Intensive Care Medicine

, Volume 7, Issue 3, pp 109–114 | Cite as

Immunological aspects of severe bacterial sepsis

  • N. Clumeck
  • C. George
Original Articles

Abstract

In spite of discovery of new antibiotics and regular progress in intensive care, mortality from severe bacterial sepsis remains high. In this review the importance of cellular and humoral immunity in the pathogenesis and the outcome of severe infection is delineated. Immunological evaluation of patients in Intensive Care Units should be performed almost routinely in order to detect “high risk” patients with acquired defect in host-defence mechanisms. For these patients in addition to nutritional care, passive or active immunotherapy will help to restore resistance to bacterial infection.

Key words

Septic shock Gram-negative sepsis Endotoxin Skin tests Humoral immunity Immunotherapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abrard E, Eygonnet JP, Estenne B (1980) Interest of polyvalent intravenous immunoglobulins in the treatment of severe peritoneal infection. Intensive Care Med 6:51Google Scholar
  2. 2.
    Ah-Kau NG, Chen-Lo H, Chung-Ming C, Nowotny A (1976) Relationship of structure to function in bacterial endotoxins: serologically cross-reactive components and their effects on protection of mice against some gram-negative infections. J Gen Microbiol 94:107Google Scholar
  3. 3.
    Back U, Broch Møller B, Bøg-Hansen TC (1976) Host resistance to lipopolysaccharides in the pathogenesis of multiple sclerosis and membranoproliferative glomerulonephritis. Lancet 1:188Google Scholar
  4. 4.
    Bauer AR, Mc Neil C, Trentelman E, Swiet SA, Mason VD (1978) The depression of T lymphocytes after trauma. Am Surg 136:674Google Scholar
  5. 5.
    Bayer AS, Theofilopoulos AN, Eisenberg R, Dixon FJ, Guze LB (1976) Circulating immune complexes in infective endocarditis. N Engl J Med 295:1500Google Scholar
  6. 6.
    Bayer AS, Theofilopoulos AN, Tillman DB, Dixon FJ, Guze LB (1979) Use of circulating immune complex levels in the sero differentiation of endocarditic and non endocarditic septicaemias. Am J Med 66:58Google Scholar
  7. 7.
    Belghiti J, Champault G, Fabre F, Patel JC (1978) Appréciation du risque infectieux post opératoire par les tests d'hypersensibilité retardée. Influence de la dénutrition et de sa correction. Nouv Presse Med 7:3337Google Scholar
  8. 8.
    Benedict CR, Grahame-Smith DG (1978) Plasma noradrenaline concentrations and dopamine-β-hydroxylase activity in patients whith shock due to septicaemia, trauma and haemorrhage. Q J Med 185:1Google Scholar
  9. 9.
    Bjornson AB, Altemeier WA, Bjornson MS (1978) Host defences against opportunist micro organisms following trauma II. Change in complement and immunoglobulins in patients with abdominal trauma and septic patients without trauma. Ann Surg 188:102Google Scholar
  10. 10.
    Blaese RM, Weiden P, Oppenheim JJ, Waldmann TA (1973) Phytohemagglutinin as a skin test for the evaluation of cellular immune competence in man. J Lab Clin Med 81:538Google Scholar
  11. 11.
    Bokish VA, Top FH, Russel PK, Dixon JF, Muller-Eberhard HJ (1972) The potential pathogenic role of complement in Dengue hemorragic shock syndrome. N Engl J Med 289:996Google Scholar
  12. 12.
    Bowers TK, O'Elamerty J, Simmons RL, Jacob MS (1977) Post surgical granulocyte dysfunction: studies in healthy kidney donors. J Lab Clin Med 90:720Google Scholar
  13. 13.
    Braude AI, Douglas H, Davis CE (1973) Treatment and prevention of intravascular coagulation with antiserum to endotoxin. J Infect Dis 128:S 157Google Scholar
  14. 14.
    Braude AI, Ziegler EJ, Mc Cutchan JA (1978) Antiserum treatment of gram-negative bacteriema. Schweiz Med Wochenschr 108:1872Google Scholar
  15. 15.
    Carlet J, Bernaudin JF, Sabatier C, Lange F, George C, Rapm M (1978) Immunomorphological study of human lungs in non hemodynamic pulmonary edema during severe sepsis. Am Rev Respir Dis 117:270Google Scholar
  16. 16.
    Christou NV, Meakins JL (1979) Neutrophil function in surgical patients: two inhibitors of granulocyte chemotaxis associated with sepsis. J Surg Res 26:355Google Scholar
  17. 17.
    Clumeck N, George C, Lafontaine T, Rapin M, Butzler JP (1980) Immunological study of patients with gram negative sepsis. Importance of antibodies against common shared antigen in the outcome of sepsis. Intensive Care Med 6:51Google Scholar
  18. 18.
    Conrad JD, Leach RP (1976) Antigenemia in fulminant pneumococcemia. Ann Intern Med 84:561Google Scholar
  19. 19.
    Constantian MB, Menzoian JO, Nimberg CB, Schmid K, Mannick JA (1977) Associated of a circulating immuno suppressive polypeptide with operative and accidental trauma. Ann Surg 185:73Google Scholar
  20. 20.
    Davis JAS, Peters N, Mahammed I, Oacmajor, Holborow EJ (1976) Circulating immune complexes in a patient with meningo coccal disease. Br Med J 1:1445Google Scholar
  21. 21.
    Dupuy C, Dupuy JM (1977) Complement studies in severe viral hepatic of childhood. Pathol Biol (Paris) 25:553Google Scholar
  22. 22.
    Elin RJ, Robinson RA, Levine AS, Wolff SM (1975) Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia. N Engl J Med 293:521Google Scholar
  23. 23.
    Falco HA, Gould DB (1975) Immune complex nephropathy in schistosomias. Ann Intern Med 83:148Google Scholar
  24. 24.
    Fearon DT, Ruddy S, Schur PH, McCabe WR (1975) Activation of the properdin pathway of complement in patients with gram-negative bacteriema. N Engl J Med 292:937Google Scholar
  25. 25.
    Finland M, Barnes MW (1978) Bacteriemic superinfections of patients with bacteriema: occurrence, bacteriology, mortality and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972. J Infect Dis 138:829Google Scholar
  26. 26.
    Freeman J, Mc Gowan JE Jr (1978) Risk factors for nosocomial infection. J Infect Dis 138:811Google Scholar
  27. 27.
    Freid MA, Vosti KL (1968) The importance of underlying disease in patients with gram negative bacteriema. Arch Intern Med 121:418Google Scholar
  28. 28.
    Fust G, Petras G, Ujhelyi E (1976) Activation of the complement system during infections due to gram negative bacteria. Clin Immunol 5:293Google Scholar
  29. 29.
    George C, Matamis D, Carlet J, Sabatier C, Rapin M (1979) Utilisation des tests cutanés explorant l'immunité cellulaire en réanimation. In: Goulon M, Rapin M (eds) Réanimation et médecine d'urgence. Expansion Scientifique, Paris, p 148Google Scholar
  30. 30.
    George C, Carlet J, Sobel A, Intrator L, Robin M, Sabatier C, Rapin M (1980) Circulating immune complexes in patients with gram negative septic shock. Intensive Care Med 6:123Google Scholar
  31. 31.
    George C, Matamis D, Sabatier C, Carlet J (1980) Randomized assay of an immunostimulant (Isoprinosine) in anergic patients. Intens Care Med 6:52Google Scholar
  32. 32.
    George C, Robin M, Carlet J, Rapin M, Landais C, Sabatier C (1978) Tests cutanés explorant l'immunité cellulaire chez les malades en réanimation. Relation entre les résultats et la mortalité. Nouv Presse Med 7:2541Google Scholar
  33. 33.
    Gougerot-Pocidalo MA, Hakin J, Lecompte Y, Troube H (1978) Modifications des défenses immunitaires après chirurgie cardiaque faite sous circulation extra corporelle. Bull Eur Physiopathol Respir 14:659Google Scholar
  34. 34.
    Greisman SE, Hornick RB (1973) Mechanisms of endotoxin tolerance with special reference to man. J Infect Dis 128:S 265Google Scholar
  35. 35.
    Hahn-Perdersen J, Sorensen H, Kehlet H (1978) Complement activation during surgical procedures. Surg Gynecol Obstet 146:66Google Scholar
  36. 36.
    Hawiger J, Hawiger A, Steckley S, Timmons S, Cheng C (1977) Membrane changes in human platelets induced by lipopolysaccharide endotoxin. Br J Haematol 35:285Google Scholar
  37. 37.
    Herreman G, Godeau P, Cabane J, Digeon M, Laver M, Bach JF (1975) Etude immunologique des endocardites infectieuses subaiguës par recherche de complexes immuns circulants. Résultats préliminaires à propos de 13 observations. Nouv Presse Med 4:2311Google Scholar
  38. 38.
    Howard CJ, Glynn AA (1971) The virulence for mice of strains of E. Coli related to the effects of K antigens on their resistance to phagocytosis and killing by complement. Immunology 20:767Google Scholar
  39. 39.
    Jacob HS (1978) Granulocyte complement interaction. A beneficial antimicrobial mechanism that cause disease. Arch Intern Med 138:461Google Scholar
  40. 40.
    Johnson MW, Maibach HI, Salmon SE (1971) Skin reactivity in patients with cancer. Impaired delayed hypersensitivity or faulty inflammatory response? N Engl J Med 284:1255Google Scholar
  41. 41.
    Kantor FS (1975) Infection, anergy and cell mediated immunity. N Engl J Med 292:629Google Scholar
  42. 42.
    Kass EH (1973) Bacterial lipopolysaccharide — clinical aspects. J Infect Dis 128:S 303Google Scholar
  43. 43.
    Law DK, Dudrick SJ, Abdou NI (1972) The effects of dietary protein on immunocompetence, this importance of nutritional repletion prior to immunologic induction. Ann Surg 179:168Google Scholar
  44. 44.
    Law DK, Dudrick SJ, Abdou NI (1972) The effects of proteincaloric malnutrition on immune competence of the surgical patient. Surg Gynecol Obstet 139:257Google Scholar
  45. 45.
    Law DK, Dudrick SJ, Abdou NI (1973) Immunocompetence of patients with protein caloric malnutrition. The effects of nutritional repletion. Ann Intern Med 79:545Google Scholar
  46. 46.
    Ledingham I McA, Mc Ardle CS (1978) Prospective study of the treatment of septic shock. Lancet 1:1194Google Scholar
  47. 47.
    Levin J, Poore TE, Zauber NP, Oser RS (1970) Detection of endotoxin in the blood of patients with sepsis due to gram negative bacteria. N Engl J Med 24:1313Google Scholar
  48. 48.
    Lodinova R, Jonja V, Wagner V (1973) Serum immunoglobulins and coproglobulins and coproantibody formation in infants after artificial intestinal colonization with E. Coli 083 and oral lysozyme administration. Pediatr Res 7:659Google Scholar
  49. 49.
    Mc Cabe WR (1973) Serum complement levels in bacteriema due to gram negative organisms. N Engl J Med 288:21Google Scholar
  50. 50.
    Mc Cabe WR (1972) Immunization with R mutants of S. Minnesota. Protection against challenge with heterologous gram negative bacilli. J Immunol 108:601Google Scholar
  51. 51.
    Mc Cabe WR, Greely A, Digenio T, Johns MA (1973) Humoral immunity to type specific and cross reactive antigens of gram-negative bacilli. J Infect Dis 128:S 284Google Scholar
  52. 52.
    Mc Cabe WR, Jackson GG (1962) Gram negative bacteriema. Clinical laboratory and therapeutic observations. Arch Intern Med 110:92Google Scholar
  53. 53.
    Mc Cabe WR, Jackson GG (1962) Gram negative bacteriema. Etiology and Ecology. Arch Intern Med 110:83Google Scholar
  54. 54.
    Mc Gowan JE Jr, Barnes MW, Finland M (1975) Bacteriema at Boston city hospital: occurrence and mortality during 12 selected years (1935–1972), with special reference to hospitalacquired cases. J Infect Dis 132:316Google Scholar
  55. 55.
    Mc Grath JM, Stewart GJ (1969) The effects of endotoxin on vascular endothelium. J Exp Med 129:833Google Scholar
  56. 56.
    Mc Lean LD, Meakins JL, Taguchi K, Ovignan JP, Omillon KS, Gordon J (1975) Host resistance in sepsis and trauma. Ann Surg 182:207Google Scholar
  57. 57.
    Madnar MA, Voller A (1975) Circulating soluble antigens and antibody in schistosomiasis. Br Med J 1:435Google Scholar
  58. 58.
    Meakins JL, Christou NV, Shizgal HM, Mc Lean LD (1979) Therapeutic approaches to anergy in surgical patients: surgery and levamisole. Ann Surg 190:286Google Scholar
  59. 59.
    Meakins JL, Pietsch JB, Budenick O, Kelly R, Rode H, Gordon J, Mc Lean LD (1977) Delayed hypersensitivity: indication of acquired failure of host defences in sepsis and trauma. Ann Surg 186:241Google Scholar
  60. 60.
    Myerowitz RL, Medeiros AA, O'Brien TF (1971) Recent experience with bacillemia due to gram negative organisms. J Infect Dis 124:239Google Scholar
  61. 61.
    Nies AS, Greineder DK, Cline MJ, Melmon KL (1971) The divergent effects of endotoxin fractions in human plasma and leucocytes. Biochem Pharmacol 20:39Google Scholar
  62. 62.
    Nies AS, Forsyth RP, Williams HE, Melmon KL (1968) Contribution of kinins to endotoxin shock in unanesthetized rhesus monkey. Circ Res 22:155Google Scholar
  63. 63.
    Olling S (1977) Sensitivity of gram negative bacilli to the serum bactericidal activity: a marker of the host parasite relationship in acute and persisting infections. Scand J Infect Dis Suppl 10Google Scholar
  64. 64.
    Pietsch JB, Meakins JL (1977) The delayed hypersensitivity response. Application in clinical surgery. Surgery 82:349Google Scholar
  65. 65.
    Pillemer L, Blum L, Lepow IH, Ross DA, Todd EW, Wardlay AW (1954) The properdin system and immunity. I: Demonstration and isolation of a new serum protein, properdin, and its role in immune phenomena. Science 120:279Google Scholar
  66. 66.
    Robin M, Intrator L, André C, Lagrue G, Rapin M (1974) Anomalies du complément et choc infectieux. Nouv Presse Med 3:883Google Scholar
  67. 67.
    Robin M, Intrator L, Rapin M (1975) Complement activation in septic shock. N Engl J Med 293:1261Google Scholar
  68. 68.
    Robinson JA, Klodnycky ML, Loeb HS, Racic MR, Gunnar RM (1975) Endotoxin, prekallikrein, complement, vascular resistances. Sequential measurements in man. Am J Med 59:61Google Scholar
  69. 69.
    Saba TM (1978) Prevention of liver reticulo endothelial systemic host defence failure after surgery by intravenous opsonic glyco-protein therapy. Ann Surg 188:146Google Scholar
  70. 70.
    Shedin A (1979) Monitoring the nutritional status of critically ill patients. Intensive Care Med 5:165Google Scholar
  71. 71.
    Slade MS, Simmons RL, Yunis E, Greenberg LJ (1975) Immunodepression after major surgery in normal patients. Surgery 78:363Google Scholar
  72. 72.
    Thomas L, Gerard M, Malcuarti V, Kirkorian G, Robert D, Bertoye A (1979) Etat nutritionnel des malades admis en réanimation. Relation avec la mortalité. Nouv Presse Med 8:409Google Scholar
  73. 73.
    Vermesse G, Camus D, Wattre P, Capron A, Gauthier-Benoît C (1978) Modifications immunitaires dans les suites opératoires immédiates. Nouv Presse Med 7:529Google Scholar
  74. 74.
    Waisbren BA (1964) Gram-negative shock and endotoxin shock. Am J Med 36:819Google Scholar
  75. 75.
    Walker LC, Amlin TD, Tung KSK, Williams RC (1978) Circulating immune complexes in disseminated gonorrheal infection. Ann Intern Med 89:28Google Scholar
  76. 76.
    Walton B (1978) Anaesthesia, surgery and immunology. Anaesthesiology 33:322Google Scholar
  77. 77.
    Wands JR, Mann E, Alpert E, Isselbacher KJ (1975) The pathogenesis of arteritis associated with acute hepatitis B surface antigen positive hepatitis complement activation and characterization of circulating immune complexes. J Clin Invest 55:930Google Scholar
  78. 78.
    Wands JR, Perroto JL, Isselbacher KJ (1976) Circulating immune complexes and complement sequence activation in infectious mono-nucleosis. Am J Med 60:269Google Scholar
  79. 79.
    Wattel F, Chopin C, Durocher A, Fourrier F (1979) Modifications du complément sérique lors des septicémies à germes gram positifs. Nouv Presse Med 8:702Google Scholar
  80. 80.
    Weinstein RJ, Young LS (1976) Neutrophil function in gram negative rod bacteriema. J Clin Invest 58:190Google Scholar
  81. 81.
    Whaley K, Yee Khong T, Mc Cartney AC, Mc Ledingham A (1979) Complement activation and its control in gram negative endotoxin shock. J Clin Lab Immunol 2:227Google Scholar
  82. 82.
    Whittle HC, Dossetor J, Oduloju A, Bryceson ADM (1978) Cell mediated immunity during natural measles infection. J Clin Invest 62:678Google Scholar
  83. 83.
    Winslow EJ, Loeb MS, Rahintoola SH, Kamaih S, Cunnar RH (1975) Haemodynamic studies and results of therapy in 50 patients with bacteriema shock. Am J Med 54:421Google Scholar
  84. 84.
    Young LS (1975) Opsonizing antibodies, host factors and the limulus assay for endotoxin. Infect Immun 12:88Google Scholar
  85. 85.
    Young LS, Stevens P, Ingram J (1973) Functional role of antibody against core glycolipid of enterobacteriacease. J Clin Invest 56:850Google Scholar
  86. 86.
    Ziner SH, Mc Cabe WR (1976) Effects of IgM and IgC antibody in patients with bacteriema due to gram negative bacilli. J Infect Dis 133:37Google Scholar

Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • N. Clumeck
    • 1
  • C. George
    • 2
  1. 1.Départment de médecine interne et de microbiologieHôpital Universitaire St PierreBruxellesBelgique
  2. 2.Service de Réanimation MédicaleHôpital Henri MondorBrusselsCreteilFrance

Personalised recommendations