Chapter 3 Flashcards
What is Acantholysis?
Dissolution of the intercellular bridges of the prickle cell layer of the epithelium.
What is Acquired Immune Response?
An immune response to a foreign substance based on the specific memory of a past exposure to that same foreign substance.
What is Active Immunity?
A type of immunity based on antibodies developed in response to an antigen, which includes both natural and acquired types.
What is Adjuvants?
The agents that can be added to a vaccine to modify the immune response.
What is Allergen?
An antigen that produces a hypersensitivity or allergic reaction.
What is Allergy?
Hypersensitivity acquired through exposure to a particular allergen that elicits an exaggerated reaction on reexposure to the same allergen.
What is Anaphylaxis?
A severe immediate type of hypersensitivity in which an exaggerated immunologic reaction occurs on reexposure to a foreign protein or other substance after sensitization, resulting in not only hives, itching, and swelling, but also vascular collapse and shock, as well as death.
What is Antibody?
A protein molecule or immunoglobulin that is secreted by plasma cells and reacts with a specific antigen; includes five classes: IgA, IgD, IgE, IgG, and IgM.
What is an Antibody Titer?
The level of antibody in the blood that can be measured by a diagnostic laboratory test.
What is an Antigen?
Any substance able to induce a specific immune response.
What is Attenuated?
The ability to reduce the virulence of a pathogenic microorganism but still keep it viable, as is done in the development of certain vaccines.
What is Autoantibody?
An antibody that reacts against a tissue constituent of one’s own body.
What is Autoimmune Disease?
An immunopathologic condition characterized by tissue trauma caused by an immune response against tissue constituents of one’s own body.
What is B-Cell Lymphocyte?
A type of lymphocyte that develops in lymphoid tissue. other than the thymus and that can later differentiate into a plasma cell that produces antibody, the main initiator of humoral immunity.
What is Cell-Mediated Immunity?
A type of immunity in which the major role is played by T-cell Lymphocytes.
What is Connective tissue diseases?
A category of autoimmune diseases with connective tissue as the primary target of the pathology.
What is Cytokines?
The proteins produced by various cell types for the purpose of intercellular communication or signaling; Immunologic cytokines are involved as biochemical mediators in the immune response.
What is Delayed hypersensitivity?
A type of hypersensitivity reaction that takes time to develop after T-cell lymphocytes are previously introduced to an antigen to either directly cause damage to the tissue cells or recruit other cells that cause damage.
What is Dendritic Cell?
A type of white blood cell that acts as an antigen-presenting cell in the skin and mucosa.
What is Dysgeusia?
An alteration in taste
What is Humoral Immunity?
A type of immunity in which both the B-cell Lymphocytes and the antibodies they produce as plasma cells play a predominant role.
What is Hypersensitivity?
An altered state of reactivity in which the body reacts to a foreign agent such as an allergen with an exaggerated immune response; includes the four types, types I through IV.
What is Hyposalivation?
Decreased salivary flow that may result in xerostomia(dry mouth).
What is Immune Complex?
The combination of an antibody and antigen, producing a complex that can initiate a hypersensitivity or allergic reaction.
What is Immunization?
An induction of active immunity, such as when the pathogenic microorganism used to induce active immunity is encountered after vaccination.
What is Immunodeficiency?
A type of immunopathologic condition that involves a compromised or entirely absent immune system involving its white blood cells and their products.
What is Immunoglobulins?
The proteins that, when secreted by plasma cells, serve as antibodies designed to respond to a specific antigen.
What is Immunomodulator?
A substance that alters the immune response by augmenting or reducing the ability of the immune system to produce antibodies or sensitized cells that recognize and react with the antigen that initiated their production.
What is Interferon?
A family of glycoproteins that have immunoregulatory, antineoplastic, and antiviral activity; it is one of the cytokines.
What is Langerhans cell?
A specialized dendritic cell found in the skin and mucosa that is involved in the immune response.
What is LE cell?
Mature neutrophil with a phagocytized spherical inclusion derived from another neutrophil; it is used as a marker of autoimmune disease.
What is Lymphocytes?
The white blood cells involved in the immune response that have three major subsets: the B-cell Lymphocyte, T-cell Lymphocyte, and natural killer cells.
What is Lymphoid Tissue?
Tissue composed of lymphocytes supported by a meshwork of connective tissue; includes tonsillar tissue, Lymph nodes, and Lymphatic Organs.
What is Lymphokines?
The subset of cytokines produced by B-cell or T-cell lymphocytes in contact with antigens that serve as biochemical mediators in an immune response.
What is Macrophage?
A large tissue-bound mononuclear phagocyte derived from derived from monocytes circulating on the blood, which can become mobile when stimulated by inflammation and interact with lymphocytes in an immune response as well as during inflammation.
What is Monokines?
The subset of cytokines primarily produced by monocytes or macrophages that serve as biochemical mediators in an immune response.
What is Mucositis?
The inflammation of a mucosal tissue due to a disease process.
What is a Natural Killer Cell?
Type of lymphocyte that is part of the initial innate immune response, which by unknown mechanisms is able to directly destroy cells recognized as foreign.
What is Nikolsky sign?
Diagnostic sign whereby the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure with the fingers or a tongue blade.
What is Passive Immunity?
Type on immunity that uses antibodies produced by another person to protect an individual against infectious disease, which includes both natural and acquired.
What is a Plasma Cell?
The cell derived from B-cell Lymphocytes that produces antibodies in response to the presence of antigen.
What is Pruritis?
The symptom of severe itching due to a disease process, possibly a hypersensitivity reaction or allergy.
What is a Rheumatoid factor?
Antibody that binds to certain antibodies found in the serum of patients with rheumatoid arthritis and connective tissue diseases such as Sjogren syndrome. Current assays test for IgM-class rheumatoid factor.
What is Schirmer Test?
A test that measures lacrimal gland flow by placing special filter paper strips inside the lower eyelid for 5 minutes.
What is Serum Sickness?
A classic example of type III hypersensitivity that involves a drug allergy to antitoxin serum from horses.
What is Syndrome?
A group of signs and symptoms that occur together.
What is Symblepharon?
Fibrous adhesion between the eyeball and conjunctiva.
What is a T-cell Lymphocyte?
A Lymphocyte that matures in the thymus and is mainly responsible for initiating cell-mediated immunity as well as modulating humoral immunity.
What is Thymus?
Organ consisting of lymphoid tissue located high in the chest, which is large in a infant and gradually shrinks in size in adulthood; site of T-cell lymphocyte maturation.
What is Xerostomia?
Dryness of the mucous membranes, including the oral cavity; usually caused by hyposalivation or decreased salivary flow.
An Acquired Immune Response has what?
Memory Capability
An acquired immune response defends the body against injury by what?
Recognizing substances called antigens.
What happens if an antigen is encountered more than once?
The Acquired Immune Response responds quicker than the inflammatory response.
An antigen typically includes?
a foreign substance such as protein, microorganisms or toxins.
What are the tissues/cells of our bodies that are considered foreign?
- Tumor Cells
- Cells infected with virus
- Organ transplant
- Tissue Graft
- Incompatible blood transfusion
- Cells of own body: Autoimmune Diseases (example: Lupus)
Non0recognition or decreased recognition of antigens is seen in certain immunodeficiency disease such as?
HIV or Leukemia
What does the body experience in an Excessive Immune Response?
Hypersensitivity to antigens
Ex. Autoimmune disease
What are the cellular involvements in the Immune Response?
- Lymphocytes
- B-Cell Lymphocytes
- T-Cell Lymphocytes
- Natural Killer (NK) Cells
- Macrophages
- Dendritic Cells
- Cytokines
What are the primary WBC involved in the immune response?
Lymphocytes
Which WBC constitutes 20-25% of the WBC population?
Lmyphocytes
What are the different types of Lymphocytes?
- B-Cell Lymphocytes
- T-Cell Lymphocytes
- Natural Killer Cell
What do B-cell Lymphocytes develop from?
Stem cells in bone marrow
Where do B-cell Lymphocytes Mature and reside?
Lymphoid Tissue
When B-cells are stimulated by antigens, what happens?
B-cells travel to the site of injury
What are the two types of B-cells?
Plasma Cells and B-memory cells
What do the Plasma Cells do?
Produce specific antibodies
What do B-memory cells do?
Retain the memory of previously encountered antigens and will clone itself in the presence of antigen.
What are the Plasma Cell Characteristics?
Round, Pinwheel shaped nucleus with visible cytoplasm.
What does the plasma cells produce and release in response to the presence of antigen?
Protein (antibody)
What are these proteins/Antibodies called?
Immunoglobulins
What are the five different types of Immunoglobulins?
- IgA
- IgD
- IgE
- IgG
- IgM
What do the T-Cell Lymphocytes develop from?
Bone Marrow Stem Cells
Where do the T-Cell Lymphocytes Travel to mature?
Thymus
What are the different types of T-Cell Lymphocytes?
- Memory Cells
- T-helper cells
- T-suppressor cells
- T-Cytotoxic cells
What do T-helper Cells do?
Increase functioning of B-cells
What do T-Suppressor cells do?
Turn off functioning of B-cells
What do Cytotoxic cells do?
Attack virally infected cells or tumor cells
What are the functions of the T-Cell Lymphocytes?
- Increase the functions of B-cells: Enhancing the antibody response.
- Carry the CD8 marker
- Active in surveillance against virally infected cells.
- Directly attacks virally infected and neoplastic cells.
- Start, regulate, and coordinates the overall immune response.
What do Natural Killer Cells do?
Destroy foreign cells soon after their appearance without first recognizing the specific antigen.
Where are Natural Killer Cells located?
within the microcirculation not outlying tissue.
Natural Killer Cells are Active against what?
Viruses and Cancer Cells
What disease compromises and evades the Natural Killer Cells?
HIV
What are Macrophages?
Accessory cells in immune response
Where are the macrophages located during inflammation?
The connective tissue
What are the functions of macrophages?
- Phagocytosis
- Assist B-cells and T-cells
- Messenger between Inflammatory and immune response.
- Activation factor: Produce and secrete Lysosomal enzymes
- Amplify the immune response but do not have memory of the encountered antigen.
Do Macrophages have memory?
NO
What are Dendritic Cells?
Types of WBC found on the skin, on Mucosa, and in blood.
What are Antigen Presenting cells (APCs) (dendritic cells)?
Process antigenic material and present it to other immune system cells. The messenger between innate immunity and acquired immunity.
What cell is considered as the Antigen Presenting Cells (APCs)?
The Dendritic cells
What are Langerhans cell?
Specialized dendritic cell
What are Immunomodulating agents do?
Alter the immune response.
What are the major divisions of the immune response?
Humoral Immunity and Cell-mediated Immunity
Which division of immunity is considered the Antibody-mediated immunity?
Humoral Immunity
Which division of immunity is considered as the cellular immunity?
Cell-Mediated Immunity
What does humoral immunity do?
- production of antibodies
- protection against bacteria and viruses
- B cells are the primary cells
What is the primary cells in Humoral Immunity?
B-cells
What does Cell-Mediated Immunity do?
regulates both major immune responses.
What is the primary cells in Cell-mediated Immunity?
T-cells
Does the Immune system have memory?
Yes
Does the Inflammatory system have Memory?
No
After an initial response to an antigen, some lymphocytes what?
Retain memory of the antigen which means the immune response will be faster and stronger the next time an antigen enters the body.
The retained memory is called what?
Immunity
What are the different types of immunity?
Passive and Active
What is an example of Natural Passive Immunity?
Mother to Fetus
What is an example of Acquired Passive Immunity?
Injection
What is an example of Natural Active Immunity?
Microorganisms causes the disease
What is an example if Acquired Active Immunity?
Immunization, vaccination, booster
What is Immunopathology?
The study of immune reactions involved in disease; the study of diseases caused by the malfunctioning of the immune system.
- Hypersensitvity
- Autoimmune diseases
- Immunodeficiency
What is Hypersensitivity Type I?
- Reaction happens within minutes of exposure to an antigen.
- Plasma cells produce IgE which causes mast cells to release histamine, causing increased dilation and permeability of blood vessels and constriction of smooth muscle in bronchioles of lungs.
- This reaction may range from hay fever to asthma and life-threatening anaphylaxis.
What is Hypersensitivity Type II?
Cytotoxic type: Antibodies combines with an antigen bound to the surface of tissue cells, usually a circulating RBC.
-Activated complement components and IgG and IgM antibodies in blood participate un this type of hypersensitivity reaction which destroys the tissue that has the antigens on the surface of its cells. (Rh compatibility)
What happen to the blood cells in Hypersensitivity Type II?
They are destroyed
What is Hypersensitivity Type III?
- Immune complexes are formed between microorganisms and antibody in circulating blood.
- These complexes leave the blood and are deposited in body tissues, where they cause an acute inflammatory response.
- Tissue destruction occurs after phagocytosis by neutrophils.
What is another name for Hypersensitivity Type III?
Serum Sickness
What is the most common Type of hypersensitivity?
Type III
What is Hypersensitivity Type IV?
- Cell-Mediated Type (delayed)
- T-Cells that previously were introduced to an antigen cause damage to tissue cells or recruit other cells.
- Responsible for the rejection of tissue grafts and transplanted organs.
What is Drug Hypersensitivity?
- Drugs can act as antigens.
- Topical administration may cause a greater number of reactions than oral or IV routes. However, the IV route may cause a more widespread and severe reaction.
Immunologic tolerance
The body learns to distinguish self from nonself
Autoimmune disorder
The recognition mechanism breaks down some body cells are not tolerated and are treated as foreign antigens
Immunodeficiency
- An immunopathologic condition
* May be congenital or acquired
A deficiency in number, function, or interrelationships of the involved WBCs and their products
Immunodeficiency
What are the oral immunologic lesions and diseases?
Aphthous ulcers Urticaria and angioedema Contact mucositis and contact dermatitis Fixed drug eruptions Erythema multiforme Lichen planus Reactive arthritis (Reiter syndrome) Langerhans cell disease
What is the most common oral lesions
Aphthous ulcers
Aphthous uclers
Painful oral ulcers with an unclear cause Occurs in three forms - Minor - Major - Herpetiform
Minor aphthous ulcers
- Occur on the movable mucosa
- Up to 1cm in diameter
- Erythematous halo surrounding a yellowish-white fibrin surface
- May have a prodrome of 1 to 2 days
Major aphthous ulcers
Larger then minor aphthous ulcers (>1cm)
May leave a scar
Herpetiform aphthous ulcers
Tiny (1 to 2 mm)
Resemble herpes simplex ulcers
Occur in groups
Aphthous ulcers treatment
- Topical corticosteroids
- Topical NSAIDs
- Lidocaine, benzocaine
- Nicotine replacement therapy
Urticaria (Hives)
- Appear as multiple areas of well-demarcated swelling of skin
- May include itching ( pruritus )
How are urticaria caused
By localized areas of vascular permeability in superficial connective tissue
Angioedema
Lesions caused by diffuse swelling as a result of increased permeability of deeper blood vessels
Does not itch
Causes of angioedema and uritcaria
- Idiopathic
- Infection
- Trauma
- Emotional stress
- systemic diseases
- ingested allergens
Treatment of angioedema and urticaria
Antihistamine drugs
Epinephrine
Allergic contact mucositis and dermatitis
Lesions result from contact of an allergen with skin or mucosa
Involves T-cells in a call-mediated immune response
Type IV hypersensitivity
Fixed drug eruptions
Lesions that appear in the same site each time a drug is introduced
A type of allergic reaction type III
Erythema multiforme
Acute, self-limited disease that affects skin and mucous membranes
Cause may be a hypersensitivity reaction
Target or bull-eye lesion
Stevens-Johnson syndrome
Classified as a variant of toxic epidermal necrolysis (TEN)
Extensive and painful oral lesions
Genital/eye mucosa may be involved`
Lichen planus
A benign, chronic disease affecting the skin and oral mucosa
Unknown cause
Wickham striae (lacelike)
Most common on buccal mucosa
Types of lichen planus
Reticular lichen Plans
Erosive and bellous lichen planus
Reticular lichen planus
Most common form
Erosive and bullous lichen planus
Epithelium separates from connective tissue
What can be associated with lichen plans?
Desquamative gingivitis
Skin lesions
Sjogren syndrome, systemic lupus erythematosus, pemphigus vulgaris, mucous membrane pemphigoid, bullous pemphigoid, and behcet syndrome
Autoimmune diseases with oral manifestations
Affects the salivary and lacrimal glands. Results in a decrease in saliva and tears, causing xerostomia and dry eyes (xerophthalmia), and keratoconjunctivitis sicca (damage to eyes)
Sjogren syndrome
May be associated with other autoimmune disorders and affects both major and minor salivary glands
Sjogren syndrome
When sjogren syndrome occurs alone
Primary
When sjogren syndrome occurs with other autoimmune disorders
Secondary
Parotid gland enlargement occurs in about 50% of patients
Sjogren syndrome
Oral discomfort caused by dry mouth, lips are cracked and dry, may see loss of filiform and fungiform on tongue, high risk for caries, perio disease, and oral candidiasis
Sjogren syndrome
20% of patients with sjogren syndrome have this disorder affecting the fingers and toes
Raynaud phenomenon
Initial pallor and subsequent cyanosis of skin caused by cold or stress, hyperemia when blood vessels are warmed, myalgia, arthralgia, and chronic fatigue
Sjogren syndrome and raynaud phenomenon
90% of these patients have a positive response to a rheumatoid factor, an antibod to igG present in serum
Sjogren syndrome
Diagnosis of sjogren syndrome is made when 2 of these 3 components are present
Xerostomia, keratoconjunctivitis (confirmed by eye exam), and rheumatoid arthritis
How is sjogren syndrome treated?
Treated symptomatically. Nonsteroidal anti inflammatory agents for arthritis, saliva substitutes, glasses and artificial tears to protect eyes, good oral hygiene, fluoride, and frequent dental appointments
An acute and chronic inflammatory autoimmune disease with no known cause. Affects women 8 times more frequently than men, predominantly during child bearing years. 3 times more frequent in black women than white women
Systemic lupus erythematosus
A syndrome with a wide range of disease activity. Usually chronic and progressive. Antibodies to DNA are present in serum and may have a genetic component
Systemic lupus erythematosus
Skin lesions occur in 85% or individuals. Butterfly rash on nose and cheeks.
Systemic lupus erythematosus
Erythematous plaques or erosions
May have white striae, resembles lichen planus but are less symmetric
Diagnosis of SLE
Based on multiorgan involvement and presence of antinuclear antibodies in serum
Treatment of SLE
Aspirin and anti inflammatory drugs. Hydroxychloroquine and corticosteroids along with immunosuppressive agents
A severe progressive autoimmune disease affecting the skin and mucous membranes
Pemphigus vulgaris
Characterized by intraepithelial blister formation resulting from acantholysis, a breakdown of cellular adhesion between epithelial cells
Pemphigus vulgaris
The first signs of disease occur in the oral cavity in more than 50% of cases. There may be shallow ulcers, to fragile vesicles, go bullae. Nikolsky sign
Pemphigus vulgaris
Microscopic appearance is pemphigus vulgaris
Acantholytic cells, loss of attachment, tzanck cells
Treatment of pemphigus vulgaris
High doses of corticosteroids. May include immunosuppressive drugs
A chronic autoimmune disease, affects oral mucosa, conjunctiva, genital mucosa, and skin. Nikolsky sign
Mucous membrane pemphigoid( benign mucous membrane pemphigoid, cicatricial pemphigoid
Gingival lesions have been called desquamative gingivitis but this type of gingivitis may be seen with lichen planus and pemphigus as well
Benign mucous membrane pemphigoid
Diagnosis of mucous membrane pemphigoid is made by
Biopsy and histologic examination. No degeneration in epithelium occurs and inflammatory infiltrate is found in connective tissue
Treatment of mucous membrane pemphigoid (a chronic disease with a benign course)
Topical corticosteroid for mild cases and systemic corticosteroid for severe cases. Eye lesions can lead to severe eye complications
Some people believe this and mucous membrane pemphigoid are variants of a single disease
Bullous pemphigoid
Bullous pemphigoid ages.. predisposition, treatment
Most pts older than 70
Oral lesions less comin than in cicatricial pemphigoid
Treated with systemic corticosteroids and NSAIDS
A chronic, recurrent autoimmune disease. Primarily oral ulcers, genital ulcers, ocular inflammation. No sex predilection. Oral ulcers are similar in appearance to aphthous ulcers
Behçet syndrome
Diagnosis of behçet syndrome requires 2 of these 3 types of lesions to be present
Oral genital ocular
What suggests behçet syndrome
A pustular lesion after needle puncture
Treatment of behçet syndrome
Systemic and topical corticosteroids
Can involve various components of the immune system. Divides into primary and secondary. Signs and symptoms depend on the degree of deficiency and type of immune response involved
Immunodeficiency
Primary immunodeficiencies
Severe combined immunodeficiency and leukocyte adhesion deficiency
Group of genetically inherited syndromes that have defects in both humoral and cell mediated immune responses
Severe combined immunodeficiency
Primary immunodeficiency characterized by defects n function on neutrophils
Leukocyte adhesion deficiency
Occurs as a result of an underlying disorder, more common than the other, may accompany malnutrition, renal diseases, and hiv infection
Secondary immunodeficiencies
