Ch 3 Immunity Flashcards
Immune Response
Defends the body against _____
Especially from _____
Injury. Especially from microorganism
Immune Response
Differs from ______ response
How? 2 main things
This response involves _____
Primarily the _____ (25% of WBC)
They recognize an antigen and respond to it
Inflammatory
It’s specific (1) and has memory (2) so it responds more quickly to forgein substance 2nd time it enters body
White Blood Cells
Lymphocytes
Immune Response
May result in an increased level of ______ and ______
To the host due to byproducts from inflammatory and immune response
Injury and damage
Antigens
Foreign substances against which the _____ _____ _____ ___ ____
Immune system defends the body
Antigens can be ______ ____, human cells infected by _______
Examples?
Tumor cells
Viruses
Organ transplant
Tissue graft
Blood transfusion
Antigens are substances mainly ______________ and their ______
Type of protein, large molecules
Microorganisms
Toxins
Autoimmune Disease
part of an individuals ___ ____ _______ _______
Own body become antigens
Helper T cells
1st responders
Once all stimulated memory cells differentiate and defend
CD4
Cytotoxic
Kill infected cells
CD8
Type of WBC
Ingests foreign substances
Contain lysosomal enzymes that digest antigens
Serve as link bw inflammatory and immune response
Unlike lymphocytes, have no memory
Macrophages
Process of ingestion
Phagocytosis
Lysosomal enzymes released into tissue as macrophages digest antigens AND healthy structures.
Get destroyed along with infectious substances
During immune response there is collateral damage
Can occur naturally or can be inquired
Occurs naturally when disease is caused by microorganism
(Work for $)
Active immunity
Example of active immunity
If you get it once your body will make antibodies for it.
Protected against further attacks
Immune response has memory, inflammatory response does not
Measles
Can be acquired by artificial means
Entails getting injected with altered pathogenic microorganisms or their products
Vaccination. Body worked for it either way
Active immunity
Using antibodies produced by another person
Can occur naturally or can be acquired
(Parents give $)
Passive immunity
Natural passive example
Until own immune system starts working
-Through placenta
-Breast feeding
Acquired passive example
Ex: I have Hep B vaccine or have and disease itself and produced antibodies. You get a needle stick. Dr takes my antibodies and injects you. you get sick and develop antibodies. Short lived but protected right away,
-Short loved but immediate immunity
-Antibodies given from individuals who has had a disease-naturally produced by their own antibodies
Interval bw start of an infection and appearance of symptoms
The pt is infected but does not know it yet
Period of incubation
The beginning of appearance of symptoms
Pt starting to get sick
Progress may end here in the case of ______ _____ against a pathogen
-rapid immune response to infection
Prodromal period
Acquired immunity
Peak of illness intensity
Acme
Periods of disease (6)
Incubation
Prodromal
Illness
Acme (peak)
Decline
Convalescence
Also called canker sores or ______ stomatitis
Painful, recur in episodes, very common (occurs in 20% of population)
Etiology is unclear, but trauma (also dental), stress, and eating certain foods (citrus fruits) are often reported as factors
Aphthous ulcers
Evidence suggests that they have an immunological basis (accumulation of lymphocytes is present in the lesion)
Occur with some systemic diseases: Chron’s, Colitis, Behcet syndrome
There are 3 types, classified on the basis of their size and duration: minor, major and herpetiform
All three forms of occur on UNATTACHED MUCOSA . That differentiates them from herpes simplex which appears on mucosa fixed to the bone (hard palate, gingiva)
Aphthous Ulcers
T cell lymphocytes surround ulcer
Aphthous ulcers
Most common type of ulcer
round to oval ulcers up to 1 cm in diameter (usually 3-5 mm)
shallow
Clinical appearance: have a yellowish white fibrin surface surrounded by halo of erythema
occur on movable mucosa (not covering bone), may extend onto gingiva
more common in anterior part of mouth
Minor Aphthous Ulcer
During the prodromal period of 1 - 2 days symptoms of paresthesia and hyperesthesia in the area are often reported. Paresthesia is a sensation of tingling, pricking (pins and needles). Hyperesthesia an increased sensation to painful stimuli.
painful, heal in 7 - 10 days
No scarring
Minor aphthous ulcers
Larger than 1 cm in diameter (5-10 mm)
Crater-like ulcers
Deeper than minor aphtae
Last longer than minor aphtae; can take several weeks to heal and may result in scarring
also painful
may require biopsy to rule out other causes of ulceration such as squamous cell carcinoma, deep fungal infections
Most commonly seen in posterior regions of the mouth, but– they can occur anywhere
seen in individuals that are HIV+, but not also in otherwise health people
Major aphthous ulcers
Fibron surrounded by red halo
Major aphthous ulcers
on ATTACHED GINGIVA
ill (fever, headache)
Contagious
*Systemic manipulation
Do not place steroids
Real Herpetic infection
very tiny (1-2 mm)
resemble ulcers caused by herpes simplex virus
painful
develop on unattached mucosa anywhere in the mouth
generally occur in groups
they leave no scars
ulcers coalesce (to grow together)
Herpetiform aphthous ulcers
Is the term herpetiform real herpes or meaning it just resemble herpes?
No just resembles herpes
Diagnosis of Aphthous Ulcers:
Appearance, do not have what?
Location which mucosa?
Complete pt history they will have …
Do systemic signs or symptoms exist in herpetiform?
Distinctive clinical appearance, do NOT from vesicles
On mucosa (movable) not fixed to bone. Non keratinized. Location differentiates them from herpes simplex- on mucosa on bone (palate, gingiva)
Pt states having reoccurring history of lesions (possible stress)
No just in primary herpes simplex infection
**occur on non-keratinized mucosa, most often the labial and buccal mucosa, lateral tongue and floor of the mouth
Red halo, shallow, painful
Minor aphthae
**are common on the lips, soft palate and oral pharynx
Bigger, deeper, scar when healed
Major aphthae
**are small, clustered lesions, which may occur on KERATINIZED MUCOSA and resemble herpes simplex or other viral lesions.
Herpetiform aphthae
Aphthous ulcers do not occur on hard palate and attached gingiva
True or false
True
Distinguishes it from herpes simplex lesion on basis of location
Herpetiform aphthous are treated with liquid tetracycline
Does herpes simplex virus respond?
No they need to be treated by antiviral agents
What is primary therapeutic agent to treat aphthous ulcers?
Topical corticosteroids
What is often needed for major and herpetiform aphtae?
Systemic corticosteroids
Also called hives
Appears as multiple areas of WELL DEMARCATED SWELLING of skin
Accompanied by itching
Urticaria
(Urt was not hiding his feelings for caria) on the surface he wanted a connection
Caused by localized areas of vascular permeability in superficial connective tissue beneath the SURFACE epithelium (skin)
Urticaria
(Urt was not good at hiding his emotions from caria) all on surface, he wanted a connection
Occurs in acute, self-limiting episodes
Etiology: Ingested allergens can cause (you eat something and it gives you rash). We really do not know what causes it.
Treatment: antihistamines
Urticaria
Similar to urticaria
DIFFUSE swelling of tissue caused by permeability of DEEPER blood vessels
Skin overlying swelling appears normal
Not accompanied by itching
Angioedema
(Angie and her cat Ed had DEEP, NOT well defined issues but appeared normal)
Increase permeability of blood vessels, plasma leaks out
DEEP structures have swelling
Much more dangerous than urticaria
Angioedema
(Angie and her cat edema had deep issues)
mucosa becomes erythematous and edematous
the area burns and itches where allergen contacted mucosa, and gets a smooth, shiny appearance
may get small vesicles, ulcers in area
Contact mucositis
Initially the area may be erythematous with swelling and vesicles
Eventually the area becomes encrusted with a scaly, white epidermis
can be caused by wearing gloves in dentistry, glove powder
Contact dermatitis
Tx for both contact mucositis and contact dermatitis
Topical and systemic corticosteroids
It is an acute, self-limiting disease affecting skin and mucous membranes
The cause is not clear – may be it is a hypersensitivity reaction
Skin lesions are called target, iris, or bull’s eye lesions; they are concentric rings of erythema alternating with normal skin color; the color is darkest at the center of the lesion
refers to the variety of skin lesions: macules, papules, bullae
Oral lesions are: ulcers present on the lateral borders of tongue, crusted and bleeding lips
Erythema multiforme
(Self limiting for me to go to target)
It affects skin and oral mucosa, may affect both at same time; some patients only get either oral mucosa or skin lesion alone
Skin lesions cause pruritus
Wickham’s striae - the interconnecting white lines and circles – are a characteristic of
will find small papules in the lesion
most common location is buccal mucosa, but can occur anywhere – usually symmetrical
more common in middle aged people, slight female predominance
Lichen planus - wickhams striae
(Looks like the “plains” interconnecting lines)
Types of lichen planus (4)
Reticular lichen planus
-wickhams striae present
-most common
Erosive lichen planus
-epithelium secrets from CT
-ulcerated
Desquamative gingivitis
-can be caused by LP
-attached gingiva
Skin lesions
Lichen planus on gingiva
Desquamative gingivitis
Mixture of red and white areas
Sore mouth, sensitive to cold and hot, spicy
Areas painful and bleed easy
May need biopsy
Erosive lichen planus
44% of pts who have an oral manifestation will present with _____ _____
Skin lesions
white, raised areas on oral mucosa
looks like leukoplakia,
typically affects tongue
Plaque form of lichen planus
Tx of lichen planus is indicated only when lesions are
_________
________ ______ used for tx
These pts are at increased risk for ______ _____ ______
Therefore they need
_____ _____ _____ ____
And biopsy of suspicious lesions not consistent with appearance of lichen planus
Symptomatic
Topical corticosteroids(especially erosive)
Squamous cell carcinoma
Regular! Soft tissue exams
Sjogren’s with another autoimmune disease accompanying it
Secondary
Sjogren’s with just the lacrimal and salivary gland involvement
Primary
Can the tongue lose paipila with sojerns?
Yes
Becomes non glistening and pale
Pale, dry gingival mucosa with marginal inflammation
Sjögren’s syndrome
Dry eyes
Parotid enlargement (50% of pts)
What happens to the parotid gland?
Sjögren’s syndrome
Destroyed and replaced by CT
Bilateral enlargement of submandibular glands associated with
Sjögren’s
What should you treat Sjögren’s with first? Like arthritis?
Severe cases?
Other things useful like saliva substitutes, humidify, sugarless gum, artificial tears, pilocarpine, fluoride, etc
NSAIDS (non steroidal anti inflammatory drugs)
Corticosteroids
acute and chronic inflammatory autoimmune disease of unknown cause
It is a syndrome. There are many symptoms and signs, that range from skin lesions to a widespread, debilitating disease that involves multiple organ systems.
The most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems
The severity of the disease varies. The mildest form is called discoid LE
Affects women 8-1 (usually young, 3x more frequent in black women)
Systemic Lupus Erythematosus
Skin lesions
They are the most common sign – occur in 85% of individuals
Classic skin lesion: “butterfly” rash over the bridge of nose
Skin lesions worsen when exposed to sunlight
Skin lesion often heal with leaving scars
Discoid Lupus
blood spots on the skin
Purpura
Lesions may have white striae resembling lichen planus, but they are less symmetric
Radiate out instead of laced
Oral lesions associated with lupus
some patients need antibiotic prophylaxis for prevention of bacterial endocarditis
Diagnosis based on multiorgan involvement
Oral lesion lupus
It is a severe, progressive autoimmune disease
It affects skin and mucous membranes
ACANTHOLYSIS occurs: adhesions between epithelial cells breakdown and blisters form in these areas
Oral lesions – range from shallow ulcers to fragile vesicles to bullae that rupture
Pemphigus Vulgaris
(Vulgar, severe)
What is called when you gently press on the mucosa of a patient with Pemphigus Vulgaris?
adhesions between epithelial cells break down and form a bulla.
Positive Nikolskys Sign
Indicates healing with scars
Cicatrical
With cicatrical what does the epithelium do in regards to the underlying CT?
Breaks away
After pemphigus vulgaris the adhesions of the epithelium and CT were broken down
C. Pemphigoid
Mucous membrane pemphigoid
Benign mucous membrane pemphigoid
All entities of
Cicatrical (heals with scar)
Nikolsky sign can also be observed in this disease (bullae with thick wall)
Diagnosed by
Cicatrical pemphigoid
Biopsy and histologic exam
Painful ulcers, recurrent - chronic (antibodies to human mucosa)
Lesions range from few millimeters to several centimeters
Clinical diagnosis: 2 out of 3 signs must be present
*oral ulcers, genital ulcers, ocular inflammation
Looks similar to aphthous ulcers
Behcet Syndrome
