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A 6 year old dancer almost dies after a simple infection. What do you need to know about sepsis?

Tessa is a 6-year-old Ohio girl who loved dancing. But is now fighting for her life after developing a life-threatening infection. Although being treated with antibiotics for a sore throat, she deteriorated and ended up developing necrotising fasciitis (fash-ee-eye-tis), commonly referred to as ‘flesh-eating disease.’ She had to have her leg amputated to save her life. Clearly, this is an awful situation for her and her family. Sadly, it’s just another in a long line of news stories about serious infections and the new medical media buzzword, sepsis.

What went wrong?

Tessa had a sore throat. This is usually caused by a virus and heals itself. However, it can also be caused by bacteria. The most common one is called Streptococcus pyogenes, or ‘Group A strep’, hence the term ‘strep throat’. Incidentally, the name simply describes (in Greek) what they look like, ‘strepto’ means chains and ‘coccus’ means berries. So, they look like chains of berries under the microscope. Group A strep is responsible for a variety of illnesses. Some are mundane. Some are potentially fatal. Strep throat is one of these illnesses, and so is necrotising fasciitis. How can the same bacteria cause two illnesses that are at opposite ends of the scale? The bacteria’s location is key.

In strep throat, the bacteria are sat in the first layer of the lining of the back of your throat. In necrotising fasciitis, they are much deeper down in the soft tissue (anything that isn’t skin or bone).The back of the throat is a pretty hostile place for something to live. That’s before you even consider that there are all sorts of different bugs competing with each other just to survive, let alone to do well enough to cause us to feel unwell.

The muscle in your leg is much nicer. It’s got a good blood supply to keep them the right temperature and to provide them with all the food they need to grow and it’s free from competition from other bugs. They thrive. They arrived via your blood. Once there, the bacteria are free to go wherever the blood takes them. Theoretically, any infection could get into the bloodstream, but it tends to only happen in the most serious ones.

What is sepsis?

Sepsis is actually a specific medical term often confused in the media. It’s used to describe the body’s response to an infection. The severity of sepsis is on a spectrum and treatment varies by just ‘how ill’ a patient is. If someone has a cough and a noisy chest, they have a chest infection. Treatment is usually just antibiotics at home. If the same patient has signs of sepsis, i.e a fast heart rate, high temperature, they may need hospital admission or further tests before being allowed home. If they are ill enough to have a low oxygen reading it means the infection is bad enough to disrupt their body’s systems, and that is called severe sepsis. Admission to hospital is imperative, as well as antibiotics, a fluid drip and oxygen. Worse still, is abnormally low blood pressure that can occur in severe infection. This is called septic shock and can easily be fatal.

What sepsis is not, is a new killer disease we know nothing about. Chances are you have seen it before, although you may not realise it. The ‘meningitis rash’ is actually meningococcal sepsis.

Why is sepsis so important now?

There is now a greater understanding that earlier treatment improves survival and so earlier recognition is key, hence the apparent increase in sepsis. We’re simply applying the label to more people. Doctors already use scoring systems to pick up sepsis earlier. Can we predict who will get septic shock? Could doctors have foreseen Tessa getting so ill? Not really. There are some risk factors for getting an infection in general (like having diabetes or being treated with immune suppressants), but otherwise, it can just happen. Tessa may not dance again, but she should live.

What we can do is to think ‘could this be sepsis?’ and pick up as many cases as possible. What you can do is what you’ve already been doing for years. Be aware, and come and see your doctor if you’re worried.

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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.

 

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About Nick Heuston (1 Article)
UK trained junior doctor, currently based in Yorkshire.

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