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How a tiny cut on your finger could cost you your life - if it means you develop sepsis.

Tuesday, October 1, 2013

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When Chris Aldred cut his finger moving a computer, he didn't give it a second thought. 'I just popped a plaster on and forgot about it - I've had worse cuts opening an envelope.'

He can't even recall which digit was affected. 'I just remember catching my right hand on something sharp,' says Chris, 45, an IT specialist from Bolton, Lancashire.

But this apparently innocuous wound led to an abscess on his spine and then sepsis - a life-threatening response to infection that kills more people a year than breast and bowel cancer combined. Chris lost four stone in six weeks and was off work for 18 months.
His ordeal started two weeks after his cut, when he felt a sharp twinge in his lower back - slightly to the right of his spine.

'I thought I'd pulled a muscle,' he says. 'But over the next few days the pain became more intense.'  By this point, in December 2006, Chris also had a high temperature, felt hot and shivery, and had aches and pains - he assumed it was the flu.

Three days later, Chris tried to get up to go to the bathroom in the middle of the night but was unable to move his legs. 'I was terrified and woke my wife, Lisa, crying, asking her to get an ambulance.'

Lisa, now 39, a telecommunications worker, stayed with their older daughter, Stacey, then 17, and Abigail, then two months, as Chris was rushed to Royal Bolton Hospital. (The couple have since had a son, Jamie.)

'The first doctor who saw me must have thought I was faking,' Chris says. 'Three times he pulled me to my feet, then let go - leaving me to fall on the floor - before admitting he had no idea what was wrong.'

Five days later, an MRI scan revealed an eight-inch mass on his spine and Chris was transferred to the spinal unit of Salford Royal Hospital.

The mass had pushed into his spinal cord, crushing his nerves and causing the paralysis. Chris was told he'd be operated on the next morning, so doctors could see what it was and if it was cancerous.

'I felt relieved they were taking action. But I was terrified at the thought of cancer or never being able to walk again,' says Chris.

'I was active, cycling 150 miles a week and playing golf and football. The thought of life in a wheelchair didn't bear thinking about, especially with a baby.
'Coming around afterwards, I remember groggily asking, “What was it?” When a nurse replied, “It's not cancer,” I mumbled, “Thanks very much,” and drifted back to sleep, hugely relieved.'

The mass was, in fact, an abscess. His doctors explained that Staphylococcus aureus bacterium, known for causing infections, had entered his body via a recent wound or cut. 'The only cut I could think of was the one to my finger,' says Chris. 

Professor Anthony Hilton, a microbiologist at Aston University, Birmingham, explains: 'Microorganisms such as Staphylococcus aureus are in the environment and on our skin; 40 per cent of people carry it, typically in moist areas like nasal passages or armpits.
Hospitalised: An MRI scan revealed an eight-inch mass on Chris's spin, here pictured with daughter Abigail
Hospitalised: An MRI scan revealed an eight-inch mass on Chris's spin, here pictured with daughter Abigail

'As long as it's outside the body it doesn't cause harm. The skin acts as a barrier. However, a cut - whether it's a severe wound or a paper cut - provides the organism with an entry. Usually the immune system detects the microorganism in the body and responds accordingly, attacking and destroying it, and the wound heals.

'However, if the microorganism is present in particularly large numbers or pathogenic [highly specialised in causing disease] which this can be, or if the person is very young, elderly or unwell, the ability to fight infection may be compromised. Chris's immune system may have been weakened by lack of sleep because of the baby.'

The risk is if the microorganism gets into the bloodstream, and spreads. 'The immune system will have tried to destroy it - producing pus and goo in the process. Healthy cells nearby may then build a wall around the area to enclose the attacked cells - forming an abscess,' says Professor Hilton.

'The abscess could have happened anywhere in the body but in Chris's case it happened to settle near the spinal column.'

Doctors drained the abscess during his surgery but although it relieved the pressure on his spinal cord, Chris remained paralysed and it wasn't clear if long-term damage had been caused. He was put on intravenous antibiotics to fight the remaining infection.
Happy family
Ironman
Recovery: Kevin (left) pictured with wife Lisa, son Jamie, 4, and daughter Abigail, 6, and (right) back on his feet, competing


But three days later, on Christmas Day, Chris deteriorated.

'I felt confused, couldn't stop shaking, and was sweating so much my bedsheets had to be changed several times. Thankfully, a nurse realised something was wrong.' Chris had developed sepsis, caused when the body overreacts to an infection - in his case, the abscess - and starts attacking its own organs and tissues, triggering a catastrophic drop in blood pressure and organ failure.

The condition is little known among patients - and even some health professionals - but is, in fact, 'incredibly common', and, 'alarmingly, causes 37,000 deaths a year', says Dr Ron Daniels, consultant in intensive care medicine at the Heart of England NHS Foundation Trust, and chair of the UK Sepsis Trust. 'We see around 102,000 cases of life-threatening sepsis a year in the UK '

After five days of intravenous antibiotics, with the infection finally under control, Chris began to recover. Doctors warned of a slow recovery and couldn't say if he'd walk again. But within three weeks of his operation, Chris was overjoyed when he could wriggle his toes.

With physiotherapy, he soon progressed to standing for a few seconds at a time, before moving to a Zimmer frame, then crutches, before finally being able to walk unaided five months after falling ill. Eighteen months after cutting his finger, Chris was finally able to go back to work.

He has since worked hard at improving his fitness - and even completed the Ironman UK endurance triathlon in Bolton this summer, with his family cheering him on as he finished in a little more than 15 hours.

'I loved every minute. It was amazing to think how far I'd come in six years. I could have died or been paralysed. Instead, I've never felt fitter, healthier and happier.
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