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47 Cards in this Set
- Front
- Back
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IgG
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70% of total immunoglobulins
Mainly seen in secondary immune response Crosses placenta Fixes complement Four subtypes |
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IgA
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20% of total immunoglobulins
In serum, colostrum, saliva, tears, respiratory and intestinal mucosa |
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IgM
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10% of total immunoglobins
Predominant antibody in primary immune response. Fixes complement best |
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IgD
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1%
B cell surface receptor |
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IgE
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0.01%
Triggers histamine release from mast cells. Immediate hypersensitivity reactions (allergy, anaphylaxis, asthma) - Increases in parasitic infections |
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Diseases causing immunodeficiency:
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AIDS
Hodgkins disease, lymphoma Leukemia Advanced solid tumors (MM, CLL) Diabetes mellitus Sarcoidosis |
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Drugs causing immunodeficiency:
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High-dose corticosteroids
Chemo Radiation |
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Immunodeficient associated inections:
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Bacteria:
Listeria, Nocardia, mydobacterium tuberculosis, legionella, salmonella Virus: Varicella, herpes simplex, HBV Fungi: Cryptococcus, Candida, histoplasma, coccidioides, aspergillus, PCP Protozoa: Toxoplasma, Cryptosporidium, Giardia |
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Hypoglammaglobulinemia
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Low levels of IgG, IgA, IgM
Normal number of B cells, but defective Increased susecptibility to infections, autoimmune diseases. |
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Selective IgA Deficiency
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Mucous membrane deficiencies (URTI, UTI, GI)
- IgA replacement causes anaphlaxis |
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Fever in the immunocompromised:
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Cancer patients: fever of unknown orgin
Gram positive, or neg aerobes Viruses: RSV, parainfluenza, adeno, CMV Fungi: Candida, aspergillus, PCP, Cryptococcus |
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Transplant Patients: fever
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CMV, EBV, HBV, Hep C, adeno
Aspergullus, PCP CMV - 30-60 days post transplant |
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Splenectomy patients: fever
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Encapsulated organisma:
strep pneumonia neisseria meningitis H influenza Klebsiella Salmonella PARASITES: Malaria, babesia |
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Leukemia patients within three days of beginning chemo are vulnerable to pneumonia with what bacteria?
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PCP
(In any immunodeficiency, a pulmonary infiltrate is usually PCP) |
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AIDS:
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CD4 < 200, regardless of symptoms
An AIDS defining clinical condition, regardless of CD4 count (candidiasis, cervical cancer, cryptococcus, MAI, |
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AIDS treatment:
Zidovudine (AZT) side effects |
Nausea, headache, malaise
Macrocytic anemia secondary to low EPO levels. Can be treated with EPO injections |
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Lamivudine Side effects
(AIDS) |
Only for use in combo with AZT
Toxicities: pancreatitis, peripheral neuropathy |
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Protease Inhibitor Side Effects
(AIDS) |
Diarrhea
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Treatment of AIDS
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- 2 nucleoside reverse transcriptase:
AZT and Lamidvudine (3TC), and - 1 Protease inhibitor: Indinavir Initiate if: CD4 < 500 Viral load > 20,000 Symptomatic, disease progressing Asymptomatic, CD4 < 200 |
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Timeline for AIDS CD4 and opportunistic infections:
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< 500, Oral hairy leukoplakia, fever, night sweats, fatigue, candidiasis, mucocutaneous lesions, Kaposi's sarcoma, recurrent bacterial infections
TB < 200, PCP, cryptococcus, coccidioides, histoplasma < 100, PML, Toxoplasmosis < 50, MAI < |
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Diagnosis of Opportunistic Infections:
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PaO2 decreases, a-A gradient increases
CXR normal, or faint bilat infiltrate LDH elevated |
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Toxoplasmosis
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Late complication of AIDS.
MRI - multiple ring-enhancing lesions in brain Fever, focal neurological deficits |
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AIDS patient with brain lesions:
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Toxoplasmosis - multiple ring-enhancing lesions
CMV - Periventricular ring |
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Toxoplasmosis treatment:
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Pyrimethamine and sulfadiazine
(leukopenis is SE, treat with folinic acid) Lifelong treatment is necessary due to high relapse rate |
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Mycobacterium Avium
(MAC) |
Most common cause of death in AIDS patients, after diagnosis 6-8 mo.
< 100 CD4, unexplained fever, elevated Alk Phos |
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Treatment of MAC
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Clarithromyin and ethambutol
Prophylaxis: Rifabutin when CD Can have lower lobe interstitial infiltrates |
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MAC diagnosis:
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Blood culture
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Leading cause of meningitis in AIDS patients
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Cryptococcus
Life threatening. Can give fluconazole prophylactically Dx: Multiple ring enhancing lesions on MRI Pulm CXR: interstitial pattern CSF- cryptococcal atigen, India ink stain Positive culture |
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Treatment of Cryptococcus
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Amphotericin B x 6 weeks
Fluconazole indefinetely for relapse |
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Aspergillus - how does it present
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As a fungus ball in immunocompromised patinet
Mold with septated hyphae |
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Treatment of Aspergillus
Note: causes lung disease, wheezing, bronchiectasis |
Amphotericin B
Steroids |
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CMV
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95% of AIDs patients. Esophagitis, colitis
Painless, vision loss, floaters. Irreversible Fundoscopy - hemorrhage |
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CMV Treatment
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Ganciclovir - causes bone marrow suppression. Should not be given with Septra or AZT
(with foscarnet for maintenance) |
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HIV-associated malignancies
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HHV-6,8: Kaposi's sarcoma
HPV: Cervical cancer HBV: Hepatocellular carcinoma |
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Kaposi's Sarcoma
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HIV associated neoplasm
Vascular nodules in skin, MM Purple nodule, lesions in sun exposed areas Pulm involvement. CD4 can be normal |
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Kaposi's Sarcoma Diagnosis:
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Biopsy of lesion - spindle cells, endothelial cells, extravasation of RBC
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Kaposi's Sarcoma Treatment:
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Irradiation (local) - lesions that interfere with swallowing.
Cryotherapy if painful lesions |
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Lymphoma in AIDS:
3 main types Poor prognosis |
Grade 3 or 4 immunoblastic
Burkitt's lymphoma Primary CNS lymphoma Persistent unexplained fever, focal seizures, rapidly growing mass in oral mucosa. Treatment: Chemo |
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Anthrax
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Gram positive bacilli
Dx: culture CXR: wide mediastinum with normal lungs Tx: Amoxicillan, Cipro, doxycycline |
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Plague
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Yersinia: Gram negative bacilli with bipolar staining
Treatment: Streptocycin |
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Smallpox
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Accutely ill initially.
Spots on tongue, develop into sores Feels better with onset of rash. Rash becomes vesicles within 5 days Lesions all at the same stage of dvpt |
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Smallpox
Diagnosis |
PCR
ELISA of throat swab Culture of fluid from pustules No treatment for virus, can treat secondary bacterial infection |
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Rocky Mountain Spotted Fever
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Ticks
Gram negative cocccobacillus Fever, N&V, MP rash on distal extremeties, palms, progresses centrally. May become petechial. Can be fatal TREATMENT: Doxycycline or amoxicillin if no cardiac stuff If cardiac: Penicillin or cephalosporin |
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Borrelia
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Presents with Bells Palsy and history of tick bite.
Causes Lyme Disease: Erythema Chronicum Migrans - pathognomonic skin rash. Starts at bite and progresses until central clearing. First stage - fever, arthralgia Second - Recurring rash, myocarditis, heart block, meningitis, cranial nerve palsy Third - migratory or oligoarthritis |
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hearing aid
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la prótesis auditiva, audífono, aparatos para sordos, aparatos para la audición
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Epidural Abscess
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Triad: Pain, fever, progressive weakness
White count Staph a, gram neg, TB Dx: MRI LP only if meningitis is suspected Treatment: Emergent decompressive laminectomy, long-term abx |
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Malaria
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P.falciparum - Africa
Most severe. Infects erythrocytes P.vivax - India, central america Younger erythrocytes P.vivax and ovalle - persistent liver infection Treatment: Chloroquine for vivax, ovale and P.malariae Pyrimethamine/sulfa if chloroquine resistent Quinidine if very ill |
