Janet Ogundepo
Medical practitioners in the field of surgery have again reminded Nigerians of the need for prompt and proper treatment of infections to prevent the onset of a life-threatening syndrome known as sepsis.
The surgeons noted that once infections are not properly diagnosed and promptly treated, the body’s immune system could begin to have an extreme reaction to the infection-causing organism by damaging its tissues, consequently leading to septic shock.
The World Health Organisation notes that once the body’s reaction causes damage to its tissues, it could lead to shock, multiple organ failure and sometimes death if not recognised early and promptly treated.
The WHO states that sepsis is one of the most frequent causes of death worldwide, noting that about 20 million of all estimated cases occurred in children under the age of five.
The health agency further asserted that although there were challenges in collecting reliable data, in 2020, there were 48.9 million cases and 11 million sepsis-related deaths worldwide.
It added that sepsis could affect any individual but the highest incidence rates occurred in lower-middle-income countries.
Pregnant women, children, older persons and people with health conditions are at a higher risk of sepsis.
The experts, who spoke to PUNCH Healthwise, urged malnourished individuals to improve their nutrition and persons with suppressed immunities to adhere to their drug regimen.
Speaking with PUNCH Healthwise, a professor of General Surgery at the Bayelsa Medical University, Bayelsa State, Paingha Alagoa, stated that sepsis was a serious condition in which the body’s protective mechanisms results in inflammation and damage of tissues and could be caused by bacteria, viruses, fungi or parasites.
Prof Paingha Alagoa
He explained that increased or decreased temperature, increased heart and respiratory rate, and an increase in white blood cells were clinical signs of sepsis.
The researcher on breast and abdominal surgery noted that age, malnutrition, and infections were some predisposing factors for sepsis.
“Sepsis is commoner in the extremes of life. In infants and neonates when the immune system is not fully developed and in the elderly when it also is reduced in efficacy. Also, malnutrition is a major predisposition because the malnourished have low levels of immunity and may not be able to contain infections.
“Infections such as bacterial, fungal, viral and other infections particularly in the presence of malnutrition and other factors like immune suppression as it occurs in HIV/AIDS, tuberculosis and others,” Alagoa said.
The Deputy Vice-Chancellor Administration at BMU further noted some invasive procedures such as intravenous catheterisation and urethral catheterisation could lead to sepsis.
He asserted that persons with noncommunicable diseases such as diabetes, and kidney and liver diseases were at risk of sepsis.
The don added, “Severe trauma such as burns in which the covering protective skin is removed and also a reduction in immunity, other kinds of severe injury, particularly with destruction of tissues and infection. Also, chronic illnesses such as kidney disease, liver disease and diabetes were at risk of sepsis.”
Alagoa also corrected the notion that sepsis usually occurred after surgery, noting that immune suppression, malnutrition and unsafe abortions could trigger sepsis.
Speaking on measures to prevent sepsis, the surgeon advised that persons on chronic steroid treatment were closely managed and symptoms of infections promptly treated.
He urged Nigerians to promptly and properly treat all infections, advising individuals who have undergone surgical procedures to ensure they adhere to the prescribed antibiotics.
The don encouraged persons living with Human Immunodeficiency Virus and other immunity-suppressing conditions to adhere to their drug regimen and eat a balanced diet to prevent malnutrition.
Prof Mobolaji Oludara
Also, a professor of General Surgery at the College of Medicine, Lagos State University, Ojo, Mobolaji Oludara, explained that sepsis is the body’s inflammatory response to a severe infection and not a primary disease on its own.
He noted that sepsis emanates from a severe infection that evokes a systemic inflammatory response syndrome, SIRS, causing septic shock and damage to multiple organs including the kidneys, lungs, and liver.
The professor clarified that while most surgical procedures create wounds in a patient’s body, which might get infected, they are not the only cause of sepsis.
The researcher on Laparoscopic Surgery said, “Any infection whatsoever from any part of the body could be the initiating problem. It could be in the middle ear (otitis media), maybe the sinuses, or a chest infection or pneumonia that is not properly managed and thus progresses.
“It might be a collection of pus in the chest cavity, which we call empyema. It might be abdominal conditions, for example, intra-abdominal abscesses, disease of the colon where there’s an ongoing inflammation. (Diverticulitis, Appendicitis) Disease of the gallbladder, (Cholecystitis) and pancreas (Pancreatitis with pancreatic abscesses). These are all examples of possible diseases with an infection that can progress to become systemic, leading to the “sepsis response.”
“Of course, it could also occur when there’s a urinary tract infection, which now progresses to what we call urosepsis. Also, for patients who have gynaecological conditions, either from unsafe abortion or post-delivery, (in the postpartum period). In that period we call the puperium, it is referred to as puperial sepsis. So any part of the body where infection occurs, and it is not quickly, adequately or comprehensively managed can lead to the development of a systemic infection and sepsis response.”
The professor of surgical gastroenterology, endocrinology and breast surgery decried the late hospital-seeking behaviour of many Nigerians, stating that most report to the hospital when infections have deeply affected them.
Oludara added that individuals with compromised immune systems, due to conditions such as multiple chronic diseases, HIV infection or those on immunosuppressive drugs, could develop sepsis-like conditions even without an initiating focus of infection.
The general surgeon noted that sepsis could affect people of any age, but it is more common in the older age group due to their reduced immunity and other underlying chronic conditions, such as diabetes, and other non-communicable diseases.
He noted that individuals who have undergone an unsafe abortion are at risk of severe infection and sepsis.
The don, a former Dean of the clinical science faculty at LASU, stated that since surgical procedures create wounds, surgeons immediately need to work and prevent escalation of infection that can lead to sepsis by the use of prophylactic antibiotics, good surgical and safe operating theatre techniques
“Things that can easily lead to the kind of infection that will progress to sepsis should be nipped in the bud.
“We know that sepsis can lead to septic shock, in which case the blood pressure falls, patients become sweaty, develop fever, fast heart rate, poor perfusion of vital organs (brain and heart) and develop poor urinary output, with the attendant collapse of organ functions. So these are the issues to take note of which will remind the doctor and the people generally that any infection, no matter how relatively simple it may be, is a potential focus and if not properly managed can lead to the development of sepsis,” the General surgeon said.
He added that the major culprits are bacterial infection, both aerobes and anaerobes. Rarely other germs have been incriminated like viruses, fungi and parasites.
Oludara, who is also a former Ag Provost of LASUCOM, advised that infections be treated promptly by certified healthcare personnel, warning that delayed or improper diagnosis and the use of inappropriate drugs could allow the disease organisms to fester.
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