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Sepsis > Host-microbe immune response > Flashcards

Host-microbe immune response Flashcards

1
Q

What is present in the skin that acts as an immunological barrier?

A

Keratinocytes secrete antimicrobial peptides such as defensins
Sebaceous/sweat glands secrete microbe-inhibiting substances (fatty acids)
Antigen-presenting cells - langerhans

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2
Q

What is present in the mucosa of the resp/GI/GU tract that acts as an immunological barrier?

A

Antimicrobial substances such as lysozyme
IgA
Gastric acid

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3
Q

What clinical problems in the skin can lead to infections?

A

Eczema,psoriasis, erythroderma
Tinea pedis
Ulcers
Pressure sores

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4
Q

What clinical problems in the lungs can lead to infection?

A

CF
Bronchiectasis
COPD
Poor swallow

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5
Q

What clinical problems in the GI tract can lead to infection?

A

Mucositis secondary to chemo
IBD
Bowel cancer

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6
Q

What clinical problems in the GU tract can lead to infection?

A

Impaired bladder emptying e.g. benign prostatic hyperplasia

Catheterisation

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7
Q

What are phagocytes?

A

Neutrophils (blood) and macrophages (tissue)

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8
Q

What infections can be seen deficiencies of phagocytes?

A 
Strep
Staph
Coliforms
Aspergillus
Candida
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9
Q

What conditions can lead to deficiencies of phagocytes?

A 
Haematological malignancy (acute leukaemia, myelodysplasia) 
Cytotoxic chemo
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10
Q

What is the action of CD4+ T lymphocytes?

A

Active phagocytes to kill microbes

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11
Q

What is the action of CD8+ T cells?

A

Destroy infection cells containing microbes or microbial proteins

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12
Q

What infections can be seen in deficiencies in T lymphocytes?

A

Viruses
Fungi
Mycobacteria
Parasites

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13
Q

What conditions can lead to deficiencies to T lymphocytes?

A 
HIV infection (acquired deficiency in CD4+)
Lymphoma
Primary immunodeficiency syndromes (SCID)
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14
Q

What pathogens will B cells destroy?

A

Bacteria

Viruses

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15
Q

What conditions can lead to deficiencies in B cells?

A

Myeloma (paraproteinemia with immune paresis)
Primary immunodeficiency syndromes
Certain immune suppressants e.g. rituximab

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16
Q

Describe the pathological process of HIV?

A

HIV infects CD4+ T lymphocytes and produces a progressive decline in numbers of CD4+ lymphocytes resulting in deficiency in cell-mediated immunity

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17
Q

What conditions are HIV infected people susceptible to?

A

Invasive S.pneumoniae (bacteraemia/meningitis/empyema) irrespective of CD4 count
CD <350: TB, candidiasis
CD4<200: pneumocystis jirovecii, toxoplasma
CD4 <100: cryptococcus neoformans, CMV

18
Q

What is hyposplenism and what can cause it?

A

Decreased spleen function

Splenectomy (trauma, ITP, lymphoma) or functional hyposplenism (sickle cell, cirrhosis, coeliac disease)

19
Q

What conditions are those with hyposplenism more susceptible to?

A

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis (meningococcus)

20
Q

How can the risk of infections in hyposplenism be reduced?

A

Vaccination before the splenectomy

21
Q

Why are the elderly more susceptible to infections?

A

Phagocytes destroy bacteria/antigen more slowly
T cells respond more slowly
Less antibody is produced and it binds to antigen less well
Less complement produced

22
Q

What conditions is immune suppression required in?

A 
Inflammatory arthritis
Vasculitis/ connective tissue diseases
Glomerulonephritis 
IBD
Interstitial lung disease 
ITP/ autoimmune haemolytic anaemia
Transplants: solid organ or bone marrow
Cancer: biologics used in breast/lung/liver cancer and melanoma
23
Q

What are the effects of immune compression?

A

Blunted response to stimulus
Will not exhibit the same response to infections as “normal people”: absent fever, lack of inflammatory response (CRP/neutrophils), non-specifically unwell

24
Q

What will immunosuppression with steroids make you susceptible to?

A

Fungal infections (candida, aspergillus)

25
Q

What will immunosuppression with anti-TNFa (infliximab/etanercept) make you susceptible to?

A

TB

Fungal infections - aspergillus

26
Q

What will immunosuppression with purine analogues (fludarabine/cytarabine) make you susceptible to?

A 
Viral infections (HSV, VZV) 
Pneumocystis jirovecii
27
Q

What prophylaxis is given in HIV?

A

Co-trimoxazole (used to treat pneumocystis jiroveci)

28
Q

What prophylaxis is given in those with a bone marrow transplant?

A

Antifungals such as itraconazole

29
Q

What groups of people is the flu vaccine given to?

A 
Pregnant women
Chronic heart/lung/kidney/liver disease
Immunocompromise
Diabetes
Aged >65 or between 2-12
30
Q

What groups of people is the streptococcus pneumoniae vaccine given to?

A 
Chronic heart/lung/kidney/liver disease 
Hyposplenism
Immunocompromise (HIV)
Diabetes
Aged >65
31
Q

What groups of people is the HiB/DTP/MMR vaccine given to?

A

All children

32
Q

What prophylaxis is given to those with hyposplenism?

A

Phenoxymethylpenicillin V

33
Q

What cytokines are released in sepsis?

A

IL-1
TNF alpha
IL-17

34
Q

Describe cardiovascular dysfunction in sepsis?

A

Hypotension due to widespread vasodilation leading to fall in total peripheral resistance
Can be corrected with fluid resuscitation +/- inotropes/vasoconstrictors

35
Q

Describe pulmonary dysfunction in sepsis

A

Endothelial injury within lung tissue/ capillary leak
Diffuse alveolar oedema (ARDS)
Resp failure

36
Q

Describe renal dysfunction in sepsis

A

AKI - rise in urea/creatinine or oligo-anuria due to renal hypoperfusion

37
Q

Describe liver dysfunction in sepsis

A

Shock liver - transaminitis (grossly elevated ALT/AST) +/- jaundice due to hepatocyte injury

38
Q

Describe CNS dysfunction in sepsis

A

Delirium/ acute confusional state due to poor cerebral perfusion
Drowsy
Decreased condsious level

39
Q

Describe lactic acidosis in sepsis

A

Diffuse tissue hypoperfusion/hypoxia
Anaerobe metabolism leads to lactic acid production - metabolic acidosis
Acidosis worsens CV stability

40
Q

Describe haematological dysfunction in sepsis

A

Disseminated intravascular coagulation
Consumptive coagulopathy due to endothelial dysfunction/ platelet aggregation and coagulation cascade activation
Evidence by low Plts, prolonged APTT/PT, low fibrinogen and fragments on film

Sepsis (7 decks)

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