Dr Z B Banoo Inkosi Albert Luthuli Central Hospital Paediatric ...
Dr Z B Banoo Inkosi Albert Luthuli Central Hospital Paediatric ...
Dr Z B Banoo Inkosi Albert Luthuli Central Hospital Paediatric ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Dr</strong> Z B <strong>Banoo</strong><br />
<strong>Inkosi</strong> <strong>Albert</strong> <strong>Luthuli</strong> <strong>Central</strong> <strong>Hospital</strong><br />
<strong>Paediatric</strong> Intensive Care Unit
Unwanted<br />
Persistent<br />
Ubiquitous<br />
Mysterious<br />
Leading cause of death
Pathophysiology<br />
Definition dilemmas<br />
Diagnostic Tools<br />
Clinical to Cultures<br />
Biomarkers to genomics<br />
Summary
Derived from the Greek word ŋΨις<br />
Decomposition of animal and vegetable<br />
organic matter<br />
100 years ago link between bacteria<br />
and sepsis<br />
sepsis synonymous with severe infection
Precise definition of the disease process<br />
in question<br />
Complex process, multiple sites, multiple<br />
organisms<br />
Multitude of symptoms & signs, varying<br />
over time, severity from mild to fatal<br />
Complexity and variation- single<br />
definition impossible
Microbiological markers<br />
Blood cultures<br />
Tracheal Aspirates<br />
Urine MCS<br />
Cerebral Spinal Fluid<br />
Pus Swabs
Clinical<br />
Manifestation<br />
Acute Phase<br />
Proteins<br />
Cytokines<br />
Cytokines<br />
Inflammatory<br />
Cells<br />
Inflammatory<br />
cells<br />
Orgs<br />
Organisms
Indicator of a biological state<br />
Measurable substance in an organism<br />
Molecular marker or signature molecule<br />
Diagnostic and/or prognostic utility<br />
Surrogate endpoint
Leucocytosis<br />
Leucopenia<br />
White Blood<br />
Count<br />
Insensitive<br />
Non-specific<br />
Marker of<br />
Inflammation<br />
Bandemia
Inflammatory stimuli marginalization,<br />
extravasation and activation of<br />
granulocytes and monocytes<br />
Release of pro-inflammatory cytokines<br />
TNF<br />
IL-1<br />
IL-6<br />
Production of acute phase proteins
Late<br />
Biomarker<br />
Serial<br />
Measurements<br />
C- reactive protein<br />
Low<br />
sensitivity<br />
and<br />
specificity<br />
Peak 2-3 days
APP produced in response to proinflammatory<br />
cytokines<br />
Direct measure of the cytokines earlier<br />
indication of infection<br />
IL-1, IL-6, TNF, sIL2R<br />
Initial reports of high sensitivity and<br />
specificity have not been borne out in<br />
clinical trials
Soluble triggering receptor expressed on<br />
myeloid cells<br />
Upregulated in neutrophils and<br />
monocytes during bacterial infection<br />
Limited value in neutropenia
Identification of resistant genes by<br />
molecular techniques<br />
Genomics – identification of genes<br />
upregulated in infection eg IL8 AND<br />
MCP-1 Mrna<br />
Proteonomics – mass spectrometry<br />
profiling technology to identify host<br />
response proteins<br />
Gelsolin, Copeptin, Endothelial-1…..
Sepsis – homogenous disease process<br />
inadequate<br />
Clinical variables – too sensitive,<br />
nonspecific<br />
Synthesis of clinical, physiological and<br />
laboratory features
Gut<br />
instinct<br />
Clinical<br />
features<br />
Sepsis<br />
Special<br />
Investigations<br />
Biomarkers
Change language