By Tammy Cohen
The death of former Dynasty star Christopher Cazenove from septicaemia last week is a reminder that, despite advances in medical treatment and standards of hygiene, septicaemia or blood poisoning – a common cause of death in childbirth until the mid-1930s – remains a fast-acting and extremely dangerous condition.
The 66-year-old actor contracted the infection at the end of February after complaining of migraines during a business trip to California. On his return to the UK, he was treated at St Thomas's Hospital, in London, where he died on April 7.
Septicaemia occurs as a result of bacteraemia, the proliferation of bacteria in the bloodstream. In many cases, the source of the infection is never clear but it may be due to a wound, internal bleeding after an accident, or it can arise from an infection within the body, in the intestines or urinary tract, for example.
"Septicaemia occurs when toxins produced by bacteria in the bloodstream hyper-stimulate the patient's immune system," explains infections expert Prof Mark Enright, formerly of Imperial College London. "Your body is trying to fight the infection by pumping more blood around, so you get far too hot, which can lead to organ failure."
Any type of bacterium can cause septicaemia, but the most common types of infection are streptococcal, staphylococcal – which includes the hospital superbug MRSA – and meningococcal. Sometimes there is an obvious site of infection such as a wound or laceration, but not always.
"In 40 per cent of septicaemia cases, there is no obvious site of entry," says George Griffin, Professor of Infectious Diseases at St George's Hospital, University of London. "The infection generally progresses quickly, and early symptoms are usually low blood pressure, altered consciousness and high fever, sometimes accompanied by chills."
With meningococcal septicaemia, there might also be headache and flu-like symptoms, accompanied by a rash which doesn't fade on being pressed with a glass.
If septicaemia is diagnosed early and treated with antibiotics, most patients recover. However, its rapid progress – many of those who die do so withing 24 hours of the first symptoms appearing – makes it very dangerous.
"Even with the best intensive care, the mortality rate can be around 30 per cent because of its rapid progression and because the clinical manifestations are so profound, eventually resulting in multi-organ failure," says Prof Griffin.
Robert Read, Professor of Infectious Diseases at the University of Sheffield, puts the risks even higher. "It depends on the bacterial aetiology [which microbe is causing the septicaemia], but it is very hard to treat and can have a mortality rate of 40 per cent."
The meningococcal form of septicaemia, most often contracted by children and teenagers, is one of the most aggressive infections, according to Prof Enright.
"It can act within hours and can leave patients with lasting damage. The toxin the bacteria produces damages tissues and destroys blood vessels, meaning that blood doesn't get through to the patient's extremities, which can necessitate amputation of toes, fingers, hands and feet."
The Meningitis Research Foundation says that meningococcal disease, which can cause both meningitis and septicaemia or a combination of the two, affects around 2,000 people in the UK and Ireland every year.
Signs are that the introduction of the MenC vaccine has had a positive effect, with Health Protection Agency figures for England and Wales showing a 41 per cent decrease in the total number of cases of meningococcal septicaemia and bacterial meningitis between 1999 and 2007.
"It's uncertain whether overall rates of infection are on the decrease," says Prof Enright. "Hospital-acquired infections might be down, but rates of community-acquired infection are more difficult to assess."
While little can be done to prevent infections that have no obvious cause, the risk of contracting septicaemia can be reduced by making sure wounds are properly treated. "Any local skin trauma or laceration should be cleaned and protected," advises Prof George Griffin. "Seek medical advice if at all concerned."
But there is no doubt medical advances and awareness of the early signs of septicaemia have had a positive effect on outcomes. "Before the advent of antibiotics, the mortality rate for staphylococcal septicaemia was 80 per cent, and it could be contracted through childbirth, having an appendix removed or just cutting yourself gardening," says Prof Enright, "so clearly advances have been made."
The Meningitis Research Foundation is at www.meningitis.org
Trevor Reed, 54, a retired police officer, lives with his wife Ann, 52, in Solihull. He contracted meningococcal septicaemia at the end of 2007, as a result of which all his toes and part of his index finger were amputated.
"My last clear memory before I got ill is Christmas Eve 2007. I remember sitting on the sofa laughing and joking.
When I got up the next day, I had a bit of a headache and my hands were violently shaking, so I went back to bed. While I was asleep, I started moaning and Ann became really worried. I went to Solihull Hospital and, by the time I arrived at A&E, I had a rash on my back and was delirious. By that stage, my extremities – toes, fingers, nose, ears – were turning blue. I was showing signs of kidney failure, which is when they realised I had meningococcal septicaemia.
I was rushed to Hartlands Hospital, 20 minutes away. Ann was told I might not survive the journey. On arrival, I was put into a drug-induced coma for 18 days while doctors fought to stem the spread of the septicaemia and get my kidneys and liver functioning again.
''When I came round, my toes had turned jet black, and it was clear they would have to be amputated.
I left hospital on 25 January 2008, and went back in March to have nine toes and part of a finger amputated. I had the remaining toe amputated last December.
''I've had to learn to walk again, and it's incredibly painful. My immune system is very weak and I get flu all the time. My long- and short-term memory are poor.
Sometimes I wonder whether there were any warning signs that we might have missed, but there was nothing. One day I was fine and the next I was fighting for my life. I feel I've beaten the odds."
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