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Infection > Pyrexia/Sepsis > Flashcards

Pyrexia/Sepsis Flashcards

1
Q

How is fever defined?

A

Elevation of body temp >37C

Part of the systemic inflammatory response syndrome (SIRS)

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2
Q

What is the name of substances that cause fever?

A

Pyrogens

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3
Q

Give some examples of pyrogens

A

Endogenous - cytokines

Exogenous - Endotoxins from G-ve bacteria

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4
Q

What defines Pyrexia of Unknown Origin?

A

Temp > 38.3C
recorded on multiple occasions
present for at least three weeks
defied diagnosis after 3 days in hospital evaluation

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5
Q

What type of bacteria are staphylococci?

A

Gram-positive cocci that form grape-like clusters

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6
Q

In what types of patients is the rate of Staph Aureus colonisation higher?

A

Insulin-dependent diabetes, HIV infection, patients undergoing haemodialysis, individuals with skin damage.

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7
Q

What is the most frequent site of staph aureus colonisation?

A

Anterior narres (nostrils).

Also skin (damaged), vagina, axilla, perineum and oropharynx

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8
Q

How is sepsis defined?

A

Life-threatening organ dysfunction caused by disregulated host response to infection

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9
Q

How is septic shock identified?

A

Clinical construct of sepsis with persistent hypotension requiring vasopressors to maintain MAP >65 mmHg and serum lactate >2mmol/L

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10
Q

What are the criteria in qSOFA in sepsis and what is it used for?

A
  • Hypotension Systolic BP <100mmHg
  • Altered Mental Status
  • Tachypnea RR >22/min

Score of >2 Criteria suggests greater risk of a poor outcome

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11
Q

What are the body’s defences against sepsis?

A

Physical barrier,
Innate immune system,
Adaptive immune system

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12
Q

List some commonly released bacterial toxins in sepsis?

A

Gram negative:
Lipopolysaccharide (LPS)

Gram positive:
Microbial-associated molecular pattern (MAMP)
-Lipoteichoic acid
-Muramyl dipeptides

Superantigens

  • Staphylococcal toxic shock syndrome toxin (TSST)
  • Streptococcal exotoxins
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13
Q

What bacterial toxin needs binding proteins to bind to macrophages?

A

LPS

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14
Q

What are the two types of mediators that can be released in sepsis?

A
  • Pro-inflammatory mediators

- Compensatory anti-inflammatory mediators

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15
Q

What are the effects of excessive pro-inflammatory mediators?

A
  • Promote endothelial cell – leukocyte adhesion
  • Release of arachidonic acid metabolites
  • Complement activation
  • Vasodilatation of blood vessels by NO
  • Increase coagulation by release of tissue factors and membrane coagulants
  • Cause hyperthermia
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16
Q

What are the effects of excessive anti-inflammatory mediators?

A
  • Inhibit TNF alpha
  • Augment acute phase reaction
  • Inhibit activation of coagulation system
  • Provide negative feedback mechanisms to pro-inflammatory mediators
17
Q

What do the pro-inflammatory mediators cause?

A

Sepsis -> Multiorgan failure -> Death

18
Q

What do the compensatory anti-inflammatory mediators cause?

A

Immunoparalysis with uncontrolled infection -> Multiorgan failure

19
Q

What do the clinical features of sepsis depend on?

A
  • Host
  • Organism
  • Environment
20
Q

What host factors may effect the presentation of sepsis?

A
  • Age
  • Co-morbidities
  • Immunosuppression
  • Previous surgery
21
Q

What organism factors may effect the presentation of sepsis?

A
  • Gram positive vs negative
  • Virulence factors
  • Bioburden
22
Q

What environmental factors influence the presentation of sepsis?

A
  • Occupation
  • Travel
  • Hospitalisation
23
Q

Why would you take blood cultures in sepsis?

A

-To make a microbiological diagnosis (30-50% positive)

24
Q

Why would you take lactate in sepsis?

A

-Marker of generalised hypoperfusion/severe sepsis/poorer prognosis

(Think lactate appearing in anaerobic respiration! Low oxygen!)

25
Q

Why would you measure urine output in sepsis?

A

-Low urine output is a marker of renal dysfunction

26
Q

When would you consider HDU referral in sepsis?

A 
Low BP responsive to fluids
Lactate >2 despite fluid resuscitation
Elevated creatinine 
Oliguria
Liver dysfunction, Bil, PT, Plt
Bilateral infiltrates, hypoxaemia
27
Q

When would you consider ITU in sepsis management?

A
  • Septic shock
  • Multi-organ failure
  • Requires sedation, intubation and ventilation

Infection (7 decks)

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