Sepsis: Symptoms Diagnosis Prognosis

Sepsis, which is also referred to as septicemia is a potentially fatal bodily reaction to an infection, which is mostly bacterial but can also be viral or fungal.

It occurs when the body’s immune system goes into overdrive from fighting the invading infection, and instead turns on the body’s own tissues and organs.

The body’s infection-fighting cells begin to attack the body’s tissues and organs, instead of the invaders, causing extensive inflammation throughout the system. This abnormal or extreme reaction can destroy tissues and organs and requires urgent medical care if it isn't to turn life-threatening.

Depending on the stage at which it is diagnosed and treated, the prognosis will be better or worse. In this article, we will discuss the symptoms of sepsis, how it is diagnosed, and the prognosis depending on the diagnosis.

Stages of Sepsis

The symptoms of sepsis depend on the stage that the sepsis has reached.

There are the early stages characterized by the infection, severe sepsis in which bacteria enter the bloodstream i.e., bacteremia causing organ dysfunction, and septic shock characterized by multiple organ failure, strokes, and/or death.

Symptoms of Sepsis

The symptoms of sepsis, in ascending order of their seriousness and advancement of the sepsis itself are as follows −

• Fast breathing i.e., tachypnoea or a respiratory rate of more than 20 breaths per second – also referred to as hyperventilation and/or shallow breathing.

• Hypothermia – a body temperature less than 96.8 degrees Fahrenheit/36 degrees Celsius; Hyperthermia - a body temperature above 100.4 degrees Fahrenheit/38 degrees Celsius

• Changes in body temperature may also be accompanied by fever, and/or shaking/shivering/chills

• A red spotted rash called a sepsis rash

• Excessive sweating, clammy or overly warm skin

• Abnormally rapid heartbeat i.e., over 90-100 beats a minute or tachycardia

• Hypotension i.e., very low blood pressure

• Dizziness, feeling lightheaded, and/or weak

• Vomiting

• Loss of Appetite

• Lethargy

• Mental Confusion

• Loss of Awareness about Surroundings

• Losing consciousness/fainting

• Pain while urinating, difficulty urinating, or decreased urine output

• Painful coughs or wheezing

• Difficulty or inability to stand up

• Slurred speech

• Disorientation, alteration in mental capacity, and agitation

• Very cold skin and bluish appearance of extremities like fingers, toes, and lips

• Inability to stay awake

• Seizures

Diagnosis of Sepsis

Diagnosing sepsis is incredibly tough as there is no one test to indicate its presence and the symptoms overlap with several other chronic, serious illnesses such as congestive heart failure or chronic obstructive pulmonary disease (COPD).

This only gets more difficult when the patient is unable to convey their symptoms such as with infants or children, particularly those who haven’t begun communicating or those with learning disabilities- and the elderly who may not have awareness of recollection of the symptoms, for example, the elderly with dementia.

These are all the different tests used for diagnosis −

Blood Tests

Usually, a complete blood panel or CBC is taken to check the white blood cell count, which, if high, indicates that there is an infection the body is fighting.

The blood may also be tested for lactate which indicates low oxygen supply to the organs (hypoxia), and lactic acid accumulation which means poor organ function.

Sometimes blood cultures will also be taken to identify whether there are germs i.e., bacteria and fungi that are causing the infection.

In response to a suspected bacterial infection, a bacterial endotoxin test (BET) may be given, usually, a Limulus Amoebocyte Lysate (LAL) test on a blood sample to test via clotting of the lysate, as to whether there are endotoxins in the system.

Concurrently the levels of the protein procalcitonin may be checked – if high a bacterial infection is likely, and if low a viral infection is more probable.

The C-Reactive test may also be administered to check for inflammation, particularly in the liver and kidneys, whose function is indicative of the body’s larger state. The blood will also be tested for blood-clotting problems and to check for electrolyte imbalances.

Blood Oxygen

Pulse oximetry is often used to test the amount of oxygen in the blood. Particularly with underlying infections or diseases of the chest such as COPD, pneumonia, or pulmonary edema, this test also helps to measure lung function and health.

Urine Tests

A urinalysis is done first to check the white cell count that indicates an infection and then may be followed up by a urine culture to identify the specific bacteria or other organisms that have caused infections such as urinary tract infections or infections of the kidney.

Some indicators of infection in the chemical tests conducted during urinalysis include high levels of leukocyte esterase enzymes or nitrites.

Other Tests

Sputum/mucus cultures, saliva cultures from the respiratory tract, throat cultures to rule out strep throat, and skin cultures of the liquid oozing from open wounds to rule out cellulitis, may also be conducted depending on the doctor’s evaluation.

A stool test may also be taken to test for infection in the GI (gastrointestinal tract). A Glasgow coma scale may also be administered to determine the level of consciousness, with anything below 7 being registered as comatose.

Imaging Tests

A range of imaging tests such as X-Rays, ultrasounds, MRIs, and CTs can help doctors discern which organs have been affected by inflammation. For example, a brain MRI can be useful in detecting inflammation in the brain or meningitis.

Conclusion – Prognosis for Sepsis

Those who seek treatment in a timely manner will hopefully, have only mild sepsis and will usually recover. However, if the infection proceeds into severe sepsis, the mortality rate is between 30-40% which means a good prognosis of recovery for only60-70% of all affected.

Even after recovery, there are a host of medical issues that crop up such as insomnia and other sleep issues such as nightmares, muscle and joint pains, cognitive impairment, hallucinations, and a compromised immune system which is at risk of developing sepsis again.

Your organs and body as a whole will be considerably weakened by the sepsis, and many people see a shorter life expectancy, with about half of the total survivors dying within 5 years.

You will also have to invest time and effort into rehabilitation, both mentally and physically and this can take a toll in terms of depression, fatigue, and general trouble with everyday tasks.