management of chronic conditions: Keeping chronic health conditions like diabetes well-controlled can reduce susceptibility to infections.
Early treatment of infections: Promptly seeking medical care for infections and following prescribed treatments can prevent progression to sepsis.

Why is a multi-faceted approach to prevention necessary? Sepsis can arise from various types of infections and in diverse populations, necessitating a comprehensive strategy that addresses multiple risk factors and potential sources of infection.

The Role of Public Awareness in Sepsis Prevention

Increasing public awareness about sepsis is a crucial component of prevention efforts. Many people are unfamiliar with the signs and symptoms of sepsis, which can lead to delays in seeking medical care.

How can public awareness be improved?

Educational campaigns to inform the public about sepsis symptoms and risk factors
Integration of sepsis education into school health curricula
Training for healthcare providers to enhance early recognition and treatment
Support for sepsis survivors and their families to share their experiences and raise awareness

By increasing awareness, individuals may be more likely to recognize potential sepsis symptoms in themselves or loved ones and seek prompt medical attention, potentially saving lives.

The Future of Sepsis Care: Emerging Research and Innovations

As our understanding of sepsis continues to evolve, researchers are exploring new approaches to diagnosis, treatment, and prevention. These advancements hold promise for improving outcomes and reducing the global burden of sepsis.

What are some areas of ongoing research in sepsis?

Biomarkers for early diagnosis: Researchers are investigating novel biomarkers that could allow for more rapid and accurate diagnosis of sepsis.
Immunomodulatory therapies: New treatments aimed at modulating the immune response in sepsis are under investigation.
Personalized medicine approaches: Genetic and molecular profiling may help tailor treatments to individual patients.
Artificial intelligence in sepsis prediction: Machine learning algorithms are being developed to predict sepsis onset before clinical symptoms appear.
Novel antimicrobial strategies: Research into new antibiotics and alternative approaches to combating antibiotic-resistant bacteria is ongoing.
Post-sepsis syndrome interventions: Studies are exploring ways to mitigate the long-term effects of sepsis and improve quality of life for survivors.

Why is ongoing research crucial in the fight against sepsis? Despite advances in care, sepsis remains a leading cause of death worldwide. Continued research is essential to develop more effective prevention strategies, diagnostic tools, and treatments to reduce the devastating impact of this condition.

Global Initiatives: Uniting Against Sepsis

Recognizing the global impact of sepsis, several international initiatives have been launched to coordinate efforts in research, education, and policy development. These include:

The Global Sepsis Alliance: A non-profit organization dedicated to reducing the worldwide burden of sepsis
World Sepsis Day: An annual event to raise awareness about sepsis and its prevention
The Surviving Sepsis Campaign: An initiative providing evidence-based guidelines for sepsis management

These global efforts highlight the importance of collaboration in addressing the complex challenges posed by sepsis. By sharing knowledge, resources, and best practices across borders, the international medical community aims to make significant strides in reducing sepsis-related morbidity and mortality worldwide.

Pneumonia | Sepsis Alliance

Sepsis and septic shock can result from an infection anywhere in the body, including pneumonia. Pneumonia can be community-acquired, meaning that a person becomes ill with pneumonia outside of the hospital. Pneumonia can also be caused by a healthcare-associated infection (HAI), which affect 1.7 million hospitalizations in the United States every year. An HAI is an infection contracted by people while the hospital for a different reason, such as surgery or treatment for another illness.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Sepsis and septic shock can result from an infection anywhere in the body, such as influenza or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

The most common source of infection among adults is the lungs.

What is pneumonia?

Pneumonia is an infection in the lungs. The infection can be only in one lung, or it can be in both. There are several causes of pneumonia but the most common are:

Bacteria
Virus
Fungus

Left untreated, the infection can be deadly. In the days before antibiotics, it’s estimated that about one-third of those who developed bacterial pneumonia died.

Symptoms

Some people can have pneumonia and not know it, but the most common signs and symptoms are:

Fever
Cough, with phlegm
Shortness of breath
Sweating
Shaking chills
Headache
Muscle pain
Fatigue
Chest pain with breathing

You do not have to have all these symptoms to have pneumonia.

Who is at higher risk for developing the infection?

While anyone can develop pneumonia, some people are at higher risk than others. These include:

The elderly
The very young
People who recently had a cold, influenza, or COVID-19
Smokers
Having a respiratory illness, such as chronic obstructive pulmonary disease (COPD)
Exposure to certain inhaled toxins
Recent surgery
People in intensive care units
People who are malnourished

What is the treatment?

Treatment depends on the type of infection you have.

Bacterial

Antibiotics treat bacterial pneumonia. The type of antibiotics your doctor may choose depends on the bacteria causing the infection. If you have a prescription for antibiotics, you should finish all the medication, even if you start to feel better. You will begin to feel more like yourself before the infection is completely gone. If you stop the medications before the infection disappears, you could get a more serious pneumonia that can’t be treated as easily.

Viral

Viral pneumonia does not respond to antibiotics; they will not do any good. In general, there isn’t much that can be done for viral pneumonia other than advising that you rest and take in plenty of fluids to stay hydrated. In some cases, doctors may prescribe an anti-viral medication, but this is not common.

Fungal

Medications called anti-fungals treat fungal pneumonia.

Preventing pneumonia

Sometimes we can prevent pneumonia. If you have surgery that requires general anesthetic, you could be at risk for developing a bacterial pneumonia. To lower the risk, get up and out of bed after the surgery. If you can’t get up and move around, breathe deeply and cough on a regular basis. This is to help keep your lungs clear.

There is a vaccine that can help prevent a common type of pneumonia called pneumococcal pneumonia, caused by Streptococcus pneumoniae. There is also a vaccine that doctors can give children to decrease the risk of developing one of four types of infections:

Meningitis (infection in the brain)
Bacteremia (infection in the blood)
Otitis media (infection in the middle ear)
Pneumonia

Doctors recommend the vaccine for the elderly and for people at high risk of developing pneumonia. If you fall into one of those categories, you may want to discuss this with your doctor.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”

The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance.

Sepsis and Pneumonia. 2022. https://www.sepsis.org/sepsisand/pneumonia/

Updated October 18, 2022.

Surviving Sepsis | NIH News in Health

August 2014

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Taming a Deadly Immune Response

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Many people have never heard of sepsis, or they don’t know what it is. But sepsis is one of the top 10 causes of disease-related death in the United States. The condition can arise suddenly and progress quickly, and it’s often hard to recognize.

Sepsis was once commonly known as “blood poisoning.” It was almost always deadly. Today, even with early treatment, sepsis kills about 1 in 5 affected people. It causes symptoms such as fever, chills, rapid breathing, and confusion.

Anyone can get sepsis, but the elderly, children, and infants are most vulnerable. People with weakened immune systems, severe burns, physical trauma, or long-term illnesses (such as diabetes, cancer, or liver disease) are also at increased risk.

At one time, sepsis was thought to arise from an overgrowth of bacteria or other germs in the bloodstream. We now know that sepsis actually springs from 2 factors: first an infection (such as pneumoniaAn infection of the lungs. or a urinary tract infection) and then a powerful and harmful response by your body’s own immune systemThe system that protects your body from invading bacteria, viruses, and other microscopic threats. .

“With sepsis, the fight between the infection and the body’s immune response makes the body like a battleground,” says Dr. Derek Angus, a critical care physician at the University of Pittsburgh School of Medicine. “In the case of severe sepsis, that fight results in vital organ dysfunction, which puts one’s life in peril.”

Severe sepsis can damage essential organs like the liver and kidneys. An even more extreme disorder occurs when blood pressure plummets—a condition known as septic shock. “With septic shock, the immune response that’s trying to fight infection can actually lead to a dangerous drop in blood pressure,” Angus says. As blood pressure falls, tissues become starved for oxygen-rich blood. Organs can fail, which could lead to death.

By some estimates, severe sepsis or septic shock strikes nearly 1 million Americans each year. At least 200,000 of them die in the hospital shortly afterward. Many who survive recover completely. But others have lasting problems, including permanent organ damage and thinking difficulties (such as problems with planning, organizing, and multitasking).

Sepsis can be triggered by many types of infections. “But the most common cause of sepsis is community–acquired pneumonia,” Angus says. Scientists are still working to understand why some people with infections develop severe sepsis or septic shock while others don’t.

Researchers are exploring new ways to diagnose, reverse, or prevent this serious and costly condition. Treatment for sepsis is most successful if the condition is spotted early and then treated quickly with antibiotics to fight the infection and fluids to maintain blood pressure.

In a large NIH-funded clinical trial of sepsis care, Angus and his colleagues found that a relatively simple strategy worked as well at preventing deaths as did more complex and costly approaches. “The study helped to clarify that a lot of the treatment steps we’d been using are essential, but the extra steps with sophisticated and invasive procedures aren’t always necessary to improve survival,” Angus says.

Sepsis is a health emergency that requires swift medical care. See a doctor or get emergency assistance if you feel unwell and have a combination of the symptoms listed in the “Wise Choices” box.

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Septic arthritis is an infectious inflammation of the joints caused by bacteria. In this type of arthritis, microorganisms penetrate directly into the joint cavity and multiply there, supporting the inflammatory focus. As a result, the joint cavity is filled with pus, and the patient experiences constant excruciating pain. Pyogenic arthritis can cause dangerous complications, up to septic shock, so you should not delay visiting a doctor.

Pyogenic arthritis pathogens

This type of joint inflammation is associated with bacterial flora. The most common causes of the disease are staphylococci, streptococci, Haemophilus influenzae and enterobacteria.
Routes of entry of pathogens:
● contact – from nearby foci of osteomyelitis
● hematogenous and lymphogenous – from distant abscesses
● traumatic – with penetrating wounds or invasive manipulations on the joint

How septic arthritis manifests itself

Severe pain occurs in the affected joint, which is observed at rest and aggravated during movement. Patients notice redness and swelling of the skin over the joint, due to severe swelling of the tissues, deformation of the periarticular zone is observed. The skin in this area is hot to the touch, and touch increases soreness.
Purulent infection of the joint is accompanied by fever, weakness, sweating and other signs of intoxication.

Features of the course

Septic arthritis most often affects only one joint, and inflammation of the ankle or hip joint is considered a typical localization. A polyarthritis-type lesion is possible in patients who are on immunosuppressive therapy, suffer from primary or secondary immunodeficiencies.
Pyogenic arthritis is characterized by rapid progression and a high risk of irreversible cartilage destruction.

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Diagnosis requires a personal examination in a clinic or at home, but general recommendations can be obtained during an online video consultation.

Diagnosis of septic arthritis

● Instrumental diagnosis – ultrasound, radiography, CT or MRI of the joints
● joint puncture and microbiological examination of joint fluid
● bacteriological culture of urine and feces for infections
● clinical and biochemical blood test
● blood tests for viral hepatitis, syphilis, HIV infection

Treatment of pyogenic arthritis

Purulent effusion – indication for puncture and washing of the joint. Such manipulations are carried out regularly until the formation of pus stops. If necessary, arthrocentesis is supplemented with arthroscopic sanitation of the articular cavity.
Drug treatment includes taking antibiotics, which are selected based on the type of pathogen. The course of antibiotic therapy lasts until the inflammation subsides. NSAIDs are also used to reduce joint pain.

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