I&i: Definitions

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Type I Diabetes Mellitus

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Organ specific autoimmune disease where T cell destruction of beta cells of the pancreas results in insulin deficiency and chronic hyperglycaemia

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Acquired tolerance

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Tolerance is 'learnt' to non-self antigens e.g. In the foetus with HBV, or desensitization of allergies

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Acute rejection

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Anti-allograft response in a patient who is not pre-sensitized. Usual inflammatory mechanism involvin both antibodies and T-cells. Occurs after a few days with a rapid decline in organ function. Most can be reverse with immunosuppressive therapy

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AIDS

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Acquired immuno-deficiency syndrome - caused by HIV, a retrovirus with a ssRNA genome. It is the combination of signs and symptoms caused by the HIV infection and resulting in immunodeficiency

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Allergy

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Represents the clinical presentation of atopic IgE mediated diseases

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Allograft

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Graft between genetically different members of the same species

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Atophy

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An inherited IgE hyper-responsiveness, leading to a predisposition to allergy

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Autograft

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Graft from the same individual

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Autoimmune disease

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Clinical disease / pathology resulting from autoimmunity

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Autoimmunity

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An immune reaction to self

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Bacterial endocarditis

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Infection of the heart valves which is very difficult to eradicate and often caused by bacteraemia e.g. due to rotten teeth. Commonly left sided valves unless IV drug users. Infection metastases from valves can migrate e.g. to the brain

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Blood-bourne virus

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A virus found in the blood during at least part of its life-cycle and causes serious chronic infection e.g. HBV, HCV, HIV

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Bruton's X-linked agammaglobinaemia

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Mutation of locus for a tyrosine kinase needed for B-cell proliferation on the X chromosome, resulting in no B cells. Results in arthritis and IBD

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Bystander effect

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Potential caused of autoimmunity where a highly inflammatory environment due to infection causes the breaking of peripheral self-tolerance

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Central tolerance

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Cells bearing self-reactive receptors are destroyed during their differentiation

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Chlamydia

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Common STI caused by Chlamydia trachomatis. 75% of women and 50% men asymptomatic. In females may produce vaginal discharge, dysuria/urethritis and if it spreads, lower back pain, dyspareunia, nausea, fever etc. In men may present with penile discharge, urethritis, itching and burning

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Chronic B lymphocytic leukaemia

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Over-production of immature B cells, leading to hypogammablobinaemia (over some years)

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Chronic granulomatous disease (CGD)

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Rare X-linked deficiency in NADPH oxidase, the enzyme that powers oxidative burst in phagocytic cells, resulting in a failure to kill phagocytosed pathogens. Causes severe infections and absecesses, GI inflammation and delayed wound healing, with survival into 20s rare.

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Chronic rejection

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Irreversible long-term decline in function due to chronic immune damage causing fibrotic responses. Subsequent vascular damage

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Colonisation

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Presence of organisms but host response is slight or nil

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Common variable immunodeficiency (CVID)

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A variable disorder that is only 10% familial. B cells are normal but plasma call differentiation is defective, and class switching does not occur, so that there is reduced IgA, IgG and often IgM. May be a result of a Th defect. Arthritis, other AI disease, and haematopoeitic cancers are common.

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Complement deficiency

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Genetic defect causing a lack of one of the many components of the complement system. Results in increased bacterial infection and immune complex diseases e.g. SLE

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Congenital neutropenia

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Genetic defect resulting in the premature apoptosis of neutrophils or their precursor cells. Results in a decreased or absent neutrophil count

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Contact dermatitis

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Type IV hypersensitivity (T cell mediated) reaction causing inflammation and oedema in the skin 24-72 hours following contact with agent

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DiGeorge Syndrome

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Congenital disorder due to a deletion in chromosome 22, causing thymic hypoplasia, cardiac and facial problems. Results in low T cells

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Droplets

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Small particles that fall to the ground in a few seconds, close to the source

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Empirical therapy

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Therapy given without knowing the causative organism - based on experience, symptoms and area. Used when can't wait for a lab result

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Empyema

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Spread of infection into the pleural space, causing an inflammatory reponse and consolidation

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Eotaxin

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Chemotaxin produced by many cells in response to Th2 cytokines and are chemotactic for eosinophils

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Epidemiological triad

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Model of infectious disease causation involving agent factors, host factors and environmental factors

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Epitope

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Antigenic determinant = part of the macromolecule that is recognised by the immune system

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Epitope spreading

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Potential cause of autoimmunity where an auto-reactive TCR is activated and then spreads to targeting other, different self-epitopes due to inflammation and the release of tissue Ags not usually present in the EC space

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Exanthem

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Fever with rash

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Food allergy

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Clinical manifestation of IgE antibody response to specific food allergens. Usually within minutes of exposure and may result in itchiness, rash, wheezing or anaphylaxis

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Food intolerance

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Non-IgE mediated reaction to a foodstuff. Symptoms include abdominal pain, vomiting, diarrhoea, headache etc. Pathogenesis unknown

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Food-related exercise-induced anaphylaxis

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Patient is tolerant to a food, but suffers anaphylaxis if ingests the food and then exercises

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Graft-versus-host disease

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Caused by a graft of allogenic lymphoid tissue, or more rarely, bowel transplantation. Lymphocytes of the graft are activated by the host HLA and go on to damage host tissues (rather than the other way around), causing the graft to reject the recipient. May affect skin, bowel mucosa and most other parts of the body

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Graves disease

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Autoimmune disease where autoantibodies are targeted against the TSH receptors, stimulating the thyroid gland and producing exophthalmia and hyperthyroidism symptoms

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Haematopoietic malignancy

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Excessive proliferation of non-differentiated immune system cells which are clonal in origin resulting from a defect

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Haemophagocytosis

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An aggressive proliferation of activated macrophages which phagocytose other cells - RBC, WBC and platelets

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Haplotype

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A person's HLA composition or 'tissue type'. 3 main loci = A, B and DR, each with 2 copies that may be different, so that there are millions of potential combinations

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Health protection

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Protection of people from infectious diseases and preventing harm from non-communicable environmental hazards involving chemicals, poisons or radiation

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Hepatitis

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Inflammation of the liver resulting in liver damage and dysfunction. If severe may produce signs e.g. jaundice, and symptoms e.g. malaise. Caused by infection, aflatoxins, autoimmunedisorders and alcohol

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HLA

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Receptors that express an epitope of an antigen for immune cells to 'see'. Type I found on most cells. Type II found on APCs. Intiate the immune response and also act as a target for Tc cells. Also know as MHC

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Hyperacute rejection

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Rejection due to complement and preformed antibodies (due to previous sensitization). Reaction occurs in minutes and organ must be removed

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Immune priviledge

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Hidden antigens behind anatomical barriers

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Immunodefieciency

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Condition where a genetic defect prevents proliferation and/or function of immune system cell(s)

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Incubation period

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The time interval between initial contact with an infectious agent and the appearance of the first sign or symptom of the disease

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Infection

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Deposition of organisms into tissues and their growth with an associated host reaction

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Kaposi's sarcoma

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HHV8 infection seen in AIDS, causing large skin swellings which disappear with antivirals. May also affect GI tract which requires chemotheraphy

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Kawasaki disease

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Autoimmune disease where there is vasculitic changes of the coronary arteries, precipitated by an unknown viral infection

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Leukaemia

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Haematological cancer where cells proliferate in the bone marrow and immature cells spill over into the circulation

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Leukocyte adhesion deficiency

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Rare autosomal recessive disorder resulting in a defect in CD18, which helps recruit neutrophils from the blood to infection sites and in phagocytosis. Results in increased bacterial infection

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Lymphoma

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Haematological cancer where mature lymphocytes proliferate in lymph nodes which swell

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Minor histocompatibility antigen

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Antigen that can cause rejection in transplantation but not part of the MHC (or HLA) and a far weaker response than these

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Molecular mimicry

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Potential cause of autoimmunity where a pathogen antigen is similar to self-antigen and a cross-reaction takes place

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Multiple sclerosis

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Chronic autoimmune inflammatory process of the CNS resulting in demyelination of nervous tissue and loss of function

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Mycology

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Study of fungi and spores

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Myeloma

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Haematological cancer where plasma cells proliferate in bone marrow

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Negative selection

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T-cells that bear the TCR for self-antigen bind too strongly to the MHC and undergo apoptosis. B-cells that bear the BCR for self-antigen are not stimulated by Th2 and apoptose

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Nephrotic syndrome

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Renal damage, leading to proteinuria and hypogammaglobinaemia

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Outbreak

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Two or more linked cases or increase in background rate of disease

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Paraprotein

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Monoclonal immunoglobulin product of myeloma - may be intact Ig or fragments - and is detectable by electrophoresis as a tight band instead of a smear, or as Bence Jones proteins in the urine

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Peripheral tolerance

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Cells bearing self-reactive receptors are matured and released into the periphery but are generally unable to respond to self antigen due to Treg cells

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Primary immunodeficiency

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Intrinsic defect in the haematological system, most likely due to genetic factors. May be inherited or spordic

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Progressive multifocal leucoencephalopathy (PML)

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A rare afebrile fatal illness seen most commonly in AIDS patients which is clinically characterised by progressive neurological deficits, including impairment of higher cortical functions, visual problems, hemiparesis and cerebellar dysfunction

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Prophylaxis

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Therapy given to prevent infection - often given around surgery, to patients prone to particular infections (e.g. due to contact) or immunocompromised

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Public health

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The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

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Reiters syndrome

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Reaction to chylamydia bacteria, causing urethritis, painful joints and sore eyes, associated with HLA B27

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Rheumatic fever

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Autoimmune disease precipitated by the production of antibodies to a streptococcal infection that cross-react with the heart

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Rheumatoid arthritis

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Systemic chronic inflammatory autoimmune disease which primarily affects joints symetrically but also may effect organs

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Rheumatoid factor

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IgM directed at the Fc portion of IgG molecule = autoantibody

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Secondary immunodeficiency

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Immunodeficiency due to extrinsic factors e.g. Infection (AIDS), certain drugs (immunosuppressants), underlying disease

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Sepsis

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SIRS with a presumed or confirmed infectious process

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Seroconversion illness

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Illness caused by the initial HIV infection around 6 weeks after infection. Presents with flu-like symptoms and an itchy rash

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Serology

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The science studying antibodies and antigens in blood serum

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Severe combined immunodeficiency (SCID)

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Defect in the formation of T cells and often of B cells and NK cells, leading to a failure of all branches of the adaptive immune system. Many genes involved, X-linked being the commonest cause. Results in SPUR infections in early life and requires a CD34 stem cell transplant

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Severe sepsis

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Sepsis associated with severe organ dysfunction

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Shock

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Acute circulatory failure resulting in inadequate or disordered tissue perfusion and insufficient oxygen supply to cells

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SIRS

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Severe inflammatory response syndrome - a clinical response resulting from a non-specific insult e.g. infection, trauma, burns, pancreatitis

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Strain

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Minor variance of a particular type of virus

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Subclass deficiency

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Deficiency in the ability to produce specific subclasses of immunoglobulins. Symptoms vary depending on the Ig involved e.g. IgA mostly asymptomatic, IgG2 predisposes to lung infections

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Surveillance

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The continuing scrutiny of all aspects of the occurrence and spread of a disease through the systemic collection, collation and analysis of data and the prompt dissemination of the resulting to those who need to know so that action can result

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Syngenic

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Genetically identical individuals

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Targeted therapy

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Given when the infection and the causative organism is known - this is the best way of effective treatment

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Th

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T helper cells. Th1 = used in viruses and intracellular bacteria. Th2 used for parasites (and allergy)

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Toxoplasma

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Bacterial infection carried by cats that may be passed to humans. May be symptomless, or produce mild, flu-like symptoms but serious to foetus and immunocompromised

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Uveitis

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Inflammation of the uvea (iris, ciliary body and choroid) caused by infection e.g. herpes, fungus, parasite; autoimmune disease, surgery or idiopathic. Can result in visual loss through glaucoma, cataracts and retinal damage

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Viral myocarditis

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Infection of the heart muscle due to coxsacki virus (and mumps virus) that will cause heart failure

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VTM

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Virus transport medium - contains buffer, protein and antibiotics for use in mixed samples

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Xenograft

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Graft from a different species