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Emergency conditions for infectious diseases
Associate Professor of the Department of Infectious Diseases
and Phthisiopulmonology
Blazhnaya L.P.
Infectious-toxic shock (ITS)
- a kind of shock, in which the starting factor is an infection, leading to systemic reactions of the body, accompanied by severe hemodynamic disorders, impaired microcirculation and perfusion of tissues with blood.
FACTORS CONTRIBUTING TO ITS
1. pathogen and its toxins
Gram-negative bacteria (Shigella, Proteus, Klebsiella, Pseudomonas aeruginosa
Gram-positive microbes ( staphylococci, streptococci, pneumococci) in 1/3 of cases, the cause of shock
2. increased sensitivity of the patient's body
The development of infectious-toxic shock contributes to:
Unregulated BAS release:
Kininov
catecholamines
Interleukins
Early phase proteins
initiating a generalized inflammatory response
Infectious-toxic shock (ITS)
It develops when the concentration of LPS in the blood is more than 800-1000 ng in 1 µl
At a concentration of LPS above 8000 ng in 1 µl, the shock becomes irreversible
LPS :
Violation of energy processes in cell membranes of blood cells and vascular endothelium
Microcirculation disorders, intravascular coagulation, which already in the early stages of TSS lead to the development of multiple organ disorders
deep metabolic disorders (hypoxia, acidosis, hypokalemia, etc.)
REASONS FOR ITS:
decrease in total blood volume (hypovolemic shock)
deposition of blood in venous pools (primary vascular shock),
low output due to weakness of the heart muscle (cardiogenic shock),
decrease in ejection due to increased resistance in the pulmonary circulation (embolic shock).
PATHOGENESIS OF INFECTIOUS-TOXIC SHOCK AT THE LEVEL OF SMALL VESSELS.
A large number of microbial toxins enter the blood
Rapid release of cytokines
Spasm of arterioles and postcapillary venules
This leads to the opening of arterio - venous shunts
PATHOGENESIS OF INFECTIOUS-TOXIC SHOCK AT THE LEVEL OF SMALL VESSELS.
Tissue ischemia and metabolic acidosis.
The activity of catecholamines decreases.
Paresis of arterioles and increased tone of venules.
Stagnation in the microcirculation zone.
PATHOGENESIS OF INFECTIOUS-TOXIC SHOCK AT
THE LEVEL OF SMALL VESSELS
"sludge syndrome"
DIC is a syndrome.