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16 Immuno > Acquired Immunodeficiency > Flashcards

Acquired Immunodeficiency Flashcards

1
Q

t/f secondary immunodeficiency is more common than primary

A

true

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2
Q

conditions associated with secondary immunodeficiency

A
  • immunosuppressive therapy
  • microbial infection
  • malignancy
  • disorders of biochemical homeostasis
  • autoimmune disease
  • trauma
  • environmental exposure
  • others
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3
Q

excess amounts of infectious agents / their toxins can cause ___

A

active immune system -> nonresponsive state

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4
Q

infection of the bone marrow by viral and bacterial organisms can lead to ___

A

neutropenia or pancytopenia

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5
Q

immunopathogenesis of hiv

A
  • begins with binding of hiv gp120 to cd4 and ccr5 of target cells
  • infected cells migrate to lymph nodes
  • initial replication and infection of nearby cd4 t cells in lymph nodes
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6
Q

acute phase of hiv

A
  • galt is depleted
  • loss of cd4 t cells
  • high viremia and immune activation
  • 1-6 wks after infection
  • nonspecific symptoms
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7
Q

asymptomatic phase of hiv

A
  • clinical latency

- degree of control is determined by levels of cytokines and viral load

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8
Q

symptomatic phase of hiv

A
  • production of anti-hiv cd4 and cd8, and neutralizing anti-hiv antibodies
  • immune response evaded by virus
  • fever, weight loss, diarrhea, lymphadenopathy, infections
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9
Q

aids phase of hiv

A
  • peripheral cd4 t cell <200 cells/ml
  • infections that define aids
  • persistent viremia, progressive disease if not treated
  • death
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10
Q

hallmark of hiv

A

within 1st weeks of infection = massive loss of t cells in the galt and progressive loss of cd4 in peripheral blood

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11
Q

mechanisms of hiv to evade humoral immune system

A
  • neutralizing antibody response becomes ineffective once virus mutates
  • coats itself with sugars (glycan shield) to prevent antibody binding
  • point mutations, insertions, deletions
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12
Q

effect of inflammation on tregs

A
  • tregs: suppress virus-specific cell mediated immune responses
  • loss of th17 = loss of galt
  • loss of galt = translocation of microbial products into peripheral circulation

inflammation = expansion of tregs, less th17

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13
Q

stages of hiv infection

A
  • viral transmission
  • acute hiv infection
  • chronic hiv infection: asymptomatic, aids <200 cd4, advanced hiv <50 cd4
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14
Q

distinguishing features of hiv-2

A
  • same natural history as hiv-1
  • lower levels of plasma virus
  • slower declines in cd4
  • longer asymptomatic period
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15
Q

recommended laboratory hiv testing

A
  • sensitive elisa to detect hiv protein p24

- confirmatory: specific western blot or hiv dna pcr

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16
Q

only other viral agent implicated in significant global immunosuppression

A

measles

- leads to severe and sometimes fatal superinfection

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17
Q

important independent risk factor for severe measles or death from measles

A

malnutrition

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18
Q

most frequent infectious complications of measles

A
  • pneumonia
  • gastroenteritis
  • otitis media
  • gigivostomatitis
  • laryngotracheobronchitis
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19
Q

causes of immune alterations in measles

A
  • direct infection of t cells

- infection of dendritic cells = impaired antigen presenting function and t cell activation

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20
Q

superantigens from bacterial infections bind to ___

A

mhc class II antigens and non-antigen binding region of tcrv = stimulate large numbers of t cells

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21
Q

how do bacterial infections cause secondary immunodeficiency

A
  • many stimulated t cells -> many inflammatory cytokines -> septic shock
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22
Q

effects of mycobacterial lipids

A
  • inhibit dendritic cell devt and production of cytokines
  • macrophages: inhibited tnf-a production
  • myeloid cells: produce cytokines
  • t cells: inhibited responses and secretion
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23
Q

effects of tb

A
  • cd4 lymphopenia
  • lowered cd4/cd8 ratio
  • b cell lymphocytosis
  • cd8 lymphocytosis
  • clinical and radiographic features of more advanced diseases
24
Q

effects of parasite infestation

A
  • diminished vaccine responsiveness
  • susceptibility to infection by other microbes
  • delayed graft rejection
  • higher rate of various malignancies
  • less prone to develop allergy or autoimmune disease
25
Q

possible mechanisms for causing immune dysfunction (parasites)

A

read!!

26
Q

effects of ebv and cmv

A
  • lower cd4, higher cd8 (inverted cd4/cd8 ratio)
  • t cells respond poorly to antigens + depressed function
  • affects b and t cells = broad based transient immune deficiency
  • cd4/cd8 ratios return to normal in 4-6 wks
27
Q

____ underlies much of predisposition to bacterial and fungal infections in patients with diabetes

A

neutrophil dysfunction

28
Q

characteristic infections in dm

A
  • disseminated candidiasis
  • mucormycosis
  • malignant otitis due to pseudomonas
  • burkholderia pseudomallei
29
Q

host specific factors that predispose diabetics to infection

A
  • hyperglycemia-related impairment of immune response
  • vascular insufficiency
  • sensory peripheral neuropathy
  • autonomic neuropathy
  • increased skin and mucosal colonization
30
Q

impaired immune functions in diabetics due to hyperglycemia

A
  • neutrophil chemotaxis and adherence to vascular endothelium
  • phagocytosis
  • intracellular bactericidal activity
  • opsonization
  • cell mediated immunity
31
Q

major pathway for glycemic damage in diabetics

A

methylglyoxal glycation

32
Q

effects of vascular insufficiency in diabetics

A
  • local tissue ischemia
  • impaired local inflammatory response
  • impaired absorption of antibiotics
33
Q

effect of autonomic neuropathy in diabetics

A

urinary retention and stasis = uti

34
Q

organism-specific factors that predispose diabetics to infection

A
  • glucose inducible proteins promote adhesion of candida

- ketone reductases let rhizopus thrive (mucormycosis)

35
Q

effects of hemodialysis

A
  • reduced t cell function
  • diminished antibody production
  • compromised neutrophil and dendritic function
  • low expression and/or function of igg fc receptors
36
Q

examples of immune hyporesponsiveness

A
  • esrd = high levels of il2 receptor = diminished response to il2
  • uremic pts = suppress mitogenic response of t cells
  • chronic peritoneal dialysis = bacterial peritonitis*
37
Q

possible mechanisms of immunodeficiency in malnutrition

A
  • low adipocytes = low leptin
  • low leptin = reduced t cell response
  • weakened barrier mucosa, intestinal malabsorption
  • micronutrient deficiencies
38
Q

effects of malnutrition on immune function

A
  • decreased lymphocyte numbers
  • absent dth
  • decreased phagocytic activity
  • low serum antibody levels
  • increased infections
39
Q

dramatic feature of protein-energy malnutrition

A

lymphoid atrophy

40
Q

immune defects in protein-energy malnutrition

A

read

41
Q

t/f antibodies in malnutrition are elevated, but they have impaired quality and affinity

A

true

42
Q

hematopoietic tumors

A

read

43
Q

examples of bacteria that asplenic patients can get

A

encapsulated bacteria

  • s penumoniae
  • n meningitidis
  • h influenzae
44
Q

immunizations for patients on elective splenectomy

A

anti-pneumococcal, anti-hemophilus influenzae, anti-meningococcal at least 2 wks before surgery

45
Q

defects i the complement system in sle

A

read

46
Q

most common quantitative disorder in sle

A

t cell lymphopenia

47
Q

disorders of protein loss

A

read

48
Q

inflammatory response in trauma

A
  • loss of epithelial barriers
  • vasodilation and increased vascular permeability
  • cellular activation and increased adhesion toe dnothelia
  • neuroendocrine stress response
49
Q

mechanism of inflammatory response in trauma

A

systemic inflammatory response syndrome

- activation of monocytes and macrophages (il1, tnf)

50
Q

effects of burns

A
  • depressed cd4 %
  • reduced t cell helper activity (reduced il2)
  • depressed neutrophil function
51
Q

causes of immunodeficiency in newborns

A
  • secondary lymph organs not mature
  • no memory cells
  • innate immunity*
52
Q

causes of immunodeficiency in aging

A
  • decreased ability to clear infections
  • decline in hematopoietic tissue in marrow
  • defects in dna
53
Q

t/f depressed cellular immunity during pregnancy is assumed to have a survival benefit

A

true

54
Q

effects of stress

A
  • increased rates of rti
  • reactivation of herpes virus
  • increased cancer
  • reduced nk cell activity
  • depressed lymphocyte mitogen responses
55
Q

other environmental conditions that can cause immunosuppression

A
  • confinement, isolation, sleep-cycle alterations
  • acute sleep deprivation
  • prolonged bedrest
  • chronic hypoxia
56
Q

adverse consequence of medical intervention

A

read

16 Immuno (8 decks)

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