Viral fever and the seasonal flu are so common that they hardly spare anyone. Owing to busy schedules or not wanting to fall ill, we buy antibiotics over the counter and treat ourselves without knowing what triggers certain conditions such as running nose or sore throat. Antibiotics are meant to fight against bacterial infections, but when they are used to treat ailments caused by a virus of fungi, it results in the patient developing antibiotic resistance.
Antibiotics, developing countries, and Sepsis
The abuse of antibiotics is quite common in developing countries like India. The reason for this prevalence is lack of regulation and easy availability. In India, we don’t think twice before buying antibiotics without a doctor’s prescription. This results in the widespread abuse of antibiotics, which leads to antibiotic resistance and subsequently to a condition called Sepsis.
Let’s get to know Sepsis
When the body’s physiological regulatory mechanism such as governing metabolism, immune response or organ function gets compromised, the condition is called dysregulation. Sepsis is the dysregulated body’s response to infections caused by bacteria, virus or fungus. Sepsis is a life-threatening condition that is causing a huge burden on healthcare costs in developing countries. Though over the years various treatment methods have evolved, the mortality rate for sepsis patients is still very high even in tertiary care centres.
When there’s an infection, the body tries to fight against it by activating the white blood cells. These white cells in turn release anti-inflammatory chemical mediators known as cytokines into the bloodstream to fight the infection. When the body’s response to these chemicals goes out of control, there begins the onslaught of sepsis.
The released chemicals in the blood cause widespread inflammation in the positive feedback mechanism. As a result, individual organs are affected. Moreover, it impedes the blood flow to limbs and internal organs as a result of clots developed inside the blood vessels. This deprives the patient of nutrients and oxygen. If not treated on time, it causes the blood pressure to dip and deteriorates the patient’s health – the condition is known as Septic shock.
Who are at risk?
Though sepsis can affect anybody, certain sections of the population are more prone to the disease. They include the elderly, pregnant women, premature babies, people with chronic ailments such as diabetes, kidney disease, lung disease, cancer, those who smoke or drink, and those with compromised immunity such as HIV patients and post-transplant patients.
The onset of sepsis
Sepsis starts in myriad ways. For instance, in diabetics, even a small scar can lead to tissue infection and then to sepsis. Likewise, infections of the lung, urinary tract and abdomen can trigger the onslaught of sepsis. While the majority of sepsis cases are caused by a bacterial infection, the diseases are not considered to be contagious.
The complications
Like other diseases, sepsis progresses from low intensity to high intensity. As sepsis intensifies, blood flow to vital organs such as the brain, heart, and kidneys become impaired. It also causes blood clots in the organs, arms, legs, fingers, and toes. Sepsis leads to organ failure and tissue death (gangrene) and becomes the cause of death when it leads to multi-organ failure.
The mortality rate among sepsis patients is around 20%. If the condition deteriorates to septic shock, it goes up to 35%. In the case of multi-organ failure, the average mortality rate is 50%.
Providing care
It’s of vital importance to recognize sepsis in a person and taking them to a tertiary care centre. It takes appropriate therapy and adequate source control to save a sepsis patient from the throes of death.
The symptoms
If not treated and managed on time, sepsis progressed through three stages:
1st stage: this is the least severe stage. The symptoms include fever and increased heart rate.
2nd stage: characterized by symptoms of difficulty in breathing, this is a more severe stage wherein there are chances of organ malfunctions.
3rd stage: this is the most severe stage in which the patient will suffer from septic shock or severe sepsis with a steep dip in blood pressure that can become fatal.
Septic shock
Septic shock is sepsis with increased severity and is more likely to cause death than sepsis. To be diagnosed with the condition means to have a probable or confirmed infection as well as the following:
- The need for medication to maintain blood pressure greater than or equal to 65 millimetres of mercury (mm Hg).
- High level of lactic acid in blood after receiving an adequate fluid replacement. (Having too much lactic acid in the blood is a symptom of cells not using oxygen properly.)
Dr. Harish Mallapura Maheswarappa, Consultant Anaesthesia & Critical Care, Mazumdar Shaw Medical Center, Bommasandra