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I.

O BJECTIVE

General Goal:
To b e kno w led geable ab o u t th e n atu re o f N eo n atal Sep sis, its diagno sis, its treatm en t
an d nu rsin g respo n sibilities

Specifi c G oal:

To b e fam iliar w ith th e e tio lo gy o f th e d ise ase


To b e aw are o f th e sign s an d sym p to m s
To kn o w th e co m p licatio n s o f th e d ise ase
To b e kn o w le d ge ab le o n h o w to p re ve n t th e d ise ase
To kn o w th e tre atm en t
To kn o w th e d iff e ren ce o f th e d ise a se fro m th e n o rm al la b o ra to ry valu e s
To assu re th at n u rsin g im p le m e n tatio n m u st b e given

I.

In tro d u ctio n
In fe c t io n is th e in v a sio n o f a h o st o r g a n ism s b o d y tissu e s b y d ise a se c a u sin g o r g a n ism s,
t h e ir m u lt ip lic a t io n , a n d th e r e a c t io n o f h o st t issu e s t o t h e se o r g a n ism s a n d th e t o xin s
t h e y p r o d u c e . H o st c a n fi gh t in fe c t io n s u sin g t h e ir im m u n e sy st e m . D ise a se c a n a r ise if t h e
h o st s p r o t e c t iv e im m u n e m e c h a n ism s a r e c o m p r o m ise d a n d t h e o r g a n ism in fl ic t s
d a m a g e o n t h e h o st . S e p t ic e m ia is th e in v a sio n o f b lo o d st r e a m b y v ir u le n t b a c t e r ia ,
t r ig g e r in g a n im m u n e r e sp o n se w h ic h r e su lt s in in fl a m m a t io n a n d a slo w sh u td o w n o f t h e
b o d y s sy st e m s fo r h a n d lin g in fe c t io n . T h e k n o w le d g e a b o u t se p t ic e m ia , it s c a u se s, r isk
fa c t o r s, c o m p lic a t io n s a n d p r e v e n t io n is a v it a l o n e fo r a c r it ic a l c a r e n u r se t o r e d u c e t h e
m o r t a lit y ra t e a s w e ll a s t o r e d u c e t h e c o m p lic a t io n s.

SE P T IC E M IA is a n in fe ctio u s sta te w h e n o rga n ism a n d th e ir to xic p ro d u cts a re p re se n t in th e

rcu la tio n .

a cte ria an d o th e r o rga n ism s th a t ca u se in fe ctio n in a p a rticu la r p a rt o r o rga n o f th e b o d y ca n in vad e


o o d ve sse ls a n d e n te r th e b lo o d . If th e b a cte ria in th e b lo o d d o n o t re su lt in a n y sym p to m s, th e co n d itio n
ca lle d b a cte re m ia . B a cte re m ia re su ltin g in sym p to m s is ca lle d se p tice m ia . W h e n b a cte ria o r o th e r
z

fe ctive o rga n ism s e n te r th e b o d y, th e b o d y m o u n ts a n im m u n e re a ctio n a n d trie s to kill th e in va d in g


icro b e s. D u e to th is re a ctio n th e p a tie n t sh o w s fe a tu re s like in cre a se o r d e cre a se in te m p e ra tu re ,
cre a se o r d e cre a se in W B C a n d in cre a se in h e a rt ra te an d re sp ira to ry ra te . T h e se fe a tu re s co n stitu te th e

yste m ic in fl a m m a to ry re sp o n se syn d ro m e (SIR S). A p a tie n t w ith a n in fe ctio n sh o w in g a SIR S is sa id to

a ve se p sis.

SIRS i s characteri z ed by 2 or m ore of the fol l o w i n g:


0

Tem perature>38 C of <36 Ce


Heart rate >90 beats/ m i n
Respi r atory rate>20/m i n
W B C c o u n t> 1 2 0 0 0 c e lls/ m m 3 o r < 4 0 0 0 /m m 3 o r > 1 0 % b a n d fo rm s

I.

EPIDEM IO LO GY

A p o in t p r e v a le n c e s tu d y w a s c o n d u c te d o n 5 d a y s th r o u g h o u t 2 0 1 3 2 0 1 4 a t 1 2 8 s ite s in 2 6
c o u n tr ie s . P a tie n ts y o u n g e r th a n 1 8 y e a r s o f a g e w ith s e v e r e s e p s is a s d e fin e d b y c o n s e n s u s
c r ite ria w e re in c lu d e d . O u tc o m e s w e re s e v e r e s e p s is p o in t p r e v a le n c e , th e r a p ie s u s e d , n e w o r
p r o g r e s s iv e m u ltio r g a n d y s f u n c tio n , v e n tila to r - a n d v a s o a c tiv e -f r e e d a y s a t D a y 2 8 , f u n c tio n a l
s ta tu s , a n d m o r ta lity

O f 6 ,9 2 5 p a tie n ts scre e n e d , 5 6 9 h a d se v e re se p sis (p re v a le n ce , 8 .2 % ; 9 5 % co n fi d e n ce in te rva l,


7 .6 8 .9 % ). T h e p a tie n ts m e d ia n a ge w a s 3 .0 (in te rq u a rtile ra n g e [IQ R ], 0 .7 1 1 .0 ) y e a rs. T h e
m o st fre q u e n t site s o f in fe ctio n w e re re sp ira to ry (4 0 % ) a n d b lo o d stre a m (1 9 % ). C o m m o n
th e ra p ie s in clu d e d m e ch a n ica l v e n tila tio n (7 4 % o f p a tie n ts), v a so a ctiv e in fu sio n s (5 5 % ), a n d
co rtico ste ro id s (4 5 % ). H o sp ita l m o rta lity w a s 2 5 % a n d d id n o t d iff e r b y a ge o r b e tw e e n
d e v e lo p e d a n d re so u rce -lim ite d co u n trie s. M e d ia n ve n tila to r-fre e d a y s w e re 1 6 (IQ R , 0 2 5 ),
a n d va so a ctiv e -fre e d a y s w e re 2 3 (IQ R , 1 2 2 8 ). Sixty -se v e n p e rce n t o f p a tie n ts h a d m u ltio rga n
d y sfu n ctio n a t se p sis re co gn itio n , w ith 3 0 % su b se q u e n tly d e v e lo p in g n e w o r p ro gre ssiv e
m u ltio rg a n d y sfu n ctio n . A m o n g su rv ivo rs, 1 7 % d e v e lo p e d a t le a st m o d e ra te d isa b ility . Sa m p le
size s n e e d e d to d e te ct a 5 1 0 % a b so lu te risk re d u ctio n in o u tco m e s w ith in in te rv e n tio n a l tria ls
a re e stim a te d b e tw e e n 1 6 5 a n d 1 ,4 3 7 p a tie n ts p e r gro u p .
P e d ia tric se v e re se p sis re m a in s a b u rd e n so m e p u b lic h e a lth p ro b le m , w ith p re v a le n ce ,
m o rb id ity , a n d m o rta lity ra te s sim ila r to th o se re p o rte d in critica lly ill a d u lt p o p u la tio n s.
In te rn a tio n a l clin ica l tria ls ta rge tin g ch ild re n w ith se v e re se p sis a re w a rra n te d .

P a tie n t D a ta a n d H e a lth H isto r y


A . D e m o g r a p h ic
N am e:

Baby Z

A ge :

2 m o s.

G e n d e r:

F e m a le

A d d re ss:

A B C P a sig C ity

D a te o f b irth :

M a r ch 7 , 2 0 1 5

N a tio n ality:

F ilip in o

R e ligio n :

R o m a n C a th o lic

C ivil sta tu s:

N/A

Physical Examin atio n of th e Newborn

General Appearance: Seen baby in bed wit h ongoin g IV F of D5 0.4 5 NaCl 500ml + 5 mes KCl at
18 ml/ hr in fu sin g well on his rig ht f o od. She has good cry, good suck and demands f e edin gs. He
is well- fl exed, wit h f u l range of mot io n and wit h spont a neous movement .

A. Chief Com plain: fever


Date and Tim e of adm ission: M ay 31, 2015 10:20am at ER
M ay 31, 2015 9:45pm at PICU
Ini t ial Diagnosi s : System ic Viral Ill n ess
Diagnosis: Septicem ia, Pneum onia

C.1 His tory of Present Il n ess


Baby Z is a 2 months old f e male who came in due t o f e ver. Twelv e (1 2) hours prio r, patie nt was
noted to have f e ver of M ax Temperature of 38.9 and very ir rit able wit h decreased sle ep. No
cough and cold s noted. Giv en Paracetamol drops 0.6 ml f o r f e ver wit h temporary relie f . Patie nt
stil has good suck cry and activ it y but wit h persis tence of f e ver and ir rit abi lit y hence sought
consult at ER

A. 2 Past M edi c al Hi s tory


Baby Z i s a ful l term baby gi r l vi a NSD to a 30 years old G2P2 (2002) w i t h no know n
fetom aternal com pl i c atio ns, ful l breastfeed, w ho w as apparentl y w el l unti l ni g ht pri o r to
adm i s si o n w hen she w as noted to have fever.

A . Fam ily H isto ry


A sth m a
H eart d isease ( RH D )
H yp erten sio n
L- th allassem ia (M o th er)

A. Revi e w of Current M edi c ati o n


Paracetam ol Drops 0. 6 m l
B. Al l e rgi e s
No know n Al le rgy

I.

P H YSICA L A SSESSM EN T
P atien t B irth H isto ry
B ab y Z is a fu ll te rm d elivered via N SD to a 30 years o ld G 2P 2 (2002) n o feto m atern al
co m p licatio n s, fu lly b reastfe ed . B irth w e igh t o f 3.2kg, A P G A R Sco re o f 9.9.
Im m u n izatio n s :
B CG an d H ep B 1 given
D P T 1, O P V 1 given last A p ril 14, 2015

Upon Adm i s si o n: M ay 31, 2015 at ER


VI T AL SI G NS
BP- 78/59m m Hg HR- 140cpm RR- 46cpm Tem p. 38.7

G e n e ra l A p p e a ra n ce : S e e n b a b y in b e d w it h o n g o in g IV F o f D 5 0 .4 5 N a C l 5 0 0 m l + 5 m e s K C l a t
1 8 m l/ h r in fu sin g w e ll o n h is r ig h t fo o d . S h e h a s g o o d c r y , g o o d su c k a n d d e m a n d s fe e d in g s. H e
is w e ll-fl e x e d , w it h fu ll r a n g e o f m o t io n a n d w it h sp o n ta n e o u s m o v e m e n t .
Sk in : w ith g o o d tu r g o r , n ip p le s p r e se n t a n d o n e x p e c t e d lo c a t io n s, (-) c y a n o sis, w a r m
an d d ry.

H e a d : (-) L a c e r a t io n s, (-) b r u isin g a n d sw e llin g , w it h fl a t a n d o p e n fo n t a n e ls

E ye s: n o n su n k e n e y e s, (+) t e a r s w h e n c r y in g
E a rs: p in n a t e n d s t o b e n d e a sily , w ith st a r t le r e fl e x .

N o se : o b lig a t e n a sa l b r e a t h e r s , w it h b ila te r a l p a t e n t n o st r ils, (-) n a sa l d isc h a r g e s, (-)


n a sa l fl a r in g , w ith n a sa l c a n n u la w it h O x y g e n a t 2 L P M
M o u th : m u c o s a m o is t , to n g u e m o v e s f r e e ly a n d d o e s n o t p r o t r u d e , (+) su c k in g a n d
r o o t in g r e fl e x
N e ck : sh o r t a n d th ic k , t u r n s e a sily sid e t o s id e , a b le t o r a ise h e a d slig h t ly w h e n ly in g in
p r o n e p o s it io n
C h e st: w it h e v id e n t xip h o id p r o c e s s, w it h sy m m e t r ic a l n ip p le s, w ith s y m m e t r ic a l c h e st
m o v e m e n t s, (- ) r e t r a c t io n s ,(- ) m u r m u r
Lu n gs: S y m m e t r ic a l c h e st e x p a n sio n , n o r e t r a c t io n s n o t e d , w it h c le a r b r e a t h so u n d s

A b d o m en : w ith (+) a b d o m in a l re sp ira tio n s, so ft, (+) b o w e l so u n d s, (+) p a ssa ge o f sto o l, (-) m a ss

Extrem ities:
U p p e r: Sym m e trica l e xtre m itie s, w ith n o e d e m a n o te d , ca p illa ry re fi ll o f 1 se c, p in k ish
n a il b e d s. U n trim m e d n a ils.
Lo w e r: Sy m m e trica l e xtre m itie s, w ith n o e d e m a n o te d , ca p illa ry re fi ll o f 1 se c, p in k ish
n a il b e d s. U n trim m e d n a ils.
N eu ro lo gic: w ith n o rm a l re a ctio n s to ro o tin g, su ck in g, p a lm a r, a n d b a b in sk i re fl e xe s u p o n
in itia tio n .

Assessment

Orders

Admission
May 31, 2015 1:10pm
Pt. is 2 months old came in due to
fever and very irritable, no cough
and colds noted
BP 78/59 HR 140 RR 46 T-38.7
Noted CBC results:
Hgb 85, hct26, wbc 39.1, band 5,
neutrophil 74, lymphocyte 15,
platelet 714,
Advised admission

Admitted under dr. M


Cbc with pc, hgt, peripheral blood
smear,blood culture and sensitivity
Chest xray
Urinalysis
D5IMBB 500ml x 27ml/hr (M+10%)
Paracetamol 100mg/ml 0.6ml every
4 hours as needed for temp > 38
Ampicillin 150mg/iv every hours for
infection
Amikacin 88mg/iv once a day for
infection
Pulse oximeter check all extremities

May 31, 2015 3:15pm


Rounds with DR. M

5:30pm
Going Day 1 of illness, last febrile
episode 38.5 at 2pm, less irritable,
good suck cry and activity
T: 37.5, HR 174 RR36, BP 80/50
Nonsunken eyeballs,clear breath
sound, regular cardiac rhythm, soft
abdomen, full pulses

Please add reactive protein to


bloodworks
Hook to pulse oximeter

May go up to room 9th floor


Lab results already relayed
Iv insertion at unit pls

6:15pm
Receicing notes
Last fever noted at 2pm
Decreased duration of
breastfeeding, stops in between
feeds, fair cry compared to night
prior,less head movement, no
cough and colds,
T 37.6 HR 112 RR40 BP 90/60,
GCS 15/15
9:00pm
Rounds with Dr. M
(+) irritability, tolerated feeding,
fair suck and activity
T 37.7, HR 190-200, RR48,O2 sat
100%
10:00pm
Rounds with Dr Matibog
Tachypneic 60, Tachycardia 200,

Secure IV access and start


antibiotics as previously ordered
Accurate input and output
monitoring and record
Insert finalized xray result to chart
WOF poor suck, cry and activity, o2
sat <95%, decrease responsiveness
and increase sleeping time

For ABG (defer), and 15 L ECG now


Increase ampicillin to 300mg/iv
every 6 hours
Rfer to Dr. N for evaluation and
comanagement and to PICU
intencivist
Transfer to PICU for close monitoring
Rfer to DR. B for intensive care
Please do EG7 arterial sample and
Mg
Shift IVF to D5NSS 500ml to run for
27ml/hr

10:30pm at PICU
Sudden onset of respiratory
distress, with fever and
tachycardia
Seen crying, irritable, in
respiratory distress , pale, alar
flaring, dry mouth and lips
HR 203, RR 60, T 38.6

Increase oxygen at 10lpm non


rebreather mask
Increase iv fluids t mild
hydration : ongoing PNSS at
3ml/hr for 8hours
Difficult arterial sample extraction
for EG7, may do needle prick
method instead
Give paracetamol now (opiogesic
125mg/suppository suppository
External cooling measure for
fever
Give another 150 mg ampicillin iv
now

11:00pm
Rounds with Dr B
Sudden onset of difficulty of
breathing/ respiratory distress
with fever and tachycardia
Seen awake irritable, in
respiratory distress, pale
HR 190-200, RR 65-75, spo2
100% at 10lpm non rebreather
mask

Continue present ivf PNSS at 37ml/hr


for 8hours then will reassess
Place on NPO
Continue oxygen support at 10lpm
non rebreather mask
Reuest for stat chest CT scan (plain)
now
Give another 150mg Ampicillin per
iv now then continue ampicillin
300mg/iv every 6 hours diluted with
10ml normal saline
Continue amikacin 88mg/iv as one
hour infusion every 24hours
Paracetamol 125mg per suppository
suppository every 4hours as
needed for fever 38 and above
Please reserve 1u PRBC properly
typed and crossmatched, Divide 1 u
into 3 aliqouts, 70ml each

June 1, 2015
12:30am
Chest CT scan initial reading
showed consolidation and
atelectasis on the left Lucency
seen on the left lower lobe
may represent abcess
formation. CCAM not totally
ruled out, contrast studt is
advised

For tracheal aspirate GS and culture and


sensitivity
Start Clindamycin (dalacin c) 50mg/iv now
then every hours
Creatinine reuested
For follow up chest CT scan with contrast

2am
Latest VS
Proceed now with Chest CT scan with
HR 162, RR 74, spo2 100%
Contrast
No alar flaring, regular cardiac
rhythm, no murmur, sabcostal
and supraclavicular retractions
shallow, good air entry, clear
breath sounds Good peripheral
progression
Creatinine 0.32mg/dl
6:50am
HR 135-156bpm, BP 10/50, RR
55-65cpm, spo2 100% at
10lpm non rebreather mask
Uo : 54ml/kg/hr laast 8hours

Decrease iv fluid rate to full maintenance at


25ml/hr
Decrease Oxygen support to 6lpm face mask

8:45am
Rounds with DR. B
VS: HR 132bpm, RR 48cpm,
spo2 100% at lpm via face
mask
No alar flaring, shallow
sabcostal retractions, good
air entry, clear breath sound,
regular cardiac rhythm,
abdomen soft, strong pulses.
9:15am
Rounds with Dr. M
Afebrile, Decrease O2
support to 3lpm no episodes
of tachycardia when asleep
10:05am
Runds with Dr R
Irritable, good suck, no
cyanosis, interrupted feeding
O2sat 100% at 3lpm via
nasal cannula

Shift oxygen support to nasal cannula at


3lpm
Shift iv fluid to D50.45% NaCl 500ml to
run for 25ml/hr
For repeat cbcpc, serum Na, K tom une 2,
2015 after 7pm dose of clindamysin
Follow up culture results
Reassess this afternoon if breastfeeding
can resumed
Follow up official CT results and attach to
chart
Follow up blood culture and chart

Ma resume breastfeeding with strict


aspiration precaution
Maintain head in upright while feeding
Suggestions:
Continue antibiotics to treat infections
Decrease oxygen to maintain O2sat >95%
Repeat xray after impression is controlled
unless there is clinical deterioration

1:35pm
2:15pm
3:10pm

June 2, 2015
5:00am

8:45am
BP 93/56, HR 153 RR 46, T37.3
No alar flaring, shallow
sabcostal retractions, good air
entry, clear breath sound,
regular cardiac rhythm,
abdomen soft, strong pulses

Decrease O2 at 2lpm
Discontinue Hgt Monitoring
Refer ABG CVBG extracted
yesterday
For cranial ct ultrasound
bedside

IVFTF #2 D5 045% NaCl 500ml


to run for 20ml/hr

Carry out 7pm cbc and relay to


PROD once available, refer

12noon
Rounds with dr b
Marked clinical improvement,
intermittent low grade fever past 24
hours (last fever 4am today)
Stable Vital signs

6:35pm
Dr b updated
10:40pm
Hgb 59, hct 0.19

June 3, 2015
7:30am

Maintain O2 support at 1lpm per nasal


cannula
Iv fluids D5 half normal saline at 35%
of maintenance, 18ml/hr
Follow up tracheal aspirate culture
identification
Relay repeat cbc and serum
electrolytes results as soon as
available
Continue antibiotics
Breastfeed as tolerated/per demand
Include ck enzymes in next
bloodworks to check for myocarditis
Transfuse prbc 60ml at 10ml/hr
Use syringe pump for blood
transfusion
Once on blood transfusion, please
decrease ivf to 8ml/hr
Once ongoing ivf is consumed ivftf D5
0.45 NaCl 500ml +5me KCl
Repeat cbc with platelet at 12noon

I.

A N A TO M Y A N D P H YSIO LO G Y

Im m u n o lo gy is th e stu d y o f o u r p ro te ctio n fro m fo re ign m acro m o le cu le s o r in vad in g


o rgan ism s an d o u r re sp o n se s to th e m . Th e se in vad e rs in clu d e viru se s, b acte ria, p ro to zo a o r
e ve n large r p arasite s. In ad d itio n , w e d e ve lo p im m u n e re sp o n se s again st o u r o w n p ro te in s (an d
o th e r m o le cu le s) in au to im m u n ity an d again st o u r o w n ab erran t ce lls in tu m o r im m u n ity.

O u r fi rst lin e o f d e fe n se a ga in st fo re ign o rga n ism s a re b a rrie r tissu e s su ch a s th e skin


th a t sto p th e e n try o f o rga n ism in to o u r b o d ie s. If, h o w e ve r, th e se b a rrie r la ye rs a re
p e n e tra te d , th e b o d y co n tain s ce lls th a t re sp o n d ra p id ly to th e p re se n ce o f th e in va d e r. T h e se
ce lls in clu d e m a cro p h a ge s an d n eu tro p h ils th a t en gu lf fo re ign o rgan ism s a n d kill th e m w ith o u t
th e n e e d fo r an tib o d ie s. Im m e d ia te ch a lle n ge a lso co m e s fro m so lu b le m o le cu le s th a t d ep rive
th e in va d in g o rga n ism o f e sse n tial n u trie n ts (su ch a s iro n ) an d fro m ce rtain m o le cu le s th a t a re
fo u n d o n th e su rfa ce s o f e p ith e lia , in se cre tio n s (su ch a s te a rs a n d sa liva ) an d in th e b lo o d
stre am . T h is fo rm o f im m u n ity is th e in n a te o r n o n -sp e cifi c im m u n e syste m th a t is co n tin u ally
re a d y to re sp o n d to in va sio n .

A s e c o n d l i n e o f d e f e n s e i s t h e s p e c i fi c o r a d a p t i v e i m m u n e s y s t e m w h i c h m a y t a k e d a y s
t o r e s p o n d t o a p r im a r y in v a s io n ( t h a t is in f e c t io n b y a n o r g a n is m t h a t h a s n o t h i t h e r t o b e e n
s e e n ) . I n t h e s p e c i fi c i m m u n e s y s t e m , w e s e e t h e p r o d u c t i o n o f a n t i b o d i e s ( s o lu b l e p r o t e i n s
t h a t b i n d t o f o r e i g n a n t i g e n s ) a n d c e l l - m e d i a t e d r e s p o n s e s i n w h i c h s p e c i fi c c e l l s r e c o g n i z e
f o r e ig n p a t h o g e n s a n d d e st r o y t h e m . In th e c a se o f v ir u s e s o r t u m o r s , t h is r e s p o n se is a ls o v it a l
t o t h e r e c o g n i t io n a n d d e s t r u c t i o n o f v i r a l l y - i n f e c t e d o r t u m o r i g e n i c c e l l s . T h e r e s p o n s e t o a
s e c o n d r o u n d o f i n f e c t io n i s o f t e n m o r e r a p id t h a n t o t h e p r im a r y in f e c t io n b e c a u s e o f t h e
a c t iv a t io n o f m e m o r y B a n d T c e lls. W e s h a ll s e e h o w c e lls o f t h e im m u n e sy st e m in t e r a c t w it h
o n e a n o th e r b y a v a r ie t y o f s ig n a l m o le c u le s so t h a t a c o o r d in a t e d r e sp o n s e m a y b e m o u n t e d .
T h e s e s ig n a ls m a y b e p r o t e i n s s u c h a s ly m p h o k in e s w h ic h a r e p r o d u c e d b y c e lls o f t h e ly m p h o id
sy st e m , c y t o k in e s a n d c h e m o k in e s t h a t a r e p r o d u c e d b y o t h e r c e lls in a n im m u n e r e s p o n se ,
a n d w h ic h s t im u la t e c e lls o f t h e im m u n e s y s t e m .

T h e im m u n e sy s t e m is c o m p o se d o f t w o

m a j o r s u b d i v i s i o n s , t h e i n n a t e o r n o n s p e c i fi c i m m u n e s y s t e m
im m u n e sy st e m

(F ig u r e 1 ). T h e in n a t e im m u n e sy st e m

a n d t h e a d a p t i v e o r s p e c i fi c

i s o u r fi r s t l i n e o f d e f e n s e a g a in s t

in v a d in g o r g a n is m s w h ile t h e a d a p t iv e im m u n e s y s t e m a c t s a s a s e c o n d lin e o f d e f e n s e a n d a ls o
a ff o r d s p r o t e c t i o n a g a in s t r e - e x p o s u r e t o t h e s a m e p a t h o g e n . E a c h o f t h e m a j o r s u b d i v i s i o n s o f
t h e im m u n e s y st e m h a s b o t h c e llu la r a n d h u m o r a l c o m p o n e n t s b y w h ic h t h e y c a r r y o u t t h e ir
p r o t e c t i v e f u n c t i o n ( F i g u r e 1 ) . I n a d d i t i o n , t h e in n a t e i m m u n e s y s t e m

a lso h a s a n a t o m ic a l

f e a t u r e s t h a t f u n c t io n a s b a r r ie r s t o in f e c t io n . A lt h o u g h t h e s e t w o a r m s o f t h e im m u n e s y st e m
h a v e d i s t i n c t f u n c t i o n s , t h e r e i s i n t e r p la y b e t w e e n t h e s e s y s t e m s ( i . e . , c o m p o n e n t s o f t h e
i n n a t e i m m u n e s y s t e m i n fl u e n c e t h e a d a p t i v e i m m u n e s y s t e m a n d v i c e v e r s a ) .

A lth o u gh th e in n a te a n d a d ap tive im m u n e syste m s b o th fu n ctio n to p ro te ct a ga in st


in va d in g o rga n ism s, th e y d iff e r in a n u m b e r o f w a ys. T h e a d ap tive im m u n e sy ste m re q u ire s
so m e tim e to re a ct to a n in v a d in g o rga n ism , w h e re a s th e in n a te im m u n e syste m in clu d e s
d e fe n se s th a t, fo r th e m o st p a rt, a re co n stitu tive ly p re se n t an d re a d y to b e m o b ilize d u p o n
in fe ctio n . Se co n d , th e ad a p tive im m u n e syste m is a n tige n sp e cifi c a n d re a cts o n ly w ith th e
o rga n ism th a t in d u ce d th e re sp o n se . In co n tra st, th e in n a te sy ste m is n o t an tige n sp e cifi c a n d
re a cts e q u a lly w e ll to a va rie ty o f o rga n ism s. F in a lly, th e a d ap tiv e im m u n e sy ste m
d e m o n stra te s im m u n o lo gica l m e m o ry. It re m e m b e rs th a t it h a s e n co u n te re d a n in va d in g
o rga n ism a n d re a cts m o re ra p id ly o n su b se q u e n t e xp o su re to th e sa m e o rga n ism . In co n tra st,
th e in n a te im m u n e syste m d o e s n o t d e m o n stra te im m u n o lo gica l m e m o ry.

A lthough the innate and adaptive im m une system s bo th functio n to pro tect against invading
o rganism s, they diff er in a num ber o f w ays. Th e adaptive im m une system requires so m e tim e to
react to an invading o rganism , w hereas the innate im m une system includes defenses that, fo r
the m o st part, are constitutively present and ready to be m obilized upo n infectio n. Seco nd, the
adaptive im m une system is antigen specific and reacts only w ith the o rganism that induced the
respo nse. In co ntrast, the innate system is no t antigen specific and reacts equally w ell to a
variety o f o rganism s. Finally, the adaptive im m une system dem o nstrates im m uno logical
m em o ry. It rem em bers that it has encountered an invading o rganism and reacts m o re rapidly
o n subsequent expo sure to the sam e organism . In co ntrast, the innate im m une system does
no t dem onstrate im m uno lo gical m em ory