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Sepsis - signs, causes and treatment
Blood poisoning is not always immediately apparent and is often underestimated. It is a defense reaction of the body to an infection that spreads to the entire body and can be life-threatening. The patient's condition often worsens within a very short time, so that sepsis always requires rapid therapy and immediate intensive medical treatment.
Definition - what is blood poisoning?
Sepsis, colloquially known as blood poisoning, arises from a variety of processes and as an excessive reaction of the body to an infection that causes life-threatening functional impairment of organs. Blood poisoning is therefore a provoked immune response to a local infection, whereby pathogens (mostly bacteria) enter the bloodstream in batches or continuously from an inflammatory focus.
The first international definition of sepsis in 1992 was based on the simultaneous presence of an infection and at least two criteria for a systemic inflammatory response of the organism, also known as "Systemic Inflammatory Response Syndrome" (SIRS). Depending on the severity of the disease, a distinction was made between sepsis (whole body infection), severe sepsis (organ failure) and septic shock (drop in blood pressure, multi-organ failure). The insufficiently specific criteria and medical knowledge led to additional definitions of sepsis. The most recent and so-called Sepsis-3 definition describes this as life-threatening organ dysfunction due to an incorrectly regulated body response to an infection. The extent of the present organ failure therefore plays an important role in the diagnosis and treatment, but according to the current definition, a distinction is only made between sepsis and septic shock. (see Deutsches Ärzteblatt)
Sepsis is not always easy to recognize at first, as the first signs are usually very unspecific:
- Fever (≥ 38 ° C) or less often too low temperature (≤ 36 ° C)
- Fast and shallow breathing (tachypnea), frequency ≥ 20 / min
- High pulse and rapid heart rate (tachycardia), frequency ≥ 90 / min
- Low blood pressure (hypotension)
- Diminished consciousness (confusion)
- Decreased urine output
The most important symptom of sepsis is a high fever or fever, with the fever rising rapidly and falling to normal values within 24 hours. The fever is often accompanied by chills (adults) and febrile seizures (babies and toddlers). However, this fever can also be completely absent, especially in infants, toddlers, and people with weakened defenses. In addition to the above signs, there may also be symptoms of the infection that triggered the blood poisoning.
A red line on the skin (e.g. on the arm), which is repeatedly mentioned as a sign of sepsis, actually rarely plays a role. This occurs when there is inflammation of lymphatic vessels (lymphangitis). However, sepsis can develop as a complication of such an inflammation, the so-called "false" blood poisoning.
If the above-mentioned, albeit unspecific, symptoms occur, you should keep the possibility of sepsis in your head and better consult a doctor at an early stage.
Course of the disease
People with blood poisoning often feel seriously ill with a rapid deterioration in their general condition. The skin is cold, pale gray to bluish in color and bleeding and other skin symptoms can occur. If the symptoms remain untreated, the blood pressure drops so much that vital organs such as the heart, lungs and brain are no longer adequately supplied with oxygen and the corresponding organ functions are thus impaired or even fail. There is sleepiness, changes in consciousness (confusion) and rapid heartbeat. Other possible complications of sepsis include coagulation disorders, multi-organ failure and septic settlements in the brain, whereby bacterial foci and accumulation of pus can lead to embolic hereditary encephalitis (inflammation of the brain).
The cause of blood poisoning is usually a local infection. Common sepsis foci are infections of hollow organs with difficult drainage options, e.g. Kidney pelvic inflammation with enlarged prostate or urinary congestion, wound infections, pneumonia but also chronic inflammation of the upper respiratory tract (sinusitis, otitis, tonsillitis). More than half of the blood poisoning comes from the urogenital tract (urosepsis). Pathogens, which are mostly Gram-negative bacteria, enter the bloodstream and thus to all body organs from the inflammation centers. This is where infectious scattering spots occur, the septic metastases. In addition to bacteria, viruses, fungi or other germs can also be the causes of the infections, which can ultimately lead to sepsis.
The immune system usually fights the pathogens so that an infection heals and no further consequences and complications are to be expected. Under certain circumstances, e.g. a general defense weakness, this is not possible for the body. The pathogens can then multiply uncontrollably and enter the bloodstream in large numbers from the focus of inflammation. In the following, excessive immune response, the immune system reacts to the pathogens and their products (e.g. toxins) and various reactions and symptoms of sepsis are caused by messenger substances. In addition to infection, the causes of blood poisoning also include an excessive immune response that affects the entire body.
Risk patients for blood poisoning
Older and chronically ill people, newborns and small children as well as people with a weakened immune system are particularly at risk. There are many reasons for an immune deficiency, for example an immune deficiency can be inherited or triggered by illnesses and the associated medication. The removal of the spleen also leads to a weakened immune system.
In addition, patients after an operation or patients in the intensive care unit often develop blood poisoning, because existing germs can be easily transmitted here. But otherwise completely healthy people can get sick, because often only a small injury and its infection, e.g. B. a tooth or bladder infection, exit for the serious complication.
Early detection of the disease is crucial for successful treatment and the chances of survival in the case of sepsis. However, since the symptoms are not clear, a quick diagnosis is a challenge. It is important that medical attention is called in immediately if the symptoms mentioned occur. Every second counts in sepsis. If the doctor consulted considers sepsis to be possible after the examination or has even been diagnosed, the patient is usually immediately classified as a medical emergency and hospitalized in the intensive care unit.
Sepsis or septic shock?
Determining the infection and determining the cause or recognizing the focus of inflammation and thus sepsis are prerequisites for further treatment of those affected. By determining the pathogen, appropriate forms of therapy, such as antibiotics, can be selected and adapted, thus maximizing the chances of successful treatment. But the cause of the infection cannot always be found.
It is now possible to detect sepsis more quickly using special blood tests, but individual disease courses and the possible complications associated with them play a major role in the severity of diagnosed blood poisoning. The blood values can provide information on possible pathogens, inflammation and defense reactions of the patient, as well as provide information on organ dysfunction. The latter indicates a severe course of sepsis and the possibility of a septic shock, in which 30 to 50 percent of the patients die even under the best treatment conditions.
In addition to blood pressure measurement and blood tests, other tests can be carried out (e.g. ultrasound, X-ray or computer tomography) to check important organ functions such as heart, lung, kidney or liver function. A blood coagulation test can also be part of the diagnosis.
Sepsis is life-threatening and requires intensive medical treatment to be initiated as quickly as possible. Bacteria are usually the cause of the infection that triggered sepsis. If these could be determined during the diagnosis, the therapy consists of a high dose of antibiotics. At the start of treatment and when the pathogens are not identified, so-called broad-spectrum antibiotics or other agents that work against a large number of bacteria and germs are used. If the cause is not bacteria, other forms of therapy can lead to successful treatment, such as so-called antifungals against fungal diseases. In addition, infusions are given to compensate for fluid loss and to stabilize the circulation and, if necessary, the sepsis hearth is removed surgically. If there is already a septic shock, vital measures for restoring organ functions and organ care up to organ replacement measures are carried out before the infection treatment.
Deadly despite treatment?
With sepsis there is no 100% chance of healing and survival. Blood poisoning is the third leading cause of death after cardiovascular disease and cancer. The high mortality rate in sepsis is often attributed to the fact that more and more old, seriously ill and injured people initially survive their underlying disease through modern intensive care medicine, but succumb to sepsis in the hospital - often due to a weak immune system. This blood poisoning, known as nosocomial sepsis (Greek: nosokomeion = hospital), represents the largest proportion of septic forms of the disease.
Sepsis is a serious and life-threatening illness in which rapid and targeted antibiotic therapy and, if necessary, intensive therapy are crucial for treatment and survival chances. Sepsis is always a case for intensive care and emergency medicine.
So far, little is known about possible improved therapeutic success through the additional use of naturopathic medication. Strengthening the immune system based on naturopathy cannot prevent sepsis, but it is always good advice.
Current state of research
Scientific knowledge has already led to a fundamentally changed definition of sepsis and a change in understanding of the serious illness. However, it is still important to answer essential open questions through research in order to increase the success rate for diagnosis and therapy and thus reduce the mortality rate. Sepsis research is being promoted at the Integrated Research and Treatment Center (IFB) Sepsis and Sepsis Sequences (Center for Sepsis Control and Care - CSCC) in Jena. (Dipl.Päd.Jeanette Viñals Stein, naturopath, Dr. rer.nat.Corinna Schultheis)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. nat. Corinna Schultheis, Barbara Schindewolf-Lensch
- Robert Koch Institute (RKI): sepsis (access: July 15, 2019), rki.de
- German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Deutsche Sepsis-Gesellschaft e.V .: S2k Guideline Sepsis - Prevention, Diagnosis, Therapy and Aftercare, as of February 2010, detailed view of guidelines
- World Health Organization (WHO): Improving the prevention, diagnosis and clinical management of sepsis (accessed: 15.07.2019), who.int
- Centers for Disease Control and Prevention (CDC): What is sepsis? (Accessed: 07/15/2019), cdc.gov
- Global Sepsis Alliance: What is sepsis - Definition of sepsis (accessed: July 15, 2019), global-sepsis-alliance.org
- Sepsis Foundation: What is Sepsis? Understand "blood poisoning" (accessed: 15.07.2019), sepsis-stiftung.eu
- Merck and Co., Inc .: Sepsis (accessed: July 15, 2019), msdmanuals.com
- Mayo Clinic: Sepsis (access: July 15, 2019), mayoclinic.org
- National Health Service (NHS): Overview - Sepsis (accessed: 07/15/2019), nhs.uk
- National Institute of General Medical Sciences: Sepsis (accessed: July 15, 2019), nigms.nih.gov
ICD codes for this disease: A39-A41, P36, R65ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.