Recently, there were patients who died from or required live-saving amputation as a result of septicaemia, suspected to be following injection for cosmetic treatment. Septicaemia is caused by presence of micro-organisms (such as bacteria, viruses or fungi) in the blood. When the organisms multiply into large number in the blood, the immune system of the patient develops a whole body inflammatory response, resulting in multi-organ dysfunction.
Micro-organisms can get into the blood stream due to spread of an infection that is already inside the body. Common causes being infections of the lungs, in abdominal organs or urinary tract. Direct injection into the body may also be another source of infection though this is uncommon and should be preventable with proper medical procedures.
The initial symptoms are usually abnormal body temperature (below 36° or above 38° C); rapid heart rate (over 90 / min) or respiratory rate (over 20 / min) or increased white cell count (<4x10 9/L or >12). Unless timely treatment can be started, patient will develop septic shock and dysfunction of multiple organs:
1. Heart failure and persistent low blood pressure despite fluid resuscitation;
2. Lung – low oxygen in arterial blood;
3. Brain – agitation, confusion or coma;
4. Acidosis
5. Liver – increase in bilirubin and liver enzymes; abnormal protein synthesis, e.g. clotting factors causing coagulopathy;
6. Kidney – decrease in urine output and electrolyte abnormalities.
Septicaemia is a dangerous condition with high mortality and morbidity. Timely diagnosis is critical so that the following treatment can commence:
1. Fluid replacement and drug for circulatory failure;
2. Treatment of infection by antibiotics and surgical drainage or removal of infected materials and tissues;
3. Support of organ dysfunctions, including artificial ventilation for respiratory failure, haemodialysis for renal failure and transfusion of blood products for coagulopathy;
4. Prevention of potential complications such as adequate nutrition, prevention of deep vein thrombosis and gastric ulcer.
The extremities may be involved in 2 ways. The infected limb may be the source of infection to start with. This may be in the form of foot infection in diabetic patients or rapidly developing infections such as necrotizing fasciitis or gas gangrene. Alternatively, the decrease in blood pressure due to the septicaemic shock may end up in gangrene of the tips of extremities. Timely amputation is an effective means to help in clearing the infection. Gangrenous tissues have no functional value and removal is also important because they are a rich soil for the bacteria to flourish.
Please note a potential confusion between septicaemia (敗血症) and scurvy (壞血病) because of the similarity between the Chinese names of these 2 conditions. Scurvy is caused by vitamin C deficiency and has nothing to do with infection although it is can also be a lethal disease. Vitamin C is a co-factor required for the synthesis of collagen which is an important constituent for the building of many tissues such as capillaries and bones. In early stage of scurvy, patients may suffer from malaise and lethargy. Then, they may develop bone pain and petechial haemorrhages under the skin, mucous membrane and gum. In late stages, there will be decrease urine output, neuropathy, and convulsion. Death used to be a problem in the old days before the cause of this disease was understood but is rare nowadays.
Dr. YEUNG, Sai-hung