Sepsis has been much in the news recently due to a number of high-profile cases in which it has been said there has been systematic failure. Derived from the Greek ‘sepein’ (‘to make rotten’), sepsis is essentially a reaction to severe infection. Sepsis results in the admission to hospital of over 100,000 people in Britain each year and, tragically, the death of about 37,000. The infective organisms may be bacteria, viruses or fungi. Invasion of these causative organisms into the bloodstream (‘septicaemia’) results in the rapid spread of infection around the body.
Certain groups are particularly susceptible to sepsis, for example the very old, the very young, those who have had a surgical procedure, smokers, those who drink alcohol excessively, those with diabetes and those who are immunocompromised (by virtue of an underlying illness or due to certain medications). If you have a condition which qualifies you for flu and pneumonia jabs (for example, diabetes or asthma), it is important to take up these options. Children should be kept up to date with their vaccinations.
Every death is a tragedy but it is often cases involving children which are given prominence in the media; however, any group in society may develop sepsis, so vigilance is important. Not everyone will get typical symptoms or signs. Very young children, in particular, may not be able to articulate their symptoms which can make accurate diagnosis and timely management very difficult.
The first manifestations of sepsis are often the symptoms associated with the underlying illness such as a cough or a temperature (in the case of a respiratory illness). Most coughs and temperatures associated with a mild viral respiratory illness will resolve without complication and do not need antibiotics (which do not ease these symptoms). In a patient who is developing sepsis, the symptoms may persist and worsen and, as the illness progresses, the hands and feet may become cold and clammy even if the patient has a raised temperature. Other signs suggestive of sepsis may include a raised heart rate, fast breathing, confusion and rash. If one or more of these develop and you are concerned, urgent medical advice should be sought. Parents who notice any of these signs in their children should seek urgent medical advice or, if acutely concerned, ring 999; don’t be afraid to articulate your concerns that your child may have sepsis. If you are not satisfied with the initial assessment which has been made, ask for a second opinion.
The truth is that the early stages of sepsis may be similar to those of many minor, self-limiting illnesses. But if in doubt, seek advice; GPs are trained to recognise patterns of illness and should not make you feel that you are being a nuisance or bothering them. If you are still not satisfied, seek a second opinion — parents are, after all, the experts in their children’s behaviour patterns and often the hunch that things are ‘just not quite right’ with their child is key. Remember, no computerised algorithm or over-the-phone diagnosis can take the place of a face-to-face assessment of a child.
Treatment can be life-saving if started early. It may involve admission to an intensive care unit, oxygen and intravenous fluids and antibiotics. Sadly, not every death is preventable, but early detection and intervention optimises the chance of a positive outcome.
Dr J Christopher Hall is a GP in Hillsborough