The silent sepsis epidemic: The killer disease that strikes through tiny cuts


Last updated at 08:22 03 July 2007

When Sarah Roper felt a

bit feverish after going out

for a pizza, she thought it

might be the start of a

bout of 'flu and went to


The next morning

her skin felt clammy, she was shivering

and running a temperature.

Within a few hours Sarah, a 35-year-old

mother of two who was pregnant with a

third, had been rushed to hospital and was

in intensive care, fighting for her life.

An infection which causes nothing more

serious than a sore throat in the vast

majority of people had triggered a massive

over-reaction by her immune system:

instead of attacking the invader, it turned

on all her major organs. Within days of

falling ill, she had died.

Sarah was the victim of sepsis which kills

30,000 people a year in the UK — more than

from prostate and breast cancer combined.

Quite apart from the personal tragedies, the

illness also costs the NHS £400million

a year.

"It's really a hidden epidemic," says

Professor Jon Cohen, an infectious disease

specialist at Brighton and Sussex medical

school, who treated Sarah.

"Few outside the

medical profession understand it or even

know about it, but it's the third most common

cause of death for hospitalised

patients in the developed world, behind

heart disease and cancer."

Sepsis is actually an old enemy that was

once thought beaten but is now back with a

vengeance and stalking the wards of the

most modern hospitals. What's allowed it

back in, ironically, is the very success at

saving lives that has made modern

medicine such a triumph.

Sarah's life-and-death struggle would

have been familiar to a Victorian surgeon in

a military hospital or a maternity ward.

Back then, women in childbirth and soldiers

with infected wounds died in their millions

from 'blood poisoning' — what we now call

severe sepsis or septic shock — their vital

organs destroyed from within.

But unlike

their Victorian counterparts, modern

doctors understand rather more about this

deadly syndrome.

It happens when an infection in the

bloodstream (sepsis) tips the immune system

out of balance, and the normally precisely regulated cascade of

responses goes haywire. Then,

like a demented robot, the

immune system begins attacking

the body it is designed to protect.

Many infections

can potentially

trigger sepsis, but

speedy treatment

with the right

antibiotic can prevent it turning

into serious sepsis. Those most

at risk include the elderly,

patients who've had organ transplants

and those who've had

chemotherapy for cancer.

"To some extent, we are a victim

of our own success," says Prof.

Cohen. "Many of the patients in

intensive care have damaged or

suppressed immune systems,

which makes it harder for them

to fight off the sort of infections

that, unfortunately, they can now

pick up in hospital."

But what happened to Sarah

Roper is an example of what

many experts consider a much

more alarming development.

While the deaths of the very sick

and elderly in hospital are not

unexpected, what we don't

expect these days is for the

young and fit such as Sarah to be

plunged into life-threatening

sepsis within 24 hours — especially,

as is sometimes the case,

as the result of a small scratch.

The cause is a new wave of

infections called community-acquired

MRSA — a form of

MRSA found, as the name suggests,

not in hospitals but in the

general population.

It can enter the body through a

cut or wound — any kind of

break in the skin. In the UK, at

least a hundred such cases of

community-acquired MRSA

have been reported — most of

them with a particularly toxic

strain known as PVL which has

killed at least one person.

According to Dr Mark

Enwright, an infection expert at

Imperial College, London, numbers

affected are likely to rise. "We

are in the early stages of an epidemic

but this is moving very

fast," he says.

Marina Morgan, a microbiologist

at Royal Devon and Exeter

Hospital, believes that people

who contract these new

community-acquired infections

are more likely to end up with

organ failure in intensive care

than those who have picked up

MRSA in hospital because doctors

are still unfamiliar with the

former kind.

"Infections with these superbugs

are more likely to progress

to toxic shock because doctors

are not yet looking for them," she


"Faced with early signs of

such an infections, a GP would

most likely prescribe a standard

antibiotic which won't be strong

enough. By the time the real culprit

is identified, it could well

have triggered the cascade

leading to toxic shock."

Of course, even severe sepsis is

survivable. Someone who went

through it and lived to tell the

tale is Lin Newcombe who lives

in Devon. The 54-year-old preschool

teacher scratched her

hand one day; she remembers

going to hospital the following

morning and then woke up in

intensive care 19 days later.

"I'd been playing with some

metal toy cars and caught my

finger on a rough corner. That

evening I felt pretty woozy. I had

a pain under my arm and a temperature.

I was in a haze the next

morning and I don't remember

much more until I woke up

almost three weeks later.

"I believe that the only reason I

pulled through was that my

doctor had given me 20 times the

normal does of an antibiotic

for the bacteria I'd picked up.

"They had to fight really hard to

save me. I'd gone into toxic

shock and they'd had to support

my organs one after another: I'd

had a hole in my neck to help

with breathing, dialysis for

my kidneys and a machine to

support my liver.

"I'm fine now, apart from

having some flesh cut away from

under one arm where the bug

had settled."

Experts such as Prof. Cohen

are now looking for a way to

prevent sepsis from developing

into a full-scale collapse.


cases like Sarah's, we can often

halt the infection with antibiotics

but if serious sepsis has

started we don't have a way of

stopping it," he says.

"Finding a drug to do that is a

huge challenge because the

system is so complicated.

"When your body comes under

attack from an infection, your

immune system mounts multilevel

defence. As with any army,

its actions have to be co-ordinated

by an efficient communications

system; that's the job of

dozens of powerful messenger

molecules called cytokines.

"When serious sepsis happens,

it's this cytokine signalling

system that spirals out of

control; some have called it a

'cytokine storm'."

One possible treatment is the

cholesterol-lowering drug statin.

"Some researchers noticed that

heart patients on statins were

less likely to develop sepsis,"

Prof. Cohen told an infectious

diseases conference in Munich


"It seems to be due to

the anti-inflammatory effects of

these drugs."

Further research, he suggests,

is needed. In the meantime,

what can the general public do?

The usual hygiene advice will

protect you. This means making

sure any wound is clean, and

covering breaks in the skin with

a plaster.

If there is any sign of

inflammation (reddened skin),

boils or skin eruptions, seek

medical advice.

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