2.3. Pathophysiology of Sepsis Flashcards
What are the 3 defences the body has against Sepsis?
- Physical Barrier
- Innate Immune System
- Adaptive Immune System
What does the Physical Barrier, defending against Sepsis, consist of?
- Skin
- Mucosa
- Epithelial Lining
What does the Innate Immune System, defending against Sepsis, consist of?
- IgA in Gastrointestinal Tract
- Dendritic Cells
- Macrophages
What does the Adaptive Immune System, defending against Sepsis, consist of?
- Lymphocytes
- Immunoglobulins
What is the origin of the Pathophysiology Sepsis?
It originates from a breach of integrity of a host barrier, whether physical or immunological
What does a breach of integrity of a host barrier, defending against sepsis, allow for?
Organisms enter the bloodstream creating a septic state
What are the 3 phases in the Pathogenesis of Sepsis?
Phase 1. Release of bacterial toxins
Phase 2. Release of mediators, in response to the infection
Phase 3. Effects of specific excessive mediators
What does the Release of bacterial toxins (Phase 1 of the Pathogenesis of Sepsis) involve?
- Bacterial invasion into body tissue is a source of dangerous toxins
- This may / may not be neutralized and cleared by the existing immune system
What are some commonly released Gram Negative bacterial toxins?
Lipopolysaccharide (LPS)
What are some commonly released Gram Positive bacterial toxins?
- Microbial-associated molecular pattern (MAMP):
- a) Lipoteichoic Acid (LTA)
- b) Muramyl Dipeptides
- Superantigens
- a) Staphylococcal Toxic Shock Syndrome Toxin (TSST)
- b) Streptococcal Exotoxins (SPE)
What does the Release of mediators, in response to the infection (Phase 2 of the Pathogenesis of Sepsis) involve?
- Effects of infections due to Endotoxin release
- Effects of infections due to Exotocin release
- Effects of Specific Excessive Mediators
What is the difference between an Endotoxin and Exotoxin?
Endotoxin - bacterial toxins (consisting of lipids) within the cell
Exotoxin - Toxic substances secreted by bacteria outside the cell
Why does Endotoxin release occur (in Phase 2 of the Pathogenesis of Sepsis)?
- The Lipopolysaccharide (LPS) toxin (released from Gram Negative bacteria) needs an LPS-binding protein to bind to macrophages
- The Lipoteichoic Acid (LTA) toxin (released from Gram Positive bacteria) binds directly onto macrophages
- Macrophages then release mediators
Why does Exotoxin release occur (in Phase 2 of the Pathogenesis of Sepsis)?
- Superantigens toxins (TSST or SPE) are released from Gram Positive bacteria, which act on T-Lymphocytes
- The T-Lymphocytes then activate:
a) Macrophages (via IL-2 and IFN-gamma)
b) Endothelial Cells (Via IFN-gamma) - a) Macrophages then release IL-1 and TNF-Alpha (mediators)
- b) Endothelial Cells then release Nitric Oxide (mediators)
What type of response occurs with Exotoxin release?
- This is a pro-inflammatory response
- Small amounts of Superantigens will cause a large amount of mediators to be secreted