INTRODUCTION :
Sepsis also may be symptoms related to a specific infection,
such as a cough with pneumonia, or painful urination with a kidney infection.In
the very young, old, and people with a weakened immune system, there may be
no symptoms of a specific infection and the body temperature may be low or
normal, rather than high. Severe sepsis is sepsis causing poor organ function or
insufficient blood flow. Insufficient blood flow may be evident by low blood
pressure, high blood lactate, or low urine output.Sepsis is a life-threatening
condition that arises when the body's response to infection causes injury to its
own tissues and organs Common signs and symptoms include fever, increased
heart rate, increased breathing rate, and confusion. There Septic shock is low
blood pressure due to sepsis that does not improve after reasonable amounts of
intravenous fluids are given.
Sepsis is a life-threatening condition that arises when the body's
response to infection causes injury to its own tissues and organs. Common signs and
symptoms include fever, increased heart rate, increased breathing rate,
and confusion.There also may be symptoms related to a specific infection, such as a
cough with pneumonia, or painful urination with a kidney infection. In the very
young, old, and people with a weakened immune system, there may be no symptoms
of a specific infection and the body temperature may be low or normal, rather
than high.Severe sepsis is sepsis causing poor organ function or insufficient blood
flow. Insufficient blood flow may be evident by low blood pressure, high blood
lactate, or low urine output.Septic shock is low blood pressure due to sepsis that
does not improve after reasonable amounts of intravenous fluids are given.
Sepsis is a life-threatening condition that arises when the body's
response to infection causes injury to its own tissues and organs. Common signs and
symptoms include fever, increased heart rate, increased breathing rate, and confusion.
There also may be symptoms related to a specific infection, such as a cough
with pneumonia, or painful urination with a kidney infection.In the very young, old,
and people with a weakened immune system, there may be no symptoms of a specific
infection and the body temperature may be low or normal, rather than high. Severe
sepsis is sepsis causing poor organ function or insufficient blood flow. Insufficient
blood flow may be evident by low blood pressure, high blood lactate, or low urine
output.

DEFINITION :
Sepsis is the body’s overwhelming and life-threatening response
to infection that can lead to tissue damage, organ failure, and death. In other
words, it’s your body’s over active and toxic response to an infection.
Your immune system usually works to fight any germs (bacteria,
viruses, fungi, or parasites) to prevent infection. If an infection does occur, your
immune system will try to fight it, although you may need help with medication
such as antibiotics, antivirals antifungals and antiparasitics. However, for
reasons researchers don’t understand, sometimes the immune system stops
fighting the “invaders,” and begins to turn on itself. This is the start of sepsis.
Some people are at higher risk of developing sepsis because they
are at higher risk of contracting an infection. These include the very young, the
very old, those with chronic illnesses, and those with a weakened or impaired
immune system.
HISTORY OF SEPSIS :
 sepsis – rotten , putrid
 2 thousand years BC - Egypt – abscess
 50 years BC Celsus – 4 signs of inflamation
 first century – Galen – functiolase
 2752 – pringle – antisepsis
 2870 - 1900 - - most pacterial causalory
 1982 – fleming PNC

SIGNS AND
SYMPTOMS

• If a person has sepsis, they often will have fever. Sometimes, though, the
body temperature may be normal or even low.
• The individual may also have chills and severe shaking.
• The heart may be beating very fast, and breathing may be rapid. Low
blood pressure is often observed in septic patients.
• Confusion, disorientation, and agitation may be seen as well as dizziness.
• Decreased urination (due to poor kidney perfusion or dehydration)
• Some patients who have sepsis develop a rash on their skin. The rash may
be a reddish discoloration or small dark red dots seen throughout the body.
• Those with sepsis may also develop pain in the joints of the wrists, elbows,
back, hips, knees, and ankles.
CAUSES :

•Many different microbes can cause sepsis.
• Although bacteria are most commonly the cause, viruses and fungi can also cause
sepsis.
•Infections in the lungs (pneumonia), bladder and kidneys (urinary tract infections),
skin (cellulitis), abdomen (such as appendicitis), and other areas (such
as meningitis) can spread and lead to sepsis.
• Infections that develop after surgery can also lead to sepsis.
RISK FACTORS :
 Very young people and elderly people
 Anyone who is taking immunosuppressive medications
(such as transplant recipients)
 People who are being treated with cancer chemotherapy
drugs or radiation
 People who have had their spleen surgically removed (the
spleen helps fight certain infections)
 People taking steroids (especially over the long term)
 People with longstanding diabetes, AIDS, or cirrhosis
 Someone who has very large burns or severe injuries
 People with infections such as
pneumonia,
meningitis,
cellulitis, or
urinary tract infection

MEDICAL CARE FOR SEPSIS
• A person should call the doctor if anyone has signs and symptoms of sepsis.
• If any of the following are true about the patient's medical history, they
need to be especially vigilant regarding possible sepsis symptoms if the person
• is being treated with cancer chemotherapy or radiation,
• is taking immunosuppressive medications (for example after an organ
transplant),
• has diabetes,
• has AIDS, or
• Is very young or very old.
• Anyone suspected of having sepsis should go to a hospital.
• If a child younger than 2 months of age has fever, lethargy, poor feeding, a
change in normal behavior, or an unusual rash, call the doctor and proceed to
the hospital.
• If someone has confusion, dizziness, fast heartbeat, fast breathing, fever,
chills, rash, or dizziness, call the doctor immediately or go to the hospital's
emergency department.

Steps of sepsis

DIAGNOSIS
• Blood work may be done by inserting a needle into a vein in the patient's hand or arm and
drawing blood into several tubes. This blood may be analyzed to see if the patient has an
elevation in the white blood cell counts.
• Blood may also be sent to the lab to be placed on a medium where bacteria will grow if they
are present in the blood. This is called a blood culture. Results from this test usually take
over 24 hours (the time required to look for bacterial growth). Lab technicians may also
look for bacteria in the blood under the microscope on slides.
• Samples may be taken of sputum (mucus), urine, spinal fluid, or abscess contents to look
for the presence of infectious organisms.
– To obtain urine that is not contaminated and to measure the amount of urine being
produced, a flexible rubber tube may be placed into the bladder (catheter).
– Spinal fluid may be obtained from the lower back (spinal tap or lumbar puncture) to
evaluate if there is an infection in the brain or fluid surrounding the brain and spinal
cord. After the skin is cleaned and numbed, a hollow needle is placed between the
bones of the spine into the canal containing the spinal cord. Because the needle is
placed lower than the location where the cord ends, there is little danger of injuring
the nerves of the spinal cord. When the needle is in the correct spot, the doctor will
let the fluid drip into tubes. The sample of fluid is sent to the lab for testing.
– Other tests may include a chest X-ray to look for pneumonia or a CT scan to see if
there is infection in the abdomen.
• A dye (contrast) might be injected into a vein during a CT scan to help
highlight certain organs in the abdomen.
• The CT scan is a series of X-rays taken from different angles very quickly and
put together by the computer to show an image of the internal organs.
• Usually, a radiologist reads the results and notifies the patient's doctor.
– In the hospital, the patient may be placed on a cardiac monitor, which will show the
patient's heart rate and rhythm.
– Similarly, the patient is usually placed on a pulse oximeter which indicates the
amount of oxygen in the blood.
• If the patient is young child who is ill being evaluated by sepsis he or she will get same
treatment

Cycle of sepsis

TREATMENT:
 The patient will likely be administered oxygen, either by a tube that is
placed near the nose or through a clear plastic mask.
 Depending on the results of the tests, the doctor may order medications.
 These medications may include antibiotics given intravenously (given
directly into the vein).
 Initially, the antibiotics may be those that kill many different bacteria
because the exact kind of infection the patient has is not known.
 Once the blood culture results show the identity of the bacteria, the doctor
may select a different antibiotic that kills the specific organism responsible for
the infection.
 The doctor may also order IV salt solution (saline) and medications to
increase the blood pressure if it is too low.
 Your health care professional will likely admit the patient to the hospital at
least until the blood culture results are known. If the patient is very ill and
with low blood pressure, the doctor may admit the patient to the intensive care
unit (ICU) and may consult specialist doctors to help in the management of the
illness.
 If results show an infection in the abdomen, either drainage of the infection
by the placement of tubes or surgery may be necessary.
 Research to discover new treatments for sepsis has failed over the past 20-30
years. Many medications that were thought to be helpful were proven to have no
benefit in clinical trials. However, scientists are working diligently to discover
medications that will modify the body's aggressive immune response to
microbes, which leads to sepsis. Depending on the hospital where the patient
receives treatment, different sepsis treatment protocols might be in place.

EMERGENCY TREATMENT :
 You'll need emergency hospital treatment and may require admission to
an intensive care unit (ICU) if:
the sepsis is severe
 you develop septic shock – when your blood pressure drops to a
dangerously low level
 ICUs are able to support any affected body functions, such as breathing or
blood circulation, while the medical staff focus on treating the infection.
 Because of problems with vital organs, people with severe sepsis are likely
to be very ill. Up to 4 in every 10 people with the condition will die.
 Septic shock is even more serious, with an estimated 6 in every 10 cases
proving fatal.
 However, sepsis is treatable if it is identified and treated quickly, and in
most cases leads to full recovery with no lasting problems.
ANTIBIOTICS :
• You'll need emergency hospital treatment and may require admission to
an intensive care unit (ICU) if:
the sepsis is severe
• you develop septic shock – when your blood pressure drops to a
dangerously low level
• ICUs are able to support any affected body functions, such as breathing or
blood circulation, while the medical staff focus on treating the infection.
• Because of problems with vital organs, people with severe sepsis are likely
to be very ill. Up to 4 in every 10 people with the condition will die.
• Septic shock is even more serious, with an estimated 6 in every 10 cases
proving fatal.
• However, sepsis is treatable if it is identified and treated quickly, and in
most cases leads to full recovery with no lasting problems.

TYPES OF ANTIBIOTICS :
• These are designed to work against a wide range of known infectious bacteria
and usually cure most common infections.
• There won't usually be time to wait until a specific type of infection has been
identified, so broad-spectrum antibiotics are given first.
• Once a specific bacterium has been identified, a more focused antibiotic can be
used.
VIRAL INFECTIONS :
• If the sepsis is caused by a virus, antibiotics won't work. Antibiotics are
usually given anyway because it would be too dangerous to delay treatment until
tests confirm the specific cause.
• With a viral infection, you'll need to wait until your immune system starts to
tackle the infection, although antiviral medication may be given in some cases.
OXYGEN :
• Your body's oxygen demand goes up if you have sepsis.
• If you're admitted to hospital with sepsis and the level of oxygen in your blood is low,
you'll usually be given oxygen.
• This is either given through a mask or tubes in your nostrils.

INTRAVENOUS FLUIDS :
• If you have sepsis, your body needs increased amounts of fluid to prevent
dehydration and kidney failure.
• You'll usually be given fluids intravenously during the first 24 to 48 hours
after admission if you have severe sepsis or septic shock.
• It's important that the doctors know how much urine your kidneys are
making when you have sepsis so they can spot signs of kidney failure.
• If you're admitted with severe sepsis or septic shock, you'll usually have
a catheter inserted into your bladder to monitor your urine output.
TREATING THE SOURCE OF INFECTION :
• If a source of the infection can be identified, such as an abscess or infected
wound, this will also need to be treated.
• For example, any pus may need to be drained away or, in more serious
cases, surgery may be needed to remove the infected tissue and repair any
damage.
INCREASING BLOOD PRESSURE:
• Medications called vasopressors are used if you have low blood
pressure caused by sepsis.
• Vasopressors are normally given intravenously while you're in an ICU.
Extra fluids may also be given intravenously to help increase blood pressure.

OTHER TREATMENTS :
• You may also require additional treatments, such as:
• corticosteroids or insulin medication
a blood transfusion
• mechanical ventilation – where a machine is used to help you breathe
• dialysis – where a machine filters your blood to copy the function of your
kidneys
• These treatments are mostly used in ICUs.

RECOVERING FROM SEPSIS :
Some people make a full recovery fairly quickly. The amount of time it
takes to fully recover from sepsis varies, depending on:
the severity of the sepsis
the person's overall health
how much time was spent in hospital
whether treatment was needed in an ICU
Some people experience long-term physical and/or psychological problems
during their recovery period, such as:
feeling lethargic or excessively tired
muscle weakness
swollen limbs or joint pain
chest pain or breathlessness
These long-term problems are known as post-sepsis syndrome. Not
everyone experiences these problems

SOURCE OF INFECTION :
• Types of infection associated with sepsis include:
• lung infection (pneumonia)
appendicitis
an infection of the thin layer of tissue that lines the inside of the
abdomen (peritonitis)
• an infection of the bladder, urethra or kidneys (urinary tract infection)
an infection of the gallbladder (cholecystitis) or bile ducts (cholangitis)
• skin infections, such as cellulitis – this can be caused by an
intravenous catheter that's been inserted through the skin to give fluids or
medication
• Infections after surgery
• Infections of the brain and nervous system – such as meningitis or encephalitis
flu (in some cases)
• bone infection (osteomyelitis)
• heart infection (endocarditis)
• Sometimes the specific infection and source of sepsis can't be identified.

PROGNOSIS
Patients who survive severe sepsis have a higher risk for
mortality than the age-matched general population for at least 4 years.
Several studies have suggested 30-day mortality rates between 30% and 50%
for patients with severe sepsis or septic shock. But what is the long-term
prognosis of those who survive past day 30?
To find out, researchers in Denmark examined the course of patients who had
been treated for community-acquired severe sepsis or septic shock at their
institution between June 2004 and December 2007. Using data from several
registries, the investigators compared the mortality (adjusted for comorbidities)
between these 212 patients and a population-based reference group of 79,857
adults living in the same region.
Median follow-up duration for the patients (mean age, 70.6; 50% men; 49%
with septic shock) was 1.9 years. The most common foci were the urinary and
respiratory tracts (36% and 25%, respectively); bacteremia was present in 58%.
Mortality was 33% during the first 30 days and 57% for the entire follow-up
period.
Compared with community-based, matched controls, the patients had a greatly
increased risk for death during the first 30 days after hospitalization (hazard
ratio, 90.8; 95% confidence interval, 65.3–126.2). For patients who survived
the first 30 days, the HR for mortality until day 365 was 2.7 (95% CI, 1.7–4.3).
For those alive after the first year, the HR for mortality during years 1 to 4 was
2.3 (95% CI, 1.7–3.3). After the initial 30 days, increasing age and increasing
comorbidity level (but not severity of the sepsis episode) were risk factors for

SEPTIC SHOCK :
• In some cases, symptoms of more severe sepsis
or septic shock (when your blood pressure drops to a
dangerously low level) develop soon after.
• These can include:
• feeling dizzy or faint
• a change in mental state – such as confusion or
disorientation
• diarrhoea
• nausea and vomiting
• slurred speech
• Severe muscle pain
• severe breathlessness
• Less urine production than normal – for example, not
urinating for a day
• cold, clammy and pale or mottled skin
• loss of consciousness Bean seeds

NATURAL REMIDIES
Garlic
Ginger
Honey
Lemon
Sproutes
Bean seeds

REFERENCE
WWW.WIKIPEDIA .COM
MEDICIINET
DIPIRO
NHS