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Block 3 Found Sci > 2-Immunopathology > Flashcards

2-Immunopathology Flashcards

1
Q

types of grafts

A
  1. autograft- own tissues
  2. isograft- id twin, same genetic background
  3. allograft- same species, diff genetics
  4. xenograft- diff species
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2
Q

cellular mechanisms rejection

type IV hypersensitivity

A
  1. cell med cytotoxicity- host cytotoxic lymphs destroy graft parenchymal and endo cells by releasing perforins and granzymes = apop
  2. delayed type - helper lymphs > cytokines = recruit mononuc cells, inflamm mediators, tissue damage

inflamm meds = TNF, INF-gamma, IL-2

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3
Q

destruction pathways transplants

kidney

A
  1. direct = APC in graft from donor, leads to CD8 damaging tenal tubule epi cells, endothelitis, activated macros
  2. indirect = APC of recipient, leads to act macros, Ab’s injury endo cells of renal blood vessels
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4
Q

humoral mechanism

A

target graft vasculature
1. Ab binds HLA moles in graft endo to act complement = acute inflamm, vasculitis like type II hypersens
2. Ag-Ab complexes fix complement = necrotize, immune complex vasculitis

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5
Q

hyperacute rejection

A

-recipient sensitized from prior transplants, transfusions, pregnancies
-immediate/within minutes
-complement act, vasculitis with fibrinoid necrosis, thormbosis, ischemia

avoid by cross matching recip serum with donor lymphs to find cytotoxic Ab

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6
Q

acute rejection

A

days/months post transplant/withdrawal of immunosupp theapy
-progress rapidly
-cellular + humoral + combo mechanisms
-tubular damage and endothelitis from CD9, extensive interstitial inflamm from CD4 cytokines

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7
Q

acute humoral rejection

A

anti-graft Ab deposit in graft vasculature

patterns= necrotizing vasculitis + intimal thickening from fibros, foamy macros, myocytes

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8
Q

chronic rejection

A

months-years after transplant
-humoral injury = prolif vascular lesions
-cellular injury- cytokine induced prolif of vascular SM + collagen in ECM

vascular changes + intersititial fibrosis + tubular atrophy + chronic inflamm

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9
Q

heart transplantations

A

for advanced irreversible myocardial disease + intractable congestive heart failure
-get myocyte necrosis and coronary artery disease from intimal prolif
-also silent MI’s leading to heart failure or sudden death bc no nerve innervation of SA node

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10
Q

cyclosporine

A

blocks nuclear factor of activated T cells
-transcription factor for IL-2 stim of T cells

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11
Q

hematopoietic cell transplants

A

for treating hematologic disorders, non hematologic malignancies, immunodefs
-stem cells from donor marrow or peripheral blood + stim by hematopoietic growth factors

graft versus host disease, infection, immunodef complications

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12
Q

graft vs host disease

A

cell mediated rxn where donor T cells recog host HLA antigens as foreign = type IV rxn

targets epi of skin, GI tract, liver

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13
Q

actue GVHD

A

days-weeks post engraftment via donor cytotoxic T cells/cytokines destroy epi cells

rashes, exfoliation, ulcerative gastroenteritis, bile duct necrosis, profound immunosuppr

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14
Q

chronic GVHD

A

with or without acute GVHD
-from autoreactive T cells from donor stem not clonally deleted bc minimal immune fxn

mimics systemic sclerosis bc fibrosis of dermis/skin appendages, GI mucosa, bile ducts, lungs

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15
Q

self antigen intracellular molecules

A
  1. double stranded DNA = SLE
  2. histones = SLE
  3. topoisomerase I = diffuse scleroderma
  4. centromere proteins = limited scleroderma
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16
Q

criteria for dx autoimmune disease

A
  1. immunologic rxn to a self Ag or native tissue
  2. rxn primary to pathogenesis not secondary to tissue damage
  3. no other well defined cause/etiology
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17
Q

triggers of autoimmune disease

A
  1. genetics- certain MHC alleles on D locus, esp PTPN-22 gene for protein tyrosine phosphatase
  2. microbes - cross reactivity, tissue damage, inc APC co stim moles, non specific B and T stimulation
  3. gender- higher in females, hormones?
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18
Q

mechanisms of autoimm

A
  1. fail of tolerance/immune reg
  2. fail of T cell anergy
  3. fail of apop of self reactive cells
  4. fail/dysfxn of reg CD4 T cells
  5. molecular mimicry
  6. polyclonal lymphs activation
  7. emergence of sequestered Ag
  8. exposure of cryptic antigenic determinants
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19
Q

ANA testing

A

uses human tissue cell culture nuclei aka Hep 2 for specificity of nucleus componenets targeted by Ab
-either pos or neg
-titers
-fluorescent staining

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20
Q

peripheral staining

A

aka rim staining
-Ab to double strand DNA
-SLE active flares

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21
Q

homogenous/diffuse staining

A

Ab to chromatin, double strand DNA, histones
-anti histone specfic to drug induced LE

RA and SLE

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22
Q

speckled staining

A

Ab to ribonucleoproteins and DNA topoisomerase
-sjogrens syndrome
-if small nuclear RNP particles then SLE
-topo = systemic sclerosis diffuse

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23
Q

centromere staining

A

Ab to centromeres
-limited scleroderma, systemic sclerosis

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24
Q

nucleolar staining

A

Ab to nucleolar RNA
-SLE, systemic sclerosis, limited scleroderma

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25
Q

SLE diagnostic criteria

A
  1. malar rash/butterfly- flat or raised, fixed erythema
  2. discoid rash- raised patches with adherent keratotic scaling/follicular plugging, maybe atrophic scarrng
  3. photsensitivity
  4. oral ulcers- painless
  5. arthritis- nonerosive of 2+ joints with tender and swelling
  6. serositis- pleuritis or pericarditis
  7. renal disorder- proteinuria
  8. neurologic disoder- seizures or psychosis
  9. hematologic disorder- hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia
  10. immunologic disoder- anti DNA, anti Sm, anti phospholipid
  11. antinuclear Abs- abnormal titer
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26
Q

lupus ANAs

A
  1. to double stranded DNA- rim, active flare ups
  2. histones- homogenous, drug induced lupus
  3. ribonucleoproteins- speckled, anti-Smith, anti nucleolar
  4. blood cells
  5. phospholipid proteins- plasma proteins so prothrombin, protein C, protein S
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27
Q

SLE common presentations

A
  1. hematologic - 100% of pts
  2. arthritis, arthalgia, myalgia
  3. skin
  4. fatigue

and literally everything else rip

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28
Q

lupus effects

A

organs involved = skin, joints, kidney, serous membranes

type II hypersens vs blood cells so hematologic abnormal
type III hypersens in visceral lesions

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29
Q

SLE in joints

A

arthritis common in hands, knees, ankles
-immune complexes deposit in synovium = inflamm
-no deformities like RA

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30
Q

lupus vascular changes

A

circulating immune complexes deposit in vascular beds and act complement = acute damaging inflamm rxn type III
-ANA-nuclear proteins

if acute then vasculitis + fibrinoid necrosis of arteries
if chronic then layered fibrous thickening

onion skin appearance

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31
Q

SLE in kidneys

A

immune complex depo in glomeruli, basement mem, large blood vessels
-lupus nephritis: protoype of immune complex glomerulonephritis

major cause of morbidity and mortality

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32
Q

lupus nephritis patterns

A
  1. membranous
  2. diffuse proliferative

both have prolif of endo, epi, mesangial cells

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33
Q

SLE in serosal membranes

A

serositis with effusions of pleura and pericardium

acute = exudation of fibrin
chronic = prolif of fibrous tissue so thickened membranes, adhesions

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34
Q

SLE in heart

A

frequent pericarditis, occasional myocarditis
-nonbacterial endocarditis affects both sides of valves anywhere but usually atrioventricular (Libman and Sacks)

accelerated coronary artery disease from steroid therapy or immune damage

35
Q

libman sacks endocarditis

A

small/medium sized vegetations on either or both sides of valve leaflets

36
Q

SLE-lungs

A

pleuritis with effusion

acute = pneumonitis + alveolar damage, edema, hemorrhage
chronic = interstitial and vascular fibrosis > pulmonary fibrosis and hypertension

37
Q

SLE- CNS

A

usually seizures or neuropsychiatric symptoms but mech is unclear

small vessel thickening by intimal prolif = ischemia, microinfarcts

38
Q

SLE- CNS

A

usually seizures or neuropsychiatric symptoms but mech is unclear

small vessel thickening by intimal prolif = ischemia, microinfarcts

39
Q

SLE cause of deaths

A
  1. renal failure
  2. infection
  3. CAD (coronary artery disease?)
40
Q

cutaneous forms of lupus

A
  1. chronic discoid- variety of skin lesions without systemic features
    - plaques, erythema, scaling, atrophy
  2. subacute cutaneous- diffuse, superficial, nonscarring, photosensitive lesions, mild systemic disease
41
Q

drug induced lupus

A

lupus like syndrome with multi organ involvement
-antihistone ANAs
-rash, fever, arthralgias, serositis, but no renal or CNS pathology
-if stop drug then stop symptoms

D-penicillamine, procainamide, hydralazine, isoniazid

42
Q

sjogrens syndrome

A

autoimm destruction of exocrine glands + primarily lacrimal + salivary glands

usually female middle aged

primary form is sicca syndrome with dec in tears and saliva

43
Q

sjogrens syndrome mechanism

A
  1. CD4 T cell vs glandular epi self Ag, maybe induced by viral infection like EBV or Hep C
  2. systemic B cell hyperactivity > ANAs, rheumatoid factor positive usually too
  3. specific ANA to ribonucleoproteins like SS-A Ro and SS-B La
44
Q

sjogrens morphology

A

CD4, B cells, plasma cells, infiltrate ducts and vessels in glands
-follicle formation with germinal centers
-ductal epi hyperplasia = obstruction
-acinar atrophy + fibrosis + fat replacement of parenchyma

45
Q

clinical course of SS

A

-dry mucous mems > xerostomia, keratoconjunctivitis sicca, nasal septal erosion, perforation, dysphagia, dyspareunia
-lymph nodes massively hyperplastic
-inc risk B cell lymphoma
-systemic vasculitis with extraglandular kidneys, lungs, skin, CNS, muscle
-interstitial nephritis
-pulmonary fibrosis
-peripheral neuropathy
-synovitis

SS-A Ab

46
Q

Systemic Sclerosis

A

autoimm with chronic inflamm + destruction small vessels and progressive tissue fibrosis

-skin and CT = rigid, loss of function
-GI, kidneys, heart, lungs, musculo = morbidity/mortality

47
Q

CREST syndrome

A

limited variant of systemic sclerosis
-face, forearms, fingers, later visceral
-anti centromere Ab

48
Q

CREST symptoms

A
  1. calcinosis- dystrophic in tissue
  2. raynauds phenomenon- vasospasm > intermitt digital ischemia
  3. esophageal dysmotility >acid reflux
  4. sclerodactyly- tighten skin hands
  5. telangiectasia- purple lesions skin + mucous
49
Q

diffuse variant systemic sclerosis

A

-widespread skin involve at onset
-early visceral involve instead of later like limit
-rapid progression
-anti DNA topoisomerase Ab

50
Q

diffuse variant symptoms

A
  1. early - edema, lymphocyte CD4 infiltrates
  2. late- epi thinning, dermal/appendage fibrosis, subq calcification, ultimate contractures (claw fingers)
  3. autoamputation of digits from ischemia
51
Q

GI changes in systemic sclerosis

A

90% of cases
-esophagus collagenize and fibrosis of muscularis > dysmotility, LES dysfunction so reflux
-small bowel mucosal thinning, lose villi/microvilli, submucosal fibrosis so malabsorption

52
Q

musculoskeletal changes systemic sclerosis

A
  1. early stage- nondestructive hyperpasia, inflamm of synovium
  2. late- fibrosis of synovial and periarticular CT
    3.
53
Q

renal changes systemic sclerosis

A

thick interlobular arteries by concentric prolif of intimal cells
-depo of collagen or mucinous material and hyaline cart
-maybe hypertension

54
Q

pulmonary changes systemic sclerosis

A

mild interstitial pneumonitis
-alveolar fibrosis = resp insufficiency
-pulmonary hypertension from endo dysfxn = cor pulmonale/ R heart failure

55
Q

cardiac changes systemic sclerosis

A

pericarditis + effusion
-perivascular lymphoid infiltrated
-arteriolar thickening
-interstitial fibrosis = restrictive cardiomyopathy

56
Q

systemic sclerosis causes of death

A

renal, cardiac, pulmonary, GI

57
Q

SAD clinical features

A
  1. asymptomatic OR recurrent GI/resp/GU infections
  2. weakened mucosal defenses
  3. anaphylactic rxn if transfused blood with IgA or given immunoglob therapy
  4. inc risk dev AI disorders
58
Q

DiGeorge Syndrome

A

aplasia/hypoplasia of thymus and parathyroiid
-abnormalities of face and aortic arch bc interruption of 3rd and 4th pharyngeal pouch

T cell defect + hypocalcemia + cardiac abnorm + cleft palate
-normal immunoglob levels still

59
Q

digeorges clinical features

A
  1. viral and fungal infections
  2. facial- low set ears, midline clefs, small mandible
  3. cardiac- VSD, R subclavian A from pulmonary
  4. hypoplasia
  5. aplasia- need transplant of fetal thymus
60
Q

severe combined immunodeficiency

SCID

A

deficient cellular and humoral immune resp
-more common to have severe T cell defect than have both def in B and T
- X linked pattern bc mut of common y chain of cytokine receptor so ILs affected = impair lymph dev
- auto recessive pattern from adenosine deaminase def = lymphtoxic metabolites + fail class II MHC expression

61
Q

SCID clinical features

A
  1. early onset- thrush, diaper rash, fail to thrive
  2. recurrent infections from all microbes

treat with marrow trans, gene therapy for ADA or y-chain mutations

62
Q

wiskott aldrich syndrome

A

defect in protein gene for cytoskeletal maintenance and link membrane receptors
= progrssive depletion of T and B

x linked for males

63
Q

Wiskott aldrich syndrome features

A
  1. immunodef
  2. thrombocytopenia
  3. eczema
  4. normal or elevated Ab except IgM low
  5. poor Ab resp to protein Ag
  6. T cell deficit, peripheral depletion in blood and nodal tissue
64
Q

WAS symptoms

A
  1. hemorrhagic diathesis
  2. recurrent resp infections
  3. pyogenic bact/virus/fungi
  4. early death
  5. inc lymph alignancies in survivors
65
Q

secondary immunodef

general

A

-more common than primary
-potentially reverse if underlying condition correct
-extremely young or old are targeted
-inc risk alcoholism or other metabolic states
-drug induced
-burns, traumas, chronic infections like EBV
-hematologic disorders

66
Q

AIDS

A

-HIV 1 retroviral infection that targets immune sys and CNS
-immunosuppression > opportunistic infection, and neurologic abnormal

67
Q

AIDS transmission

A
  1. sexual contact/mucosal
  2. parenteral inoculation/blood
  3. vertical- transplacental, intrapartum, perinatal
68
Q

AIDS high risk groups

A
  1. homosex/bisex males
  2. intravenous/subq drug users
  3. recipients of transfused blood or blood products
  4. heterosexual contacts
69
Q

AIDS effects

A
  1. selective lymphopenia of CD4 T with dec fxn
  2. polyclonal B cell act + hypergammaglob but impaired specific B cell resp to new Ag
  3. alter macro fxn with dec MHC II expr so dec Ag present
70
Q

AIDS phases

A
  1. early/acute - viral rep, viremia, viral seeding of lymph tissue, fever, sore throat,
  2. middle chronic- repl in lymph tissue cont, weight loss, severe night sweats, fatigue, fever
  3. final/crisis- deplete T cells, fever, fatigue, weight loss, neoplasms
71
Q

AIDS neoplasms

A
  1. kaposi sarcoma
  2. B celll lymphomas- bc hyperplasia, burketts, EBV > large cell and hodgkins, KSHV > primary effusion lymphoma
  3. primary lympoma brain
  4. invasive carcinomas of cervix and anus
72
Q

pneumocystis pneumonia

A

alveoli fill with foamy exudate + interstitium thickened
-show cluster of fungi

symptom of AIDS

73
Q

luxol fast blue stain

A

for leukoencephalopathy
@brain with HIV

74
Q

kaposi sarcoma

A

purple dark lesions filled with blood anywhere in body usually hands or feet

kaposi sarcoma associated herpes virus from herpes type 8

75
Q

amyloid characteristics

A

starch like fibrils form beta sheet + glyoprotein
congo red, green in fluroescent

76
Q

amyloid pathogenesis

A

conversion of soluble circulating protein precursors into insoluble fibrillar form
-accum and deposit in organs

77
Q

amyloid classification

A
78
Q

amyloid light chain type

A

Ig light chains from abnormal clones from Ig plasma cells

@heart, GI, peripheral nerves, skin, tongue

79
Q

amyloid associated

A

with inflamm or infectious
-fibrils non immuno AA protein and precursor SAA

80
Q

ATTR

A
81
Q

AB-2

A

@joints, tendons

82
Q

A-beta

A

@cerebral blood vessels
alzheimers

83
Q

Rheumatoid arthritis

A

systemic autoimm inflamm disorder @ joints, skin, vessels, heart, lungs, soft tissue
-unknown antigenic triggers
-mediated by CD4 T cells and connected to citrullinated peptides in chronic
-TH17, TH1, B cells/Ab

rheumatoid factor = IgM auto-Ab to Pc portion of IgG

84
Q

RA morphology

A

prolif, destructive syn

Block 3 Found Sci (60 decks)

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