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Infection > Session 3 > Flashcards

Session 3 Flashcards

1
Q

What are the six common signs of sepsis?

A 
Slurred speech or confusion 
Extreme shivering or muscle pain 
Passing no urine 
Severe breathlessness 
I feel like i might die 
Skin mottled or discoloured
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2
Q

What would you be particularly interested in when looking for features of sepsis in a FBC?

A

A raised white cell count and raised neutrophils

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3
Q

What is CRP? Where is it produced?

A

An acute phase protein that is produced as a part of the response to infection (seen at raised levels)

Liver

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4
Q

Why is it useful to look consider U&E (urea and electrolyte) investigations in suspected sepsis?

A

Patients with acute sepsis may develop renal and other metabolic problems

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5
Q

Why may blood cultures be carried out in suspected sepsis?

A

To confirm and identify the bacteria casing the infection

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6
Q

E.coli is an important microbe that is part of the normal flora of the _________

A

Colon

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7
Q

What is sepsis?

A

Life-threatening organ dysfunction due to a dysregulated host response to infection

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8
Q

What is septic shock?

A

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

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9
Q

What is bacteraemia?

A

Presence of bacteria in the blood

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10
Q

How is sepsis clinically recognised?

A

Through clinical assessment of patients who look sick or have a raised early warning score

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11
Q

What is the early warning score?

A

Set of basic observations such as respiratory rate, heart rate, blood pressure, temperature

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12
Q

Give some examples of clinical ‘red flags’ for sepsis?

A

High RR
Low BP
Unresponsive

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13
Q

What is a purpuric rash? How can it be tested for?

A

A type of non-blanching rash

Glass/tumbler test

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14
Q

What does the sepsis six bundle involve?

A 
Oxygen 
Blood cultures 
IV antibiotics 
Fluid challenge 
Lactate 
Measurement of urine output
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15
Q

What sorts of investigations would be carried out in red flag sepsis?

A

FBC
U&E
CRP
Blood sugar

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16
Q

What is meningococcal meningitis? How is it spread? Is it dangerous in all people?

A

A bacterial infection commonly caused by Neisseria meningitidis

By direct contact with respiratory secretions

No,most people are harmlessly colonised

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17
Q

Cytokines released in the inflammatory response initiate the production of __________ which promotes coagulation

How else do cytokines seen in sepsis promote coagulation?

A

Thrombin

They inhibit fibrinolysis

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18
Q

The coagulation cascade as a result of infection leads to…

A

Microvascular thrombosis and organ ischaemia, dysfunction and failure

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19
Q

What is a major cause of shock and multi-organ failure?

A

Microvascular injury

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20
Q

When there is limited blood travelling in vessels to which organs is the blood prioritised?

A

Heart
Brain
Kidneys

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21
Q

What is the purpose of antibiotics in the treatment of sepsis?

A

They can work against the pathogen causing the infection

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22
Q

For meningococcal meningitis, what would be required of the antibiotic? What would be the best choice?

A

To be able to penetrate into the CSF

Ceftriaxone

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23
Q

State some life-threatening complications of sepsis (5)

A 
Irreversible hypotension 
Respiratory failure 
Acute kidney injury 
Raised intercranial pressure 
Ischaemic necrosis of digits/hands/feet
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24
Q

What type of bacteria is Neisseria meningitidis?

A

Gram-negative diplococcus

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25
Q

There are various serogroups of Neisseria meningitidis based on their…

A

Polysaccharide capsular antigen

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26
Q

How does Neisseria meningitidis evade the immune response?

A

Prevents phagocytosis

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27
Q

The outer membrane of Neisseria meningitidis acts as an…

A

Endotoxin

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28
Q

How is meningococcal disease spread?

A

By aerosols and nasopharyngeal secretions

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29
Q

Meningococcal disease cases in England are usually of which serogroup?

A

Group B

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30
Q

Do vaccines exist for meningitis? If so, which ones?

A

Yes

Meningococcal C conjugate vaccine
ACWY vaccines
Serogroup B vaccines

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31
Q

ACWY vaccines are commonly for which sorts of patients?

A

Immunocompromised patients and travel protection

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32
Q

Why was it difficult to create an effective vaccine for the group B N meningitidis?

A

It’s capsule is poorly immunogenicity and similar to neural tissue

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33
Q

What can be done for close contacts of someone with meningitis?

A

They can be given antibiotic prophylaxis and considered for vaccination

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34
Q

What is the immune system?

A

The cells and organs that contribute to immune defences against infectious and non-infectious conditions

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35
Q

What is an infectious disease?

A

When the pathogen succeeds in evading and/or overwhelming the host’s immune defences

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36
Q

You can not have adaptive immunity without…

A

Innate immunity

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37
Q

The immune response consists of which 2 types of responses?

A

Innate immune response

Adaptive immune response

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38
Q

The innate immune system provides what sort of protection against pathogens?

A

Immediate (within seconds)
Less specific
Consistent - no change in intensity
Response with lack of memory

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39
Q

The adaptive immune system provides what sort of protection against pathogens?

A

Slow, long-lasting protection
Specific
Response with immunologic memory
Response with changes in intensity

40
Q

What is the function of the first lines of defence in the innate immune system?

A

To prevent the entry and limit the growth of pathogens

41
Q

What are some examples of physical barriers (first lines of defence of the innate immune system)?

A

Skin
Mucous membranes
Bronchial cilia

42
Q

Give 4 examples of mucous membranes in the human body

A

Mouth
Respiratory tract
GI tract
Urinary tract

43
Q

Give 4 examples of physiological barriers that act as first lines of defence for the innate immune system

A

Diarrhoea
Vomiting
Coughing
Sneezing

44
Q

Give examples of chemical barriers that act as first lines of defence for the innate immune system

A

Low pH in certain parts of the body

Antimicrobial molecules

45
Q

What is the rough pH of the…

Stomach
Skin
Vagina

A

1-3

  1. 5
  2. 4
46
Q

Give some examples of antimicrobial molecules that act as chemical barriers in the innate immune system

A 
IgA
Lysozyme 
Mucus 
Beta-defensins 
Gastric acid + pepsin
47
Q

Where are beta-defensins found in the body?

A

In epithelium

48
Q

Where is lysozyme found in the human body?

A

Sebum
Perspiration
Urine

49
Q

Where is IgA found in the human body?

A

Tears
Saliva
Mucous membranes

50
Q

Where are normal flora not present in the body?

A

Internal organs

Blood

51
Q

What are normal flora? What benefits can they have for their host? (3)

A

Non-pathogenic microbes (in their normal locations)

They can compete with pathogens for resources
They can produce antimicrobial chemicals
They can synthesise vitamins

52
Q

Give 2 examples of normal flora of the skin

A

Staph aureus

Candida albicans

53
Q

Give 2 examples of normal flora of the nasopharynx

A

Strep pneumoniae

Neisseria meningitidis

54
Q

When can normal flora cause disease? (3)

A

When its displaced from its normal location to a sterile location

When it overgrows and becomes pathogenic when host becomes immunocompromised

When normal flora is depleted by antibiotics

55
Q

Give examples of how the skin integrity may be breached introducing normal flora to usually sterile locations

A

Burns
Surgery
Injection drug users
IV lines

56
Q

Immunosuppressed patients can be infected by normal flora that overgrows and becomes pathogenic. Give an example of such conditions.

A

Diabetes
AIDs
Malignant diseases
Chemotherapy

57
Q

What are two examples of second lines of defence in the innate immune system?

What is the function of second lines of defence?

A

Phagocytes
Chemicals (e.g. Cytokines)

They contain and clear the infection - cause inflammation

58
Q

What are the 3 main phagocytes seen in the innate immune system?

A

Macrophages
Monocytes
Neutrophils

59
Q

Where are macrophages found?

What is their function? (3)

A

In the tissues, in all organs

Produce cytokines/chemokines
Phagocytosis
APCs for the adaptive immune system

60
Q

Where are monocytes found in the body?

What is their function?

A

In the blood

They are recruited at the infection site and differentiate into macrophages

61
Q

Neutrophils are found at increased levels during…

A

Infection

62
Q

Neutrophils are recruited by ___________ at the site of infection

A

Chemokines

63
Q

What are some other cells of the innate immunity? (5)

A 
Basophils 
Mast cells
Eosinophils 
Natural killer cells
Dendritic cells
64
Q

What is the function of basophils/mast cells in the innate immunity?

A

Early actors of inflammation

Important in allergic reactions

65
Q

What function do eosinophils have in the innate immunity?

A

Important defence against multi-cellular parasites (worms)

66
Q

What function do natural killer cells have in the innate immunity?

A

Kill all abnormal host cells (e..g virus infected or malignant cells)

67
Q

What function do dendritic cells have in the innate immunity?

A

They present microbial antigens to T cells (APCs)

68
Q

How are pathogens recognised by the innate immune system? (3)

A

Through microbial structures (PAMPs)
Through structures on the phagocyte (PRRs)
Through opsonisation of microbes

69
Q

What are PAMPs?

A

Pathogen-associated molecular patterns on the microbe that allow the pathogen to be recognised

70
Q

What are PRRs?

A

Pathogen recognition receptors either on the cell surface or within the cell which help with the recognition of pathogens

71
Q

What is the purpose of opsonisation?

A

It allows for enhanced attachment of phagocytes and clearance of microbes

72
Q

Give 2 examples of complement proteins/acute phase proteins/antibodies that act as opsonins…

A

C3b
C4b

CRP
Mannose-binding lectin

IgG
IgM

73
Q

Opsonisation is particularly important in helping to clear which type of bacteria?

A

Encapsulated bacteria

74
Q

Give 3 examples of encapsulated bacteria, where opsonisation is key to their clearance by the innate immune system.

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae b

75
Q

The killing mechanisms of phagocytes can be categorised into which 2 categories?

A

Oxygen-dependent

Oxygen independent pathway

76
Q

What is involved in the oxygen dependent pathway of phagocytosis?

A

Involves the the production of toxic oxygen products to kill the pathogens - e.g. Hydrogen peroxide, hydroxyl radical etc.

Respiratory burst

77
Q

What is involved in the oxygen-indecent pathway of phagocytosis?

A

Enzymes/chemicals are produced to kill the pathogens e.g.

Lysozyme
Proteolytic/hydrolytic enzymes
Cationic proteins

78
Q

Give an example of a cationic protein. What can they be used for?

A

Cathepsin

In the oxygen independent pathway of phagocytosis to kill pathogens

79
Q

Name three functions of cytokines/chemokines in the innate immune system?

A

Chemoattraction
Phagocyte activation
Inflammation

80
Q

The complement system consists of…

A

20 serum proteins (most important C1-C9)

81
Q

Which two pathways can activate the complement system?

A

Alternative pathway

MBL pathway

82
Q

Describe the alternative pathway of activating the complement system

A

Initiated by cell surface microbial constituents (e.g. Endotoxins)

83
Q

Describe the MBL pathway of activating the complement system

A

Initiated when MBL binds to mannose containing residues of proteins found on microbes

84
Q

Give an example of a microbe whose proteins contain mannose residues

A

Candida albicans

85
Q

Which complement proteins are particularly important in the recruitment of phagocytes? (2)

A

C3a

C5a

86
Q

Which complement proteins are particularly important in the opsonisation of pathogens? (2)

A

C3b

C4b

87
Q

Which complement proteins are particularly important in the killing of pathogens and the formation of the membrane attack complex?

A

C5-C9

88
Q

TNF-a, IL-1 and IL-6 are all chemicals released from…

What parts of the body can they have antimicrobial actions on?

A

Activated macrophages

Liver
Bone marrow
Inflammatory response
Hypothalamus

89
Q

What anti-microbial actions can TNF-a, IL-1, IL-6 have on the…

Liver
Bone marrow
Inflammatory response
Hypothalamus

A

Result in CRP/MBL production (opsonisation)

Neutrophil mobilisation

Vasodilation
Vascular permeability
Attraction of neutrophils

Increased body temperature

90
Q

A decrease in phagocytosis by the phagocytes of the innate immune system can be caused by… (3)

A

Decreased spleen function
Decreased neutrophil number
Decreased neutrophil function

91
Q

In which patients can decreased spleen function (and therefore reduced phagocytosis) be seen?

A

Asplenic/Hyposplenic Patients

92
Q

What can cause a decrease in neutrophil number?

A

Cancer chemotherapy
Drug such as phenytoin
Leukaemia and lymphoma

93
Q

Give 2 examples of diseases which result in decreased neutrophil function

A

Chronic granulomatous disease

Chediak-Higashi syndrome

94
Q

How does chronic granulomatous disease decrease neutrophil function?

A

Results in no respiratory burst in neutrophils

95
Q

How does Chediak-Higashi syndrome affect neutrophil function?

A

Results in no phagolysosome formation in phagocytes

96
Q

The first lines of defence in the innate immune system consist of various barriers. What is their function?

A

To limit entry and growth of pathogens at ports of entry

97
Q

What do the second lines of defence in the innate immune system consist of? What is their function?

A

Phagocytes/Chemicals

To contain and eliminate the infection

Infection (10 decks)

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