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CMOD-Block 2 Path > Diseases of the Immune System > Flashcards

Diseases of the Immune System Flashcards

1
Q

Name some lab values that suggest histoplasmosis?

- what is the pathohistology of histo?

A

Lab Values:

  • High Lactate Dehydrogenase - general indicator of tissue damage
  • High Ferritin - indicates liver damage

Pathohistology:

  • Histoplasmosis is found in macrophages
  • Much smaller in size than Lymphocytes
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2
Q

Why is disseminated histoplasmosis an indicator of HIV/AIDS?

A
  • Immunocompetent people form caseating granulomas form to prevent dissemination
  • Immunocompromised people who get it will have disseminated infection if they lack TH1 cells/TH1 cell function
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3
Q

What is the primary target for AIDS screening?

  • what are some proteins that are important for infection?
  • why are these proteins important for infection?
A

Primary Screening Target:
- gp24

Proteins important for infection:

  • gp41
  • gp120

**gp41 and gp120 are important for CD4 and CCR5 receptor binding on CD4+ T cells

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4
Q

What is seroconversion?

A

Seroconversion happens when you are infected with a disease and your serum shows detectable amounts of Ab Specific to that bug

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5
Q

What is the seroconversion rate for Hepatitis B? HIV?

A

Hep B = 6-30%

AIDS = 0.3%

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6
Q

Why does HIV deplete T cells?

A
  • T cells are depleted because of the CYTOPATHIC effect of the virus (LYSES WHEN IT EXITS THE T CELL)
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7
Q

How are APCs involved in in acquiring the HIV virus?

A

Dendritic Cells and Macrophages take up the HIV virus and present it to T-cells

***Macrophages are believed to Harbor the Virus because they are more resistant to the cytopathic lyses, thus the virus is not seen by the immune system

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8
Q

Describe the Surface anatomy and Pathohistology of the lymphnodes of an HIV patient.

A

Surface Anatomy:
- Gross Lymph Node Enlargement

Pathohistology:

  • Atypical Shapes of germinal centers
  • Less cellular but Tingible Body Macrophages will still present
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9
Q

What are some common infections of AIDS patients?

A
  • Cyptosporidiosis
  • Pneumocytosis
  • Toxoplasmosis
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10
Q

Is it common to see a disseminated Penumocytosis infection?

A

NO, even in AIDS patients these will not be disseminated

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11
Q

Why is JC virus seen often in AIDS patients?

A

JC virus is a common disease that people get in childhood but never disseminates

  • HIV permits dissemination
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12
Q

What test is used to test for Cryptococcal infections?

- how does it work?

A

Cryptococcal Antigen Latex Agglutination System

  • Detects capsular polysaccharide antigen of cryptococcus neoformans in serum and in CSF
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13
Q

What differentiates Nocardia infections from TB as far as histology goes?

A
  • Noricardia is Gram + in addition to be Acid Fast
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14
Q

What often happens to viral infections in the immunocompromised?
- diseases that do this?

A

Normally localized infections like herpes disseminate

  • Herpes Simplex
  • Varicella Zoster
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15
Q

How will a patient with a disseminated herpes virus of the face appear?

A

Vesicles are seen over the entire face with MULTIPLE DERMATOMAL DISTRIBUTIONS

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16
Q

T or F: Shingles (varicella zoster) virus maintains its dermatomal distribution in HIV patients.

A

False, it will often disseminate

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17
Q

What disease causes Kaposi’s sarcoma?

A

Human Herpes Virus 8

18
Q

What are some common neoplasms seen in HIV patients?

A
  • Kaposi Sarcoma
  • Primary Lymphoma of the Brain
  • Invasive Uterine Cancer
19
Q

What is Wasting Syndrome?

- what symptoms define it?

A

HIV complication that is defined as:

  • Loss of at least 10% of body weight
  • Diarrhea
  • Chronic Weakness
  • Fever
20
Q

What is one of the most common neurological complications are associated with AIDS?
- symptoms?

A
  • AIDS demientia complex
  • Behavioral Changes
  • Diminished Mental Functioning
21
Q

An AIDS patient succombs to diarrhea.

- what is the likely cause if this was a fungal infection?

A

Cryptosporidosis

22
Q

Why do you suspect cryptococcus is responsible for so many CNS infections in AIDS patients?

A

Its an Encapsulated fungus

Encapsulated = meningitis

23
Q

What is the role of CCR5 in non-HIV positive people?

- what happens to people who have a mutation in CCR5 when they are exposed to HIV virus?

A

CCR5 is a chemokine receptor that is needed by the HIV virus in order to infect.

  • If no CCR5 is present, then no/little susceptibility to HIV virus
24
Q

How does HIV react when patients who are infected with HIV get a 2˚ infection?

A

Proinflammatory Signals via IL-1, IL-6, and TNF-alpha actually may promote HIV proliferation

*This makes since it is likely that more lymphocytes are trying to be synthesized in the pro-inflammatory state

25
Q

What host cell is important for INITIATION of HIV virus in a host?

  • is the same cell important for getting it to the brain?
  • What about for maintenance of the virus?
A

Dendritic Cells:

  • Initiation and Maintenance
  • DCs are most important with presenting viruses to T cells and they are abundant under epithelial layers where infections begin

Macrophages:
- Important for communiting with Microglial Cells (macrophages of the brain) and getting the virus to the CNS that way

26
Q

Differentiate a histological findings in a lymphnode biopsy of a person recently infected with HIV from someone with a lymphoma.

A

HIV lymph node will have the following not found in lymphomas:
• Tingible body macrophages
• Mantle Zone (darker ring of cells around lighter center - aka T cells surrounding B cells)
• Atypical Shape (this would likely be seen in lymphomas too)

27
Q

What is the significance of Tingible body macrophages being present in a lymph node?

A

I indicates that proliferating cells in the lymph node are still dying.

28
Q

During the acute (symptomatic phase) of HIV infection, what is happening to the virus?

  • host immune system?
  • what happens post-acute phase?
A
  • During the Acute Phase (1-3 weeks post exposure) patients have flu-like symptoms
  • Virus Shoots up and becomes prolific
  • Host immune system is suppressed
  • After the Acute phase and Until the onset of AIDS the T cell count comes back up and virus decreases
29
Q

T or F: cryptosporidosis sits on the surface of enterocytes.

A

False, while it appears that it sits on the surface it is actually INSIDE the enterocyte on the apical surface

30
Q

At what white cell count do you typically start to see patients getting Pneumocystis jirovecii?

  • what are the symptoms?
  • what is the likelyhood of dissemination?
A

Count Less than 200

  • Patients are often Asymptomatic
  • Very common opportunist
  • *Often you notice this because O2 saturation is low on room air

Dissemination = NEVER

31
Q

You see multiple ring-enhancing lesions and you suspect toxoplasmosis in an AIDS patient.

  • what does will IgG test for Toxo most likely reveal?
  • why would you take an IgM?
A
  • IgG will most likely be positive for Toxo whether or not the lesions are being caused by Toxo because Most people Carry Toxo, it just gets re-activated in AIDS patients
  • IF test is negative you might want to start thinking more about Glioblastomas
  • IgM is pointless - if they have toxo in the brain its from a re-activation event
32
Q

What is a major risk factor for getting Toxo?

A
  • Having a Cat
33
Q

If someone has thrush and they have AIDS what symptoms might they have?

A
  • Upper Abdominal Pain
  • Difficulty Swallowing
  • Chest Pain
34
Q

Why do AIDS patients often present with Subacute cryptococcal infections?

A
  • They are immunosuppressed so they don’t experience symptoms until the disease has progressed
35
Q

Differentiate packaging of Histoplasmosis and Coccidiomycosis.

A

Coccidiomycosis is packaged in ENDOSPORES (large)

Histoplasmosis is NOT packed it sequesters in MACROPHAGES

36
Q

Pigeons give you Crypto.

A

Pigeons give you Crypto.

37
Q

You have AIDS and get a Mycobacterium Avium infection.

  • what virus is this most likely complexed with?
  • what will your symptoms be?
  • How would you Dx.
A

Mycobacterium intracellulare and avium infect together

Symptoms:

  • Lack of Appetite
  • BULKY ABdominal Lympadenopathy

Dx.
- Colonoscopy biopsy or Lymph Node Biopsy would be needed to make a dianosis

38
Q

What disease starts as a cavity forming pneumonia that progresses into neurological symptoms?

A

Nocardiosis

39
Q

At what T cell count do you start to see AIDS patients with White matter Lesions?

  • what disease is causing this?
  • Prognosis?
  • Histo?
A

T cells less than 50

Opportunist:

  • JC virus
  • causes progressive multifocal leukoencephalopathy

Prognosis:
- AIDS patients can live with this for years

Histo:
- Glassy Inclusions from the virus that can be stained with IHC stain as well

**What matter lesions can cause you to walk funny etc.

40
Q

What markers would you use to see if someone had Kaposi’s Sarcoma?

  • why?
  • what are your looking for?
A

Markers for Kaposi’s:

  • CD31
  • CD34

Why:

  • You will see a lot of Blood cells in the Histological section
  • CD31 and CD34 are blood vessel markers
  • If you stain for CD31 and 34 and the cells are not located in blood vessels then its likely Kaposi’s
41
Q

What 3 common neoplasms do you see in AIDS patients?

A

Kaposi Sarcoma
Primary Lymphoma of the Brain
Invasive Cancer of Uterine Cervix

42
Q

Why are Viral Drugs for viruses other than HIV often not effective in patients who have HIV?

A
  • Drugs that patients are taking for HIV have likely selected for very Drug Resistance strains of other viruses that the patient may be infected with

CMOD-Block 2 Path (22 decks)

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