How can a “simple” infection kill in a few hours?
There are medical emergencies where every minute can be critical and make the difference between life and death. One of the most serious of them is sepsis – a violent and uncontrolled reaction of the body to an infection, which can deteriorate within a few hours to system collapse and death. This is a very significant phenomenon: according to According to recent data, nearly a fifth of the deaths in the world in 2017 were due to sepsis. Despite this, awareness of the issue is very low. Most people are completely unaware of the danger, and even more so do not know how to recognize the symptoms of the phenomenon. The price of not knowing is high, because awareness and quick diagnosis may save lives.

“If we had known better, we would have brought our son to the hospital 24 hours earlier, but we didn’t know. We thought it was the flu at best,” said Adam Grimberg, the father of Toby, a boy who almost died of sepsis. For the father, the story began when Tobi’s school called to tell him that his son was not feeling well and asked him to come quickly to pick him up. In a short time the son’s condition deteriorated, he suffered from a high fever and a skin rash, and when his condition continued to deteriorate they had to hospitalize him.

At the hospital the doctors were very afraid for his life and Tovi was euthanized. His condition continued to worsen, and when his kidneys and liver began to collapse, the doctors decided as a last resort to connect him to an Acmo device, a kind of sophisticated breathing machine that replaces the work of the heart and lungs together. Fortunately Toby survived, probably also thanks to his young age and being an athletic and healthy boy. But even so he needed prolonged medical treatment and long rehabilitation.

luck of Kim Smith Improve her less. During a vacation in Spain she felt pain in her back and the doctor diagnosed a kidney infection. When she arrived at the hospital, she was diagnosed with sepsis, and within a short time her condition deteriorated and she fell into a coma. The doctors told her family that she only had a few hours left to live and to prepare for the worst.

With great efforts, the doctors managed to keep her alive, but at a heavy price. A week after she was hospitalized, her palms and feet turned black and necrosis developed in them due to a lack of blood supply and oxygen. With no choice, they had to partially amputate all four of her limbs to save her life. Only after nine weeks she woke up from the coma. These are just two examples out of millions of cases that occur every year, many of which end in death.

“internal rot”

Sepsis is An ancient medical concept, introduced for the first time Already in the hands of the one who is considered to be the greatest physician of ancient Greece, Hippocrates, many years before they knew about the existence of bacteria and viruses. Hippocrates saw sepsis as a dangerous biological decay process that occurs in the body and therefore called it “sepsis”, from the Greek word sepsin which means “to cause decay”.

Over the years the definition of the phenomenon called sepsis has changed several times. in the early 90s of the last century, a large group of doctors and scientists established an agreed medical definition for the concept for the first time. six years ago The definition has been re-updated in accordance with the development of knowledge in the field.

Sepsis is currently defined as a life-threatening condition in which the body reacts in an uncontrolled, violent and extreme manner to a foreign infection such as bacteria, viruses or fungi. This excessive reaction generates a chain of events that cause extensive damage to tissues and organs, to the point of multi-system failure that in many cases ends in death.

When the infection is focused and found in a certain area of ​​the body, an inflammation may develop that is limited to the area around the site of the infection. If the infection worsens, it can pass into the bloodstream and from there the cause of the infection, a bacterium or a virus for example, may spread to other areas of the body. This condition, called blood poisoning (septicemia), can trigger an overreaction of the immune system and develop into sepsis – an inflammatory process throughout the body, a condition that is more dangerous than the initial infection.

A dangerous jolt

The immune system plays a crucial role in maintaining our health. It works very efficiently to detect the penetration of foreign factors into the body, and when it detects a pathogen, it destroys it and, if necessary, also neutralizes the toxins it secreted. For this purpose, it uses a complex array of cells of several types and other molecules. At the top of this array are two sets of white blood cells that complement each other.

When a foreign agent enters the body, the innate immune system is immediately activated, whose goal is to destroy or neutralize it before it causes significant damage. Since the effectiveness of this initial reaction is limited, the acquired immune system works in addition to it. The cells in it learn to specifically identify the foreign agent and work efficiently and in a targeted manner to reach it and damage it. In addition, an array of immune memory is activated designed to prevent the recurrence of the disease.

As part of the fight of the innate immune system against the infection, inflammation occurs in the body, which is accompanied by signs such as redness, fever, swelling and pain. Usually this reaction is limited to the infected area only. But sometimes the body reacts with excessive force and without control and a system-wide reaction is created, that is, one that occurs throughout the body and does not focus only on the area of ​​infection. In addition, it often happens that even after the immune system has completely destroyed the infection itself, the body fails to return to its normal state and the inflammatory process continues. Such situations damage the body’s cells and tissues in a way that may in severe cases be irreversible.

A deadly and complex situation

Sepsis is caused by an uncontrollable deterioration in the condition of patients with common diseases such as pneumonia, flu, urinary tract and kidney infections, intestinal infections and more. In some cases even a routine cut on the finger or a skin abscess can develop into sepsis. Studies that were done recently indicate that many of the seriously ill patients in the corona epidemic presented characteristics of sepsis.

According to data from the Center for Disease Control and Prevention in the United States (CDC), those who are especially targeted develop sepsis are Adults aged 65 and over, people who suffer from suppression of their immune system or suffer from diabetes, cancer and chronic respiratory and kidney diseases. Children under the age of one are also at high risk. However, even young, healthy people can develop sepsis from any untreated infection.

When sepsis is not detected in time and is not treated properly, it can quickly lead to the death of the patient. Research from 2020 who collected data from all over the world, found that about a fifth of all deaths in the world are caused by sepsis. The data shows that in 2017 alone, 11 million people worldwide died of sepsis, out of a total of 48.9 million patients. This is an estimate that is twice as high as the estimates that were accepted before.

CDC report shows that 87 percent of sepsis cases develop at home or during care provided in the community. The rapid deterioration in the condition of many of the patients when they arrive at the hospital is often related to the fact that at this stage their condition is already serious and the treatment methods open to the medical staff at the hospital are few and limited. Accordingly, the patients’ chance of survival is also low. About a third of deaths in hospitals are due to sepsis.

The lucky ones who manage to survive usually face a complex and difficult period of restoring the damages they have suffered, both on the physical level and in their thinking and information processing skills their. Extensive research from Germany, published last year, reflects the severity of the problem. Follow-up of more than 100,000 sepsis patients revealed that three quarters of the survivors later suffered from medical, mental or memory and thinking problems that they did not have before. Nearly a third of the patients required nursing support, and more than 30 percent of the patients died within a year of recovery. These phenomena were not limited only to the elderly – they also affected more than half of the convalescents under the age of 40. The cost of treating sepsis convalescents is enormous, amounting to approximately 30,000 euros over the next three years.

Symptoms of sepsis

There are several red lights that can indicate that the inflammatory process is out of control and deteriorates into sepsis.

The warning signs are an outcome of the process itself. For example, to reach the center of the infection, the cells of the immune system have to penetrate through the walls of the blood vessels. For this purpose, substances are secreted into the blood circulation that cause the blood vessels to expand and become more permeable. The result is a drop in blood pressure – one of the signs of sepsis.

In addition, increased blood coagulation may lead to leakage of fluids into the tissues, and therefore the patients will suffer from edema. Damage to the blood and oxygen supply to the organs, including vital organs such as the heart, brain, kidneys and lungs, causes the body to increase the heart rate and pulse and speed up the breathing rate.

The blood fungus also damages the function of the kidneys, which are responsible for filtering excess water and toxins from the blood. As a result, the patients will suffer from a decrease in urination. Changes in the brain, perhaps due to a decrease in oxygen supply to it, may be reflected in confusion and slurred speech. Also, the body’s temperature regulation mechanisms respond to inflammation with an increase in body temperature and chills. In extreme situations, infectious shock (septic shock) is created – a condition that manifests itself in a drop in blood pressure and blood supply to vital organs and, as a result, multisystem failure, which ends in death in more than half of the cases.

Early detection saves lives

When dysentery is diagnosed early, it is customary to give patients broad-spectrum antibiotics, even before vital organs are damaged. With this treatment, most patients recover even without hospitalization. Severe cases already require hospitalization under close supervision in the intensive care unit, and receiving a large amount of antibiotics by intravenous infusion.

At the same time as the antibiotic treatment, the doctors monitor the condition of the patients and, if necessary, give them substances to raise the blood pressure. Frequent blood tests are necessary to monitor the development of inflammatory processes and the presence of infection. Patients who suffer from breathing or kidney problems will be connected to a ventilator if necessary or will be treated with a dialysis machine.

The time of initiation of treatment is of critical importance. Research who followed critically ill patients whose blood count had deteriorated into septic shock, showed that if they received treatment within an hour, up to 80 percent of them survived; Every additional hour lowered their chances of survival by eight percent.

Research that was recently published followed adult patients who arrived at the emergency room with suspected sepsis, were hospitalized and received antibiotic treatment within a day. The researchers found that despite the relatively early diagnosis and the fact that 88 percent of the patients received antibiotic treatment within five hours of their arrival at the hospital, the condition of more than seven percent of the patients still deteriorated to infectious shock. The researchers calculated and found that every hour of delay increases the probability of infectious shock by another four percent – another illustration of the enormous importance of rapid diagnosis and the earliest possible start of emergency treatment.

Unfortunately, there is still a huge gap between the tremendous progress made in understanding the processes that occur in sepsis and the many difficulties in developing treatments Targeted that will manage to moderate the excessive reaction of the immune system and return the body to normal function.

Researchers are trying Now develop an algorithm based on artificial intelligence to predict or diagnose sepsis at an early stage. In addition Research is being done whose aim is to identify protein markers that appear on the cells of the immune system in the case of sepsis. Such studies, if successful, could help in the future to diagnose sepsis quickly and develop new and more effective treatments for it.

from studies Many epidemiological studies show that the incidence of sepsis has increased dramatically in the last decades, while the mortality rate has decreased. However, there are also studies that point to the opposite trend. It is possible that the improvement in diagnostic methods, the increase in the number of tests and the change in the clinical definition of the disease, influenced these estimates and that sepsis morbidity and mortality remained stable nevertheless, at least in the last decade.

Whatever the trends, World Health Organization Calls for resources to be directed to research and advocacy. in the United States, Center for Disease Control and Prevention In 2017, he announced a broad public campaign to raise public and medical staff awareness of sepsis, and to encourage people to seek medical attention as early as possible if signs that might suggest sepsis appeared.

Common warning signs for the development of sepsis

Fever higher or lower than usual
Chills and sweating
drop in blood pressure
Increase in pulse and heart rate
quick breathing
Confusion, slurred speech
strong pains

in serious cases

Breathing problems
decrease in urine volume
Nausea, diarrhea and vomiting
weakness and feeling faint
Changes in heart activity
pay attention! Most of these symptoms may also indicate other medical conditions, which makes diagnosis difficult.

By Editor

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