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Melanie Cole (Host): Mortality rates from sepsis are higher than heart attack, stroke, or trauma. Sepsis needs to be viewed with the same urgency as these other life-threatening conditions because we know early treatment can decrease mortality. My guest today is Dr. William Johnson. He's a pulmonologist with Nebraska Pulmonary Specialties. Welcome to the show, Dr. Johnson. Tell the listeners, what is sepsis and why someone should be concerned about it?

Dr. William Johnson (Guest): Well, sepsis is a reaction that your body has to an infection. The term itself is really a syndrome, I guess, as people can look at it, and it's your body's inflammatory reaction that occurs where a number of chemicals are released into the bloodstream. And, if you think of what it feels like to be sick and hot feeling you get, and the redness, and the lightheadedness that you get, those are all responses that these inflammatory chemicals create. Unfortunately, it can create such a severe syndrome that it causes organ failure and people become very, very ill. And, I guess the reason I think that we feel that we should be concerned about it is in today's world of medicine, unfortunately, sepsis seems to be rising yet, at the same time, we feel like if we can intervene early and treat it appropriately, that life can be saved.

Melanie: So, this is an infection and an inflammatory condition. What causes it and can it arise from even the smallest seemingly benign kind of scrape?

Dr. Johnson: Sure. Any infection, actually, can cause sepsis, it's more if the infection becomes significant enough that it can create a systemic response to that infection. So, pneumonia is a very common one. You think of people who might have appendicitis. They can develop what we call sepsis from even a urinary tract infection. Unfortunately, even things such as a skin infection can cause sepsis and, as it cascades into this overwhelming syndrome, people can actually die of that.

Melanie: Are there certain people who are higher risk for sepsis?

Dr. Johnson: Yes, and I think that that's probably part of the reason why we're running into more trouble with sepsis is our population in the United States, in some respects, is aging. As physicians, we like to think that we have something to do with that. We hope that we're keeping people healthy longer, but there are also other illnesses like cancer and some of the autoimmune connective tissue diseases like rheumatoid arthritis where newer and newer drugs come out and, unfortunately, some of those drugs create a problem with your immune system and your own immune system isn't as good and so, for those reasons, people are at higher risk for sepsis.

Melanie: So, do we have to worry about this only if our loved ones are in the hospital? Or just, I mean--because I don't want people to panic if somebody, their child gets a scrape at the park--what should we look for? What are some of the symptoms that we need to be mindful of so that we can get timely, appropriate attention?

Dr. Johnson: I think we all have gone through those types of illnesses that you get at home that maybe you stop and think to yourself, “Okay, this has lasted long enough that I need to go see my doctor,” but I think certainly any type of infection that seems to be more severe than what you think it should be or is not responding to the therapy that you're getting that you think you should be responding to. And then, there are the classic symptoms: a person who’s having fevers, or localizing signs like abdominal pain, or shortness of breath. Those are easy ones, but some people in sepsis, their symptoms can be subtle--even just a change in their mental status, and lethargy, those are the kind of things that people should watch for.

Melanie: Does it move quickly?

Dr. Johnson: It can and, in fact, that's part of the reason that we pay so much attention to it and, certainly, in a hospital setting we even have come up with the concept of sepsis alerts so that we can intervene more quickly and, hopefully, change the outcome.

Melanie: So, if we notice some of these symptoms, or we start to get that innate feeling that you described, what are the treatments and is this an emergency situation to where you call the emergency room and you mention, “I think they might have sepsis”?

Dr. Johnson: I think going back, you know, obviously common sense plays a role, but obviously, boy, when people put things off too long, and, in a timely way get health care, then mortality rates increase, and so, we're putting a major emphasis on early detection of sepsis and getting yourself involved in the health care system, whether that means going to your doctor's office, going to the emergency room, going to an urgent care setting, in order to get care so that you can be evaluated is important, if you think that this could be happening.

Melanie: And, what are the treatments that you provide?

Dr. Johnson: So, in a hospital setting, obviously, antibiotics aimed at what you think the source of infection is, is the first line of therapy. People who have severe sepsis, they can get what we call “vascular collapse”, which is they form a what you would call "septic shock", and in that situation, a person's blood pressure drops and we have to give them fluids in order to keep their blood pressure up even sometimes certain types of medications that help maintain that blood pressure. People can become so critically ill they end up in an intensive care unit and it can move, as you mentioned, very rapidly, so timely intervention is extremely important.

Melanie: And then, is this something that is ongoing? Once you've dealt with it, as a physician, and you've gotten to the root of whatever it was that caused it, wherever the infection was, is this something that then needs to be watched over time? Or, once you've kind of worked on it with those antibiotics and whatever treatment, then it is not something you worry about?

Dr. Johnson: I think that once a person has an episode of sepsis, they're probably going to be more cognizant of those symptoms so that it doesn't happen again. There are some people who, because of their underlying medical illnesses or "comorbidities" that they might be prone to sepsis. We would hope that sepsis--because by definition it's an infection--we would hope that this is something that could be curable and in today's day of technology, we would hope that we should be able to alter the outcome in this type of disease for the betterment of our patients so that they don't have these severe illnesses and potentially die of this illness. We should have the ability to avoid that.

Melanie: So, wrap it up for us with sepsis, Dr. Johnson, and what you really want people to know about the importance of recognizing sepsis for what it is at the time and getting treatment very quickly.

Dr. Johnson: I think the best way of putting it is that there's an awful lot of attention given to this all the way up the health care ladder and the Society of Critical Care medicine has put out what is called a "surviving sepsis campaign" and it's reached a point where all hospitals are looking at this to look at ways that we can benefit sepsis. It's been identified that early recognition, early treatment can alter the outcome of this and so we want our patients to recognize it early, too, because we can't necessarily force people into the health care system, we rely on them to come to us. In a hospital, we do our best to try to recognize those people who are at risk for it and identify those patients who are developing it but, certainly, patients at home, if you feel you're getting an infection and you're getting ill and it's not going away the way you think it should, seek health care early so that we can hopefully make a difference in your lives.

Melanie: Thank you so much, Dr. Johnson, for being with us. Such important information. Thanks again for being with us. You're listening to Bryan Health Radio and for more information about sepsis, you can go to sepsis.org. That's sepsis.org. This is Melanie Cole. Thanks so much for listening.