​The Microbiology Registrar put down the phone and turned to the Consultant to say “there is a patient with a possible necrotising fasciitis in A&E, I’ll go and see what is going on and make sure the surgeons are on their way”. The Consultant was on another call so nodded and off the Registrar went.
 
Sure enough there was a patient in A&E with a severe blistering skin infection and they were very unwell. They were tachycardic, hypotensive and were clearly septic. Necrotising fasciitis was a definite possibility and the A&E doctors had called the orthopaedic surgeons who were on their way down to see the patient.

​Sepsis is due to infection, it is a life-threatening condition with a high mortality even when treated quickly. Patients continue to die from sepsis. So after 15 years of the Surviving Sepsis campaign are we diagnosing and treating sepsis better? I believe the Surviving Sepsis campaign has done a brilliant job in improving the recognition of sepsis and the subsequent management of these patients. However it has also led to a dramatic over diagnosis of sepsis in patients who are not really septic. Locally, sepsis has become the most commonly documented indication for antibiotics! This is ahead of UTI, community acquired pneumonia and cellulitis. Yet sepsis is not nearly as common as these infections, so are we actually getting better at diagnosing sepsis?  It appears not, and if we are not, is the answer to redefine what sepsis is?!? It appears so!!! There seems to have been a flurry of papers in 2016 related to sepsis and how to define it; but does this actually add to the management of patients and are these actually even new definitions of sepsis!? The papers have been written by “The Third International Consensus Definitions for Sepsis and Septic Shock (sepsis 3)” and are published in the Journal of the American Medical Association (JAMA)…but these are not free to access for all…mutter, mutter, mutter.

​A 42 year old man presented to the Emergency Department feeling unwell and with a high fever and right upper quadrant abdominal pain after returning from a “trip of a lifetime” to Vietnam. He had spent 2 weeks hiking and camping in the jungle, swimming through rivers and staying in remote villages. Before travelling he had attended a travel clinic and been vaccinated against Hepatitis A and B as well as Typhoid. He had been advised to take malaria prophylaxis which he had done correctly. On examination he had tender hepatomegaly and was noted to be jaundiced.