Sepsis Definition

Introduction

Sepsis is a life-threatening disease that can be more dangerous without proper attention or medication. People with a weak immune system are more prone to this disease, which is also common in older adults or persons with chronic illness, which means those with long medical history or having medication for a more extended period.

Sepsis is the overactive effect of widespread infection over a portion of skin or organ which is caused due to weak immune of the body affected. The disease can start anywhere, and the areas of effect may be the lungs, urinary tract, skin, or abdomen, while also spreading to other sites.

Someone having Sepsis may have a slight fever from a period, rapid heartbeat, rapid breathing and confusion, disorientation, and low blood pressure. And these symptoms do not always follow Sepsis, but most of the time, patients suffering from these symptoms feel Sepsis in the future.

Note that Sepsis is a life-threatening disease, so early detection and treatment are essential to prevent a patient from future septic shocks as these are very painful.

Causes of Sepsis

Sepsis is a condition of the human body that may even be life-threatening at some point. When Sepsis gets into a human body, its immune system worsens and starts de performing at an abnormal rate. This disease can be caused by three major carriers: bacteria, Fungi, or Viruses.

Sepsis is a human condition in which the body faces inflammation and widespread infection, causing more pain, and is a response to our body's immune system. Our body releases

And some of the major causes are discussed below to show the following:

1. Bacterial infections: Bacterial infections can happen when the human body has wounds, cuts, or other breaks in the skin, lungs or urinary tract, or any other part. And note that bacteria has been the most common of Sepsis as long as it has been researched.

2. Viral infections: Another leading cause of Sepsis is viral or viruses which are caused as:

• Direct viral infection: Several viruses, such as influenza and flu, are directly dangerous to the human body and can attack the human body's cells and damage the tissues associated with it.
• Secondary bacterial infection: Some viral infections are also caused by bacteria that are not directly involved in damaging cells or causing infections but weaken our immune system and can help infectious viruses act quickly and infect the part. Anexample of this is bacterial pneumonia, which can result in Sepsis.

Viral infections can occasionally be more harmful even when they do not cause tissue damage because the body's acute inflammatory response can cause Sepsis. Therefore, cytokines, a chemical, are to blame for this inflammation.

Prime examples of viruses causing Sepsis are:

• Influenza: The influenza virus can cause pneumonia, which, in some situations, can turn into Sepsis.
• HIV: The immune system is attacked by the human immunodeficiency virus (HIV), making it more challenging for the body to fend off diseases. Sometimes, this can result in Sepsis over a prolonged period.
• Hepatitis B and C: These viruses can cause liver damage, leading to Sepsis if the infection is not treated.
• Herpes viruses: Sepsis can occasionally be brought on by specific herpes viruses, such as the varicella-zoster virus (which causes shingles and chickenpox) and herpes simplex virus.
• COVID-19: The newly discovered coronavirus (COVID-19) can cause severe respiratory disease, which can develop into Sepsis in certain circumstances.

These factors, such as viruses, are not always the only cause of Sepsis; it can also be due to other factors, such as the type and severe condition of the patient, which can determine the patient's overall health. Some minor symptoms may include infection, fever, and rapid breathing problems.

Effects of Sepsis

Sepsis can cause organ and tissue damage throughout the body and inflammation, which can have severe consequences for a person's health. The body may experience some symptoms from Sepsis, including:

• Organ failure: Sepsis can cause damage to vital organs such as the lungs, kidneys, liver, and heart, leading to organ failure. This may be life-threatening and require prompt medical attention, such as mechanical ventilation or dialysis.
• Septic shock: If Sepsis is not treated promptly, it can progress to septic shock, a severe form of Sepsis. A shallow blood pressure level brought on by septic shock can result in organ failure and even death.
• Cognitive impairment: Sepsis can cause cognitive impairment, such as confusion, disorientation, and memory problems. Even after the infection has been treated, these symptoms may still be present and may lower a person's quality of life.
• PTSD: Some survivors of Sepsis may develop post-traumatic stress disorder (PTSD) due to the traumatic experience. Flashbacks, anxiety, and trouble sleeping are a few PTSD symptoms.
• Long-term complications: Even after Sepsis has been treated, some people may experience long-term complications such as chronic pain, fatigue, and weakness. These side effects may be incapacitating and necessitate ongoing medical attention.

It's crucial to remember that Sepsis's effects can differ from person to person and rely on several variables, including the infection's severity, the patient's age and general condition, and how soon the disease was treated. It's crucial to follow up with a healthcare professional if you or someone you know has suffered from Sepsis to be monitored for potential long-term problems and receive the proper care.

Signs and symptoms of Sepsis

Sepsis is a severe medical condition and can be caused due to body's immune system response to any infection caused due to cuts, wounds, or pimples. Note that Sepsis can develop from any microorganism which can cause severe illness in the human body.

Sepsis's signs and symptoms vary and can change from person or individual. So, it is personal health specific.

• Fever, or common medical term hypothermia: In some patients, fever can be a severe symptom of Sepsis, which means the temperature of the human body above 38 degrees Celsius, while in hypothermia, the patient has a body temperature below 36-degree Celsius and both of them are severe symptoms of Sepsis.
• Fluctuating heart rate: In some patients, it is seen that Sepsis has caused significant changes in heart rate, and it can increase significantly sometimes, which can be very hazardous to the cardio health of the person.
• Increased breathing rate: Sepsis which at some point in time can increase breathing rate and the movement of lungs, which can be so severe up to a breathing rate of 20 breaths per minute in adults.
• Sudden confusion or difficulty in concentration: Sepsis can be ill-effective to patients regarding attention and can cause mental confusion.
• Low urine output: Kidneys are also affected by Sepsis, which can significantly cause low urine output, damaging both kidneys.
• Change in skin behaviour: Several patients have felt cold and clammy skin as the blood vessels of the skin get dilated. In some cases, it can be so intimidating that it causes rashes and causes the skin to get blotchy, purplish, or reddish.
• Pain in the abdomen: This pain can be due to infection caused in either liver, pancreas, or some other organs in the lower part of the human body and later get accompanied by diarrhoea, nausea, or vomiting.
• Abnormal Blood pressure: Sepsis shock is a term used to denote a drop in blood pressure. It can also cause inflammation at a high rate due to the response of the human immune system toward infection and can also cause damage to several organs.
• Nausea and vomiting: When the infection becomes severe, vomiting and nausea are regarded as clinically proven symptoms of Sepsis in the digestive system. This can be a sign of lung infections or difficulty breathing.

Diagnosis of Sepsis

Diagnosis of any disease is the doctor's early knowledge of its symptoms in the patient. It is essential to know and diagnose the problem of Sepsis as early as possible as it is not easy to cure in later stages and can even be life-threatening. So, how is it diagnosed? Doctors generally do it when their patients feel very overridden and quickly get flu or fever when their immune system weakens and cannot work correctly.

Doctors generally try different diagnostic techniques such as blood cell count, measuring serum lactate, and obtaining appropriate cultures within three hours of notable symptoms in the patient and before starting any antibiotics. And the time difference should be merely 45 minutes between the test and the conduct of antibiotics.

Doctors must take at least two blood cultures using special bottles to identify the bacteria causing Sepsis. One should be taken from the skin and another from any IV catheter for more than 48 hours. If doctors suspect infection in other areas, like urine or the respiratory system, they will also take cultures from those areas. If a person's blood pressure is still low after getting fluids or their initial lactate level is high, doctors will check their central venous pressure and oxygen saturation within six hours. They will also recheck the lactate level to see if it was high before.

Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such as a necrotizing soft tissue infection, an infection causing inflammation of the abdominal cavity lining, a condition of the bile duct, or an intestinal infarction. Signs of infection include a pierced internal organ (free air on an abdominal X-ray or CT scan), an abnormal chest X-ray consistent with pneumonia (with focal opacification), or petechiae, purpura, or purpura fulminans.

What is End- organ Dysfunction?

This can happen when different body parts are not properly working due to sickness or infection. There may be a case in which the lungs of the human body cannot work correctly to get enough oxygen; also, sometimes, the brain might be facing confusion or coma-like conditions.

Management of Sepsis

If someone is facing symptoms of Sepsis, it is imperative to diagnose its stage correctly and as early as possible so that treatment can be started just after it. Doctors generally do two basic things right after a patient is diagnosed with Sepsis: giving antibiotics and providing the patient with the required amount of fluid. Doctors typically get the patients in close observation and check their blood pressure and other activities of their body to get a better knowledge of the functioning of the body. In most cases, some organs malfunction and are not getting the required blood.

Medical specialists are called in cases with severe organ failure and absolute blood pressure. While doctors generally prefer to do some tests before diagnosing it. And sometimes, the doctors need to remove the infected part or fluid. Also, in some cases, organs such as kidneys are diagnosed with organ failure and proper dialysis and medical ventilation are needed.

Antibiotics

Doctors generally prescribe antibiotics just days after their diagnosis. The doctors typically take samples from different parts of the human body, like blood, urine, or other respiratory secretions, and start testing which part of the body has been infected and which type of bacteria is causing it. After that, they will choose the best antibiotics to fight against the infection.

The intensity of the antibiotics depends majorly upon the severity of the condition of infection or the state of the patient. Doctors prescribe better or more powerful antibiotics in case of severe infections and prefer to give them as early as possible.

There are several criteria for the choice of antibiotics, and it depends upon the type of bacteria causing the infection, the area of disease, and the allergies attaining the patient. And doctors always check it, most preferably.

Antibiotics will be stopped once the person is diagnosed with no infection over the area, as antibiotics are no more needed and, if continued even after, will lead to antibiotic resistance which can cause more tensions in treating the infection in the future.

Doses may vary from person to person or patient to patient; some patients need one amount daily, while others need two or more. And the quantity may also change from time to time by doctors.

Intravenous fluids

According to the Surviving Campaign in adults, doctors generally prefer to give approximately 30 ml of fluid according to the weight in the first three hours. They should adjust the exact amount according to the blood pressure, urine output, respiratory rate, and oxygen saturation to keep the MAP of 20 ml per kilogram of body weight.

An initial 20 mL per kilogram of body weight for children in shock is reasonable. In severe cases of Sepsis or septic shock, doctors should give fluids until the central venous pressure reaches 8-12 mmHg and then optimize the central venous oxygen saturation (ScvO2). If the ScvO2 is less than 70%, doctors may give blood to reach a haemoglobin level of 10 g/dL and then add inotropes to optimize the ScvO2.

When it comes to the type of fluid to use, the crystalloid solution is recommended for resuscitation, with albumin as an alternative if a large amount of crystalloid is required. There is little difference in the risk of death between crystalloid and hydroxyethyl starch solutions, but starches have an increased risk of acute kidney injury and may require blood transfusions. Colloid solutions, including modified gelatin, do not offer an advantage over crystalloids, and albumin does not appear to be better than crystalloids.

Biomarkers

Sepsis is a disorder in which our body has a solid response to infection, and this disease can be diagnosed with the help of several biomarkers. The biomarker procalcitonin is one such example. It can help diagnose and remove the scarce Sepsis from other bodily inflammatory conditions.Procalcitonin is sometimes not advised to be used as a prime indicator of Sepsis as it is not always correctly determine the proper criteria for Sepsis. Another such biomarker is Supar which can easily predict the likelihood of a patient having Sepsis but is not very helpful in diagnosis like its predecessor Procalcitonin. Blood lactate levels are another class of tests primarily used by doctors for the extreme condition of their patients.