SMALL SCRATCH AND A QUICK DEATH

... and ig­no­rance of the in­fec­tion is killing mil­lions

Daily Dispatch - - FRONT PAGE - MICHAEL J PORTER Michael J Porter is a lec­turer in molec­u­lar ge­net­ics at the Univer­sity of Cen­tral Lan­cashire. This ar­ti­cle is from The Con­ver­sa­tion

Most peo­ple are un­aware of just how fast sep­sis can take hold of their body, and kill them.

It’s im­por­tant to ask if you might have picked up deadly virus or bac­te­ria

A visit to fam­ily for Christ­mas in 2015 nearly had a tragic end­ing for me. Two days ear­lier I had been re­pair­ing the lock on my gar­den gate, when I scratched my hand on a nail.

By the time I ar­rived at our hol­i­day des­ti­na­tion I was feel­ing un­well. Twenty-four hours later I was in hos­pi­tal in Glas­gow in a coma. I had de­vel­oped sep­sis. My fam­ily were told that I had al­most no chance of sur­viv­ing the night.

I woke from my coma three months later and spent an­other year get­ting back to full health. I’m one of the lucky ones. Sep­sis af­fects more than 30-mil­lion peo­ple a year world­wide and kills an es­ti­mated six mil­lion peo­ple, of whom nearly two mil­lion are chil­dren. Of those who do sur­vive, 40% will have post-sep­sis syn­drome, which leaves them with last­ing phys­i­cal and men­tal symp­toms.

Sep­sis starts with a vi­ral or bac­te­rial in­fec­tion, usu­ally of the lungs, ab­domen or uri­nary tract, but it can also be­gin in a whole host of other ways, in­clud­ing a scratch (as hap­pened in my case) or a bite.

It’s not the bug that causes the po­ten­tially life-threat­en­ing con­di­tion, how­ever, it’s the body’s re­sponse to the in­fec­tion. A com­plex cas­cade of events is trig­gered to fight an in­fec­tion – in sep­sis, this process be­comes un­con­trolled, rapidly ac­cel­er­at­ing and re­sult­ing in the fail­ure of vi­tal or­gans in the body, in­clud­ing the kid­neys, heart and lungs.

Like a match be­ing lit, a tiny spark at one end of the match head spreads out rapidly, the flame grows quickly and the match is de­stroyed by the flame, un­less it’s blown out in time. The “flame” of sep­sis in a body moves very quickly, and if my brother had not spot­ted those crit­i­cal signs in time, or my treat­ment in the hos­pi­tal had been de­layed by even an hour, I would have died.

Sep­sis symp­toms can in­clude pale and mot­tled skin, se­vere breath­less­ness, se­vere shiv­er­ing or se­vere mus­cle pain, not uri­nat­ing all day, nau­sea or vom­it­ing.

If you or some­one you know has one or more of these symp­toms, you should call the emer­gency ser­vices im­me­di­ately and ask: “Could it be sep­sis?”

Any­one can get sep­sis, although re­search sug­gests that peo­ple with a vi­ta­min D de­fi­ciency have a higher risk of con­tract­ing sep­sis than most. Vi­ta­min D de­fi­ciency has also been linked to an in­creased risk of get­ting an in­fec­tion, which may then cause sep­sis.

Un­for­tu­nately, while it may be pos­si­ble to treat the orig­i­nal in­fec­tion with an­tibi­otics, there is no spe­cific cure for sep­sis – only the symp­toms can be treated.

New re­search, how­ever, shows that met­formin, a drug used to treat type 2 di­a­betes, can re­duce the im­pact of sep­sis by lim­it­ing the body’s im­mune re­ac­tion and pro­tect­ing it from dam­age by free rad­i­cals (oxy­gen-rich mol­e­cules that can dam­age cells).

Other promis­ing re­search sug­gests that gene ther­apy may prove im­por­tant in tack­ling sep­sis, by tar­get­ing a pro­tein pro­duced in the body called NF-kB, which mal­func­tions dur­ing sep­sis.

If suc­cess­ful, these and other treat­ments in de­vel­op­ment have the po­ten­tial to save lives and re­duce the long-term im­pact of the dis­ease on sur­vivors.

The lat­est re­search seems promis­ing, but the great­est de­fence we have against sep­sis is aware­ness of the con­di­tion in med­i­cal pro­fes­sion­als and the pub­lic.

But at the mo­ment aware­ness is alarm­ingly low across the world.

Sur­veys sug­gest that only 40% of peo­ple in Aus­tralia have heard of sep­sis and only onethird of this group are able to iden­tify a sin­gle symp­tom. Fig­ures are even lower in Brazil where only 14% of the pub­lic know what it is. And, although cam­paign­ing in the UK and Ger­many has cre­ated an aware­ness in over 60% of peo­ple, knowl­edge of the warn­ing signs is still lim­ited.

As you’d ex­pect, aware­ness is higher among health­care pro­fes­sion­als – but there is a need for greater ed­u­ca­tion within this group. A def­i­nite di­ag­no­sis is of­ten dif­fi­cult, and ef­forts are be­ing made to es­tab­lish clear guid­ance for health­care work­ers across the world, in­clud­ing the roll-out of an in­ter­na­tion­ally recog­nised pro­to­col called Sep­sis6.

With time, sci­en­tific re­search may pro­vide new treat­ments – but in the short-term, greater aware­ness of the con­di­tion among the pub­lic and med­i­cal pro­fes­sion­als is likely to have the big­gest ef­fect on sav­ing lives and min­imis­ing harm. So al­ways ask: “Could it be sep­sis?”

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