Sepsis Flashcards
What is the definition of sepsis?
Life threatening organ dysfunction caused by an overwhelming host immune response to infection.
Sepsis cannot occur in the absence of …. ?
Infection.
However sepsis is NOT an infection
Once the infection is treated what could happen in terms of sepsis?
It can persist.
What differentiates sepsis from infection?
The organ dysfunction.
What are the signs of sepsis?
Organ dysfunction.
identified via;
SOFA score of 2 or more.
qSOFA score of 2 or more. qSOFA clinical signs; Increased respiratory rate > 22 breaths/min. < 15 on the Glasgow coma scale. Systolic blood pressure is < 100mmHg.
What is the baseline (q)SOFA score for healthy patients and in patients with pre-existing organ failure?
Healthy patient = 0
Pre-existing failure = 1
i.e. diabetes and liver failure
List some factors which cause infection to progress to sepsis.
Microbial factors:
LPS molecules
Microorganism has Pili, fimbrae
Host factors: Immunocompromised - HIV, AIDS Medically compromised - diabetes, cirrhosis. Age Genetic
What groups of individuals are affected the most by sepsis?
Medically compromised
Immunocompromised
What is the outcome of the infection (i.e. resolved or progression to sepsis) determined by?
The interactions between the microbes and the host immune response.
What occurs in the pathophysiology of sepsis?
Blood clotting all over the body. Leaky blood vessels. Systemic inflammation Organ failure Persistent hypotension - low BP.
Describe the immunopathogenesis involved in sepsis.
Failure to eliminate the pathogen causing the infection (leads to;)
= Excessive systemic inflammation.
Localised inflammation progresses to systemic inflammation.
leads to Tissue destruction, Hyperinflammation, Activation of the vascular endothelium, coagulation system and the complement system, Strong activation of the innate immune response via PAMPS and DAMPS.
Immunosuppression
leads to Apoptosis of T and B cells, Dysfunction of dendritic cells and failure of apoptosis in immature dysfunctional neutrophils
What are the consequences of sustained systemic inflammation from the immunopathogensis of sepsis?
Tissue destruction
Hyperinflammation
Activation of the vascular endothelium, coagulation system and the complement system.
Strong activation of the innate immune response via PAMPS and DAMPS.
What are PAMPS?
Alert immune cells to destroy pathogens
What are DAMPS?
Released from damaged cells to promote the inflammatory response.
What occurs in the immune suppression from the immunopathogenesis of sepsis?
Apoptosis of T and B cells
Dysfunction of dendritic cells
Failure of apoptosis in immature dysfunctional neutrophils
What systems are mainly affected by sepsis?
Cardiovascular system
Blood coagulation system
How do you treat sepsis?
Mainly Iv antibiotics
Vasopressors in septic shock
In terms of dentistry; what can be a trigger for sepsis?
Dental abscesses
Why do dental abscesses have a risk of causing sepsis?
They an cause fistulas by eroding through surrounding tissues/structures.
They contain/ can leak highly infectious material.
What do dental abscesses contain?
LIVE BACTERIA, Immune cells and dead tissue.
How do you treat dental abscesses?
Excision and drainage.
In periapical abscesses;
Root canal treatment and extractions.
When are antibiotics given for dental abscesses?
If there is spreading infection.
What are the red flag signs of spreading dental infection?
Temperature < 36 or > 38. Increased/decreased heart rate. Increased breathing rate > 20 breaths/min Trismus Facial swelling Dehydration
