acquired immunodeficiency

Question 1

etiology of acquire immunodeficiency

Answer 1

1. Disorder of biochemical homeostatic imbalances: diabetes, dialysis, uremia and cirrhosis
2. Protein loss (nephrotic, enteropathies, dialysis, dermatitis)
3. Trauma
4. Burn
5. Infection (parasites)
6. Stress and Pregnancy
7. Splenectomy/hyposplenism
8. Environmental exposures

Question 2

acquire immunodeficiency

Answer 2

not genetic acquisitions of immunodeficiencies

Question 3

diabetes

Answer 3

• loss of peripheral vasculature- can cause decreased neurological sensations and when lesions occur they do not heal
• candidiasis problematic
• decreased neutrophils - directly related to hyperglycemia

Question 4

two types of dialysis

Answer 4

1. hemodialysis- decrease T cells, neutrophils, and Ig (=protein loss), and dendritic function
2. Chronic Ambulatory Peritoneal Dialysis (CAPD)- peritoneal catheter

Question 5

cirrhosis

Answer 5

liver failure
increased risk of sepsis and peritonitis
- cause is higher endogenous glucocorticoids and low complement

Question 6

etiologies of protein loss

Answer 6

• nephrological (kidney and urine)
• enteropathies (GI/stool)
• dermatitis (skin)
• dialysis

Question 7

symptoms of protein loss

Answer 7

• decreased innate immune system
• decreased epithelium
• decreased Ig
• hypoglammaglobulinemia (decreased IgG and A and sometime M)

Question 8

nephrotic syndrome

Answer 8

• kidney disease with significant protein loss
• low Ig
• increased risk of infection by encapsulated bacteria

Question 9

treatment for nephrotic syndrome

Answer 9

immunosuppressive drugs that can lead to further immune disorders

Question 10

____ is problematic in patients requiring immunosuppressant drugs

Answer 10

varicella - chickenpox

Question 11

trauma

Answer 11

release of inflammatory cytokine

can impact the immune system depending on how long they are in the hospital secondary infections

Question 12

burn

Answer 12

• greater impact on the immune system compared to trauma because first line of defense (skin) is impacted
• loss of fluids and proteins

Question 13

two types of environmental exposures

Answer 13

1. Ionizing radiation

2. UV radiation

Question 14

ionizing radiation

Answer 14

• damages DNA –> decreased cell proliferation –> decreased immune system cells
• B cells are greatly affected and then T cells
  therefore it takes longer for B cells to get back to normal numbers
• primary antibody response is diminished

Question 15

UV radiation

Answer 15

• due to the sun

- destroys epithelium resident immune system cells

Question 16

splenectomy and hyposplenism etiologies

Answer 16

• congenital
• trauma
• atrophy/non-functional due to sickle cell anemia, IBS, graft versus host disease

Question 17

symptoms of splenectomy and hyposplenism

Answer 17

• increased risk of sepsis and encapsulated bacteria

- can be fatal

Question 18

treatments of splenectomy and hyposplenism

Answer 18

• vaccination before splenectomy

- prophylactic antibiotics

Question 19

two types fo normal life stages/events that can lead to acquired immunodeficiencies

Answer 19

1. stress

2. pregnancy

Question 20

stress

Answer 20

• diminished cellular immune functions in PSTD
• reduced natural killer cell activity and depressed lymphocyte mitogen response
• higher risk of RTI

Question 21

pregnancy

Answer 21

• decreased immune response- so does not attack baby

- incidence of infection is increased

Question 22

Infections that can lead to acquired immunodeficiencies

Answer 22

1. HIV
2. measles
3. herpesviruses
4. parasitic infections
5. bacterial infections

Question 23

measles

Answer 23

• T cell lymphopenia (decreased T cells)

- decreased antibodies

Question 24

herpesviruses

Answer 24

• transient depression of cell mediated immunity

- cytomeglovirus

Question 25

parasites

Answer 25

- protozoan - more pronounced immune suppression than any other microbe - malaria- decreased cell mediated immunity

Question 26

bacteria infections arenot as well known to cause secondary immune suppression but one exception is

Answer 26

superantigens (staph and trep)

Question 27

superantigens (staph and strep)

Answer 27

- lead to significant immune stimulation but T cells eventually decrease in number and activity - neutrophil function is decreased

Question 28

In disorders of protein loss such as nephrotic syndrome, the immune deficiency is due to: A. Loss or inactivation of B cells B. Loss of pro-inflammatory cytokines in urine C. Loss of immunoglobulin (IgG) in urine D. Enhanced cytotoxic T cell activity in the damaged kidney

Answer 28

C. Loss of immunoglobulin (IgG) in urine

Question 29

Acquired immune defect associated with measles virus infection: A. Is due to increased protein loss leading to low levels of IgG B. Is associated with direct infection of T cells by measles virus C. Is associated with higher rates of IgG production D. Results in superinfection with opportunistic pathogens such as Pneumocystis.

Answer 29

B. Is associated with direct infection of T cells by measles virus