University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

273

Pages:

3
Author:

Mariam A. A.

IMMUNOLOGY AND INFECTIOUS DISEASE WEEK 3 SAQ (PART 1) QUESTIONS STUDY GUIDE 1. a. b. c. Distinguish between sepsis, septicaemia, SIRS, Septic shock, SOFA, qSOFA, LODS. Name some septic workup tests. Management Answer: a. • - • Sepsis: dysregulated immune response: Fever or hypothermia. Increased heart rate. Increased respiratory rate. Decreased blood pressure. Organ dysfunction: raised or lowered WBC (polymorphs), oxygenation impairment, lactic acidosis of more than 4 (due to hypoperfusion), decreased UO and increased Cr (renal impairment) Any of these signs are red flags, it is important note that the very young, the very old and the immunosuppressed may not show all of these features, especially in the early phases. Septicaemia refers to the presence of micro-organisms in the blood. It is not specific and insensitive and do not cause any organ dysfunction. Negative blood cultures do not exclude this. SIRS: Insensitive and nonspecific and simplistic. Recognised that not all causes are of an infective origin. Need to or more of: Fever or hypothermia, Resp rate over 20 and heart rate over 90 and >12x109/L or >10% band forms. Septic shock. Similar to sepsis but lactic acidosis more than 2 mmol/L despite adequate fluid resuscitation and need vasopressors to maintain a pressure of 65 mmHg of greater. SOFA • qSOFA • • • - • LODS b. • • • • • • • • c. • • • • • Blood cultures. Sputum analysis. CXR Urine analysis CT abdomen Lumbar puncture FBC, coags, EUC, LFTs, CRP, lactate, ABGs. Acute inflammatory markers. Advanced life support: Inotropes. Fluids. Organ replacement. Anti-infectives. Source control. Accurate diagnosis: how does the patient look like, history and special tests. Monitor vitals. 2. a. b. c. Name and describe the five virulence factors of E. coli. (5 marks). Describe the four pathogenic pathways of E. coli. (4 marks). Name the FOUR mechanisms in which bacteria may develop resistance to antibiotics. (2 marks). Answer: a. • • • • • b. • • • • c. • • • • IgA proteases -> destroy IgA antibodies -> prevent immune attack to the bacteria. Urease -> convert urea into ammonia and carbon dioxide -> neutralise the acidity and allow invasion of the bacteria. Flagella -> allow for bacterial motility. High Fe affinity -> compete for iron which is one of the important nutrients for humans and their energy. Fimbriae -> allow and facilitate adhesions. Enterotoxigenic -> secretion and fluid loss -> watery diarrhoea. Enter invasive -> allows invasion into the intestinal cells -> bloody diarrhoea. Enterohemorrhagic -> haemorrhage syndrome and kidney disease Enteropathogenic -> infantile diarrhoea. Decreased permeability. Increased efflux. Increased activity of enzymes that inactivate antibiotics. Decreased binding of antibiotic to target site.