1/17/18: INFLUENZA AND SEPSIS: The Death of a 21-year-old Bodybuilder

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You may have read a week ago about the flu-related death of a 21-year-old man who was described in all news reports as a bodybuilder.

The extremely fit Kyle Baughman, of Westmoreland County, Pa., worked as a mover at a local furniture store and loaded cargo at Walmart. He aspired to be a personal trainer.

Shortly before Christmas, Baughman developed a runny nose and a slight cough, but, as most of us would, thought little of his illness. He went back to work on Dec. 26, despite a fever and chest pain, and was dead two days later.

According to his mother, he died from “organ failure due to septic shock caused by influenza.” This is what physicians at the University of Pittsburgh hospital told her.

(I should add that Baughman had not been vaccinated against influenza this season.)

If you saw this news item, you might have done a doubletake as I did. Sepsis? With flu? I tend to associate sepsis, also called septicemia, with bacterial infections and hospitalized patients. How unusual is it to die from flu-related sepsis?

***

Since Baughman’s death, I’ve done some homework and learned that severe sepsis is indeed traditionally associated with bacterial diseases, not viruses. While fungi and parasites can induce sepsis, they are significantly less common causes than bacteria.

According to infectious-disease specialists at the University of Nebraska Medical Center, however, viruses are becoming a growing cause of severe sepsis worldwide. Among these viruses, Drs. Diana F. Florescu and Andre C. Kalil write in a 2014 article in the journal Virulence, “influenza is crossing all geographic boundaries and is causing larger epidemics and pandemics.”

Sepsis is difficult for those of us who are not medical people to understand because it does not arise on its own. It is not a bacterial or viral infection itself. Sepsis is “the body’s overwhelming and [potentially] life-threatening response to infection,” according to the online U.S. Centers for Disease Control and Prevention, which describes it as a “complication” of infection.

Sepsis occurs “when chemicals released into the blood stream to fight infection trigger inflammatory responses,” says the CDC.

In fighting an infection, the immune system creates a pro-inflammatory state, which, in turn, can trigger a “cascade of changes [blood clots, leaky vessels, low blood pressure] that can damage multiple organ systems, causing them to fail.”

In other words, your body’s own immune response causes sepsis. In struggling to survive, your body instead damages life-sustaining systems.

***

The pathology seen with different strains of influenza depends on the virulence of the strain and the strength of the host (human immune) response, Drs. Florescu and Kalil say. An excessive innate immune response has been found in patients infected by certain severe viral strains, such as the A(H1N1) “swine” influenza strain of 2009. (See my immediately preceding blog post for a discussion of influenza virus strains.)

The influenza virus strain that infected Baughman has not been reported.

Drs. Florescu and Kalil summarize the “complex link” between influenza and severe sepsis as follows:

“Inflammatory response triggered by a severe influenza infection is a double-edged sword. It can effectively eliminate the infection, but a prolonged and excessive inflammatory response may result in poor outcomes. Influenza virus, like other viruses, displays significant interaction with the immune system, which can directly lead to severe sepsis or to a secondary bacterial infection,” such as pneumonia.

It has been known since the mid-19th century, the Nebraska professors say, that influenza A and B viruses predispose patients to bacterial infections, especially with Streptococcus pneumoniae and Staphylococcus aureus.

Sepsis kills more than 250,000 people in the United States each year, as well as an estimated 8 million people worldwide. Most of the fatalities are hospitalized patients.

I wrote about sepsis, which killed my uncle and two acquaintances of mine in 2016, in a 3/21/16 tidbit item on my website. Check it out at https://annsjoerdsma.com/tidbits/.

Stay well.

Ann, 1/17/18

 

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