Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
11 April 2007

WHAT IS SEPTICEMIA?

            A lady 76-years of age with known diabetes came to the hospital emergency room saying she was “sick all over” and that she had a high fever.  She said she had felt well all day with no unusual activity but began to have chills and fever in the early evening.  She did not want to eat supper and went to bed early.  After sleeping an hour or so, she awakened shivering feeling very cold but with a fever of 102.5^o F.  She said she was so sick she came on to the emergency room.  There various blood tests showed she likely had a bacterial infection in her blood.  Most commonly such a bacterial infection in the blood of an elderly adult comes from pneumonia, a urinary tract infection, or a problem with the bowel.  X-ray of her chest did not suggest pneumonia.  She had a normal urine test and there was no abnormality on examination of her abdomen.  Thus, there was no clue as to where her infection might be coming from.  She was admitted to the hospital and antibiotics were administered intravenously for several days.

            Her hospital course was one of steady improvement.  Her fever resolved by the second day and she felt much better.  By that time her blood cultures that were done on admission had grown a kind of bacteria called E. coli and the next day the antibiotic sensitivity of the bacteria was determined.  Fortunately, the bacteria in her blood were sensitive to the antibiotic she had started three days earlier.  She recovered without incident and went home on the fourth hospital day.

            She and especially her family wanted to know what had been wrong and why she got sick.  They were told she had “septicemia” and then they wanted to know what is “septicemia”.   Septic means contaminated with an infectious agent-like bacteria.  The suffix “-emia” means “in the blood”.  So “septic-emia” means there is an infectious agent in the blood.  I explained that normally there are no bacteria in blood.  But if we brush our teeth or strain with a bowel movement or do other strenuous activities, bacteria can get into our blood. Normally when this happens our body defenses quickly remove any bacteria and we do not get sick.  But in some unusual situations our defenses cannot clear the bacteria from our blood and they begin to grow very rapidly.  When this occurs, the person is said to have septicemia.

            The family then asked why she had to be in the hospital and for so long.  I explained that septicemia is highly likely to be fatal left untreated.  Since nausea/vomiting commonly occur with septicemia, giving a medication by mouth is not reliable and the antibiotic had to be given intravenously.  In addition, the offending bacteria cannot be known with certainty when the person is admitted, so the choice of which antibiotic to use is somewhat of a guess.  Monitoring the patient’s response is needed until the offending bacteria are isolated and its antibiotic sensitivities are known. Then by the third or fourth day, the person can be discharged if they are recovering. 

            The family was told that while this lady’s course was uncomplicated, septicemia sometimes comes with devastating complications.    Standard South Dakota male behavior (and some South Dakota female behavior) requires that they do not seek medical attention until they are “really sick” (litterly translated: near dead).  By that time the bacterial count in their blood has reached very high levels.  Bacteria make poisons that kill body cells and the more bacteria the more poisons.  The longer the person waits to get medical attention the more organ damage occurs and the sicker they get.  If the person waits too long, body organs can be damaged in a condition called “severe sepsis” which carries a significant mortality.  The step past that is called “septic shock” and carries a major mortality.   Good Rule: “High fevers in an adult need attention NOW!!”  Fortunately, this diabetic lady had been warned about high fevers and came in to be evaluated right away.         

            Several weeks after she was discharged from the hospital, an evaluation to determine the source of her septicemia was carried out.  Because her chest X-ray and urine were both normal on admission there was no reason to pursue these areas further.  However, because the bacteria in her blood were common bowel inhabitants, colonoscopy was carried out and demonstrated a cancer in her colon.  Cancer of the colon is a known possible cause of septicemia.  Fortunately, the cancer was at an early stage and could be completely removed.  Strange to say, her case of septicemia saved her from a cancer, because the septicemia made her get checked with a colonoscopy, something she had refused to do previously.