• By Sharon Theimer

Influenza and Sepsis: Mayo Expert Describes Signs of Severe Sepsis, Septic Shock

January 13, 2015

Sepsis can be a dangerous complication of almost any type of infection, including influenza, pneumonia and food poisoningurinary tract infections; bloodstream infections from wounds; and abdominal infections. Steve Peters, M.D., a pulmonary and critical care physician at Mayo Clinic and senior author of a recent sepsis overview in the medical journal Mayo Clinic Proceedings, explains sepsis symptoms and risk factors, the difference between severe sepsis and septic shock, and how sepsis is typically treated:Sick man with cold or flu lying on sofa checking his temperature for a fever

What is sepsis?Sepsis occurs when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail.

“Many infections can cause it,” Dr. Peters says. “It is most common with bacterial infections, but you can get sepsis from other types of bugs also.”

What are symptoms to watch for? A high fever; inability to keep fluids down; rapid heartbeat; rapid, shallow breathing; lethargy and confusion are among the signs. If sepsis is suspected, seek emergency care, Dr. Peters advises. Rapid intervention is critical.

Journalists: Soundbites with Dr. Peters are available in the downloads.

For interviews with Dr. Peters, please contact Sharon Theimer
Mayo Clinic Public Affairs at 507-284-5005 or newsbureau@mayo.edu.

“Let’s say one feels some nasal congestion, and achy, like a cold or upper respiratory illness they’d had many times before, or a low-grade temperature of 99 or 100 F, and otherwise they’re up and around and able to drink fluids: That would not call for going to the emergency department,” he says. “But, if one was not able to take fluids, became more sleepy and lethargic and was lying down all day, and starting to look quite ill or appearing confused, for example — that person should definitely be seen by a doctor.”

How is sepsis treated? The first step is diagnosis: Cultures are taken from the blood and any other relevant parts of the body. Intravenous fluids are given, and antibiotics are usually started right away.

“Probably the single most important thing is to try to maintain fluids,” Dr. Peters says. “The damage of sepsis probably begins with loss of fluids.”

If sepsis is severe, with rapid heart rate, rapid breathing and shortness of breath, and the initial fluid given doesn’t prompt rapid improvement, patients are usually hospitalized.

What are the differences among sepsis, severe sepsis and septic shock? Sepsis refers to signs of inflammation in the presence of a presumed infection, Dr. Peters says.

“Severe sepsis means you’ve got that and signs of organ damage: lung injury, impaired kidney function, impaired liver function,” Dr. Peters explains. “Septic shock means you have all of those findings of severe sepsis, but now you’ve been given fluids, and there’s still poor blood pressure, poor urine output, breathing troubles, and there are still ongoing signs of sepsis.”

Septic shock can be fatal. Among hospitalized patients, septic shock is associated with a 20 to 30 percent risk of death, Dr. Peters says.

Sepsis is such a concern in hospital critical care units that Mayo Clinic has developed a sepsis “sniffer” to help detect it in patients and spot who is at higher risk. Recent improvements to the sniffer are outlined in another new article in Mayo Clinic Proceedings.

Who’s at risk? Anyone can develop sepsis. People on chemotherapy or other immune-suppressing drugs are at higher risk, as are the elderly and people with open wounds that could lead to infection. Often, immune-suppressed patients are given antibiotics preventively.  

Is there anything you can do to prevent sepsis if you catch the flu or another illness?

“Taking your temperature is important, because it gives a good assessment of how severe this might be,” Dr. Peters says. “Probably the single most important thing is to try to continue taking in fluids. Watch for signs and symptoms, and seek urgent medical care if you suspect sepsis.”

@kristenmeier

Why are the flu shots not offered earlier, like in September? It seems that every year by the time the shot is available, the flu is already rampant.

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Thank you! Good information!

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@kimberlygramling

Just being more inquisitive, but why would you as a healthcare provider giving injections, not wear gloves? If I were the nurse giving the injections, I would demand to wear gloves. One microscopic drop of dried, contaminated blood can transmit Hep B for a solid week. Hep C for 4 solid days, dried blood, microscopic amount. Nurse that says she does not get exposed to blood when giving injections without gloves is not truthful. Someone out of 200 people is going to be on an aspirin regimen or very nervous and bleed profusely no matter how you give your injection. Just wondering, why would you take that risk?

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Unless you have open sores on your hands, if you do get any blood on you when giving an injection you just do hand hygiene after doing your shot and you will be fine. I've never had an issue with patients bleeding on me when doing IM shots though.

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@tkmlondon2b

Will the flu mist be available during these times and at these locations?

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I was just told that the Flu Mist is not available at the Kasson Clinic for nonemployees because of a shortage. Are there options available in Rochester for the Flu Mist?

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I telework from my home for Rochester and was wondering if I could go to the Austin location to get my flu shot when they have the Employee Flu Clinic?

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As a mayo clinic employee who is a teleworker from home, can I go to any Mayo Clinic location during the Employee Flu Clinic times and get a flu shot?

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@farrell1

As a mayo clinic employee who is a teleworker from home, can I go to any Mayo Clinic location during the Employee Flu Clinic times and get a flu shot?

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Hi Debbie, the following link should answer your questions regarding revenue cycle employees and flu shots : http://intranet.mayo.edu/charlie/revenue-cycle-coding-operations/2015/10/19/influenza-vaccination-opportunities/

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@tkmlondon2b

Will the flu mist be available during these times and at these locations?

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In Rochester, Flu Mist will be available for employees under age 50 at all employee sites, including Cafeteria Clinics, Go Carts and Outreach Sites. – Influenza Task Force

** Comment posted by subject matter expert **

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@octobersunrise

I would like to know about getting on a list to be informed when there is more of the egg free flu shot available in Red Wing. My family member is severely allergic to eggs and ends up with the flu every year. I have tried calling several numbers and sending emails to the contacts listed and have not heard back from anyone on this. Thank you.

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Many people who have a history or concern for an allergic reaction to the influenza vaccine, including those with a history of egg allergy, can receive the vaccine safely after consulting with their provider and, in some cases, an allergist. An egg-free flu vaccine called Flublok is an option for individuals with confirmed severe egg allergy. Please have your family member talk to his or her provider about whether the egg-free vaccine or additional evaluation and testing by an allergist are appropriate for him or her. Your family member's provider should be able to help him or her obtain the egg-free vaccine if needed. Influenza Task Force

** Comment posted by subject matter expert **

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@tkmlondon2b

Will the flu mist be available during these times and at these locations?

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Due to manufacturing delays, Mayo Clinic's Rochester campus received a limited quantity of FluMist, the intranasal vaccine, and these supplies have now been exhausted. There are adequate supplies of the injectable flu vaccine (flu shot), which is as effective as the FluMist. Mayo Clinic recommends vaccination now, with available vaccine, rather than waiting for additional doses of FluMist to arrive. Updates on the availability of FluMist will be posted as we receive more information from the manufacturer. – Influenza Task Force

** Comment posted by subject matter expert **

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