Sepsis - Know the Signs

North has experienced a number of cases recently where infections have led to sepsis and the unfortunate death of a number of seafarers.  In this article we explain what sepsis is and the difficulties related to diagnosis.

What is Sepsis?

Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs.  It is an acute and life threatening illness which may involve multiple organ dysfunctions.

Normally our immune system protects our body from harmful substances by recognising and responding to an antigen. Antigens are substances on the surface of cells, virus, fungi or bacteria which our body recognise as foreign.

An individual who has an impaired immune system does not have the ability to respond normally to an infection. Inability to fight infections can be caused by a number of conditions including diabetes, HIV infection, AIDS, cancer, malnutrition and drugs, such as immunosuppressant drugs (for conditions such as arthritis) steroids and the misuse of any other intravenous drugs.  Those who have the inability to fight infections will be more susceptible to sepsis.

How is it Triggered?

The infection which triggers sepsis can be routine; a contaminated cut or wound, a urinary tract infection (UTI), an insect bite or a simple throat infection.

Sepsis can be triggered by an infection in any part of the body. The most common sites of infection leading to sepsis are the lungs, urinary tract, abdomen and pelvis.

Diagnosing Sepsis

Sepsis can be difficult to diagnose even for medical professionals.

Prompt diagnosis is preferable, early symptoms include:

• Fever or low body temperature.
• Chills and shivering.
• Fast heartbeat.
• Fast breathing.

In most instances, patients suffering from sepsis may have high or low body temperature, increased heart rate and respiratory rate which can also be encountered in mild infections. So the early symptoms can be easily mistaken as less serious.

The difficulty in diagnosing means that sepsis is often diagnosed late or when it has already progressed to severe sepsis.

Many recover from mild sepsis however, mortality rate goes up to nearly 50% when the patient goes into septic shock.

Sever Sepsis/Septic Shock

Symptoms of more severe sepsis or septic shock (when the blood pressure drops to a dangerously low level) develop rapidly.  These symptoms include:

• Feeling dizzy or faint.
• A change in mental state such as confusion or disorientation.
• Diarrhoea.
• Nausea and vomiting.
• Slurred speech.
• Severe muscle pain.
• Severe breathlessness.
• Less or no urine production in past 18 hours.
• Cold, clammy and pale or mottled skin.
• Cyanosis of the skin, lips or tongue.
• Loss of consciousness.

If the above symptoms are apparent, the patient is at high risk of severe illness or death from sepsis so serious consideration should be given to urgent medical evacuation.

Without timely treatment patients with sepsis can deteriorate rapidly and this can cause tissue damage, organ failure and ultimately death. 

Sepsis can be serious.  One of North’s recommended repatriation clinics, Ship to Shore Medical Assists, had a total of 7 cases of sepsis from 2014-2017, and all cases required hospital and intensive care unit admissions.  One person recovered and was able to return to his previous line of work. Three of these cases resulted in long term cognitive impairment and neurologic deficits and 3 out of the 7 cases died.

Early recognition of sepsis and prompt treatment is the key to a better outcome, which is why symptoms should be reported early and advice received from medical professional ashore.

With thanks to Marilar F. De Guzman, MD Medical Director SHIP TO SHORE MEDICAL ASSIST for contributing to this article.

References:

Medline Plus Immune Response, The sepsis seesaw: tilting toward immunosuppression – RS Hotchkiss, CM Coopersmith, JE McDunn
annals.org/aim/article/705002/pathogenesis-sepsis
The puzzle of sepsis fitting the pieces of the inflammatory response with treatment –
J Cunneen, M Cartwright – AACN Advanced Critical Care, 2004 – AACN
Sepsis, Severe Sepsis, and Septic Shock – by Paul M. Maggio, MD, MBA, Assistant Professor of Surgery and Co-Director of Critical Care Medicine, Stanford University Hospital ; Carla Carvalho, MD, MPH, Surgical Critical Care Fellow, Stanford University Hospital