Sepsis Syndrome: New Insights into its Pathogenesis and Treatment

Lateef A. Olopoenia, M.D.*

(*Medical Director, Liberty Medical and Research Centre, Lagos Nigeria)

Sepsis is a well-recognized complication of serious infection with pathogenesis and pathophysiology that are poorly understood. While sepsis, sepsis syndrome and septic shock may not be separate disorders; they represent severe stages of the same disorder. Just as the pathogenesis of sepsis is very complex, involving interactions of a large number of endotoxin induced endogenous mediators, so is the understanding and clinical applications of the mediators complex in management of septic patients. Half a century of research has shown that most of the endotoxin's toxic effects are indirectly involved in the pathogenesis of sepsis, and that a number of endotoxin-inducod endogenous molecules participate directly in the pathogenesis of the sepsis syndrome. It has thus be come apparent that the in itiating event in the sepsis cascade is the release of the endotoxin into the systemic circulation. While the sepsis cascade can become selfperpetuating event,1 a host of new treatment modality that can interrupt this cascade at one or more places are being de veloped. Studies have shown that exclusive reliance on antimicrobial agents alone is unlikely to improve the outcome of the sepsis condition to any substantive degree. Among the most important of the endotoxin-induced mediators that have been studied adequately with some clinical application include tumor ne crosis factor (TNF), interleukin-1, -2, and -6 (IL1, IL-2, and IL-6), and platelet activating factor (PAF).2,3 As complex as the pathogenesis of the sepsis may seem, its study offers insights into new treatment modalities. Until recently, treatment available for septic patients had been antibiotics and supportive care (mechanical ventilation and fluid administration). Data from the use of specific monockmal antibodies to several of the endogmous cascade substances in sepsis syndrome has been very encouraging. While further studies are in progress on other cytokines, current treatment modalities attempt to incorporate anti-cytokine specific monoclonal anti-bodies into treatment of sepsis. [Phil J Microbiol Infect Dis
1996; 25(2):S7]

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