Blood poisoning (sepsis)

Blood poisoning is an inflammatory reaction of the body. This can manifest itself in a variety of symptoms and strengths and, if left untreated, poses a host of dangers to the body. In the worst case, sepsis can even be fatal. In this article you will find all the important information about the types of blood poisoning, what symptoms they have and how blood poisoning is treated.

What is blood poisoning?

Blood poisoning is an inflammatory reaction of the body. It reacts to infections that spread with the blood throughout the body. Actually, this is not really poisoning, but an immune defense reaction of the body. Blood poisoning is not due to the presence of pathogens in the blood, but is the body’s reaction to the pathogens. Mostly bacteria are the specific causative agents, but viruses, fungal pathogens (Candida) or protozoa can also cause blood poisoning. With the defense reaction the immune system harms not only the pathogen itself, but also the body. Blood poisoning is considered a potentially life-threatening disease that must be treated quickly.

Simple sepsis

Simple sepsis is caused, for example, by respiratory diseases, dental abscesses or by stomach and intestinal infections, and affects about 80 people each year.000 people in Germany. In most cases, only medical treatment is necessary and not intensive care.

Severe sepsis

As soon as organs are hindered in their function by blood poisoning, it is a severe sepsis. Organs can fail due to blood clots, severely reduced blood pressure and also due to reactions to messenger substances in the body. The risk of dying from severe sepsis is relatively high and is around 47 percent.

Septic shock

Septic shock is the final stage of sepsis and occurs when blood pressure drops due to the body’s inflammatory response, which has not been sufficient to protect the body. The messenger substances of the immune system also dilate the vessels so that organs and body tissues can continue to be supplied with sufficient blood. However, this overwhelms the heart and blood pressure drops. This compromises the blood supply to vital organs and, in the worst case, leads to death.

Types of sepsis

Because sepsis can be caused by different things, there are different types of sepsis that manifest themselves differently and require different treatment. These are presented in more detail in the following sections.


Urosepsis is blood poisoning that originates in the genitourinary tract, such as the kidney or ureter. It is usually caused by toxigenic bacteria. Half of the cases can be traced back to Escherischia coli, or E. coli bacteria, and occur when urine outflow is disturbed, from germs that have entered during medical procedures, or from bacterial infections of the renal pelvis.

Puerperal sepsis

Puerperal sepsis is also colloquially referred to as puerperal or postpartum fever. It describes a bacterial infection that develops in the female reproductive tract during the puerperium and is caused by pathogenic germs that have entered the birth wounds. Such sepsis is favored by, among other things, vaginal and surgical delivery, cesarean section, frequent vaginal examinations, premature rupture of the membranes, retention of placental debris, or lochial congestion.

SIRS (Systemic Inflammatory Response Syndrome)

It is referred to as SIRS when the body has an inflammatory response but no causative agent can be detected. In order to treat SIRS, however, it is important to identify and stop the triggering factor. Possible causes include:

  • Injuries
  • Burns
  • Severe allergic reaction
  • Major organ damage
  • Organ Inflammation
  • Severe bleeding
  • Oxygen deficiency of tissue or organs

An elevated or low body temperature, increased pulse, increased respiratory rate, and a deviation of white blood cells in the blood from normal may indicate SIRS. In the treatment of SIRS, infusions and vasoconstrictive agents are used to try to stabilize the circulation.

Neonatal sepsis

Maternal immune protection is transmitted via the placenta and breast milk during the first month of life, as the newborn’s immune system is still developing during this time. In some cases, however, this is not enough and sepsis develops. A distinction is made between early and late sepsis, depending on when it occurs. In early sepsis, there is a high probability that the pathogen was transmitted by the mother during birth and appears in the first three days of life. If the newborn suffers from sepsis afterwards, it is called late sepsis. The most common pathogen is the bacterium Streptococcus agalactiae.

Neonatal sepsis can lead to life-threatening illness much more quickly. Therefore, the mother’s vagina is examined before birth for bacteria that could possibly endanger the child.

Sepsis in MRSA infection

MRSA stands for methicillin-resistant Staphylococcus aureus and describes a multi-resistant bacterium that is usually found in salt-rich areas of the body, such as on the skin and mucous membranes and the cilia of the nasal mucosa. Once these bacteria get into the bloodstream through infection, this can happen with injuries or medical procedures in the tissue, sepsis can then be triggered. Treatment is quite difficult, as common antibiotics do not help against such blood poisoning.


Landouzy is also called sepsis tuberculosa acutissima and is a fulminant, septic sequelae of tuberculosis. It occurs only very rarely and mostly only in patients suffering from primary tuberculosis. It affects only 1 to 2 percent of these patients. These suffer from severe immunodeficiency, which is associated with multiple organ failure and high mortality in septicemia.

Sepsis in candidiasis

Candidiasis is an infectious disease caused by yeast fungi, which belong to the Candida genus. These fungi affect the mucous membranes of the oral cavity, esophagus and vagina, respectively the mucous membranes of the whole body. Systemic candidiasis can cause sepsis and if it is not treated, advanced disease often leads to death.

Viral sepsis

Sometimes sepsis can be caused by a viral infection. Almost any virus can cause sepsis, but it happens enormously rarely. Possible types of viruses include dengue virus, influenza virus and Ebola virus.

Blood poisoning symptoms – how to recognize blood poisoning?

Direct recognition of sepsis is very difficult, especially in the early phase. Many complaints are unspecific and indicate other diseases. However, sepsis should be detected as early as possible, because the chances of recovery are higher that way.

In the early stages, certain changes may be observed – especially if these occur together, this provides further clues to possible sepsis. Possible symptoms in the early stages include:

  • Heated skin
  • Sometimes skin rash
  • Pale or gray skin
  • High fever above 38 degrees Celsius
  • Chills
  • Young and old sepsis patients are more likely to have a hypothermia below 36 degrees Celsius
  • Accelerated breathing, hyperventilation
  • Accelerated heartbeat, tachycardia
  • Confusion, poor general condition
  • High or low leukocyte level

In addition, the symptoms differ depending on the type of infection present. In the case of pneumonia, shortness of breath and/or purulent sputum may indicate sepsis, while in the case of a urinary tract infection, pain when urinating and/or a change in the odor of the urine may indicate sepsis. Furthermore, infections in the central nervous system, for example meningitis, cause severe headaches, sensitivity to light and torticollis, and abdominal infections, for example appendicitis, cause severe abdominal pain.

If the sepsis persists, the following symptoms continue to be decisive or are added to the first symptoms that appear:

  • Confusion
  • Rapid, throbbing pulse
  • Rapid breathing
  • Warm, reddened skin
  • Low blood pressure
  • Decreased urination

If the sepsis has not yet been treated, it is called progressive sepsis. In this case, the following symptoms may also occur:

  • Low body temperature
  • Difficult breathing
  • Cold, blotchy or blue skin, due to reduced blood circulation

Above all, the reduced blood circulation is enormously dangerous, because vital organs are also supplied with less blood and tissue can die off.

Blood poisoning causes – How to get blood poisoning?

In general, any infection can cause sepsis – but it doesn’t have to. Sepsis begins with a localized infection caused by bacteria, viruses or fungi, for example. The immune system starts a defense reaction and inflammation occurs. This means that the blood flow to the affected tissue is increased and the permeability of the blood vessels is thus increased. In this way, a large amount of leukocytes, white blood cells, can reach the site of infection and pass into the tissues. There they eliminate the pathogens and the destroyed cells.

However, these defenses are not always sufficient and the infection cannot be contained and eliminated at the point of origin. The pathogen then enters the bloodstream and spreads throughout the body. This is called bacteremia and by definition is not yet blood poisoning. Only as soon as these substances trigger a body-wide inflammatory reaction is it called blood poisoning.

The symptoms already described are related to the body-wide fight against the intruder. Because blood flow is altered and damage to vessels and tissues is triggered due to the pathogens, the blood clots more quickly. Due to the dilated vessels, the blood pressure drops and the signs of inflammation in the blood experience a drastic increase. Breathing and heart rates increase as the heart and lungs try to compensate for the lack of return flow and oxygen.

Blood poisoning – who is particularly at risk?

Blood poisoning is considered very dangerous in itself, but it can affect some groups particularly severely. In the next sections, the elderly, children and pregnant women groups are presented. Apart from these three groups, people with weakened immune systems and those suffering from addiction are also particularly at risk.

Sepsis in the elderly

In the elderly, it is difficult to diagnose infection because fever is less common in old age and older people also have a less pronounced increase in temperature compared to young adults. Fever can also be absent completely in blood poisoning. Even when sepsis is recognized, the fight for survival is often very strenuous and in most cases is not without health consequences.

Sepsis in children

In Germany, an average of 10.000 children suffer from blood poisoning and in the early stages, blood poisoning looks more like a cold. Mostly children get sepsis in the hospital, because the dangerous hospital germs easily attack weakened patients and premature babies. Often sepsis is also caused by an injury or a purulent inflammation. Therefore it is important to disinfect wounds in children quickly. Rapid intensive medical and antibiotic treatment prevents worse consequences. Even if the child survives the poisoning, chronic organ damage may remain and, in very severe cases, amputations may occur.

In premature infants and infants with a tremendously low birth weight, it is called neonatal sepsis. It is easily triggered because the infant’s immune system is not yet developed enough. A distinction is made here between early sepsis and late sepsis. Early sepsis is an infection that occurs before or during birth. The germs usually come from the mother’s rectum and migrate through the vagina into the uterus. The symptoms of early sepsis can be seen within the first three days after birth. Any sepsis after the third day of life and usually after the first week of life is called late sepsis and usually occurs in the birth canal or during birth due to direct contact with obstetricians.

Sepsis in pregnancy

Pregnant women, and especially those just before delivery, are at high risk of getting blood poisoning. If it occurs during pregnancy, it is called pregnancy-related sepsis, and if it occurs within the first six weeks after delivery, miscarriage or abortion, it is called postpartum sepsis.

Women under 25 and over 40 are particularly affected by such blood poisoning and also especially if they already suffer from heart defects, lupus, liver disease or diabetes, as the immune system is then additionally weakened and cannot fight diseases well.

Sepsis Diagnosis

As soon as sepsis is suspected, it is common to check the following criteria:

  • Existing infections with patient specimens or x-rays
  • Body temperature: fever or low temperature
  • Heart rate
  • Changes in the large blood count, for example leukocyte count
  • CRP values
  • Defective organ function
  • Coagulation disorders, decrease in platelet count

If impaired organ functions are detected, the patient is said to have severe sepsis – even if the causes have not yet been clarified at all. If the blood pressure drops critically, this is called septic shock.

Blood poisoning – course of the disease and prognosis

As a rule, the course of blood poisoning is always the same. It starts when bacteria enter the bloodstream in one place in the body and then spread through the bloodstream. Unless the body is able to limit this infection, blood poisoning develops in the form of a defensive reaction of the body. How quickly a pathogen spreads depends on the causative pathogen, the patient’s age, and how efficient their immune system is. If left untreated, the infection and the fight against the pathogens spread further and vessels and organs suffer severe damage. In the further untreated course it can come up to the cardiovascular failure and the blood supply of vital organs is then no longer guaranteed. Therefore, it is important to start treatment as early as possible, because this is the only way to be completely cured. If organs are already damaged, the damage often lasts a lifetime.

How long does sepsis last?

As soon as the causes, i.e. the specific pathogens, have been identified, the sepsis can be fought and treated within a few days. Causative therapy takes seven to ten days, i.e. the patient must be patient until he can resume his daily routine.

Once a patient has survived moderate to severe sepsis, rehabilitation is recommended to strengthen and restore damaged nerves and non-functioning muscles. The rehabilitation must be carried out as an inpatient and can last longer than 3 to 4 weeks. This depends on the severity of the individual sequelae.

What are the chances of survival from sepsis??

In some cases, sepsis cannot be successfully treated and it ultimately leads to death. A rule of thumb is that the risk of death increases by about one percent per untreated hour. So, if blood poisoning is not treated for one day, the risk is already 24 percent. If organ damage has already occurred as a result of sepsis, 47 percent of patients do not survive, and in the case of septic shock, which can lead to death from circulatory failure, the risk of death increases to 60 percent.

What are possible late sequelae?

Blood poisoning can have numerous late consequences. However, half of the people who have survived sepsis have no permanent damage after their hospital stay.

One third of those affected die in the following year and one sixth suffer from late effects. After discharge, many patients suffer late effects:

  • Reduction in performance
  • Reduction of mental capacity
  • Unintentional weight loss
  • Nerve damage
  • Muscle damage
  • Chronic pain
  • Chronic kidney failure
  • Chronic liver failure
  • Amputation because individual limbs have not received sufficient oxygen

Once sepsis has been overcome, it can still have late effects on the psyche. The severe course of the disease, the fear for one’s life and the long stay in the hospital leads to psychological problems, post-traumatic stress syndrome, which manifests itself through depression, panic attacks and nightmares.

Blood poisoning – treatment

In order to treat sepsis successfully, the underlying disease, i.e. the source of infection, must be treated, since this is what caused the sepsis. Depending on the condition, it is treated surgically or with medication. Eliminating sepsis is called "sanitation," and in 80 percent of cases, a source of infection can be identified. In most cases, the infection originates from the lungs, abdomen, urinary tract, skin, bones, joints, teeth or central nervous system. Foreign material in the body can also trigger sepsis.

Simple sepsis

If it is only a simple sepsis, it is not necessary to stay in the intensive care unit. In this type of sepsis, only the source of the infection must be eliminated, and antibiotic therapy must be started – in most cases, the blood poisoning is caused by bacteria. If there were other sources of infection, such as a fungal, parasitic or viral infection, these are treated accordingly.

Severe sepsis

In addition to eliminating the source of infection and antibiotic therapy, it is important to pay attention to and treat impaired organ function in cases of severe blood poisoning. In order to be able to respond to severe sepsis, there is necessary equipment in intensive care units.

Here, too, it is important to precisely determine and analyze the source of infection so that an optimal therapy, for example an antibiotic or antifungal agent, can be selected. Furthermore, the following measures are often taken in the treatment of severe sepsis:

  • Fluid replacement with IV fluids
  • If the patient could no longer eat: Nutrient solutions or gastric tube
  • Replacement of blood cells and plasma with a transfusion
  • Treatment of the affected organs, for example artificial respiration
  • Pain medication
  • Sedative
  • Blood sugar-lowering insulin therapy – if blood sugar levels have risen
  • Treatment of a stress ulcer, an ulcer in the stomach or duodenum triggered by physical stress, which can cause bleeding
  • Anticoagulant medication – blood clots can form throughout the body in severe sepsis

Septic shock

If a septic shock occurs, it is a medical emergency that requires intensive medical treatment. This requires a lot of treatment methods, and in addition to the interventions and ways to treat sepsis already mentioned above, there are other measures that need to be performed in septic shock. Above all, it is necessary to ensure that blood pressure is adequate and that the heart’s pumping function is working so that all organs are always supplied with blood. For this purpose, vasopressor, i.e. vasoconstrictor, substances are used to increase the blood pressure again.

In addition, fluid intake is increased with the help of infusions so that the vessels have a filled state. If the vessels remain dilated, a lot of blood will pool in the tissue and the periphery and cannot flow back to the heart quickly enough. In many cases, the patient must also be artificially ventilated.

How to prevent blood poisoning?

There is no way to specifically avoid sepsis. Therefore, in case of infections, even if they seem harmless, it is advisable to have them treated by a doctor at an early stage. It is also helpful to maintain a good and functional immune system, it often already helps to observe the following measures:

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