Six red flags for sepsis you should never ignore

Cases of the potentially fatal blood infection sepsis are increasingly in the news. We look at its causes, symptoms and how it is treated

Sepsis is a life-threatening condition in which the body overreacts to an infection and starts attacking its own tissues and organs.
Having a pre-existing health condition raises the risk of sepsis, as can a history of extensive antibiotic exposure. The UK Sepsis Trust reports that sepsis leads to around 48,000 deaths every year, more than lung cancer, bowel cancer and breast cancer combined.
“The problem is that the signs of sepsis can be really quite subtle,” said Prof Peter Ghazal who previously ran the Cardiff University’s Project Sepsis research collaboration. “They can be nothing more than maybe your heart rate being slightly raised, you may have a temperature, and then people can very suddenly become very sick, feel absolutely awful and they’re about to die.”
As a result, there are many cases where sepsis is either misdiagnosed or missed until it’s too late. 
According to Dr Michael Ramsay, the chief executive of the non-profit Patient Safety Movement Foundation, the vast majority of people who die of sepsis would have been saved, if it had been spotted sooner.
“As many as 80 per cent of septic shock patients can be saved with rapid diagnosis and treatment,” says Dr Ramsay. “Delayed diagnosis results in limb amputations and death, and children make up around 50 per cent of all those who die from sepsis.”
So how does sepsis develop and is there anything you can do to prevent it?
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Sepsis occurs when the body’s immune system overreacts to an infection and begins to mistakenly damage its own tissues and organs. 
“Sepsis may present with individuals feeling weak, tired, and perhaps with muscle aches,” advises Stephen Hughes, an emergency medicine consultant and senior lecturer at Anglia Ruskin University. “There may be pain at the site of infection and there may be a fever. It is common for some of these features to be absent.”
Children may have sepsis if they are breathing fast, experiencing fits or convulsions, look mottled, bluish or pale, have a rash which does not fade if pressed, are lethargic or difficult to wake, and feel abnormally cold to touch.
According to the UK Sepsis Trust, any of these six symptoms indicate that someone has sepsis and requires urgent medical help.
1. Slurred speech or confusion
Difficulty speaking means that the muscles you rely on for speech have been weakened. This is a sign that a blood-borne infection may have reached the brain, causing damage.
2. Extreme shivering or muscle pain
Extreme shivering is a sign of worsening sepsis which is progressing beyond an ordinary fever. The skeletal muscle system can become compromised as a result of sepsis, causing pain.
3. Passing no urine in a day
Because the body is in a state of shock due to the widespread inflammation caused by sepsis, patients pass little to no urine, even after a day.
4. Severe breathlessness
Sepsis impacts organs throughout the body, and this is an indication that the person’s lungs have become compromised and they may need a replacement ventilator.
5. It feels like you’re going to die
Studies examining warning signs of sepsis have reported patients becoming anxious and describing a fear that their life is in danger.
5. Skin mottled or discoloured 
This is another sign of septic shock, in which the body’s immune system goes into overdrive, reducing the blood supply to the skin and vital organs.
An easy way to remember the six signs is that the above list spells out ‘SEPSIS’. 
While the skin is an excellent defence against infections for the majority of the time, Hughes says that incidents of sepsis sometimes arise from minor cuts or grazes, often via relatively innocuous activities such as gardening.
One of the first patients ever to be treated with the antibiotic penicillin in the 1940s was a police officer who contracted sepsis after a scratch from a rose thorn.
“Different environments harbour different pathogens,” says Hughes. “Breaching the skin’s defence can allow pathogens to get into the body and perhaps cause an infection.”
There are several infections that can cause sepsis in many different areas of the body, as demonstrated in the diagram below:
Hughes explains that the best protection is simply maintaining good hygiene practices. “If you sustain a cut or an abrasion, wash it immediately,” he says. “If working in a dirty environment, wear gloves. Don’t handle contaminated materials with your bare hands. Reduced immunity is an important factor, and people with diabetes, on chemotherapy, and people who have had a transplant among many others are all at increased risk and should take extra care.”
People who are in good physical condition are also more likely to recover well from sepsis. “A good protection against sepsis comes from maintaining good physical fitness, attention to staying healthy and keeping up with immunisations such as tetanus,” says Hughes.
Steps you can take to prevent sepsis include:
According to the NHS, the main treatment for sepsis is antibiotics, injected directly into the veins, before being replaced by tablets within two to four days.
One of the major concerns for doctors is that the growing threat of antibiotic resistance will lead to some treatments not working and causing more deaths from sepsis in the coming decades.
“This is the nightmare that keeps my colleagues working in public health awake at night,” says Hughes. “If antibiotic resistance gets worse, then we can expect to see an increase in the incidence of sepsis and an increase in mortality.”
The UK Sepsis Trust have devised a set of six tell-tale signs of severe sepsis which suggest you should seek medical help urgently and call 999.
These signs are slurred speech and confusion, extreme shivering or muscle pain, passing no urine in a day, severe breathlessness, mottled or discoloured skin and a feeling that you are going to die.
Experts say that if you have any of these signs, it is vital to either call an ambulance or go straight to A&E and ask the medical professionals to consider whether it could be sepsis. 
“The suspicion of sepsis has to be there in every unwell patient in hospital,” says Prof Manu Shankar-Hari, the chairman of translational critical care medicine at the University of Edinburgh.
According to the NHS, sepsis may occur either during pregnancy or after birth.
“When you’re pregnant, and you get infected, you have a greater chance that you’re going to have a more severe infection than if you were not pregnant,” said Prof Ghazal. “Physiologically, a woman’s system has changed and that puts her into a higher risk category.”
The risk is heightened for women who have had a miscarriage, premature birth, developed a urine infection or if their waters ruptured early. Women whose baby was born by C-section, by forceps or vacuum, or who had a third- or fourth-degree tear during childbirth, are also more vulnerable.
NHS advice recommends preventing sepsis through good personal hygiene, including daily showers or baths, frequent maternity pad changes, proper hand washing and drying, and keeping C-section wounds clean and dry.
A single diagnostic test for sepsis does not yet exist and so doctors currently rely on screening tools, many of which have been shown to be largely ineffective. In September, research presented at the European Emergency Medicine Congress in Barcelona found that two of the four ways in which medical professionals commonly screen for sepsis do not work.
One of the goals of Project Sepsis is to find better ways of identifying early signs in the blood which indicate that a particular patient is going to have a much more severe response to a particular infection, which is likely to lead to sepsis.
“The bottom line is that what kills you is really how you respond to the infection,” said Prof Ghazal. “It’s not the bug per se. So this is where diagnostics can come in, because you want to pick up those signals which show that someone’s going to go on this trajectory, that their response to that bug is going to be really detrimental and then get them into intensive care units.”
While we can reduce the number of preventable deaths from sepsis by developing faster and better diagnostics, experts say that it will never be completely eliminated because evolution dictates that pathogens will continue to find ways to infect us.
“We have co-evolved with bacteria and viruses,” says Shankar-Hari. “So sepsis is not going to go away, it is going to be there forever. But we need to figure out better ways of understanding how to help our immune system kill and remove the bug in these cases, rather than killing us.”