Q & A: Sepsis

1. What is sepsis?

Sepsis is a severe illness caused by infection of the bloodstream and the body’s resulting inflammatory response.

2. What are the clinical symptoms of sepsis?

The signs of sepsis may include: fever or abnormally low body temperature, chills, fast heart rate, low blood pressure, lethargy, confusion or irritability, skin rash, inability to eat or drink and/or decreased urine output. There may or may not be any signs of a localized infection such as pneumonia or meningitis.

3. What causes sepsis?

Bacteria in the bloodstream (bacteremia) is the most common cause of sepsis, but viruses, parasites and fungi in the blood may also cause sepsis. Sepsis usually results from the spread of an infection from a local site in the body such as the lungs, skin, abdomen, central nervous system or urinary tract.

4. Who is most at risk for acquiring sepsis?

Newborns, young children, the elderly and those with weakened immune systems as a result of under-nutrition or infections such as AIDS are at greater risk for developing a serious infection that results in sepsis. Other high-risk groups include people who are in the hospital, and those who have other infections, serious underlying medical conditions or severe injuries such as large burns.

5. How is sepsis diagnosed?

Sepsis is diagnosed by the clinical symptoms present and confirmed by the growth of bacteria from the blood culture. The blood culture may not be positive if the person has recently received antibiotics. A high or low white blood cell count is also suggestive of sepsis, but only the blood culture can truly confirm the diagnosis and the bacteria causing the infection.

6. How is sepsis treated?

Prompt, appropriate antibiotic treatment in a hospital is crucial in the case of bacterial sepsis. The type of antibiotic depends on the age of the patient, the likely causative bacteria and local patterns of antimicrobial resistance. For example, for children 2 months to 5 years of age with sepsis, the WHO recommends treatment with intravenous benzylpenicillin and chloramphenical. A third-generation cephalosporin, such as ceftriaxone, may be necessary instead if there are high rates of resistant bacteria where the patient lives. Supportive therapy with oxygen, intravenous fluids and medications to increase blood pressure may also be necessary.

7. How common is pneumococcal sepsis?

Pneumococcus, Streptococcus pneumoniae, is an important bacterial cause of sepsis particularly in young children: a study conducted in four developing countries found that 30% of positive blood cultures in sick children 2 and 3 months old contained pneumococcus. In a study from Kenya, pneumococcus accounted for almost half of all cases of clinically significant bacteremia in children under 5 years of age.

8. How serious is pneumococcal sepsis?

Sepsis is a very serious infection that can progress rapidly to septic shock and multi-organ failure due to lack of oxygen delivery to important organs in the body. In a WHO study among sick infants under 3 months of age, 33% of those with pneumococcal infection died.

9. How can sepsis be prevented?

There are effective, safe vaccines against some bacterial causes of sepsis such as pneumococcus, meningococcus and Haemophilus influenzae type b. Vitamin A and zinc supplementation can reduce the incidence and severity of some diseases such as pneumonia and gastroenteritis in undernourished children that can progress to sepsis. Early recognition of serious illness and prompt, effective treatment with antibiotics as well as intravenous fluid can prevent progression of disease to sepsis and multi-organ failure.

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