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Clinical Pathology > Core Immunology - Infections and Immunocompromised (15) > Flashcards

Core Immunology - Infections and Immunocompromised (15) Flashcards

1
Q

Immunocompromised

A

Disruption of specific defence of an organ/system (humoral/cellular)

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2
Q

Humoral immunity

A

Antibody led

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3
Q

Cellular immunity

A

T/B cells

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4
Q

Innate defences

A
  • Skin
  • Interferons, complement, lysozyme, acute phase proteins
  • Mucous membranes
  • Normal commensal flora in gut
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5
Q

How are mucous membranes an innate defence?

A

Tears, urine flow, phagocytes

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6
Q

Example in the lungs

A

Cystic fibrosis - goblet cells, much-ciliary escalator

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7
Q

Classification of immunodeficiencies

A
  • Congenital/Primary

- Acquired/Secondary

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8
Q

What is 2nd line of defence?

A

Neutrophil

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9
Q

What is a qualitative defect of neutrophils?

A

Lose ability to kill/chemotaxis

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10
Q

What is a quantitative defect of neutrophils?

A

Less present

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11
Q

Qualitative chemotaxis neutrophil defect

A

Rare, congenital, inadequate signalling/abnormality in receptors/NE movement

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12
Q

Qualitative killing power neutrophil defect

A

Inherited, NE fail to mount respiratory burst in phagocytosis, deficient in NADPH oxidase - H2O2 not formed, at risk of staph aureus (Chronic Granulomatous Disease)

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13
Q

Cause of quantitative defects (Neutropenic)

A

Cancer treatment, bone marrow malignancy, aplastic anaemia caused by drugs

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14
Q

Quantitative defect complications

A

Over half develop infection - highly lethal (50% pseudomonal infections will die in 24hrs if not treated)

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15
Q

Neutropenic bacterial infections

A

Gram neg bacilli (E.coli), Gram positive cocci (S.aureus), normal flora (coagulase neg staph)

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16
Q

Neutropenic fungal infections

A

Candida, Aspergillus

17
Q

Treatment of neutropenic infections

A

Gentamicin and antipseudomonal penicllin (cabanpenem then antifungals)

18
Q

GCSF

A

Granulocyte stimulating factors - gets immune system working again

19
Q

Congenital T cell deficiencies

A

Rare

20
Q

Acquired T cell deficiencies

A
  • Drugs (ciclosporin after transplantation/steroids)

- Viruses (HIV)

21
Q

T cell deficiency opportunistic pathogens - bacterial

A

Listeria monocytogenes (food),

Mycobacteria – MTB, MAI

22
Q

T cell deficiency opportunistic pathogens - viral

A

Leukaemia and transplant - HSV, CMV, VZV

23
Q

T cell deficiency opportunistic pathogens - fungal

A

Candida, cryptococcus

24
Q

T cell deficiency protozoan - Cryptosporidium parvum (sporozoa)

A

Occysts spread by cattle/humans, faecal-oral, recover after 3 weeks (T deficient longer)

25
Q

T cell deficiency protozoan - Toxoplasma gondii (sporozoa)

A

Cats/humans infected by contact with cat faeces/transplanted heart with bradyzoites present, lesion in brain/neurological signs (immunocompetent asymptomatic)

26
Q

T cell deficiency protozoan - Strongyloides sterocoralis (Nematode)

A

Larvae penetrate skin and migrate, normally asymptomatic/rash, immunocompromised huge invasion of tissues/gram -ve septicaemia as larvae move, suspect in tropical countries/old, picked up on feet - dormant

27
Q

Hypogammaglobulinaemia

A

Antibody problems, encapsulated bacteria (S.pneumoniae in resp tract/Giardia lambila/cryptosproidium in GIT)

28
Q

Congenital Hypogammaglobulinaemia

A

Rare

29
Q

Acquired Hypogammaglobulinaemia from

A

Multiple myeloma, chronic lymphocytic leukaemia, burns

30
Q

Compliment deficiency

A

Hereditary and rare, encapsulated bacteria, need complement to help kill organisms, earlier defect in pathway greater number of organisms may infect

31
Q

Complement deficiency illnesses

A

Neisseria meningitidis and S.pneumoniae lysis not achieved by MAC/opsonisation (50-60% patient 1 epsiode of disease)

32
Q

Spleen

A

Source of complement and antibody producing B-cells, removes opsonised bacteria from blood

33
Q

Causes of splenectomy

A

Traumatic, surgical, functional (sickle cell anaemia)

34
Q

Infections in splenectomy patients

A

Strep penumoniae, H. influenza type B, N. meningitis, malaria (high mortality - prophylactic penicillin)

35
Q

Biologics

A

Antibodies/other peptides, inhibit inflammatory cytokine signals (TNF/T-cell activation/deplete B-cells)

36
Q

Biologics used for

A

RA

37
Q

Biologics increased risk of

A

TB, Herpes zoster, Legionella pneumophila, Listeria monocytogenes

38
Q

Organ transplant e.g.

A

Liver in HCV/paracetamol OD, stem cells in haematological malignancy

39
Q

Anti-rejection treatment

A

Suppresses cytoxotic and NK cells

Clinical Pathology (60 decks)

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