Healthcare professionals specializing in surgery in Nigeria are emphasizing the critical importance of swift and appropriate treatment for infections to prevent a dangerous syndrome called sepsis.
They caution that if infections are not accurately identified and promptly addressed, the body’s immune response could escalate, causing damage to tissues and potentially leading to septic shock.
According to the World Health Organization (WHO), when the body’s response to an infection begins to harm its own tissues, it may result in shock, failure of multiple organs, and in severe cases, even death if not detected early and treated promptly.
Sepsis is highlighted as a leading cause of mortality globally, with a significant number of cases affecting children under five years old.
Despite the challenges in gathering precise data, the WHO reported a staggering 48.9 million cases of sepsis and 11 million sepsis-related deaths worldwide in 2020.
While sepsis can impact individuals of any age, it tends to have higher incidence rates in countries with lower to middle-income levels. Pregnant women, children, the elderly, and individuals with underlying health issues are identified as being at a heightened risk of developing sepsis.
Experts are urging individuals who are malnourished to prioritize improving their nutrition, and those with compromised immune systems to diligently follow their prescribed medication regimens.
Notably, Professor Paingha Alagoa from Bayelsa Medical University in Bayelsa State underlined that sepsis is a severe medical condition characterized by the body’s defenses causing inflammation and tissue damage, triggered by bacteria, viruses, fungi, or parasites.
Recognizing clinical signs such as abnormal body temperatures, elevated heart and breathing rates, and increased white blood cell counts are crucial indicators of sepsis, as outlined by the specialist in breast and abdominal surgery. Factors such as age, malnutrition, and existing infections are highlighted as predisposing elements for the onset of 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 of Administration at BMU added that certain medical procedures, like inserting IV lines or urinary catheters, can increase the risk of developing sepsis.
Additionally, individuals with pre-existing conditions such as diabetes, kidney disease, or liver disease are more susceptible to 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 dispelled the common misconception that sepsis typically occurs after surgery, pointing out that other factors such as immune suppression, malnutrition, and unsafe abortions can also trigger sepsis.
To prevent sepsis, he recommended close management of individuals on long-term steroid treatment, prompt treatment of infection symptoms, and adherence to prescribed antibiotics for those who have undergone surgery.
He also urged Nigerians to treat all infections promptly and properly, and advised individuals living with HIV or other immune-suppressing conditions to adhere to their medication regimens and maintain a balanced diet to prevent malnutrition.
Professor Mobolaji Oludara, a renowned surgeon, explained that sepsis is not a standalone disease, but rather the body’s severe inflammatory response to infection.
He noted that sepsis arises from a severe infection that triggers a systemic inflammatory response syndrome (SIRS), leading to septic shock and damage to multiple organs, including the kidneys, lungs, and liver.
While acknowledging that surgical procedures can create wounds that may become infected, Professor Oludara clarified that surgery is not the sole cause of sepsis, and that other factors can contribute to its development.
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.”
Professor Mobolaji Oludara, a specialist in surgical gastroenterology, endocrinology, and breast surgery, lamented the tendency of many Nigerians to seek medical attention only when infections have advanced to a critical stage.
He emphasized that individuals with weakened immune systems, such as those with chronic diseases, HIV, or those taking immunosuppressive drugs, are susceptible to developing sepsis-like conditions even without an apparent source of infection.
Oludara noted that while sepsis can affect anyone, it is more prevalent among older adults due to their compromised immunity and underlying conditions like diabetes and other non-communicable diseases. He also highlighted the risk of severe infection and sepsis in individuals who have undergone unsafe abortions.
As a seasoned surgeon and former Dean of Clinical Sciences at LASU, Oludara stressed the importance of preventive measures in surgery, including the use of prophylactic antibiotics, good surgical techniques, and safe operating theater practices to prevent infections from escalating into sepsis.
“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.
Professor Oludara further explained that the primary causes of sepsis are bacterial infections, including both aerobic and anaerobic bacteria. Although less common, other microorganisms such as viruses, fungi, and parasites can also be responsible.
He emphasized the importance of prompt treatment by qualified healthcare professionals, cautioning that delayed or inaccurate diagnosis and the use of ineffective medications can allow the infection to worsen, enabling the disease-causing organisms to thrive.
