Sepsis, an overwhelming infection in the body, results in severe inflammation. Untreated, it can turn to severe sepsis, which can cause multi-organ failure (e.g., acute kidney failure, acute respiratory distress syndrome, or liver failure). When severe sepsis overwhelms the body, it results in septic shock. Even with aggressive treatment, septic shock can be fatal in dogs and cats; reported mortality rates range from 20% to 68% in dogs.
One cause of septic shock could be an untreated, severe infection, such as from:
Symptoms of septic shock include:
Diagnosing septic shock in dogs
To diagnose sepsis, your veterinarian will need to run certain tests, including the following:
Blood work findings consistent with sepsis include:
Septic shock treatment
Treatment for sepsis depends on the underlying cause, but is aimed at removing the source of infection (which is typically done by surgery, if involving the abdomen) or symptomatic supportive care. Specific treatment to counter septic shock includes:
Prognosis of septic shock
Unfortunately, even with aggressive treatment, the prognosis is poor to grave once septic shock has set into the body. The best thing that an owner can do is to seek veterinary treatment immediately. The sooner a problem or infection is recognized, the sooner treatment can be started, hopefully mitigating the risk of sepsis.
If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.
In a terrifying paper called “The Lick of Death,” doctors from the Department of Medicine for the Elderly at the University College London Hospitals found that those precious kisses your pup gives you could actually leave you with a life-threatening infection.
According to CBS, a 70-year-old woman in England came down with a serious infection all because her pet Greyhound gave her a few licks. Doctors knew about the bacteria that caused the infection, but what made the case surprising is that the infection typically only occurs in humans after a dog bite or scratch. The woman’s dog had only licked her, not bitten her, making her infection surprising to doctors and horrifying to pretty much everyone else.
CBS reports the woman’s dog gave her the bacterium Capnocytophaga canimorsus, something commonly found in dogs’ mouths. The bacteria caused the woman to have slurred speech and become unresponsive, prompting a hospital trip. Days later, after doctors had calmed her symptoms, she again became confused, developed a headache, diarrhea, a high fever and kidney failure. CBS reports doctors diagnosed her with sepsis, a serious blood poisoning that caused organ failure. All this came from some puppy kisses.
Now, this doesn’t mean you should send your puppy to the dog house. Infections like this are very rare, according to CBS, and probably would only occur in someone very young or old if there's no dog bite or scratch present. If you do come down with the bacteria, though, symptoms of the infection include chills, fever, lack of energy and upset stomach. The difference between this and a common cold is you'll become very sick very quickly. Luckily, a round of penicillin usually clears the infection right up.
Despite the rarity, doctors felt the need to let the public know that dog kisses can be potentially harmful, according to CBS. They don’t want to scare you too much, though. They wrote the paper to alert other physicians to look for the bacteria as a cause for spesis in the elderly, basically just making doctors aware that this could happen.
"The last thing you want to do is alarm people that they'll be infected if they get licked or kissed by a dog." Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital and Long Island Jewish Medical Center in New Hyde Park, New York, told CBS.
If you get bitten or scratched by a dog, you might want to get checked out. But, aside from that, it’s probably safe to let your pup give you a couple cheek kisses every now and then. That's enough bad dog news for the day. Head over here for a little pup pick-me-up.
What is sepsis? If your dog or cat was just diagnosed with sepsis, it’s a life-threatening infection that you must be aware of. Sepsis is one of the leading causes of death in human – and likely veterinary – intensive care units. The term sepsis is defined as an overwhelming infection is the body, typically where bacteria has spread to the blood stream. The body responds to sepsis by triggering its inflammatory system, where inflammatory mediators and cytokines are released.
Unfortunately, sepsis can result in inappropriate, severe inflammation, commonly called systemic inflammatory response syndrome (SIRS). Untreated, SIRS and severe sepsis can progress to organ failure (typically called multiorgan dysfunction syndrome or MODS). This can be seen as acute kidney failure (e.g., elevated kidney values such as creatinine and BUN), acute respiratory distress syndrome (ARDS) (e.g., acute difficulty breathing), liver failure (e.g., increased liver enzymes) and even gastrointestinal failure (e.g., bloody diarrhea, bloody vomiting, etc. Even with aggressive treatment, sepsis can progress to septic shock, and is often fatal in dogs and cats. Sepsis typically has a poor to grave prognosis, with overall survival being reported in veterinary medicine anywhere between 20% to 68% in dogs and cats.1-6
So what causes it? Sepsis is typically caused by an untreated, severe infection. This can be seen from numerous sources in the body. The most common source of sepsis is often related to the gastrointestinal tract (e.g., stomach, intestines). Other sources include:
• Ruptured intestines (e.g., typically from intestinal cancer or a foreign body obstruction)
• Ruptured organs (e.g., a ruptured stomach secondary to gastric dilatation volvulus a ruptured bladder secondary to bladder stones a ruptured gall bladder secondary to gall bladder stones)
• Severely infected wound (e.g., abscess, bite wound)
• Urinary tract infections (UTI) that migrated up to the kidney, resulting in a severe kidney infection (e.g., pyelonephritis)
• Pancreatic infection (e.g., pancreatitis, pancreatic abscess)
• Uterine infection in intact females (e.g., pyometra)
• Prostatic infection in intact male dogs (e.g., prostatic abscess)
• Severe pneumonia of the lungs
Rarer causes of sepsis include:
• Bacterial infection on the heart valves (e.g., bacterial endocarditis)
• Bacterial infection in the vertebrae (e.g., diskospondylitis)
• Blood infections
• Joint infections
• Severe dental disease
There are no specific breeds that are documented to be predisposed to sepsis. That said, clinically, certain breeds and ages of dogs and cats may be slightly more overrepresented. Clinically, it seems like Labradors and mixed breed dogs seem to develop sepsis more, as do older cats. This may be due to the popularity and nature of dogs for example, the Labrador retriever has been bred to be so food-motivated (hence, easier to train) that they may present more for intestinal obstructions that had perforated due to something stuck in the intestines (e.g., foreign bodies like toys, rawhides, etc.). Older cats may develop sepsis secondary to ruptured cancer of the intestinal tract. Lastly, neonates (e.g., puppies and kittens) and immunosuppressed patients (e.g., those on chronic steroids or chemotherapy) may be more at risk, as they cannot fight of infection as well.
Signs of sepsis range tremendously depending on when it is first detected. These include:
• Not moving or getting up
• Decreased appetite to complete anorexia
• An abnormal heart rate (e.g., elevated heart rate in dogs, slower heart rate in cats)
• An abnormal temperature (e.g., either hyperthermia/fever or hypothermia)
• Abnormal gum color (from dark red to pale pink)
• Breathing harder than usual
• Exercise intolerance
• Difficulty breathing
• Acting painful
• Groaning when getting up or moving
• Straining to urinate or defecate
• Jaundice (e.g., yellowing of the gums and skin)
• Abnormal thirst or urination (e.g., increased or decreased)
• Excessive licking of the rear end
• A foul odor from the rear end
• Vaginal discharge
• Warm or cold to the touch
• A distended abdomen
• Death, even with treatment
The diagnosis of sepsis is typically based on an extensive work-up, including blood work, x-rays, ultrasound, and even fluid analysis (off abnormal fluid in the abdomen, chest, etc.). Tests that your veterinarian may need to perform include:
• Complete blood count (looking at the white and red blood cells and platelets)
• Chemistry (looking at the kidney and liver function, protein, blood glucose/sugar, electrolytes)
• Urine culture
• Chest and abdominal x-rays
• Abdominal ultrasound
• Fluid analysis if there is abnormal fluid in the abdomen or chest
• Culture of the fluid
• Coagulation testing (including a PT, PTT, and platelet count)
• Blood cultures (rare)
• CT or MRI
• Ultrasound of the heart (e.g., echocardiogram)
With sepsis, there are certain blood work changes that are highly suggestive of severe infection, including:
• A very elevated or decreased white blood cell count
• A very elevated (e.g., hyperglycemia) or decreased blood sugar (e.g., hypoglycemia)
• An elevated or decreased red blood count (from dehydration or anemia)
• Increased liver enzymes (e.g., total bilirubin)
• Increased kidney values
• Abnormal clotting due to a severe complication called disseminated intravascular coagulation (DIC)
Ultimately, the goal of treatment for sepsis is removing the source of infection (which is typically done by surgery, if involving the abdomen) and aggressive supportive care. While there is no “cure” for sepsis, supportive care includes:
• Intravenous (IV) fluids to help hydrate
• IV protein (called colloids such as Hetastarch to help increase the protein in the blood stream and blood pressure)
• Possible plasma transfusions if DIC is present
• Possible blood transfusions if anemia is present
• Vasopressors to increase the blood pressure
• Blood pressure, electrocardiogram (ECG), blood glucose monitoring
• Blood work monitoring (specifically of the electrolytes, blood sugar, white and red blood cell count, and clotting)
• Dextrose (e.g., sugar) supplementation
• IV antibiotics
• Anti-vomiting medication
• Pain medication
• Nutritional support
• Surgery, if indicated
The best way to prevent sepsis is to always seek veterinary attention as soon as you notice any medical problems in your pet. The sooner you recognize a problem, the easier it will be to treat. For example, if your dog shows signs of a UTI (e.g., increased urination, bloody urine, straining to urinate, etc.), seek veterinary attention immediately before it progresses to the kidneys. As soon as your dog or cat shows signs of lethargy, anorexia, and vomiting, seek veterinary attention for x-rays to rule out an obstruction. Once the problem progresses, severe complications can be seen. If sepsis is seen, immediate advanced care at a tertiary referral or specialty hospital is recommended for life-saving care and monitoring.
Sepsis has a very poor to grave prognosis once it develops. Even with aggressive treatment and expensive therapy, dogs and cats can succumb.
1. Boller EM, Otto CM. Septic Shock. In Small Animal Critical Care Medicine. Eds. Silverstein DC, Hopper K. Saunders-Elseiver 2009:pp. 459-463.
2. Costello MF, Drobatz KJ, Aronson LR, King LG. Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990-2001). J Am Vet Med Assoc 2004225(6):897-902.
3. Mueller MG, Ludwig LL, Barton LJ. Use of closed-suction drains to treat generalized peritonitis in dogs and cats: 40 cases (1997-1999). J Am Vet Med Assoc 2001219(6):789-794.
4. Lanz OI, Ellison GW, Bellah JR, et al. Surgical treatment of septic peritonitis without abdominal drainage in 28 dogs. J Am Anim Hosp Assoc 200137:87-92.
5. Greenfield CL, Walshaw R. Open peritoneal drainage for treatment of contaminated peritoneal cavity and septic peritonitis in dogs and cats: 24 cases (1980-1986). J Am Vet Med Assoc 1987191(1):100-105.
6. Bentley AM, Otto CM, Shofer FS. Comparison of dogs with septic peritonitis: 1988-1993 versus 1999-2003. J Vet Emerg Crit Care 200717(4):391-398.
Objective: To appraise the evidence behind the Surviving Sepsis Campaign Guidelines on antimicrobial therapy in sepsis and evaluate relevant literature in small animal veterinary critical care.
Data source: Electronic searches using MEDLINE and EMBASE databases.
Human data synthesis: Current recommendations are to administer appropriate antimicrobials within 1 hour of a diagnosis of severe sepsis or septic shock. Evidence is supportive of this recommendation in septic shock but the evidence is less compelling in milder forms of critical illness-related infections. It is unclear when the administration of appropriate antimicrobials is most beneficial and when it should be considered essential. Evidence supports shorter courses of antimicrobial therapy for many infections seen in the critical care unit with the biomarkers procalcitonin and C-reactive protein helpful in guiding the duration of therapy.
Veterinary data synthesis: Current evidence is lacking to support the use of early and aggressive use of antimicrobials in all patients with critical illness-related bacterial infections. Two studies failed to demonstrate improved survival in patients with pulmonary or abdominal infections administered appropriate vs inappropriate empirical antimicrobials. One study failed to show an improved survival when dogs with abdominal infections were administered antimicrobials within 1 hour vs 6 hours of diagnosis of infection. Information regarding ideal duration of antimicrobial therapy and use of biomarkers to guide therapy is currently lacking.
Conclusion: Clinicians should aim to administer early and appropriate antimicrobials however, the impact this will have on patient outcome remains uncertain. The ability to administer early and appropriate antimicrobials may be considered a measure of the quality of medical practice rather than a prognostic indicator.
Keywords: bacterial resistance biomarkers timing of therapy.
© Veterinary Emergency and Critical Care Society 2015.