An orthopaedic surgeon in the Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Dr Olanipekun Olaolu, speaks about sepsis, its stages, diagnosis, complications and treatment, in this interview with ALEXANDER OKERE
What is sepsis?
According to International Consensus 2016, sepsis is a life-threatening organ dysfunction caused by the dysregulated host response to a new infection. It is a continuum of severity ranging from infection, bacteremia to sepia and septic shock which can lead to multiple organ dysfunction and eventually death of the patient.
What are the causes of sepsis?
Infection in any part of the body can cause sepsis. However, the common infections causing sepsis include respiratory tract infection, abdominal infection and urinary tract infection. These infections are usually caused by microorganisms, bacteria, viruses, including COVID-19, and fungi (candida). Bacterial infection is responsible for 90 per cent of cases. In about half of the cases, no organism is identified from the culture.
Apart from community-acquired sepsis, there is hospital-acquired infection, otherwise called nosocomial infection, especially in patients with prolonged hospital stay or immunosuppression. This type of sepsis is very difficult to treat because the microorganisms causing them are resistant to commonly-used antibiotics. This may lead to deterioration in the condition of the patient and sepsis may progress to septic shock and then death.
Can someone easily know that they have sepsis without seeing a doctor?
It is better to see a doctor when you feel unwell so that correct diagnosis is made and appropriate treatment instituted. Sepsis, if missed, can lead to death. However, some signs and symptoms may suggest sepsis depending on the location of the infection, immune status, age of the patient and others.
How common is sepsis in Nigeria?
The national burden of sepsis is difficult to ascertain but among the neonates, the prevalence of sepsis confirmed by culture ranges from 25 to 55 per cent reported in various studies in the country.
What are the symptoms of sepsis?
These include fever or chill, difficulty in breathing, altered mental status, fast heart rate, low urine output, dizziness, low blood pressure, to mention a few.
Who is at risk of sepsis?
People at the extremes of age (children and the elderly) and immunosuppressed individuals; these individuals include people with HIV/AIDS, diabetes mellitus, patients on some drugs, like immunosuppressants, cytotoxic drugs, people on steroids, people with rheumatoid arthritis and patients with prolonged hospital stay, especially in the intensive care unit.
When is sepsis of the bone said to have occurred?
Infection of the bone results from the spread from remote areas through the blood or by direct inoculation of microorganisms during a surgical procedure or trauma. Infection of the bone, also called osteomyelitis, especially in the acute stage, can cause sepsis. This is also similar to what is seen in septic arthritis (infection of the joint).
What are the different stages of sepsis?
There are three stages traditionally and they are early sepsis, severe sepsis and septic shock.
Early sepsis occurs when an infection gets to the bloodstream and causes inflammation. Severe sepsis (which is not commonly used) is an infection and inflammation severe enough to affect organ function. The sign and symptoms of severe sepsis are hypotension, altered level of consciousness, reduced urinary output, difficulty in breathing, fast heartbeat. Septic shock is a severe complication of sepsis that causes hypotension (low blood pressure) and subsequent organ dysfunction and then death, if not reversed.
Are there serious complications that may result from septic shock?
What are they?
These may include clotting problems, organ failure, especially in the lungs, kidneys, brain and heart.
Is sepsis contagious?
No, sepsis is not contagious. Sepsis is caused by a body reaction to an infection that is out of proportion. However, pathogens like bacteria, viruses and fungi can spread from person to person and can cause infection in them that can trigger sepsis.
Is sepsis connected to pneumonia, COVID-19 or cancer in any way?
As mentioned earlier, pneumonia and COVID-19 affect primarily the respiratory system which can trigger sepsis. Cancer, on the other hand, causes immunosuppression and patients with cancer are treated with cytotoxic drugs, which further suppress their immunity. This puts cancer patients at high risk for sepsis.
Superstitious beliefs are common in Nigeria. What are some of the unproven or erroneous beliefs Nigerians have about sepsis?
Many believe that their ailment is a result of spiritual attacks which require spiritual intervention. Many waste precious time seeking traditional help and eventually present when it is late, and expect doctors to do magic. Sepsis, when diagnosed and treated early, will not progress to multi-organ failure that eventually leads to death.
You recommend seeing a doctor when one feels unwell so a correct diagnosis would be made and appropriate treatment instituted. How is sepsis diagnosed?
There is what is called sepsis work-up for patients with suspected sepsis. These include a blood test, like a blood culture that identifies the offending organism. Other blood tests to detect infections are full blood count and erythrocyte sedimentation rate, c-reactive protein test.
Other ways in which a diagnosis can be done are swabs from orifices for microscopic culture and sensitivity, chest x-rays for evidence of infection in the respiratory tract, and urine microscopic culture and sensitivity. Other imaging modalities may be required as the case may be. They include a CT scan, ultrasound and an MRI scan.
Sepsis is treatable with good results, early diagnosis and appropriate treatment.
What are the options for treatment?
There are various options but care should be individualised. The various options for treatment are intravenous antibiotics – broad-spectrum antibiotics, intravenous fluid and output monitoring, oxygen therapy, medications to increase blood pressure – vasopressors, corticosteroids and pain medicine. Others are intensive care support – respiratory support, and the use of a ventilator in severe cases. Dialysis may be required. There may be a need for incision and draining of abscess or joint washout
Which among the treatments options is commonest?
Many will require antibiotics and fluids.
How many of the treatment options are available in Nigeria?
Almost all of them are available, depending on the centre. However, many centres don’t have a functioning and well-equipped ICU.
Can sepsis cause permanent damage even after treatment?
The answer is yes.
What are they and why?
This depends on the severity of the infection, background medical condition, age of the patient and time of presentation. Some people recover fully while others may live with residual complications. Some children who had neonatal sepsis may end up with seizure disorder. Others are damaged organs, loss of function in the musculoskeletal system and insomnia.
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