Rohan Krishnappa does not cry. The boisterous and hyperactive 9-year-old of Bangalore is known for braving pain and regaling his friends with tales about his scars.
He didn't shed a single tear when he fell down from his cycle and got a nasty wound. But two days later, things got out of hand. Rohan cried in pain as the wound got infected and was oozing pus. The next day, he couldn't lift his right arm because of intense pain and, by evening, he became breathless, was drowsy and had fever.
A trip to the local hospital confirmed that Rohan had septicaemia. "His infection spread from the wound to his shoulder, lungs and brain," says Rohan's physician Dr Sanjeeva G.N., assistant professor, department of paediatrics, Indira Gandhi Institute of Child Health, Bangalore. "His blood grew a dreaded organism called MRSA (Methicillin-resistant Staphylococcus aureus)." Rohan recovered after being treated with antibiotics, surgery to drain pus from shoulder joint, ventilator support and intensive care for one month.
Scrapes, cuts, bruises, stings, bites... the list of everyday injuries is endless.
An infected wound, if left untreated, can lead to septicaemia or blood poisoning. "Septicaemia is an array of clinical manifestations termed as Systemic Inflammatory Response Syndrome (SIRS). It develops as a complication of localised infection and spreads to various organs through the blood stream," explains Sanjeeva. Untreated septicaemia can cause multi-organ dysfunction and even death as the immune system succumbs to it. In India, approximately 36 patients die an hour due to septicaemia.
Sometimes septicaemia can occur without any external wounds. Even a urinary tract infection can lead to the condition. Pregnant women, patients having post-operative infections or hepatitis compounded with anaemia and a decreased immune reserve can be at a higher risk of developing sepsis.
One of the recent septicaemia deaths that made headlines was that of Savita Halappanavar. The Irish dentist of Indian origin died four days after the dead baby in her womb was removed. "In Savita's case, the membrane had ruptured and she was leaking. Then the infection from the vagina crept inside and spread to the rest of the body," says Dr Kamini Rao, gynaecologist and infertility specialist, Bangalore Assisted Conception Centre, Bangalore. "The placenta occupies a large area. The infections can spread through the open blood vessels in the placenta to the rest of the body."
Extremes of age can increase the risk of sepsis, says Dr Satish Koul, internal medicine expert at Columbia Asia Hospital, Gurgaon. "Infections in newborns, especially pre-terms and the elderly, need to be treated very carefully, lest it develops into sepsis," he says.
Somesh Sharma of Gurgaon had some anxious moments when his dad Madan Lal Sharma, 75, was diagnosed with urosepsis because of a prostate problem. “He had high fever and loss of appetite. His temperature would go up to 104 degrees Celsius,” says Somesh. Madan Lal had diabetes, which also aggravated because of sepsis. He recovered after vigorous treatment for five days.
People with poor immunity like HIV patients, those receiving chemotherapy and long-term steroid therapy also may easily develop complications due to untreated wounds and infections. Those on anti-microbial therapy for longer duration, malnourished children, people having chronic diseases like diabetes and kidney failure are also in the high-risk group.
Proper management of open wounds can help prevent septicaemia. Antibiotic therapy and supportive measures, including intensive care, may be required in some cases. New diagnostic tools, which offer much hope, include XCyton's Syndrome Evaluation System (SES) that helps identify the root cause of an infection. "It allows for the accurate identification of 18 species of bacteria and fungi in seven hours from a single sample. SES facilitates early initiation of appropriate therapy and reduction of death and disability," says Dr B. Ravikumar, managing director of XCyton Diagnostics Pvt. Ltd, Bangalore.
But there are challenges in the prevention and treatment of septicaemia. "Due to rampant irrational use of antibiotics, bugs are acquiring resistance to available antibiotic drugs," says Sanjeeva. "These resistant organisms are increasingly becoming difficult to treat."
Classic symptoms of septicaemia
* Fever or low body temperature
* Variation in leucocyte count
* High pulse rate
* Difficulty in breathing
* Low blood pressure
* Excessive irritability
* Altered mental status including confusion, agitation, lethargy, obtundation or coma
* Petechiae (red skin patch due to bleeding under the skin).
* Bleeding from multiple sites