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Human Diseases > 12.1 Clinical immunology > Flashcards

12.1 Clinical immunology Flashcards

1
Q

Describe the innate vs adaptive immune systems.

A

Innate: non-specific, general, immediate, no memory
- Humoural: pattern receptors, complement, enzymes, cytokines
- Cell mediated: phagocytes, NKcells

Adaptive: specific, lag time from exposure to response, memory
- Humoural: antibodies and cytokines
- Cellular: T cells and B cells

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2
Q

What are the primary and secondary organs of the immune system?

A

Primary:
- Bone marrow for production of all haematopoietic cells
- Thymus for T cell maturation

Secondary:
- MALT, tonsils, adenoids
- Lymph nodes and lymphatic system for tissue fluid surveillance
- Spleen for blood surveillance

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3
Q

What are the lymphoid organs?

A

Sites of generation, maturation and initiation of adaptive immune response.
- Central lymphoid organs: thymus and bone marrow
- Peripheral lymhpoid organs: lymph nodes, spleen, mucosal/gut-associated lymphoid tissue

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4
Q

Outline the functions of the immune system.

A
  • Searches out and destroys pathogens
  • Searches out and destroys cancerous self-cells
  • Clears debris from sites of inflammation
  • Promotes healing of wounds
    All of this while not harming normal self-cells.
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5
Q

What is immunodeficiency?

A

Defects or deficiencies in the immune system (congenital or acquired).

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6
Q

What is autoimmunity?

A

Abnormal activation of the immune system.
Immune response directed at self-antigens due to breakdown of normal regulatory mechanisms.
Caused by failure of central tolerance: failure of deletion of self reactive T-cells and B-cells.

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7
Q

What is an autoimmune disease?

A

Damage or disturbed physiological function due to autoimmunity.
Women are more commonly affected than males.

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8
Q

How are autoimmune disease classified?

A

Organ specific:
- Thyroid disorders e.g. Grave’s
- Tybe 1 diabetes
- Autoimmune haemolytic anaemia

Non-organ specific:
- Systemic lupus erythematosus
- Connective tissue diseases (e.g. rheumatoid)

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9
Q

What are the risk factors and triggers of autoimmune disease?

A

Genetics:
- Multigeneic
- Complement classical pathway deficiency

Environment:
- Hormones: oestrogen
- Infection
- Drugs e.g. penicillamine
- Others: stress, diet, UV

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10
Q

How are autoimmune diseases treated?

A
  • Endocrine: replace deficient hormone/remove oversecreting gland
  • Immunosuppression: steroids, cyclosporin, methotrexate, azathioprine
  • Newer treatments: monoclonal antibodies e.g. anti-B cell, anti-TNF-alpha
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11
Q

What autoimmune condition may present with diffuse parotid gland enlargement?

A

Sjogren’s syndrome

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12
Q

Describe the main features of Sjogren’s.

A
  • Autoimmune disorder affecting the exocrine glands (esp salivary and lacrimal glands)
  • Complaints of dry mouth and dry eyes
  • Affects females more than males (9:1)
  • Clinical diagnosis from history and signs
  • Schirmer’s test: tear production
  • Lab diagnosis: biopsy; positive ANA,
    anti-Ro and anti-La antibodies
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13
Q

What are the oral features of Sjogren’s, how can these be managed?

A

Zerostomia can lead to:
- Dental caries
- Gum and tongue atrophy
- Difficulty swallowing
- Associated with other autoimmune diseases (RA, SLE)

Management:
- Mouth washes and good dental care
- Salivary stimulants
- Dental check-ups
- Artificial tears

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14
Q

What are autoinflammatory disorders?

A

Lack of control of inflammation.
Not autoimmune, as there is not an immune response targeted at self antigens in autoinflammatory disorders.

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15
Q

Give an example of an autoinflammatory disorder.

A

Periodic fever with apthous stomatitis, pharyngitis and cervical adenitis (PFAPA).
Hereditary.

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16
Q

What cytokines do activated macrophages secrete?

A
  • IL-1
  • TNF-alpha
  • IL-6
  • IL-8
  • IL-12
17
Q

How might a dentist recognise an immunodeficiency?

A

Patients with peristsent infection e.g. oral candida

18
Q

How are immunodeficiencies classified?

A

Primary: genetic defect, can cause missing component, missing cell type, missing enzyme

Secondary: acquired, secondary to an underlying disease or drug induced.

19
Q

What are the possible signs of primary immunodeficiency in children?

A
  • 4 or more new ear infections within a year
  • 2 or more serious sinus infections within a year
  • 2 or more months on abx with little effect
  • 2 or more pneumonias within a year
  • Failure to gain weight or grow normally
  • Reccurent, deep skin or organ abscesses
  • Persistent thrush or fungal infection
  • Need for IV abx to clear infection
  • 2 or more deep seated infections including septicemia
  • Family history of PI
20
Q

What underlying disease or drugs can cause secondary immunodeficiencies?

A
  • Malignancy
  • Infection (e.g. HIV)
  • Malnutrition
  • Immunosuppressive drugs e.g. chemo, biologic drugs such as Rituximab, long term prednisolone
21
Q

Describe antibody deficiencies.

A
  • Can be hereditary, acquired, iatrogenic, idiopathic
  • Recurrent sinus/respiratory infections
  • Diagnosis: family history, Ig levels measures, functional test respinses to vaccination
  • Management: prophylactic abx, replace immunoglobulin, promptly treat infections
22
Q

How do antibody deficiencies affect dental treatmemt?

A
  • If patient is diagnosed, they’re likely to be established on immunoglobulin replacement therapy
  • Other than usual high standards of hygiene no further special measures may be necessary
  • Low threshold for treating (suspected) infection
  • If in doubt, discuss case in advance with immunologist looking after the patient
23
Q

Describe neutrophil deficiencies.

A
  • Reduced numbers either due to decreased production (e.g. cytotoxic drugs, leukaemia) or increased destruction (e.g. hypersplenism)
  • Causes impaired intracellular killing and impaired leukocyte adhesion
24
Q

Describe T cell deficiencies.

A
  • T-cell deficiency is often very severe
  • SCID: severe combined immunodeficiency
  • Presents early (weeks/months after birth)
  • Chronic diarrhoea and failure to thrive are common
  • Lymphopenia
  • Bone marrow transplant is usually the only possible treatment
25
Q

Describe complement deficiencies.

A
  • C3 deficiency = recurrent bacterial infections
  • Terminal pathway deficiencies = recurrent Neisserial infections (meningitis)
26
Q

What is hereditary angiodema?

A
  • Autosomal dominant condition
  • Mutation in SERPIGN1 gene
  • Uncontrolled classical pathway complement activation, deficiency of C1 esterase inhibitor
  • Oedema of skin and mucous membranes
  • Dental procedures are potential triggers of angiodema attacks
  • NOT an allergy
27
Q

How should hereditary angiodema be managed in dental practice?

A
  • Liaise with physicians
  • Cover procedure with an increase in medications (e.g. tranexamic acid) and/or with C1 inhibitor concentrate
  • Emergency: protect airway and give C1 inhibitor
28
Q

Describe HIV and AIDS.

A
  • HIV: retrovirus, single stranded RNA
  • Main target cells are CD4+ T helper cells and macrophages
    Stages of disease:
  • Infection and seroconversion
  • Asymptomatic phase
  • Symptomatic phase (generalised lymphadenopathy)
  • AIDS
29
Q

What are the possible dental complications of HIV and AIDS?

A
  • Oral candidiasis
  • Oral hairy leukoplakia: triggered by EBV
  • Kaposi’s sarcoma: virally driven cancer, associated with HSV-8
  • Aphthous ulceration
  • NUG
30
Q

How are pts with HIV and AIDS managed?

A
  • Antiretroviral therapy
  • Monitor CD4 T cell count and viral load
31
Q

What is infective endocarditis?

A

Inflammation of the endocardium, particularly affecting the heart valves, caused mainly by bacteria but occasionally by other infectious
agents.
Life threatening disease with significant mortality (approx. 20%) and morbidity.

32
Q

What are the important causative organisms in IE?

A
  • Streptococci
  • Staphylococcus aureus
  • Enterococci
33
Q

What are the signs and symptoms of IE?

A
  • Fever
  • Murmur
  • Roth spot (eyes)
  • Janeway lesions (palms of hands and feet)
  • Splinter haemorrhages (nails)
  • Anaemia
  • Osler nodes (hands)
  • Emboli
34
Q

What medication do hereditary angiodema patients require prior to dental treatment?

A

Prophylactic C1-esterase inhibitor

35
Q

What medication do patients with antibody deficiencies require prior to treatment?

A
  • Preoperative prophylactic abx +/- immunoglobulin replacement according to lecture
  • No official guidelines

Human Diseases (47 decks)

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