Pathogenesis of Sepsis

Question 1

Gram + Organisms

Answer 1

Streptococcus
Staphylococcus
Enterococcus
Mycobacterium Tuberculosis

Question 2

Gram + Contribute

Answer 2

exotoxins (Sag)

Peptidoglycan/Lipotechoic Acid

Question 3

Gram - Organisms

Answer 3

Neisseria
Enterobacteriaceae
Pseudomonas
Rickettsis

Question 4

Gram - Contribute

Answer 4

Endotoxin

Question 5

Superantigen (SAg)

Answer 5

Toxic Shock Syndrome: Staph Aureus, Strep Pyogens

Bind MHC II TCR Independently of Ag
-cause massive T-Cell Activation

Pro-inflammatory Response

Question 6

What Inflammatory Cytokine do Super-Ag activated T cells produce

Answer 6

Il-1

Question 7

What part of gram - LPS is toxic

Answer 7

Lipid A

Question 8

Gram - sepsis Mechanism

Answer 8

TLR-4 binding LPS

Question 9

LPS in circulation binds

Answer 9

LPS binding protein (LPB)

Transferred to CD14

Question 10

sCD14-LPS can

Answer 10

activate endothelium

activates TLR4-R complex on monocyte/PMN

Question 11

Activated TLR-4 Complex stimulates

Answer 11

NFkB activation

TNFa, IL-1, IL-6 expression

Question 12

Pyrogen Cytokines

Answer 12

TNF-a
IL-1
IL-6

Question 13

IL-1 and IL-6 effect on liver

Answer 13

produce fibrinogen: DIC

Question 14

TNFa and IL-1 act on

Answer 14

hypothalamus

Question 15

TNFa action

Answer 15

inhibit myocardial contractility: hypotension

Stimulate Tissue factor: DIC

muscle/fat cell wasting

Question 16

Pro-Inflammatory Cytokines

Answer 16

IL-1
Il-6
IL-8
IL-12
TNFa

Question 17

Anti-inflammatory Cytokines

Answer 17

IL-4
IL-10
TGFb
IL-1-R antagonists