Blood Borne Illness 1

Question 1

Sepsis… what happens

Answer 1

Bacterium or endogenous danger signals bind to receptors causing an UNCONTROLLED CASCADE!It is a DYSREGULATED RESPONSE TO INFECTION!!!*** At peak with sepsis… some people will die from this… then system tells body .. Chill! And so then everyone goes away and we get a hypoimmune response which can lead to death!

Question 2

Sepsis Definitions

Answer 2

Systemic Inflammatory Response Syndrome (SIRS) due to documented or presumed infection. Have to have two or more of the following… high temp, heart rate, resp rate, white blood cell count
- New: Life-threatening organ dysfunction caused by a dysregulated host response to infection (life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs)

Question 3

Severe Sepsis

Answer 3

Sepsis complicated by organ dysfunction

Question 4

Septic Shock Definitions (old and new)

Answer 4

• sepsis induced hypotension persisting despite adequate fluid resuscitation
• New: Sepsis and vasopressor theray needed to increase mean arterial prssure to >65 mmHg and lactate to >2 mmol/L despite adequate fluid resuscitation

Question 5

Epidemiology of Sepsis

Answer 5

• 2% of hospitalization for severe sepsis
  
  • 50% of sepsis cases treated in intensive care units
  • Incidence of sepsis is increasing
  • Older patients account for 60% of ALL espisodes of sepsis!
  • > 20$billion!
  • Leading cause of critical illness worldwide
  • Highest incidence in winter and among African American Males

Question 6

Pathogenesis of Sepsis

Answer 6

• Our arsenals for fighting off bacteria are so powerful … we are in more danger from them than the pathogen intself..
  
  • It is our response to a pathogen’s presence that makes the disease
  • Release of pro-inflammatory mediators spreads beyond the local environment … giving a more generalized response
  • Uncontrolled, unregulated, self-sustaining
  • Mediators usually confined to cell-to-cell interactions within the interstitial space spread via circulation
  • Normal inflammatory response exaggerated

Question 7

Normal Host Response to Infection

Answer 7

• Innate cells (macrophages) recognize and bind to microbial components
  
  • Pattern recognition receptors (PRRs) on surface of host immune cells recognize and bind to pathogen associated molecular pattern (PAMPs)
  • **- Host immune cell bits of bacterium bind to receptor or endogenous danger signals bind to receptor and create a response!
  • Important Cytokines…
    - TNFa
    - IL-1
  • Clinical signs… warmth, erythema, edema due to vasodilation and hyperemia, increased microvascular permeability

Question 8

Top 5 organisms that cause bloodstream infections?

Answer 8

Mainly Gram positive

• Staph. Aureus
• Streptococcal sp. (Group A strep.. pyogenes…. then also pneumoniae)
• Escherichia Coli
• Klebsiella spp.
• Pseudominas aeruginosa

Question 9

Clinical manifestations, diagnosis, and management of sepsis

Answer 9

• Clinical Manifestations:
  
  • Hypotension, Tachycardia (HR >90), Fever, Tachypnea (RR>20)
• Diagnosis: based off of how the patient is
• Managment:
  
  • Give antibiotics to patients EARLY!!! (within 1 hour!)
  • Source control: If you have an abscess … DRAIN IT!!
• Prognosis: Mortality rate increases with Sepsis severity.. ex. Sepsis… severe sepsis… septic shock!
  
  • Nosocomial infection highest mortality… whereas urinary tract infection is lowest mortality!

Question 10

Risk factors for Sepsis

Answer 10

• ICU admission (nosocomial infection)
• Older age
• Immunosuppresion
• Genetic Factors