iii. Diseases of The Blood Flashcards
L71: What is sepsis?
Life-threatening organ dysfunction due to a dysregulated host immune response to infection
L71: What are the three main stages of sepsis?
- Infection in susceptible patient;
- Excessive immune response which causes harm;
- Organ dysfunction.
L71: What differentiates sepsis from any other infection?
Progression to organ dysfunction
L71: Diagnosis of sepsis can be based upon ‘infection plus SIRS’, what is SIRS?
Systematic Inflammatory Response Syndrome
L71: What are the signs and symptoms of SIRS?
- Elevated HR;
- Elevated respiratory rate;
- Elevated wbc count;
- Altered mentation (glagow coma scale);
- Fever or chills.
L71: Organ dysfunction can be identified as an acute change in the total SOFA score of how many points?
> or = to 2
L71: What is septic shock?
Sepsis in which the underlying circulatory and cellular and/ or metabolic abnormalities are marked enough to substantially increase mortality
L71: What type of infection can cause sepsis?
Any type of infection and from any site
L71: What microbial factors can cause some infections to progress to sepsis?
- Virulence factors, e.g. LPS, peptidoglycan, pili
these contribute to pathogenicity
L71: What host factors can cause some infections to progress to sepsis?
- Innate immunity;
- Adaptive immunity;
- Immunocompromisation (HIV/ AIDs, cancer, autoimmunity, organ transplantation;
- Pre-existing chronic conditions (diabetes, cirrhosis, CKD);
- Age;
- Genetics.
L71: Why are microbes more pathogenic to an immunocompromised host?
Microbes have a competitive advantage over the host and can overcome immune response more easily
L71: Who are most prone to sepsis? (based on stats)
- Ageing population (65% of cases in US);
- Immune-compromised patients.
L71: What is the pathophysiology of sepsis?
- Dysregulated, excessive systemic inflammation;
- Body-wide blood clotting and leaky vessels;
- One or more organs begin to fail;
- Persistent hypotension (septic shock).
L71: How does the body usually react to acute infection, in summary?
- Cardinal signs of inflammation, localised to site of infection;
- Clearance of the source of injury and necrotic tissues;
- Tissue repair;
- Homeostasis.
L71: How does the normal immune response become dysregulated in sepsis?
Failure to eliminate pathogen, localised acute inflammation progresses to acute systemic inflammation
L71: In a normal immune response to an infection, what inflammatory mediators regulate inflammation?
IL-10 and TGF-b
L71: Alongside excessive inflammation, what do patients with sepsis also demonstrate?
Immune suppression (apoptosis of T and B cells - adaptive immunity impaired)
L71: Organ dysfunction can lead to hyper-permeability of the gut, how does this further impede sepsis?
Further microbial load (from gut) into bloodstream
L71: What are two important factors of the course of tx for a sepsis patient?
- Early IV antibiotics;
- Vasopressors (to contract blood vessels and increase bp), 1-6 hours after onset.
L71: In dentistry, what can cause sepsis?
- Fungal infections;
- MRSA;
- Caries (due to high bacterial load);
- Abscesses.
L71: What two factors make dental abscesses a risk factor for sepsis?
- Can lead to creation of a fistula and drain elsewhere to in head/ neck;
- High risk of spread of infection
L71: What are the ‘red flag’ signs and symptoms of a spreading dental infection?
- Temp < 36 or > 38;
- Elevated breathing rate (>20 breaths/min);
- Elevated or reduced HR;
- Varying degrees of facial swelling;
- Trismus;
- Dehydration.
L71: What should you do, as a dentist, if you suspect a patient has signs/ symptoms/ risk of sepsis from a dental abscess?
- Refer to oral or maxillofacial surgeon in hospital, without delay;
- qSOFA criteria - medical emergency?
L71: What is qSOFA?
A tool to clinically characterise patients at risk of sepsis (at risk of prolonged ICU or death)
