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Session 3 Flashcards

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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
There are various serogroups of Neisseria meningitidis based on their...
Polysaccharide capsular antigen
26
How does Neisseria meningitidis evade the immune response?
Prevents phagocytosis
27
The outer membrane of Neisseria meningitidis acts as an...
Endotoxin
28
How is meningococcal disease spread?
By aerosols and nasopharyngeal secretions
29
Meningococcal disease cases in England are usually of which serogroup?
Group B
30
Do vaccines exist for meningitis? If so, which ones?
Yes Meningococcal C conjugate vaccine ACWY vaccines Serogroup B vaccines
31
ACWY vaccines are commonly for which sorts of patients?
Immunocompromised patients and travel protection
32
Why was it difficult to create an effective vaccine for the group B N meningitidis?
It's capsule is poorly immunogenicity and similar to neural tissue
33
What can be done for close contacts of someone with meningitis?
They can be given antibiotic prophylaxis and considered for vaccination
34
What is the immune system?
The cells and organs that contribute to immune defences against infectious and non-infectious conditions
35
What is an infectious disease?
When the pathogen succeeds in evading and/or overwhelming the host's immune defences
36
You can not have adaptive immunity without...
Innate immunity
37
The immune response consists of which 2 types of responses?
Innate immune response | Adaptive immune response
38
The innate immune system provides what sort of protection against pathogens?
Immediate (within seconds) Less specific Consistent - no change in intensity Response with lack of memory
39
The adaptive immune system provides what sort of protection against pathogens?
Slow, long-lasting protection Specific Response with immunologic memory Response with changes in intensity
40
What is the function of the first lines of defence in the innate immune system?
To prevent the entry and limit the growth of pathogens
41
What are some examples of physical barriers (first lines of defence of the innate immune system)?
Skin Mucous membranes Bronchial cilia
42
Give 4 examples of mucous membranes in the human body
Mouth Respiratory tract GI tract Urinary tract
43
Give 4 examples of physiological barriers that act as first lines of defence for the innate immune system
Diarrhoea Vomiting Coughing Sneezing
44
Give examples of chemical barriers that act as first lines of defence for the innate immune system
Low pH in certain parts of the body | Antimicrobial molecules
45
What is the rough pH of the... Stomach Skin Vagina
1-3 5. 5 4. 4
46
Give some examples of antimicrobial molecules that act as chemical barriers in the innate immune system
``` IgA Lysozyme Mucus Beta-defensins Gastric acid + pepsin ```
47
Where are beta-defensins found in the body?
In epithelium
48
Where is lysozyme found in the human body?
Sebum Perspiration Urine
49
Where is IgA found in the human body?
Tears Saliva Mucous membranes
50
Where are normal flora not present in the body?
Internal organs | Blood
51
What are normal flora? What benefits can they have for their host? (3)
Non-pathogenic microbes (in their normal locations) They can compete with pathogens for resources They can produce antimicrobial chemicals They can synthesise vitamins
52
Give 2 examples of normal flora of the skin
Staph aureus | Candida albicans
53
Give 2 examples of normal flora of the nasopharynx
Strep pneumoniae | Neisseria meningitidis
54
When can normal flora cause disease? (3)
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
Give examples of how the skin integrity may be breached introducing normal flora to usually sterile locations
Burns Surgery Injection drug users IV lines
56
Immunosuppressed patients can be infected by normal flora that overgrows and becomes pathogenic. Give an example of such conditions.
Diabetes AIDs Malignant diseases Chemotherapy
57
What are two examples of second lines of defence in the innate immune system? What is the function of second lines of defence?
Phagocytes Chemicals (e.g. Cytokines) They contain and clear the infection - cause inflammation
58
What are the 3 main phagocytes seen in the innate immune system?
Macrophages Monocytes Neutrophils
59
Where are macrophages found? What is their function? (3)
In the tissues, in all organs Produce cytokines/chemokines Phagocytosis APCs for the adaptive immune system
60
Where are monocytes found in the body? What is their function?
In the blood They are recruited at the infection site and differentiate into macrophages
61
Neutrophils are found at increased levels during...
Infection
62
Neutrophils are recruited by ___________ at the site of infection
Chemokines
63
What are some other cells of the innate immunity? (5)
``` Basophils Mast cells Eosinophils Natural killer cells Dendritic cells ```
64
What is the function of basophils/mast cells in the innate immunity?
Early actors of inflammation | Important in allergic reactions
65
What function do eosinophils have in the innate immunity?
Important defence against multi-cellular parasites (worms)
66
What function do natural killer cells have in the innate immunity?
Kill all abnormal host cells (e..g virus infected or malignant cells)
67
What function do dendritic cells have in the innate immunity?
They present microbial antigens to T cells (APCs)
68
How are pathogens recognised by the innate immune system? (3)
Through microbial structures (PAMPs) Through structures on the phagocyte (PRRs) Through opsonisation of microbes
69
What are PAMPs?
Pathogen-associated molecular patterns on the microbe that allow the pathogen to be recognised
70
What are PRRs?
Pathogen recognition receptors either on the cell surface or within the cell which help with the recognition of pathogens
71
What is the purpose of opsonisation?
It allows for enhanced attachment of phagocytes and clearance of microbes
72
Give 2 examples of complement proteins/acute phase proteins/antibodies that act as opsonins...
C3b C4b CRP Mannose-binding lectin IgG IgM
73
Opsonisation is particularly important in helping to clear which type of bacteria?
Encapsulated bacteria
74
Give 3 examples of encapsulated bacteria, where opsonisation is key to their clearance by the innate immune system.
Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae b
75
The killing mechanisms of phagocytes can be categorised into which 2 categories?
Oxygen-dependent Oxygen independent pathway
76
What is involved in the oxygen dependent pathway of phagocytosis?
Involves the the production of toxic oxygen products to kill the pathogens - e.g. Hydrogen peroxide, hydroxyl radical etc. Respiratory burst
77
What is involved in the oxygen-indecent pathway of phagocytosis?
Enzymes/chemicals are produced to kill the pathogens e.g. Lysozyme Proteolytic/hydrolytic enzymes Cationic proteins
78
Give an example of a cationic protein. What can they be used for?
Cathepsin In the oxygen independent pathway of phagocytosis to kill pathogens
79
Name three functions of cytokines/chemokines in the innate immune system?
Chemoattraction Phagocyte activation Inflammation
80
The complement system consists of...
20 serum proteins (most important C1-C9)
81
Which two pathways can activate the complement system?
Alternative pathway MBL pathway
82
Describe the alternative pathway of activating the complement system
Initiated by cell surface microbial constituents (e.g. Endotoxins)
83
Describe the MBL pathway of activating the complement system
Initiated when MBL binds to mannose containing residues of proteins found on microbes
84
Give an example of a microbe whose proteins contain mannose residues
Candida albicans
85
Which complement proteins are particularly important in the recruitment of phagocytes? (2)
C3a | C5a
86
Which complement proteins are particularly important in the opsonisation of pathogens? (2)
C3b | C4b
87
Which complement proteins are particularly important in the killing of pathogens and the formation of the membrane attack complex?
C5-C9
88
TNF-a, IL-1 and IL-6 are all chemicals released from... What parts of the body can they have antimicrobial actions on?
Activated macrophages Liver Bone marrow Inflammatory response Hypothalamus
89
What anti-microbial actions can TNF-a, IL-1, IL-6 have on the... Liver Bone marrow Inflammatory response Hypothalamus
Result in CRP/MBL production (opsonisation) Neutrophil mobilisation Vasodilation Vascular permeability Attraction of neutrophils Increased body temperature
90
A decrease in phagocytosis by the phagocytes of the innate immune system can be caused by... (3)
Decreased spleen function Decreased neutrophil number Decreased neutrophil function
91
In which patients can decreased spleen function (and therefore reduced phagocytosis) be seen?
Asplenic/Hyposplenic Patients
92
What can cause a decrease in neutrophil number?
Cancer chemotherapy Drug such as phenytoin Leukaemia and lymphoma
93
Give 2 examples of diseases which result in decreased neutrophil function
Chronic granulomatous disease | Chediak-Higashi syndrome
94
How does chronic granulomatous disease decrease neutrophil function?
Results in no respiratory burst in neutrophils
95
How does Chediak-Higashi syndrome affect neutrophil function?
Results in no phagolysosome formation in phagocytes
96
The first lines of defence in the innate immune system consist of various barriers. What is their function?
To limit entry and growth of pathogens at ports of entry
97
What do the second lines of defence in the innate immune system consist of? What is their function?
Phagocytes/Chemicals To contain and eliminate the infection

Infection (10 decks)

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