Red alert for sepsis!

The most important information

Many parents do not know the term sepsis. Sepsis stands for blood poisoning. Sepsis is rare, but if it is discovered too late, it is usually fatal for the affected child. Most blood poisoning is caused by bacteria.

What are the signs of sepsis? Fever for no apparent reason or poorly perfused, «marbled» limbs can indicate sepsis. You can find out more signs of possible blood poisoning in the full text.

It's a race against time: the sooner septicaemia is treated, the better the chances of surviving it. But in order to be able to treat it, the correct diagnosis must be made. And this is precisely the Achilles heel of sepsis: its symptoms are so unspecific and can be confused with so many other diseases that even experienced doctors often do not immediately realise what they are dealing with. An ignorance that can have fatal consequences.

Fever, for example, chills, palpitations and a feeling of illness similar to a severe flu-like infection are possible signs of septicaemia. «This makes the disease difficult to diagnose, as children very often have a fever,» says Horst von Bernuth, Head of the Paediatric Immunology and Infectiology Section at Charité-Universitätsmedizin Berlin.

An invasive infection

According to statistics, eight to ten banal infections per year are completely normal in small children, with the number rising to 15 to 18 at kindergarten age. «Recognising sepsis among the thousands of children who come to the practice with these symptoms is a challenge for any paediatrician,» says von Bernuth.
But how exactly is the blood poisoned? Normally, our body copes well with pathogens. It fights countless battles against bacteria, viruses and fungi every day - and wins. Sometimes it takes a little longer, then we get sick, but with patience and sometimes medication, the body gets to grips with this too. «However, while coughs, colds or pneumonia take place on the surface, i.e. on the mucous membranes, in the case of sepsis, the pathogens reach otherwise sterile places. We then speak of an invasive infection,» explains von Bernuth.

Cause: congenital defect?

Most blood poisoning is caused by bacteria. Such a localised focus can be an infected wound from a cut, but also a festering tooth or an inflammation of the lungs, bladder or meninges. Parents who warn against dirt in a wound are absolutely right: this can lead to blood poisoning and should be cleaned and disinfected as quickly as possible. But a rusty nail or an infected graze are just a few of the many potential culprits. Pneumococci, staphylococci and meningococci are the pathogens that scientists frequently find on the mucous membranes of healthy people. «What is striking is that many people are carriers of these bacteria, some also become ill, but not all of them develop septicaemia,» says von Bernuth. Measured by the degree of infection in children and adults, septicaemia is actually rare.
«We therefore suspect that it could be congenital defects, errors in the defence mechanism, which lead to the immune system not handling an infection properly in some people,» says von Bernuth. After all, even a pathogen has no interest in killing its host, as this also means the end for itself. «The fact that blood poisoning occurs is therefore probably an evolutionary accident.»

There is no protection against blood poisoning.

American scientists are already creating genetic profiles of affected patients, but the significance is questionable: the human defence system is regulated by around 2000 to 3000 genes; we only know with a high degree of certainty the significance of just over 300 immune system genes. It is therefore quite possible that the error lies in completely unknown spheres. There is no protection against blood poisoning. The only thing that can save lives is recognising the danger at an early stage. Antibiotics then support the body in its fight against the infection.
Sepsis pathogens divide approximately every 20 to 30 minutes and are particularly vulnerable each time they divide. If they are exposed to antibiotics in this state, they can attack well. If the septicaemia is recognised too late, mechanisms are triggered in the body that are themselves harmful. Put simply, people do not die from the infection itself, but from the collateral damage.

«We focus on prevention»

In a national study, the ten largest paediatric hospitals in Switzerland worked together for four years to research the causes and effects of sepsis. The results were published last summer in the specialist journal «The Lancet Child & Adolescent Health». «We were astonished that so many children contract sepsis,» says Christoph Berger, Head of the Department of Infectious Diseases and Hospital Hygiene at the University Children's Hospital Zurich.
In Switzerland, more than 1000 children fell ill during the study period. The doctors were able to divide the young patients into three roughly equal groups: One third of the children fell ill with septicaemia «out of the blue», so to speak; they had previously been completely healthy. Another third were newborns and premature babies who had been hospitalised for a relatively long time. And the final third were children with a serious underlying illness such as leukaemia, a heart defect or kidney failure. These children are frequently hospitalised and therefore exposed to more germs. In addition, their immune system is already weakened by the illness. A combination that can favour the development of blood poisoning. «You have to be particularly vigilant with these children, because frequent hospital visits or a venous catheter increase the risk of infection,» says infection expert Berger.
Berger and his colleagues also ask themselves: what works differently in children who develop sepsis compared to those who do not under the same circumstances? «Is it really just a random event? Or is it a genetic disposition? Unfortunately, we don't know yet,» says Berger, «but until the cause is clear, we are focussing on prevention.»

The lower the number of circulating germs, the lower the chance of infection.

He advises parents to adhere to the vaccination programme recommended by the Federal Office of Public Health in order to ensure that children receive basic immunisation. Hospitals have a role to play in improving hospital hygiene, as the lower the number of circulating germs, the lower the chance of patients becoming infected. To ensure that doctors are able to recognise blood poisoning in good time, hospitals and associations are increasingly focusing on education as a further preventative measure.
In the German state of Lower Saxony, this has been successful: Thanks to special training, only one to two per cent of children with blood poisoning die there, compared to ten per cent previously. The doctors there have experts available around the clock who can be connected via video or even flown in in an emergency. A decisive support: for every hour that passes without treatment, the probability of survival for the patient decreases by more than seven per cent.

Septic shock

If septicaemia is not treated or the treatment does not work, it can lead to septic shock. More than half of those affected do not survive this life-threatening emergency. The reason is an extremely severe drop in blood pressure, the heart can no longer supply the dilated blood vessels with sufficient blood. The organs are undersupplied and eventually fail. Septic shock requires intensive medical care. If a patient survives septic shock, he or she usually suffers long-term damage caused by the undersupply of one or more organs.

The red line

Many people think that a dark red or blue line spreading towards the heart or «travelling» in this direction is an unmistakable sign of blood poisoning. This is wrong. Such streaks do not occur with blood poisoning, but with lymphangitis. In this case, the lymph channels are inflamed. Lymphangitis must also be treated by a doctor. In rare cases, it reaches the bloodstream - and blood poisoning can develop.