What is blood poisoning - sepsis? What are its symptoms, how does it proceed?

Sepsis or even blood poisoning is considered a serious disease or a serious disease complication with a high mortality rate.

It should be noted that sepsis is primarily a systemic, inflammatory response of the body to infection. It is therefore a natural defence mechanism of the body which, under certain circumstances, leads to organ damage and failure.

It can occur even after a seemingly minor infection, such as a finger abrasion, animal bite or stepping on a rusty nail. A wound can also become infected in secondary ways.

Interesting:
Systemic inflammatory response syndrome SIRS (systemic inflammatory response syndrome) is the inflammatory response of the body to various insults.
These are divided into two basic categories, namely, insults of infectious and non-infectious origin.
Insults of non-infectious origin(burns, severe trauma, amniotic fluid embolism) cause SIRS but not sepsis.
Insults of infectious origin (viruses, bacteria, rickettsiae, yeasts, parasites) cause sepsis, which is a subcategory of SIRS.

Sepsis incidence and mortality rates

Blood poisoning affects up to 30 million people annually worldwide. Its incidence is increasing every year due to bacterial resistance to antibiotic treatment.

The majority of these patients are over 65 years of age, patients with immune disorders or other serious diagnoses (diabetes, cancer), or patients admitted to hospital. In this case, the infection is nosocomial (hospital-acquired).

Mortality from sepsis is high. It depends on several factors:

• 15% in young healthy individuals
• 28 % in patients who have sepsis during hospitalisation
• 40 % to 60 % in patients with sepsis who develop septic shock
• almost 100% in patients at risk (immune disorders, severe cancer)

Mortality from sepsis is likely to be much higher. However, sometimes the underlying disease is cited as the cause of death, so the final figures may be biased.

Mortality depends primarily on the cause of the septic condition (infectious agent), on early diagnosis and early initiation of treatment, on the age of the patient and his/her general health.

Definition of sepsis, septic condition

Sepsis, septicemia, septicaemia, popularly also blood poisoning, is a life-threatening organ dysfunction. It is caused by an inadequate response of the human immune system to infection.

Simply put, it is a severe defensive response of the body to the presence of microorganisms or the body's response to the invasion of microorganisms into organs and systems that are normally sterile.

It is accompanied by excessive activation of inflammatory mechanisms with typical inflammatory manifestations.

Interesting:
The term sepsis is derived from the Greek word sepsis, sepo, meaning to rot.
The name describes the real processes in the body that are induced by sepsis (tissue death - necrosis).

Pathophysiology of sepsis

We consider any septic (purulent) deposit anywhere in the body to be the source of sepsis.
It can be, for example, a purulent abscess or infection in the abdominal cavity, an infected surgical wound, an inflammatory process in the lungs, urological or gynaecological infections, and others.

The microorganisms found in the lesion are of various origins.
Most often they are bacteria (staphylococci, streptococci, escherichia). Yeast infections (candida) are also a frequent causative agent.
Less frequently they are viruses, rickettsiae, parasites.

Interesting:
Any microorganism has the ability to cause sepsis, but the degree of ability is determined by the reactivity of their surface structures (enzymes, toxins).
In practice, this means that some microorganisms are more dangerous to us in terms of causing blood poisoning.
These include, for example, gram-positive staphylococci and enterococci, and gram-negative E. Coli, Enterrobacter, Klebsiella.

Blood poisoning is caused by the repeated or sustained shedding of microorganisms from the source of infection into the blood (called bacteraemia). It then spreads throughout the body.

What happens to our immune system during infection?

• The immune system is able to recognise the molecular structures of these microorganisms
• once they are recognised, a natural defence reaction is triggered, i.e. an inflammatory response with the production of mediators, pro-inflammatory and anti-inflammatory substances
• specific proteins that regulate blood clotting are activated

What happens to our immune system in sepsis?

• the regulation of the inflammatory process by signalling substances is disturbed
• the blood vessel walls are damaged and lose their ability to regulate wall tension and therefore blood pressure
• specific proteins that affect clotting are present in excessive numbers (coagulation, fibrinolytic, complement)
• pathologically increased coagulation activity occurs - so-called disseminated intravascular coagulopathy (DIC) with clot formation
• dysfunction of the microcirculation results in damage to the heart muscle
• lung damage and acute respiratory distress syndrome (ARDS) leading to lung failure
• Gradually, other organs in the body (kidneys, liver, intestine) fail, called MODS (multiple organ dysfunction syndrome)

How does sepsis manifest itself?

Sepsis is initially manifested by non-specific symptoms of infection (fever, shivering, low blood pressure, dizziness, sweating, weakness). Therefore, laboratory results from blood tests are crucial for diagnosis.

Manifestations only become apparent when organ dysfunction occurs and on the basis of laboratory blood test results.

Manifestations and stages of sepsis, septic shock

There are three stages of sepsis.

Stage 1 - Sepsis is very important in terms of patient survival. If the diagnosis is made in the first stage and the correct antibiotic treatment is given, the patient has a good chance of survival.

Stage 2 - Severe sepsis, the condition is critical and the chance of life is reduced by almost 50%.

The last...

Stage 3 - Septic shock means a mortality rate of almost 100% (shock is further divided into mild, warm and cold).

General information about shock.

Stages of sepsis

Course of sepsis and progression to septic shock

After the invasion of microorganisms, the human body fights these pathogens. A natural defensive reaction occurs, namely inflammation.

1. An inappropriate and excessive response to infection is called mild sepsis.
2. It is manifested by weakness, fatigue, increased body temperature, shivering, chills, sweating, rapid breathing.
3. Severe sepsis results from a worsening of the previous symptoms, especially rapid heart rate and rapid breathing.
4. Failure to fight the infection progresses to the early stage of septic shock. This is manifested by vasodilatation (dilation of blood vessels), a drop in blood pressure. Its compensation is accelerated heart action to deliver blood to vital organs as soon as possible.
5. The early shock stage rapidly develops into severe septic shock (warm shock). Marked signs of organ dysfunction are present.
6. For example, reduced urine production due to kidney dysfunction, up to complete anuria (cessation of urine production) is a typical symptom. Alternatively, the patient's mental state may change due to increased permeability of blood vessels.
7. The final stage of severe septic shock is cold shock. As a result of hypoperfusion (reduced blood flow through the vessels) and a general reduction in blood volume in the vessels, the blood supply to the heart is impaired and metabolic acidosis (hyperacidity) occurs.
   The patient's skin is cold, clammy, objectively map-like. The heart rate is high, the pressure is markedly low, even unmeasurable. Pulses are faintly palpable. The patient is disoriented, loses consciousness, death occurs.

Diagnosis and treatment

Laboratory parameters play a key role in the diagnosis, especially when sepsis is in its early stages.

It is then that symptomatology may be underestimated and treatment inadequate. The history only clarifies the possible mode of infection and is therefore supplementary.

Laboratory parameters important in the diagnosis of sepsis

Laboratory parameters are of great importance in the diagnosis of sepsis. On the basis of these parameters, a definitive diagnosis is made and the correct treatment is initiated.

Laboratory results do not only reveal the diagnosis but also the causative agent.

Its identification is necessary for the most effective antibiotic therapy, or a combination thereof. If antibiotic therapy is initiated quickly, a significant positive reversal of the patient's condition is possible.

Laboratory parameters of sepsis:

• oxygen - decreased blood oxygenation
• glucose - increase in blood sugar above normal values - above 6.6 mmol/l in a non-diabetic
• white blood cells - more than 12,000/mm3, less than 4,000/mm3, or presence of more than 10% immature white blood cells in serum
• platelets - platelet count below 100 000/ml
• bleeding disorders - INR more than 1.5 sec or aPTT more than 60 sec.
• creatinine and urea - increase above normal values
• bilirubin - increased concentration of yellow dye in the blood
• sodium - decreased concentration of sodium in the blood
• potassium - increased concentration of potassium in the blood
• thyroxine and tyrosine - decreased levels of thyroid hormones in the blood
• lactate - rise in the concentration of lactic acid in the blood
• other - rise in the concentration of specific proteins and mediators in the blood (C-reactive protein, procalcitonin, interleukin 6, presepsin)

Treatment options for the septic patient

The treatment of the septic patient consists of four basic pillars.

The most important pillar is the initiation of antimicrobial therapy (usually antibiotic). Equally important are hemodynamic, respiratory and metabolic support and treatment.

1. Antibiotic therapy - Treatment with antibiotics or other antimicrobial drugs should be initiated as soon as possible. If the pathogen (bacterial species) is identified, targeted antibiotic therapy is initiated. If laboratory results are not yet available, nonspecific broad-spectrum antibiotic therapy is recommended. In severe cases, a combination of two or more of these drugs is given.
2. Haemodynamic support (circulatory support) - Fluid therapy, i.e. treatment of hypovolaemia and shock, is very important in the treatment of sepsis and septic shock. There is insufficient blood volume in the bloodstream. As a standard, crystalloid solutions of at least 30 ml/kg are administered during the first 3 hours. Subsequently, the doses of infusion solutions depend on haemodynamics. Maintenance doses of fluids (continuous administration via an injector/infusion pump) are also appropriate. In case of insufficient fluid therapy, or poor response to fluid therapy, treatment is supplemented with vasopressors to increase blood pressure and maintain perfusion. Among ionotropic agents, these include dobutamine, dopamine, adrenaline.
3. Respiratory support - Inadequate blood supply to organs and organ systems does not only mean a lack of nutrients, but also of oxygen. Organs react quite rapidly to oxygen deprivation by ischaemia, rejection and impaired function. Respiratory support includes both haemodynamic support with fluids and drugs, but also administration/inhalation of oxygen. In severe cases, intubation and artificial pulmonary ventilation are necessary due to respiratory failure.
4. Metabolic support - Metabolic modification is important in metabolic upset, again indicated by laboratory results. Based on these, the internal environment is monitored and individual parameters are adjusted.

Septic states in children

Sepsis in children is a very serious and separate chapter. Children are one of the highest risk groups for sepsis.

It mainly affects the smallest and most vulnerable, namely newborns. In older children, sepsis progresses in a similar way to adults.

Tip:
A childis not a miniature adult! What are the differences?

Sepsis is a life-threatening condition for newborns

Newborn babies have not yet developed immunity and are therefore more susceptible to infection. They do not know how to deal with it as well as adults, especially when it comes to sepsis.

The breakdown of sepsis in newborns:

In early neonatal sepsis, the infant is most often infected from a sick mother (by blood) or from infected amniotic fluid. Less frequently, it is when the infection is injured and carried during birth. This mode of transmission is called iatrogenic damage. However, this rarely occurs, usually only in complicated births (breech birth, wrapping the umbilical cord around the neck).

Late sepsis is not related to the birth. The baby becomes infected afterwards, from a sick relative, from another newborn in the ward, from the staff, during cord catheterisation, during uncareful suctioning, during insertion of an intravenous cannula.

Manifestations of sepsis in the newborn:

• Paradoxically, a decreased temperature.
• Pallor to grey discolouration of the skin
• marbled maps on the newborn's body
• rapid breathing
• short-term respiratory arrest (apnoeic pauses), respiratory arrest
• disinterest (apathy), somnolence, disturbances of consciousness
• indigestion
• excretory disorders (reduced urine production)
• changes in laboratory parameters

Septic states in older children

In older children, sepsis and shock progress similarly to adults.

However, in children under three years of age, some aspects are more likely to overlap with the neonatal period.

Newborns and children under three years of age share the severe respiratory difficulties of this diagnosis. Such young children are very susceptible to oxygen deprivation, which in sepsis and shock is caused by hypoperfusion. They usually die from respiratory failure.

In young children, therefore, preservation of respiration and adequate oxygenation of the body are most important.

Interesting:
Acute respiratory distress syndrome (ARDS), also known as child respiratory distress syndrome, occurs quite frequently in septic shock in children. It is a serious complication.
It is manifested by accelerated or slowed breathing, grunting (pathological phenomena in breathing audible without a phonendoscope), retraction during breathing (involvement of the accessory respiratory muscles), alaryngeal constriction (chest and abdominal movements during breathing) and cyanosis (blue colouration of the extremities).