Not infrequently, sepsis is triggered by bacteria such as pneumococci, the causative agents of pneumonia. Image: CDC / Dr. Richard Facklam
Read aloud Sepsis, also known as blood poisoning, is one of the leading causes of death in hospitals. Triggers are mostly bacteria that enter the bloodstream from an injury. Contrary to popular belief, however, external injuries are by no means the most common cause, but internal diseases. When the first symptoms appear, it means acting fast. Hardly any disease is as often misjudged as sepsis. And that, even though she is the third leading cause of death in Germany. Many still think that the so-called blood poisoning could only be triggered by open wounds. Sepsis is more often triggered by pneumonia or abdominal disease. What matters is an early diagnosis. And that's exactly the problem.

According to a survey by the University Hospital Jena, about 60, 000 people die from sepsis every year in Germany. This makes it one of the leading causes of death after heart attack and cancer; in ICUs even the most common. Still, most people think they just recognize blood poisoning with a red line on their skin. This wanders, as Astrid Lindgren describes it in "Michel from Lönneberga", from an open wound in the direction of the heart. In fact, a cut wound, as incurred by Michel's friend Alfred, is only one of many triggers for sepsis.

There are always pathogens behind blood poisoning, in 95 percent of the cases bacteria, more rarely fungi or parasites. Under normal circumstances, the immune system fights these pathogens and their toxins where they have attacked the body. So it comes to a local inflammation, for example in the lungs or on a wound. The pathogens do not get into the bloodstream thanks to the good defense. However, when the immune system is weakened or the bacteria are particularly aggressive, they can pass into the blood and spread throughout the body. Through a kind of snowball effect, new sources of inflammation develop everywhere in the body. In the worst case, this chain reaction can lead to severe sepsis and the failure of various organs within a few hours. On average, only about 60 percent of those affected survive this rampage of the immune system.

The earlier sepsis is detected, the greater the chances of defeating it. The problem: unlike a stroke or heart attack, there are no clear signs of disease. For malaise, fever, chills or confusion can also occur for many other reasons. As soon as these symptoms occur together, sepsis may be present. "Anyone who suffers from an infection and suddenly feels sick, confused and seriously affected is in the hospital, " explains Frank Brunkhorst, Senior Physician at the University Hospital Jena. In order to track down a sepsis, the doctors must draw the correct conclusions based on various signs of disease. display

Symptoms that indicate sepsis include increased heart rate, low blood pressure and accelerated breathing. In addition, the number of white blood cells may increase or decrease significantly. "Sepsis varies greatly from patient to patient, " says Brunkhorst. As secretary general of the German Sepsis Society, he recommends to carry out another blood test in case of a suspected sepsis: Based on the concentration of the thyroid hormone procalcitonin, the diagnosis "sepsis" can be confirmed. However, this blood value may also be elevated after a major surgery or shock without actually having sepsis.

Once the treating physicians have recognized sepsis as such, every hour counts. "The effective use of time is the cheapest sepsis drug we have, " says Stefan Hofer of the Anaesthesiological University Hospital Heidelberg. The sooner the patient receives the first antibiotics, the better they fight the bacteria. At the same time, the physicians need to find out where in the body the inflammatory focus lies. For example, an inflamed gallbladder is removed during surgery. But if pneumonia is the cause, not just the lungs can be taken out. In about ten percent of cases, the source of inflammation can not be located at all. Therefore, medics try to break the chain reaction in other ways.

"We always have to fight sepsis from different angles, " says Hofer. "There will never be a single miracle cure." Together with his team, he is researching a new treatment method. In doing so, the scientists are relying on an active ingredient that is already used for poisoning: Physostigmine inhibits the secretion of pro-inflammatory messengers and therefore also influences the septic chain reaction. As the researchers have so far only been able to show in mice, they will next year for the first time investigate whether physostigmine fights sepsis in humans. Whether the drug can prevail, will show up only after many more years.

ddp / - Larissa Kessner

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