PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Sepsis: Get this Shocking Diagnosis on your Radar

Everyone knows what the word “infection” means, right? People tend to toss that word around like they know it so well they made it up themselves. And that’s probably just about true for many people. It’s fairly straightforward to understand the concept of the body being invaded by an outside germ or organism and multiplying, causing illness and therefore frequently unpleasant symptoms, like cough, ear pain, etc. Most of the time a simple course of antibiotics (if the infection is bacterial) and supportive care (fluids, rest, and all that) are all that’s needed for resolution of the infection. Done and dusted.

But… (and there’s always a but in medicine) what if an infection isn’t stopped and gets more severe and serious, overwhelming even? What then? It’s one of my least favorite situations, and it’s called SEPSIS. I’m hoping that this blog entry will be the only time that you have to encounter this word and its meaning, but it’s critical enough that it deserves attention and respect.  SEPSIS, according to the CDC, is the “body’s extreme response to an infection. It is life threatening, and without timely treatment, can rapidly cause tissue damage, organ failure, and death.”

image of definition of sepsis from CDC.gov What is sepsis? Sepsis is the body’s extreme response to an infection. It is life-threatening, and without timely treatment, sepsis can rapidly cause tissue damage, organ failure, and death. Sepsis happens when an infection you already have – in your skin, lungs, urinary tract or somewhere else – triggers a chain reaction throughout your body.

definition courtesy of CDC.gov

So, not something to be taken lightly.

Both viruses and bacteria can cause sepsis, and infections in the lungs, urinary tract, and skin are typical points of entry into the body. Common bacteria implicated in sepsis include E. Coli, Staph aureus, and some types of Strep. The germs multiply and the body’s immune response goes into overdrive, to the point where it attacks its own tissues, and the organs fail. Death frequently results in these situations, as the destruction goes beyond the point of repair. Even when antibiotics or (in some instances) antiviral medicines are given, it’s often too late. When it starts to affect blood pressure and oxygen delivery to the tissues, it’s called septic shock. One of the kickers here is that it can be difficult to recognize in its early stages so “catching it” in time, though absolutely paramount to treatment, doesn’t always happen.

First, who gets sepsis?

Is it just people with chronic medical problems? Sadly, the answer is no, although this is a high risk group. As with most infections, the very young (especially babies under 3 months old) and the very old are susceptible to overwhelming infection as are those with a weakened immune system, but every year we hear about fluke cases of random healthy people getting overwhelming infections and dying. Sometimes sepsis isn’t picky about whom to victimize. Luckily, it is rare, with estimates from 2005 suggesting that there are 0.89 cases per 1000 children (Randolph, AG and McCullah, RG. Pediatric Sepsis. Virulence. 2014 Jan 1; 5(1): 179-189).

I’m not trying to instill panic in any way, just raise awareness, which isn’t easy, because the symptoms of sepsis can sometimes be vague.

Usually, septic people have fever, extreme pain, elevated or markedly decreased heart rate, rapid breathing, clammy skin, drop in urine output, rapidly evolving rash, and mental confusion. Well, that sort of sounds like me whenever I come down with something so I’m not sure that list is terribly helpful, but the diagnosis can only happen with a high degree of suspicion, so put this on your radar with the additional general parent intuition of “something’s just not quite right,” because this is often what I have heard from parents of kids with sepsis as I interview them to find out the relevant history. The Sepsis Alliance has a good mnemonic:

 

I hope you are getting the message that sepsis is more than just feeling very sick or really crummy: it’s next level feeling bad.

If you have a concern about sepsis for you or your child, THIS IS A MEDICAL EMERGENCY and care needs to be sought immediately. Sepsis is diagnosed by a variety of physical signs plus lab analysis of the blood, urine, wound site (if applicable) and cerebrospinal fluid in some instances. X-rays of the chest can be helpful as well. If the results of the combination of all this input are suggestive of sepsis, then broad spectrum antibiotics are started intravenously and admission to the hospital (often the intensive care unit) will occur. In addition to antibiotic medicine, fluids and sometimes oxygen are used as supportive care as well. The concern for sepsis is so high in newborn infants less than 28 days old that if they have a fever of 100.4°F or above, then they are automatically admitted to the hospital on IV antibiotics after getting cultures of the blood, urine, and spinal fluid just because they are so high risk. After 48 hours, if the cultures show no growth of any serious disease causing organism, then the medicines are discontinued and the baby may be safely discharged. Clinicians are very conservative in this age group, and rightly so.

Current trends in sepsis research run the gamut from diagnosis to new forms of treatment during circulatory collapse. On the front end it includes refining understanding of the early signs of sepsis to improve identification of affected patients with the goal of earlier initiation of therapy. Early detection is crucial to patient survival.

After reading all this, do you wonder if there’s anything at all you can do to help avoid this serious diagnosis? There are in fact, a few things:

  1. Stay up to date on immunizations.
  2. Maintain vigorous hand hygiene.
  3. Keep all wounds clean.
  4. If you or your child have a chronic illness, discuss with your doctor any ways specific to your particular situation that may be beneficial for countering infections.

I’m not trying overrate my writing abilities here, but I honestly think that just by reading this entry, knowing the word SEPSIS and what it means, and having it on your radar puts you ahead of the game in terms of your best chances at early recognition. If all else fails and you’re just not sure, don’t hesitate to get checked out by a clinician. We would rather tell a thousand people in the earlier phase of illness that “No, this isn’t the picture of sepsis” than one person late in the course that septic shock is the diagnosis.

 

 

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