Sepsis: the symptoms of this bacterial infection, all about sepsis-associated infection

Sepsis is a generalized infection caused by bacteria. This infection is usually bacterial, but it can also be caused by viruses or fungi.

In this article, we answer your questions to better understand where sepsis comes from, its symptoms, and how to treat it.

What is sepsis?

Sepsis is a generalized infection caused by bacteria. This infection is the cause of significant inflammation.

The disease has been known for a long time since the term sepsis was coined in 1837 by a French physician, Pierre Piorry.

Currently, infectious disease specialists tend to replace the term sepsis with that “bacteremia associated with sepsis” (bacteremia meaning “circulation of bacteria in the blood” and sepsis “generalized inflammatory response, following a serious infection”).

The word sepsis is still widely used by the general public and doctors.

Bacteremia

Bacteremia is defined by the presence of bacteria in the bloodstream.

When their number is low, bacteria are eliminated thanks to the body’s defenses, which is the most common situation. In this case, the person has no symptoms, but may sometimes experience a mild fever (fever) or mild transient fatigue.

When there are too many bacteria or the person’s immune defenses are diminished (by treatment, disease, HIV infection, for example, or congenital immunodeficiency), or overwhelmed by their number, the body is no longer able to eliminate them. This can lead to sepsis.

Sepsis

Sepsis is the excessive generalized inflammatory reaction in response to a serious infection.

Septic shock

Septic shock can also occur in sepsis. This shock is related to the release into the blood of toxins secreted by certain bacteria.

Symptoms of sepsis

Sepsis results in widespread infection. This infection is responsible for high fever, but sometimes on the contrary for a drop in body temperature (hypothermia), and major fatigue, often associated with an acceleration of the heart and respiratory rates.

Sepsis is accompanied by:

  • chills;
  • sweating;
  • abdominal pain
  • vomiting;
  • diarrhea;
  • or even mental confusion among the oldest and youngest.

Fever, chills, and sweats usually occur in flare-ups. Other signs vary depending on the site of the initial infection and complications.

In case of septic shock

Sepsis can be complicated by “septic shock”, with a drop in blood pressure and impaired function of various organs due to lack of blood supply.

When the blood supply of oxygen is insufficient, the skin becomes cold, mottled, and cyanotic (bluish tone), especially at the extremities.

Causes of sepsis

Presence of bacteria

The release of bacteria into the blood may be linked to:

  • sometimes banal situations: brushing teeth, dental care;
  • rarer situations: cleaning a wound, changing a probe, surgery, pulmonary, urinary, osteoarticular, digestive (especially in the bile ducts), skin (infected wounds, abscesses, or bedsores), or endocarditis (infection of a pathological heart valve).

The risk of sepsis is increased by the presence of a “foreign body” in the body, such as:

  • a bone or joint prosthesis;
  • a prosthetic heart valve;
  • a vascular catheter;
  • a urinary or digestive catheter;
  • a tracheal intubation tube (the tube that ensures the arrival of air in the bronchi).

Bacteria that accumulate in this foreign material or in an infectious focus are released episodically into the bloodstream.

All bacteria can cause sepsis, including those that are not pathogenic (which usually do not cause infection) and that the body carries in the skin, respiratory tract, or digestive tract for example.

Mushrooms

Fungi such as candida can, but rarely, cause sepsis called fungemia mainly in people with a weak immune system.

The risks of sepsis

People at risk

People with weakened immune systems are particularly at risk of sepsis. Those most at risk are:

The word sepsis is still widely used by the general public and doctors.  

Bacteremia 

Bacteremia is defined by the presence of bacteria in the bloodstream.

When their number is low, the bacteria are eliminated by the body’s defenses, which is the most frequent situation. In this case, the person has no symptoms, but may sometimes experience a slight fever (low fever) or slight transient fatigue.

When there are too many bacteria or the person’s immune defenses are diminished (by treatment, disease, infection against HIV, for example, or congenital immune deficiency), or overwhelmed by their number, the body is no longer able to eliminate them. This can lead to sepsis.

And sepsis

Sepsis is the excessive generalized inflammatory reaction in response to a severe infection.  

septic shock

Septic shock can also occur in the case of sepsis. This shock is linked to the release into the blood of toxins secreted by certain bacteria. 

Symptoms of sepsis

Sepsis results in generalized infection. This infection is responsible for high fever, but sometimes, on the contrary, a drop in body temperature (hypothermia), and major fatigue, are often associated with an acceleration of the heart and respiratory rates.

Sepsis is accompanied by:

  • chills;
  • sweats;
  • abdominal pain;
  • vomiting;
  • diarrhea;
  • even mental confusion in the oldest and youngest.

Fever chills and sweats usually come in flare-ups. Other signs vary depending on the site of the initial infection and complications.

In case of septic shock

Sepsis can be complicated by “septic shock”, with a drop in blood pressure and impaired function of various organs due to lack of blood supply.

When the blood oxygen supply is insufficient, the skin becomes cold, mottled, and cyanotic (bluish in tone), especially at the extremities. 

The causes of sepsis

Presence of bacteria

The release of bacteria into the blood can be linked to:

  • sometimes banal situations: brushing teeth, dental care;
  • rarer situations: cleaning a wound, changing a probe, surgery, pulmonary, urinary, osteoarticular, digestive (in particular in the bile ducts), skin (infected wounds, abscess or bedsores), or endocarditis (infection of a pathological heart valve).

The risk of sepsis is increased by the presence of a “foreign body” in the body, such as:

  • a bone or joint prosthesis;
  • a prosthetic heart valve;
  • a vascular catheter;
  • a urinary or digestive catheter;
  • a tracheal intubation tube (tube ensuring the arrival of air in the bronchi).

The bacteria that accumulate at the level of this foreign material or an infectious focus are released episodically into the bloodstream. 

All bacteria can cause sepsis, including those that are not pathogenic (which usually do not cause infection) and which the body carries in the skin, respiratory tract, or digestive tract for example.  

The mushrooms

Mushrooms such as candida can, but rarely, cause septicemia then called fungemia mainly in people whose immune system is failing. 

The risks of sepsis

People at risk

People with a weakened immune system are particularly at risk of sepsis. Here are the people most at risk:

  • Women who have just given birth (sepsis is then called puerperal fever) and newborns. Sepsis is a major cause of birth mortality in emerging countries;
  • the elderly;
  • people with diseases that reduce immunity such as diabetes, cirrhosis, certain cancers or blood diseases (blood cancers), HIV-AIDS, congenital immunodeficiencies;
  • drugs or treatments likely to weaken immunity such as corticosteroids, certain chemotherapy or biotherapies;
  • Hospitalized people are at risk of sepsis with nosocomial germs, often resistant to antibiotics

Risk factors for sepsis

Some factors can promote infection and cause sepsis, we quote:

  • injecting drugs with contaminated equipment or without skin disinfection;
  • the wearing of osteoarticular prostheses, urinary and digestive catheters, intubation catheters, drains, and catheters;
  • valvular heart disease (heart valve disease) or prosthetic heart valves (heart valve prostheses);
  • skin infections boils, bedsores, burns, wounds;
  • dental, sinus, biliary infectious foci;
  • surgical procedures.

Diagnosis of sepsis

The diagnosis of sepsis can be made during a blood test:

  • on the complete blood count, the white blood cell count is usually very high or on the contrary, significantly lowered;
  • CRP (C Reactive Protein) and blood procalcitonin indicate the existence of inflammation, but their elevation is not specific to an infection. Low levels make sepsis unlikely.

Diagnosis of bacteremia

Bacteremia is seen on a blood sample highlighting the presence of bacteria in the blood, bacteria sometimes visible on direct examination under a microscope.

The blood sample is cultured (hence the term blood culture) to identify the bacteria(s) responsible and determine their sensitivity to various antibiotics.

Blood culture should ideally be done as soon as bacteremia is suspected, before taking antibiotics that could distort the results. This is not always done and complicates the interpretation of the results.

Other samples are taken at the potential entry points of infection (sputum, urine, catheter, probe, wounds) to identify the bacteria and culture it.

Other tests to detect sepsis

Radiological, biological, or cardiological examinations may be requested to look for the initial site of infection, and secondary infectious sites.

These examinations will then be able to assess the severity of the infection and shock and their impact on the cardiovascular and respiratory systems in particular.

Prevention and treatment of sepsis

Sepsis is a particularly serious disease, with a risk of death.

The risk of death due to sepsis occurs mainly in cases of septic shock, complications in initial or secondary infections, and damage to “noble” organs that can leave sequelae after healing of the infection.

The risk of complications depends on the fragility of the person, the speed of starting treatment, and the existence of antibiotic resistance.

It is necessary to consult urgently when the signs of infection persist despite antibiotic treatment, especially since it is a vulnerable person, suffering from valvular heart disease or carrying foreign equipment.

Prevention of sepsis

People at risk due to impaired immunity or wearing a joint or valve prosthesis should receive preventive antibiotic treatment before certain dental or medical/surgical care.

To ensure the complete recovery of an infectious focus and avoid the development of antibiotic-resistant bacteria, you must adhere to the doses and durations of treatment.

Take antibiotics only if they are absolutely necessary and then really take them for the duration recommended by the doctor.

Treatments for sepsis

Treatment of sepsis is carried out in hospitals, usually in intensive care units or intensive care.

Treatment of the infection is based on intravenous antibiotics, initiated as soon as possible after blood cultures, but without waiting for their result. We associate 2 or 3 antibiotics, the choice based on the supposed origin of the initial infection, the condition of the subject, and the existence of other pathologies.

The results of blood cultures are obtained in 1 to 3 days depending on the germ and allow to adapt antibiotics.

The duration of antibiotic therapy is 7 to 14 days or more, depending on the negativation of blood cultures, clinical status, fever, germ, and initial and secondary locations.

The material on which the bacteria may have been deposited such as a catheter must be removed, open wounds perfectly cleaned, and abscesses drained.

Treatment of vital functions

The management and monitoring of the cardiovascular, respiratory, renal systems generally involve infusing intravenous fluids to fight shock and restore normal blood pressure and provide oxygen.

In severe cases, good ventilation should be ensured by intubation or even by a machine assisting breathing.

Injectable corticosteroids are prescribed in some cases when blood pressure remains low despite treatment.

Image Credit: Photo by Pranidchakan Boonrom pexels.com

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