Stepwise Progress Towards Septic Shock Treatment

A pilot clinical trial of a polyclonal antibody targeting tumor necrosis factor alpha has provided early evidence that such a product may have a role to play in the treatment of sepsis. The work, in a disease called louse-born relapsing fever which can serve as a model of septic shock, was published in the New England Journal of Medicine on August 1.

Patients with louse-borne relapsing fever, caused by infection with the organism Borrelia recurrentis, are generally treated with antimicrobial drugs, but these often trigger an inflammatory response a couple of hours after treatment in which patients experience sudden fever, hypotension and rigors.

This syndrome, known as the Jarisch-Herxheimer reaction, is associated with increases in plasma TNF-alpha, interleukin-6 and IL-8. It usually resolves in six to 12 hours, but in around 5% of cases it can be fatal. Many of the hallmarks of the Jarisch-Herxheimer reaction are the same as are encountered in patients suffering septic shock.