Question

Could you say something about sepsis and ME? A friend of mine who has ME has been seriously ill in hospital with sepsis but is now back home again. The doctors say that she is going to need a prolonged period of recovery from the effects of sepsis. This has also caused a significant relapse of her ME. Are people with ME more at risk from developing sepsis if they just have a minor injury or infection? And is there anything we should be doing to reduce the risk of developing sepsis?

Answer

While there is no evidence to indicate that people with ME/CFS are more at risk of developing sepsis, possibly due to the way in which the immune system in ME/CFS may already be in an overactive state, it is likely to cause a significant and prolonged relapse of ME/CFS symptoms.

What is sepsis?

Sepsis, also known as blood poisoning or septicaemia, is a very serious life-threatening reaction to an infection. Almost any type of bacterial (and sometimes viral) infection can trigger sepsis – common ones include lung, kidney, skin and gastrointestinal infections. It happens when the body’s immune system overreacts to an infection and starts to damage the body’s own tissues and cause organ failure. Sometimes it’s very obvious that something serious is happening because of the rapid deterioration in health.

But sepsis can be hard to spot because it can also cause vague flu-like symptoms to start with. Sepsis is a real medical emergency – so it needs to be recognised and treated in hospital as soon as possible. Sadly, this is not always the case. If not, it can quickly turn into septic shock – where vital organs start to fail. Sepsis can happen to people who are otherwise fit and healthy.

Risk

Some groups are at a significantly increased risk of developing sepsis, in particular, those who:

• are over 65,
• have diabetes or kidney disease,
•  have a weakened immune system – from cancer, chemotherapy or an organ transplant,
• have recently had surgery or a serious illness,
• who have just given birth.

Symptoms of Sepsis

Sepsis can initially present like flu, gastroenteritis or a chest infection. There is no one diagnostic symptom or sign and symptoms present differently between adults and children. Even where the infection arises in a skin wound or infection, there may or may not be any obvious swelling, redness or pain around a cut or wound.

Signs of sepsis in adults and older children:

• Slurred speech or confusion,
• Extreme shivering, very high or low temperature, feeling very hot or cold to touch,
• Passing no urine during the day,
• Skin is pale, blue, blotchy, cold or clammy,
• Increased pulse rate and low blood pressure,
• Difficulty with breathing or fast breathing.

Signs of sepsis in children:

• Breathing very fast or with difficulty,
• Having a fit or convulsion,
• Skin looking mottled, blue or pale,
• Rash that does not fade when pressed with a glass,
• Very lethargic,
• Skin feels abnormally hot or cold to touch.

Signs of sepsis in children under 5:

• Not interested in normal activities,
• Not feeding,
• Vomiting repeatedly,
• Not passing any urine for 12 hours,
• Weak or high pitched cry.

If any of the above symptoms are present you need to seek urgent medical advice. If you are really worried dial 999 or go straight to casualty. NHS 111 can tell you what to do and call a doctor or ambulance if necessary.

Treatment

ACT FAST! The most important treatment is the urgent use of antibiotics – which should be given within an hour of sepsis being suspected – and admission to hospital. Once in hospital, treatment may need to continue in an intensive care unit, possibly including ventilation and surgery to remove infected skin tissue.

Recovery

Fortunately, most previously healthy people make a full recovery from sepsis but it can take time. In other cases people develop what is called a more prolonged post-sepsis syndrome involving:

• Feeling tired and week,
• Sleep disturbances,
• Lack of appetite,
• Changes in mood – anxiety or depression.

This syndrome obviously has a considerable overlap with ME/CFS – which is why sepsis poses extra risks to people with ME/CFS. So people need to follow many of the basic aspects of ME/CFS management: pacing, good sleep management etc.

Prevention

To reduce the risk of developing sepsis:

• Keep up to date with tetanus vaccination,
• Carefully clean any skin wounds,
• Wash hands regularly.

Further information

• The NHS: Symptoms of sepsis and what to do if you are affected.
• The Sepsis Trust provides information and support for people recovering from sepsis.