The clinical manifestation of endotoxic shock arising from high level contamination

Abstract

‘Endotoxic shock’ is a disease state found in man, which bears some resemblance to the experimental endotoxic shock so extensively investi gated in animals. It is important to realize that endotoxic shock as diagnosed by its clinical manifestations is not necessarily accompanied by a demonstrable bacteraemia. The endotoxin, believed to be responsible for the pathophysiology of Gram-negative bacteraemia, is a lipoprotein—carbohydrate complex found in the cell wall of the bacterium. Mice, rabbits, cats, dogs and monkeys have all been studied after the injection of endotoxin but in humans, only the intravenous infusion of heavily contaminated fluids has provided any situation analogous to the experi mental work. The clinical syndromes found in man do not parallel exactly the features of experimental shock and although attempts to isolate endotoxin in human infection have been reported, at present it can only be inferred that the shock associated with Gram-negative septicaemias is due to endotoxin.