Septic Shock: Causes, Symptoms, and Concerns

Sepsis

Dear Dr.
Cheng,
I have some questions regarding my father's recent passing (May 3, 2023) due to septic shock.
My father was participating in a self-improvement activity (traveling in Hualien and Taitung) when he developed high fever, cough, vomiting, and fainting while in Luodong, Yilan.
He was taken to Sheng Tian Hospital in Luodong for treatment.
At that time, it was during the peak of the SARS outbreak, so he was initially treated as a suspected case.
However, after thorough examinations by the hospital, SARS was ruled out.

Severe symptoms of septic shock began to manifest, including pneumonia, low platelet and white blood cell counts, jaundice, and hypotension.
My father was just a fruit farmer living in Ershui, Changhua, and also raised some fish and chickens.
Prior to the onset of his illness, he had been involved in a minor car accident, resulting in some minor internal injuries and superficial bruises.
It is quite suspicious that he suddenly developed septic shock without any prior warning signs.

Based on my investigations during this period and the analysis of environmental and pathological conditions, it is highly suspected that he may have contracted a bacterium known as glanders (Burkholderia mallei), which is classified as a Category IV infectious disease in our country.
Additionally, are there other bacterial species that exhibit similar symptoms?
Thank you.

linext, 30~39 year old female. Ask Date: 2003/05/11

Dr. Zheng Shuxing reply Internal Medicine

Hello! Septic shock is caused by bacterial infections.
Our hospital handles thousands of cases each year, with nearly one-third resulting in death, and the mortality rate is higher among the elderly.
Many types of bacteria can cause septic shock, such as Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus.
Burkholderia pseudomallei is also one of the causative agents, but local cases are quite rare.
Best wishes for health from Dr.
Cheng Shu-Hsing of the Department of Internal Medicine, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/05/11

More Info

Septic shock is a severe and life-threatening condition that arises when the body's response to an infection leads to dangerously low blood pressure and organ failure. Understanding the causes, symptoms, and concerns surrounding septic shock can provide valuable insights, especially in the context of your father's unfortunate passing.

Causes of Septic Shock
Septic shock typically results from an infection that spreads throughout the body, leading to systemic inflammation. Common sources of infection include:
1. Pneumonia: As in your father's case, pneumonia can lead to septic shock, especially if caused by bacteria such as Streptococcus pneumoniae or Staphylococcus aureus.

2. Urinary Tract Infections (UTIs): Particularly in older adults, UTIs can escalate to sepsis.

3. Abdominal Infections: Conditions like appendicitis or peritonitis can also trigger septic shock.

4. Skin Infections: Severe skin infections, including cellulitis, can lead to sepsis.

5. Invasive Procedures: Any surgical procedure or invasive device (like catheters) can introduce bacteria into the bloodstream.

In your father's case, the combination of pneumonia and the potential for a bacterial infection, possibly linked to his recent accident, could have contributed to the onset of septic shock.

Symptoms of Septic Shock
The symptoms of septic shock can develop rapidly and may include:
- High Fever: An elevated body temperature is often one of the first signs.

- Chills and Shivering: As the body fights off infection, chills may occur.

- Rapid Heart Rate: The heart works harder to pump blood to vital organs.

- Low Blood Pressure: This is a hallmark of septic shock, leading to inadequate blood flow to organs.

- Confusion or Disorientation: Reduced blood flow to the brain can cause cognitive changes.

- Shortness of Breath: Respiratory distress may occur, especially with pneumonia.

- Nausea and Vomiting: Gastrointestinal symptoms can accompany the infection.

In your father's situation, symptoms like high fever, cough, vomiting, and fainting were indicative of a severe systemic response to infection.

Concerns and Considerations
1. Rapid Progression: Septic shock can develop quickly, often within hours. Early recognition and treatment are crucial for survival.

2. Underlying Health Conditions: Older adults or those with chronic health issues are at higher risk for severe infections and septic shock.

3. Bacterial Resistance: Infections caused by antibiotic-resistant bacteria can complicate treatment and worsen outcomes.

4. Environmental Factors: Exposure to certain bacteria, such as those found in agricultural settings, can increase the risk of infections leading to septic shock.

Potential Bacterial Causes
While you mentioned the possibility of a bacterium like *Nocardia* (which can cause a condition similar to what you described), other bacteria that can lead to septic shock include:
- Escherichia coli: Commonly associated with UTIs and abdominal infections.

- Klebsiella pneumoniae: Known for causing pneumonia and bloodstream infections.

- Streptococcus and Staphylococcus species: Can lead to skin infections and pneumonia.

Conclusion
The sudden onset of septic shock in your father, particularly following an event like a car accident, underscores the importance of monitoring for signs of infection after any trauma. While it is natural to seek answers and understand the underlying causes, it is essential to recognize that septic shock can occur without clear pre-existing symptoms, especially in older adults. If you have further concerns or questions about your father's case, discussing them with a healthcare professional who can provide personalized insights based on his medical history would be beneficial.

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