SEPSIS AWARENESS DAY 2021 by Dr.T.V Rao MD

SEPSIS AWARENESS DAY 2021

WHAT IS SEPSIS? – A great challenge to deal?

Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multi-organ failure, and death – especially if not recognized early and treated promptly. Sepsis is the final common pathway to death from most infectious diseases worldwide, including viral infections such as SARS-CoV-2 / COVID-19.

Definition of Sepsis – Sepsis is defined as the life treating organ dysfunction due to a dysregulated host response to infection It can lead to shock multiple organ failure and death especially if not recognized early and promptly, (NHS Scotland)

Definition of Sepsis is Clinical and supported by Microbiology and Immune assays

The newest definition of sepsis has recently been published. In 2016, the Third International Consensus Definitions Task Force (Sepsis-3) defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The new criteria are based on just three symptoms:

Altered mental status

Fast respiratory rate (> 22 breaths/minute)

Low blood pressure (≤ 100 mm Hg systolic)

Patients who meet the above criteria likely have sepsis and are also termed septic. Blood tests are no longer required for the diagnosis. Essentially, patients who show two of the three criteria listed above are considered likely to be septic according to studies that led to the new criteria as part of the sepsis campaign to simplify and speed sepsis diagnosis.

BLOOD CULTURING AND SEPSIS -

BLOOD CULTURE-NEGATIVE BY CURRENT AND NEWER METHODS DOES NOT MEAN THE PATIENT IS NOT SEPTIC

BLOOD CULTURE POSITIVE FOR PATHOGENIC BACTERIA DO NOT MEAN ALWAYS SEPTIC?

SEPSIS IS JUST NOT ALWAYS A BACTERIAL INFECTION -Most cases of sepsis are due to bacterial infection. However, most types of microorganisms can cause sepsis, including bacteria, fungi, viruses, and parasites. However, it may also be caused by infections with seasonal influenza viruses, dengue viruses, and highly transmissible pathogens of public health concern; such as avian and swine influenza viruses, Ebola, and yellow fever viruses. (Source Global Sepsis Alliance) it stands with the basic principle of sepsis any type of infection can cause sepsis it is much identified as a Clinical condition when the Immune system reacts in dysfunctional or dysregulated and can cause the target effect on Multi-organ involvement Sepsis is the final common pathway to death from most infectious diseases worldwide

Much of the Pathophysiology on Sepsis is shifted to be an Immunological phenomenon and people react to infections in different ways and makes the topic confusing and certainly need the scientific approaches

Sepsis is often diagnosed too late because the clinical symptoms and signs that are currently used for the diagnosis of sepsis, like raised temperature, increased pulse or breathing rate, or white blood cell count are unspecific. The problem is that, in its early stages, sepsis causes symptoms that aren't much different from those of a viral infection that will go away on its own. Consequently, sorting out who can go home from the emergency department and who needs quick hospitalization can be tough. The mortality raises in many developing countries when they change the physicians and hospitals and events are not documented properly and not communicated to referral hospitals, in children, the signs and symptoms may be subtle, and deterioration is rapid. Sepsis is under-recognized and poorly understood due to confusion about its definition among Doctors and healthcare providers,

Most deaths in Africa and many developing countries happens due to lack of medical facilities, improperly trained doctors, and Nurses Lack of aseptic practices in normal deliveries, abortions by non-medical personnel and lacking aseptic practices,Cases of Pelvic Inflammatory disease, and people subjected to surgery thinking as a surgical problem carries the very high mortality

It is aimed by 2020; all countries will have established learning needs for sepsis among health professionals and ensured the inclusion of training on sepsis as a medical emergency in all relevant undergraduate and postgraduate curricula. Recognition of sepsis by health professionals as a common complication of high-risk medical interventions will have significantly improved, thereby reducing the number of patients who become exposed to the risk of life, many of the patients admitted in critical care units succumb to poor management lacking coordination between laboratory and clinicians.

Our Hospitals in Developing countries should initiate developing competent Microbiology Departments and empowering clinical microbiologists to Reduce Morbidity and Mortality associated with Sepsis.

Currently, sepsis continues to cause approximately between six and nine million deaths worldwide every year, most of which are preventable. Many surviving patients suffer from the consequences for the rest of their lives

SEPSIS IS A CLINICAL PUZZLE MODERN MEDICINE SAVES LIVES BUT INCREASES THE RISK OF SEPSIS

Many of the advances in modern medicine actually weaken our immune system, paving the way for severe illnesses like sepsis. These include cancer-fighting agents (chemotherapeutics) and some drugs used to treat severe rheumatism, gastro-intestinal illnesses, or to suppress the body's rejection of an organ transplant, amongst them cortisone. People with diabetes or chronic disease of the liver or the kidneys are also at greater risk. Furthermore, the advances in modern medicine like minimal-invasive surgery and improved intensive care make it possible to perform major surgery in older patients, putting them at a higher risk of infection and sepsis compared to younger patients. These patients at risk need specific care and caution, including education and regular screening.

1 Needs good clinical assessment wisdom will save and ignorance kills

2 Aggressive antibiotic treatments only sterilize blood and the majority of Blood culture soon become negative? It is truly an Immunological dysfunction with many predictable events however many immunoassays are more relied than on culturing of Blood

3 Many Monoclonal antibodies are available to block the entry of endotoxin into organs

4 The pathophysiology of Sepsis is much related to Hepatitis B infections where the much damage in liver and other organs happens due to excessive or dysregulation of T lymphocytes in a violent fight with HBV virus even the viral counts are less? (Greenwood textbook of Microbiology)

SMARTPHONE AND APPS ON SEPSIS –

1 NEWS AND SEPSIS( App ) free to download with collaboration between NHS Education for Scotland (NES) and Scottish patient safety Programme SPSP

The app contains the national Early warning score

B It helps to calculate qSOFA

C Multiple peer-reviewed sites can be contacted easily

References 1 Global Sepsis Alliance 2018 updates

2 CDC NIH WHO Medscape and PubMed resources for open source peer-reviewed documentation

Article contributed to Critical care medicine and Nursing on open-source learning on Infectious diseases

Available to download at many international web pages formulated by Dr.T.V.Rao MD