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17 Cards in this Set
- Front
- Back
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Types of immunity
• Inate |
o First line of defense
• Skin, mucosa, non-specific inflammatory response to cell injury and death • Innate immunity cells • Phagocytes • Inflammatory mediator cells o Basophils, mast cells • Natural killer cells • Complement proteins • Etc. • |
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Acquired
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– specificity and memory
o Active • Acquired by introduction of antigen • Components: • B and t cells, immunoglobulin’s • Leads to mediated immunity (cytotoxic t-cells) and humoral immunity (b-cells: memory cells and plasma cells o Passive • Ab’s or sensitized lymphocytes produced by one person and transferred to another • Temporary |
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The immune response
• Antigens (epitope) |
o Specific location on the antigen where the receptor, or antibody, binds to it
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Major histocompatibility complex (mhc)
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o Cell surface marker unique to each person
o Presents antigens o Some types predispose to autoimmune disease |
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Factors affecting immunity
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• Aging
• Hormonal influences • Malnutrition • Environmental pollution • Toxic chemicals • Trauma • Burns • Sleep disturbance • Concurrent illness • Medications • Hospitalization • Surgery • General anesthesia • Splenectomy • Stress • Socioeconomic status • Psychospiritual well being • Increased pathogen exposure o Urinary catheters, ng tubes, et tubes, chest tubes, icp monitor, external fixation devises, implanted prostheses, sexual practices |
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Immunodeficiency diseases
Primary immunodeficiency |
• More than 95 inherited diseases
• Increased susceptibility to infection, autoimmunity and increased cancer risk o Especially with organisms that are normal flora or not normally infectious (opportunistic) • May affect one or more components of immune system |
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Secondary immunodeficiency
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• Due to another disease
o Leukemia, lymphoma, alcoholism, malnutiriton, aging, DM, cancer • Can be iatrogenic o Immunosuppressive drugs (cytotoxic drugs, corticosteroids cyclosporine, etc.), radiation, chemotherapy, splenectomy, etc. |
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AIDs
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• Etiology/risk
o HIV infection • Retrovirus • Exchange of bodily fluids • IV drug use • Sexual contact • Path o Infection of helper T lymphocytes (CD4) o Macrophages and B cells also affected o Leads to progressive immune function loss o Reverse transcriptase copies viral RNA into DNA o When CD4<200, AIDs results in opportunistic infections, unusual malignancies, autoimmunity (RA, autoimmune antibodies, etc.), neurologic dyfunction (AIDs dementia complex, HIV encephalopathy and peripheral neuropathies) • CM o Heterogenous in CM’s and time course o Asymptomatic stage (CD4>500) • Acute, self limiting infections mononucleosis-like illness in some • Asymptomatic seroconversion • Early symptomatic stage (CD4 200-500) • Adenopathy • Weight loss, fatigue, and fevers • Sometimes HIV encephalopathy, PCP, CMV, toxo or malignancy o CMV • Peripheral neuropathy and retinitis o PCP • Dyspnea, cough, weight loss o Toxoplasmosis • CNS infection • HIV advanced d |
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Hypersensitivity reactions
• Type 1 Hypersensitivity |
o Immediate hypersensitivity
• Immediate hypersensitivity, allergic disorders, anaphylaxis • Allergic rhinitis, asthma, anaphylactic shock • IgE mediated • On mast cells • Releases histamine • |
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Type II hypersensitivity
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o Cytotoxic rxns to self antigens
o Reaction to something that is human or self • Blood transfusion reactions • Hemolytic disease of the newborn • Autoimmune hemolytic anemia • |
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Type III hypersensitivity
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o Immune complex disease
o IgM mediated • Multiple bind together and form a “wheel” that has multiple binding sites • IgM secreted from B cells • Antigen binds to Igm, and another COmplex binds to the same antigen, forming a large complex • Gets very large – and gets stuck in blood vessels • Deposition of circulating immune complexes in tissues leading to inflammation and tissue injury • Lupas • |
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Type IV hypersensitivity
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o Cell-mediated immunity
• Antigen processed by macrophages and present to T cells which recruit other lymphoctyes and cells • Contact dermatitis, TB skin test o Delayed sensitivity o Reactions to metal, lanolin • Transplant rejection |
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Autoimmune diseases
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• Examples
o Organ specific disease • Hashimoto’s, graves, chrons, addisons, type 1 DM, hemolytic anemia, ulcerative colitis, idiopathic thrombocytopenic purpura, etc. o Non organ specific diseases • Sle, amylodosis, ankylosing spondylitis, ms, sceroderma, psoriasis, rheumatoid arthritis, sarcoidosis, sjogrens, etc • Etiology o Multifactorial • Genetic, hormonal, environmental and other influences • Genetic susceptibility by certain HLA types (Human leukocyte antigen = MHC) o Can be auto-antibodies, cell mediated or immune complex mediated, etc • Dx o Several blood tests for different diseases • Thrombocytopenia, leucopenia, immunoglobulin excess, ana, rheumatoid factor, false-positive serologic tests, etc o Typically, Most have no gold standard test • Tx o Immune suppression, generally o Depends on disease o Anti-inflammatory medications • NSAIDs |
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Systemic Lupus Erythematosis
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• Autoimmune disease
• Young women (10-15:1); age 15-40 • Risk/etiology o Strong familial link with 1st degree relatives o Probably multifactorial o Very heterogeneous – many auto-antibodies present • Pathology o Auto-antibodies against cell nuclei (ANA – or anti-nuclear antibody) • Immune complex deposition • Most people with lupus will have it but not all, can have ANA with out having lupas o Many other auto-antibodies in different patients o All organs susceptible to injury over time • Very heterogeneous • Which organs with which effects differ from patient to patient • Many subtypes • CM – no two patients are the same, and present as something completely unrelated depending on what organ is being effected o MSK • Arthralgias (joint pain), arthritis (most common presenting sx; not destructive as in RA), malaise, fatigue, etc. o Cutaneous and membranous • Skin rash in sun exposed areas, butterfly rash, discoid rashes, vasculitis (inflammation of blood vesse |
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Scleroderma
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• Autoimmune attack on connective tissue leading to chronic scaring and fibrosis
• Heterogeneous and diverse • Different forms of it: • Diffuse and limited forms o Calcinosis, GI disease (esp. esophagous), lungs, heart, kidneys, skin, etc • Dx o History, blood tests • ANA • Anticentromere antibody (limited forms or CREST syndrome) • Anti-sci 70 antibody (antitopoisomerase I Ab; diffuse) • Tx o Symptomatic and immunosuppressant’s |
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Rheumatoid arthritis
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• Autoimmune attack on joints and other tissues
o Rheumatoid factor in joints o Destructive, leading to bone and cartilage erosion and joint deformity • Typical ulnar deviation o Symmetrical, worse in morning o Can affect other tissues • Inflammation of glands of eyes and mouth leading to dryness (sjogren’s syndrome), etc. • Dx o Hx and blood tests (RF, ana, others) • Tx o Many anti inflammatories, immunosuppressant’s and immune modulating drugs |
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Fibromyalgia
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– not an AI disease
• Incidence o Common, F>M • Risk factors o Prolonged anxiety, depression, emotional stress, trauma (physical or emotional), rapid steroid withdrawal, hypothyrodism, infection o Can develop without known predisposing factor • Pathology o Unclear o May seem to affect hypothalamic-pituitary adrenal axis, autonomic nervous system, reproductive hormone axis, and immune system • Cm o Muscle pain (aching and burning), diffuse pain or tender points on both sides of body in many muscle groups, fatigue o Less common and less severe in aerobically and physically fit individuals • Dx o History and PE o Rule out other conditions –dx of exclusion • Hypothyroidism, RA, SLE, polymyositis/dermatomyositis, metastatic CA, AIDs, tubercuosis, etc. |
