Anest. intenziv. Med. 2008;19(5):269-278

Immunopathogenenis of sepsisIntesive Care Medicine - Review Article

Průcha Miroslav^1,*, Fedora Michal²

¹ Oddělení klinické biochemie, hematologie a imunologie, Nemocnice Na Homolce, Praha

² Klinika dětské anesteziologie a resuscitace LF MU a Fakultní nemocnice Brno

Sepsis represents a major unresolved problem of current medicine. The important characteristic of sepsis is the interaction between the two subjects - the macro and the microorganism. The concept of a hyperinflammatory syndrome, dominant for two decades, has been challenged and our current understanding is that sepsis represents a dynamic syndrome characterized by many often antagonistic phenomena. Inflammation which characterizes sepsis does not act as a primary physiological compensatory mechanism but rather oscillates between the phases of a hyperinflammatory response and anergy or immunoparalysis. Understanding the pathogenesis of sepsis means understanding the immunopathological processes that characterize the interaction between the macro and the microorganism. The characteristics of the macroorganism - the genetic predisposition, the role of the innate and adaptive immunity systems, the "high" or "low" host response concerning the intensity of inflammation - form one side of the coin. The role of the microorganism is also important. The different ability of the species to produce pro- and antiinflammatory cytokines, their role in the innate immunity system and their different ability to escape the surveillance of the immune system form the second part in the pathogenesis of sepsis. The outcome of a patient is therefore the result of a very heterogenous and dynamic set of interactions and these complicated interactions have not been fully elucidated and understood yet.

Keywords: sepsis; macroorganism; microorganism; inflammation; innate immunity; immunoparalysis; apoptosis

Received: May 14, 2008; Accepted: August 20, 2008; Published: October 1, 2008  Show citation