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AGUS SUARJAYA PUTRA

 Sepsis is symptoms as a manifestation of


systemic inflammatory response to
infection.
 The cause of sepsis is the most common
bacterial infection.
 The cause of sepsis is gram-negative
bacteria with a percentage of 60% -70%
of cases
 Staphylococci, pneumococci,
streptococci and other gram-positive
bacteria rarely cause sepsis (20-40%).
Classified by an imbalance of activity of
proinflammatory and anti-inflammatory:
Stage 1
In response to injury, including infections, local
environment formed proinflammatory cytokines>
mediator recruited to fight pathogenic organisms.
Stage 2
A small number of cytokines released into
circulation which aims to recruit
macrophages and platelets, stimulating
growth factors (growth factors) as well as
acute phase reaction. Still considered
physiology (to be controlled by the
secretion of anti-inflammatory cytokines
and mediators endogenous> as
antagonists of IL-1).
Stage 3
 Homeostasis is not refundable (injury that is
too large / normal body can not control)>
massive systemic reaction> cytokines
becomes destructive> organ damage
a. Progressive endothelial dysfunction
(peremabilitas pemb.darah increased)
b. Platelet sludging (circulation blocked)
c. Coagulation system activation and inhibition
of protein-C pathways and protein-S.
d. The existence of vasodilation, fluid
transudation and maldistribusi blood flow
resulting in the onset of shock.
 stage 4
 Compensation anti inflammatory reaction that
causes excessive immunosuppressant.
 ("Immune paralysis" or "window of
immunodeficiency"). Bone et al mention that as
CARS (compensated anti-inflamation response
syndrome) the expression of HLA-DR <30%>
secretion of TNF alpha and IL-6 down so
susceptible to infection with other microorganisms
Stage 5
 In most patients due to excessive
inflammation, partly because of
persistent immune depression.
 ("Immunologic dissonance" a
"inapproprriate out of balance respone
of the immunomodulatory respone
system")
 Vitamin D3 yang dibentuk dikulit kemudian
memasuki sirkulasi darah dan berikatan
dengan vitamin D binding protein yang
kemudian mengalami hidroksilasi pada hati
menjadi 25 hidroksivitamin D (25(OH)D) dan
ginjal menjadi 1,25 dihidroksivitamin D
(1,25(OH)2D).
 25 (OH) D merupakan bentuk yang tidak
aktif dan menunjukkan jumlah vitamin D
yang tersimpan pada tubuh, sedangkan
1,25(OH)2 D merupakan bentuk aktif
metabolik vitamin D
VITAMIN D
DEFICIENCY

DECREASING T CELL

DECREASING IMMUNE
SYSTEM