NCM 112 GENERAL CLINICAL

MANIFESTATIONS OF INFECTIONS
aliyah mondelo

1 LOCALIZED INFECTION
INFLAMMATORY RESPONSE
● Caused by microbes in one area that
● The inflammatory response occurs as a triggers the inflammatory response
result of any body injury ● Symptoms may include:
● This can be caused by pathogens, trauma, - Redness
or others events causing injury to tissues - Swelling
● Infection may or may not be present - Warmth at the site
● Pain is not severe when the infection occurs
in CLOSED cavities. Redness and swelling
3 STAGES
are seen when surface structures are
involved
1 VASCULAR RESPONSE
● Ascites - accumulation of fluid, is painful
● Warmth may be felt at the site
● 1st step of the inflammatory process is
● Temperature may rise, producing an
LOCAL VASODILATION - increases blood
ANTIMICROBIAL EFFECT
flow to the injured part
● Pathogenic organisms can trigger the 1st
step of the inf process 2 GENERALIZED INFECTION
● Increased blood flow creates redness and
heat at the injury - to carry WBC ● Occurs when there is systemic or whole
● Increase in blood flow brings more plasma body involvement
to the area to nourish tissue and carry ● Symptoms may include:
debris away - CREATE REDNESS AND - Headache
HEAT SA VASCULAR RESPONSE - Malaise
- Muscle aches
2 INFLAMMATORY EXUDATE - Fever
- Anorexia
● Increased permeability of the blood vessels, ● As the infection progresses:
allows plasma to move out of the capillaries - Increase in fever
and in the tissues - Elevated WBC count
● Swelling occurs, resulting in pain from - Decreased blood pressure
pressure on nearby nerve endings - Mental confusion
- Tachycardia
- Shock
3 PHAGOCYTOSIS AND
● SEPSIS - an infection that has spread to the
PURULENT EXUDATE
bloodstream

● The final step - destruction of pathogenic

LABORATORY ASSESSMENT
organisms and their toxins by leukocytes
● During this process, a purulent exudate ● Microscopic examination such as gram’s
(pus) may form that contains protein, method of staining
cellular debris, and dead leukocytes ● Culture sensitivity (C&S)
● When there is pus, there is a presence of - Organisms found in the culture specimen as
infection grown on a laboratory plate and identified
within 24 to 48 hrs
5 CARDINAL SIGNS OF INFLAMMATION ● Serum antibody test
● Complete blood cell count w/ differential
● Redness and heat - vascular response (CBC w/ diff)
● Swelling and pain - exudate phase ● Erythrocyte sedimentation rate (ESR, sed
● Loss of function - phagocytosis rate)
- All the underlined bullets above are the
explanations for each of these signs -
EXAM !!!
- Why is there pain? The accumulation of the
plasma in the tissue that creates pressure in
● Lymphocytes - Create antibodies to fight
the nerve endings thereby causing pain
against bacteria, and other potentially
harmful invaders
● Monocytes - Have a longer lifespan than
many WBC and help breakdown bacteria
● Basophils - Small cells that alarms when
infectious agents invade your blood. They
secrete chemicals such as histamine, a ● Pseudomonas aeruginosa is the most
marker of allergic disease that help controls common pathogen in nosocomial
the body immune response pneumonia
● Eosinophils - Attack and kill parasites and ● It is found in soil, around water, and in the
cancer cells and help with allergic health-care setting around sinks, water,
responses irrigating solutions, and nebulizers on
● Neutrophils - Kill and digest bacteria and respiratory equipment.
fungi. Most numerous type of WBC and the
first line of defense when infection strikes INFLAMMATION

ERYTHROCYTE SEDIMENTATION RATE ● When the body activates the immune

(ESR,sed rate) system, it sends out inflammatory cells
● These cells attack bacteria or heal damaged
● An early screening test for inflammation but tissue. If the body sends out inflammatory
not a definitive test for infection cells when an individual is not sick or
● During the inflammation process, RBC injured, may have chronic inflammation
become heavier and during the test settle to ● Inflammation is a symptom of many chronic
the bottom of the tube disease, such as arthritis or Alzheimer’s
● ESR measure in millimeter per hr the speed disease
at which the RBC settle in the tube ● Inflammation is a result of damage to body
● The faster the setting the greater the tissues and can be caused by a number of
infection factors including trauma, repetitive use and
those conditions affected by age such as
What other tests? Osteoarthritis.
● X-rays ● When the body encounters an offending
● Computed tomography (CT) and agent (like viruses, bacteria, or toxic
● Magnetic resonance imaging (MRI) are chemicals) or suffers an injury it activates
helpful in identifying, abscesses, the immune system.
(walled-off-infections)
● Skin tests diagnose infections The immune system sends out its first responders:
● Inflammatory cells and cytokines
INFECTION CONTROL IN (substances that stimulate more
HEALTHCARE AGENCIES inflammatory cells)

● An infection that develops as a result of the CYTOKINES

stay in the hospital - NOSOCOMIAL
INFECTION - Are small proteins that are crucial in
● Multiple antibiotic therapy also increases controlling the growth and activity of other
susceptibility to other types of infection and immune system cells and blood cells
promotes the resistance of pathogens to - When released. They signal the immune
antibiotics. system to do its job
● ICU, neonatal, dialysis, oncology, and burn - Cytokines affect the growth of all blood cells
units and other cells that help the body’s immune
and inflammatory responses
PATHOGENS ARE COMMONLY RESPONSIBLE
FOR CAUSING NOSO-INFECTIONS FUNCTIONS OF CYTOKINES

● Escherichia Coli (E.Coli) is the most - Chemically induced tissue damage repair
common pathogen causing nosocomial - In cancer development and progression
UTI - In the control of cell replication and
● E. coli normally lives in the healthy intestinal apoptosis
tract of human - In the modulation of immune reactions
● E. Coli can be spread by the patient, by the
unwashed hands of a health-care worker, or
HISTAMINE, BRADYKININ, AND
through contaminated food and water.
PROSTAGLANDINS
● Staphylococcus aureus (commonly known
as Staph) is the most common pathogen
● Histamine - A chemical messenger that
causing nosocomial surgical wound
mediates several cellular responses:
infections and nosocomial septicemia.
- Inflammatory reactions
● Staph usually lives in the nose and on the
- Allergic reactions
skin of healthy people.
- Gastric secretions
- Limited neurotransmitter action in the brain
● Bradykinin - A protein that lowers blood 4. Pain (dolor) - stretching of pain receptors
pressure by widening blood vessels and nerves by inflammatory exudates,
- At the same time, it allows water to leak chemical mediators
from the vessels into surrounding tissues, 5. Loss of function (functio laesa) - pain,
which increases inflammation in the area disruption of tissue structure, fibroplasia,
- Also worsens feelings of pain and itchiness and metaplasia
triggered in nerve fibers by increasing their
sensitivity

● Prostaglandin - A group of lipids made at

sites of tissue damage or infection that are
involved in dealing with injury and illness
- They control processes such as
inflammation, blood flow, and the formation
of blood clots
- Play a key role in the generation of the
inflammatory response
- Their biosynthesis is significantly increased
in inflamed tissue and they contribute to the
development of the cardinal signs of acute
inflammation

2 TYPES OF INFLAMMATION

1 ACUTE INFLAMMATION

● Prostaglandin The response to sudden body damage, such as

- Increase in blood flow to the kidney cutting your finger. To heal the cut, your body sends
- Protection of the lining of the stomach inflammatory cells to the injury. These cells start the
- Participation in memory and other brain healing process
functions
- Contraction and relaxation of uterine
muscles 2 CHRONIC INFLAMMATION

Body continues sending inflammatory cells even

● Prostaglandin sensitizes nerve endings,
when there is no outside danger.
resulting in transmission of pain to the brain
For example, in rheumatoid arthritis, inflammatory
and spinal cord. They also lead to the
cells and substances attack joint tissues leading to
dilation of blood vessels, leading to redness
an inflammation that comes and goes and can
usually seen in inflamed areas.
cause severe damage to joints with pain and
deformities.
NOTE:
- Analgesics inhibit prostaglandin synthesis
TYPES OF INFLAMMATION:
- The more prostaglandins, the more pain
1. Microbial inflammation - Abscess
transmitted to the brain
2. Autoimmune inflammation - Rheumatoid
arthritis
5 INFLAMMATORY RESPONSES 3. Allergic inflammation - Atopic dermatitis
4. Metabolic inflammation - Gouty arthritis
1. Heat (calor) - increased blood flow,
5. Physical inflammation - Burns
exudation of fluid, release of inflammatory
mediators
TOPHI - gouty arthritis
2. Redness (rubor) - increased blood flow
3. Swelling (tumor) - exudation of fluid
IMMUNOLOGIC RESPONSE

● The way the body defends itself against

substances it sees as harmful or foreign
- In an immune response, the immune
system recognizes the antigens (usually
proteins) on the surface of substances or
microorganisms, such as bacteria or
● Major components
viruses, and attacks and destroys them.
- Bone marrow
- WBC
IMMUNE SYSTEM - Lymphoid tissues
● The body’s defense mechanism against
invasion BONE MARROW
● IMMUNITY - the body’s specific protective
response to an invading foreign agent or ● The production site of WBCs involves
organism immunity
● The soft, spongy tissue has many blood
What affects the immune system? vessels and is found in the center of most
● Immune function is affected by: bones
- Age
- CNS function There are 2 types of bone marrow:
- Emotional status 1. Red bone marrow - contains blood stem
- Medications cells that can be red blood cells. WBC, or
- Stress of illness platelets
- Trauma 2. Yellow bone marrow - made mostly of fat
- Surgery and contains stem cells that can become
cartilage, fat, or bone cells
IMMUNOPATHOLOGY
● Like other blood cells, lymphocytes are
● The study of diseases resulting from generated from stem cells, which are
dysfunctions within the immune system undifferentiated cells
● Descendents of stem cells become
Disorders of the Immune System may stem lymphocytes, the B lymphocytes (B cells),
from: and the T lymphocytes (T cells) B
● Excesses or deficiencies of lymphocytes mature in the bone marrow
immunocompetent cells and then enter the circulation
● alterations in the function of these cells, ● T lymphocytes move from the bone marrow
immunologic attack on self-antigens to the thymus, where they mature into
● Inappropriate or exaggerated responses to several kinds of cells capable of different
specific antigens functions
QUIZ !!!

LYMPH NODES

EXAM: stages of immune response ● The lymph nodes are distributed throughout
(see book) the body
● They are connected by lymph channels and
capillaries, which remove foreign material
LYMPHOID TISSUES from the lymph before it enters the
bloodstream
● Found in all vertebrates and are essential ● The lymph nodes also serves as centers
for adaptive immunity for immune cell proliferation
● Primary found lymphoid tissues (thymus,
fetal liver and bone marrow) nurture APPENDIX
lymphocyte development, whereas
secondary lymphoid organs support ● Contains lymphoid tissue that can destroy
lymphocyte maturation, survival and bacteria before it reaches the intestine wall
activation during absorption
● Scientists also believe the appendix plays a
LYMPHOID ORGANS role in housing “good bacteria” and
repopulating our gut with good bacteria
● These organs are the sites where the after an infection has cleared
maturation and proliferation of
lymphocytes occur and help carry out
various immune functions PARTS OF THE LYMPHATIC SYSTEM
● These organs from a part of the lymphatic
system composed of lymphatic vessels, TONSILS
lymph node, lymph
● Tonsils are clusters of lymph tissue on the
SPLEEN sides of your throat
● They help protect your body from
● Organ that is located in the upper left part of infection, trapping & destroying bacteria
the abdomen, not far from the stomach, and other pathogens that enter your nose
produces lymphocytes, which are and mouth
important elements in the immune ● However, your body can function without
system tonsils
● The spleen is the largest lymphatic organ
in the body