Shock and Multiple-Organ Dysfunction after Self-Administration of Salmonella Endotoxin

Open Access
Publisher Website
Google Scholar
Abstract
Endotoxin, a lipopolysaccharide component of the outer membrane of gram-negative bacteria, is involved in the pathogenesis of septic shock, but it is unclear whether endotoxin alone is capable of causing all the manifestations of the septic shock syndrome. In animals, endotoxin causes many of the clinical features1 but produces a low-cardiac-output form of shock that is unlike the hyperdynamic cardiovascular profile of septic shock in humans2,3. In humans, the administration of endotoxin (4 ng per kilogram of body weight) triggers the release of cytokines,4 activates the coagulation and fibrinolytic systems,5,6 and causes a decrease in systemic vascular resistance and an increase in cardiac output7. At these low doses, however, endotoxin does not cause shock, disseminated intravascular coagulation, or clinically important organ dysfunction. A septic shock-like syndrome occurred in patients treated for cancer with crude preparations of endotoxin8 and in patients who received transfusions of blood products contaminated with gram-negative bacteria9. These reports, however, did not include detailed hemodynamic data, and other bacterial products may have contributed to the clinical signs and symptoms. We describe a patient who self-administered a single large dose of endotoxin and in whom the full clinical manifestations of septic shock syndrome developed.