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Editor's Notes

• #3: Septic shock is a continuumalong this pathway of worsening of microorganisms in normally sterile host tissues and their ongoing invasion. Infection- the presence of microorganisms in normally sterile host tissue. Bacteremia- the presence of viable bacteria in blood Sepsis- The systemic response to infection Severe sepsis- sepsis associated with organ dysfunction, hypoperfusion or hypotension. Septic shock- sepsis with hypotension despite adequate fluid resuscitation, and perfusion abnormalitites. 71% of patients with culture proven septic shock are initially identified as being in one of the milder categories, yet only 4% of patients with SIRS progress to full septick shock. Rangel-Fausto MS, Pittet D, Castigan M, Hwang T, et al., The natural history of the systemic inflammatory response syndrome. JAMA 1995; 273: 117-123. Its important to identify these patients early when they are more amenable to succsessful intervention.
• #16: Bacteria produce a range of extracellular products and cell wall constituents which stimulate human immune cells produce inflammatory mediators. Many of these agents bind to their target cells via host-derived carrier and receptor molecules. Bacterial endotoxin or lipopolysaccharide binds a # of different carrier molecules the most important of which is lipopolysaccharide binding protein. The LPS-LBP complex then interacts with host monocytes via a cell surface molecule, CD 14. Interaction with other host targets, such as endothelial cells, which do not express CD 14 on the cell surface, is mediated by soluble CD 14 molecules which bind to the LPS-LBP complex and interact with other yet unknown surface receptors.