Sepsis: Symptoms, Diagnosis, Prognosis

Sepsis — an extreme immune system response to an infection — can lead to organ failure and death if the condition is not diagnosed and treated quickly. This medical emergency affects about 1.7 million adults in the United States each year. (1) For the best outcome, it’s important to identify symptoms of sepsis early and get immediate medical care.

Here’s what you need to know about sepsis and severe sepsis, as well as information on how your doctor can diagnose this condition.

Sepsis occurs when chemicals released by the immune system to fight an infection cause widespread inflammation in the body. This condition can happen to anyone who has an infection, whether the infection is bacterial, viral, or fungal. (2)

Most cases of sepsis are caused by a bacterial infection, and certain groups of people are at higher risk for this complication. (3) This includes the elderly, children, and people who have a weaker immune system because of a chronic disease. (4)

There are certain warning signs of sepsis. But despite these signs, some people don’t receive medical treatment fast enough.

With sepsis, your heart and breathing rate may increase. (4) Many doctors use the Systemic Inflammatory Response Syndrome (SIRS) criteria when you arrive at a hospital or clinic to assess your risk and severity of sepsis according to the following: whether your body temperature is less than 96.8 degrees F or greater than 100.4 degrees F; if your heart rate is greater than 90 beats per minute; if you have a high respiratory rate (called tachypnea), with more than 20 breaths per minute; and other measures. You’ll need to seek immediate medical help if you develop any of these symptoms, especially if you were previously diagnosed with an infection.

Signs of sepsis in babies and children are the same as they are in adults. Other symptoms of sepsis in children include: (5)

• Vomiting
• Refusing to eat
• Lethargy

You shouldn’t downplay these symptoms or assume they’re caused by the infection you’re currently treating. Sepsis can come on quickly and progress fast. See a doctor if you develop new symptoms after starting treatment for an infection.

Delaying medical help can cause mild sepsis to advance to severe sepsis. If you show signs of severe sepsis, don’t drive to the emergency room. Call an ambulance.

Symptoms of severe sepsis include the above symptoms, as well as the following: (6)

• Dizziness or fainting
• Confusion
• Nausea, vomiting, diarrhea
• Difficulty breathing
• Cool or pale extremities
• Loss of consciousness
• Low urine output
• Muscle pain
• Slurred speech

It is imperative to treat sepsis in its earlier stage. As a general rule of thumb, go to the hospital if the pain or discomfort you feel is the worst you’ve ever felt. Some people who’ve recovered from sepsis describe the condition this way. (7)

Sepsis and severe sepsis can lead to septic shock if left untreated. During septic shock, you may experience the above symptoms and have dangerously low blood pressure (hypotension).

Septic shock has its own set of complications. This includes organ failure, gangrene, and death. Septic shock has a mortality rate of about 40 percent. (4)

Identifying sepsis can be difficult. There isn’t a single medical test to confirm the condition, and sepsis is also tricky because it can mimic other conditions, says Kimberly Brown, MD, MPH, an ER doctor in Memphis, Tennessee.

“Exacerbations of chronic diseases such as COPD can mimic sepsis and are quite frequent in my practice,” she says. “For example, a longtime smoker who has been diagnosed with COPD can come in with elevated heart rate, breathing fast, have a productive cough, and have a low oxygen level.”

She explains that congestive heart failure can also portray a similar picture, with patients having shortness of breath, elevated heart rate, and mottled skin, which are signs of sepsis too. But in these cases, patients don’t need treatment for an infection. They need breathing support and medications to control their heart rate.

For this reason, doctors don’t make a diagnosis of sepsis on the basis of physical symptoms alone. Along with symptoms, they also use results from blood tests and other laboratory tests.

When you arrive at the hospital, it’s important that you mention any recent infections you’ve had. This information can be helpful as your doctor examines you for sepsis or another condition.

Tests to help diagnose sepsis include:

1. Blood Test

If your doctor suspects sepsis, you may need a blood test to make a diagnosis. This also helps your doctor rule out conditions that can cause similar symptoms. Blood tests include: (8)

Complete Blood Count (CBC) This test evaluates the number of white cells in your bloodstream. These cells help your body fight off bacteria, viruses, and other germs that invade your system. A high white blood cell count can indicate an infection somewhere in your body.

Lactate This test measures the level of lactic acid in your blood. This acid is created by your muscle cells and red blood cells, and it’s used as an energy source when your oxygen level is low. Higher levels of lactic acid can indicate a severe infection.

C-Reactive This protein is produced by the liver, and it’s a marker for inflammation. Levels of C-reactive protein increase when there’s inflammation throughout the body.

Blood Culture Samples of blood may be taken from your veins and sent to a lab to look for a bacterial or fungal infection circulating in your bloodstream.

2. Other Laboratory Tests

If results from the above tests point to sepsis, you’ll begin treatment with a broad-spectrum antibiotic to stop an infection, and you’ll receive intravenous fluids to increase your blood pressure.

After starting you on treatment, your doctor may conduct other tests, too. This includes an endotoxin to check for bacteria in the bloodstream, or a test to check your level of the protein procalcitonin.

Higher levels of procalcitonin occur with a bacterial infection. If you have a low level of this protein, this tells your doctor that your infection is likely due to a virus and not bacteria. (8)

3. Tests to Determine Underlying Infection

Of course, it isn’t enough to diagnose sepsis. If you haven’t been previously treated for an infection, treatment will also involve determining the type of infection that led to sepsis.

Sepsis is a complication of different types of infections, although urinary tract infection and pneumonia are common infections that trigger the condition, explains Dr. Brown.

You may need one or more of the following tests to identify the underlying infection: (8)

Urinalysis You’ll provide a urine sample that your doctor uses to check for urinary tract infections, kidney infections, and other problems with kidney function. If you have an infection, a urine culture can help your doctor determine whether the infection is caused by bacteria or another organism.

Chest X-Ray Untreated pneumonia (or pneumonia that didn’t respond to antibiotics) can progress into sepsis. To diagnose pneumonia, your doctor will order a chest X-ray to check for inflammation around your lungs.

Pulse Oximetry Measures the oxygen level in your blood and helps evaluate lung function.

Sputum Culture Test Examines a sample of your sputum (mucus) to identify the bacteria, virus, or fungus that causes an infection.

Other Imaging Tests A computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan looks for signs of infection throughout the body. For example, they may note swelling or inflammation in your head on a brain MRI, which could be a sign of meningitis. Your doctor can also diagnose meningitis by removing a sample of cerebrospinal fluid with a lumbar puncture procedure.

Throat Culture To confirm or rule out strep throat as the underlying infection, your doctor may swab the back of your throat and check this sample for the strep bacteria.

Skin Culture If you have an open wound, secretion from the wound or a skin sample can help diagnose cellulitis, staphylococcus aureus (MRSA), or another skin infection.

Stool Tests To help your doctor look for infection in the gastrointestinal tract, you may be asked to provide a sample of your stool for testing.

Although sepsis is serious, most people recover from mild sepsis. Recovery is also possible with severe sepsis. But unfortunately, about 30 percent of people diagnosed with severe sepsis do not survive. (2) Among those who survive, about 50 percent deal with long-term effects of the illness, such as insomnia, muscle or joint pain, fatigue, decreased cognitive function, and poor concentration. (9)

Because it takes time for the immune system to strengthen after sepsis, there’s also the risk of recurrence. Be mindful of signs of a setback and contact your doctor right away if you are not feeling well.