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MICI Module 3 > Immune Compromised, Immunization And Diagnostic Testing > Flashcards

Immune Compromised, Immunization And Diagnostic Testing Flashcards

1
Q

What are classic features of inflammation

A

Rubor (redness)
Calor (heat)
Tumor (swelling)
Dolor (pain)

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2
Q

Describe innate immunity

A 
Primitive and broad 
Immediate onset
No memory 
Unspecific
Lasts a few days
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3
Q

Describe Adaptive Inmunity

A 
Highly specific
3 day lag
High potency 
Memory & amplification 
Lasts months to years
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4
Q

What are some components of innate immunity

A 
Barriers ex. skin
Secretions ex. Sweat, vaginal, vomiting
Macrophages
NK cells
Complement pathway
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5
Q

Describe macrophage’s

A

Component of innate immunity
Form of cellular defence
Eat foreign materials and dead cells dissolve in enzymes

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6
Q

Describe NK cells

A

Component of innate immunity also known as natural killer cells
Kills strange looking cells and important in cancer surveillance
Delivers signals to abnormal cells to kill them

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7
Q

What are the two types of adaptive immunity

A

Antibody mediated immunity

Cell mediated immunity

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8
Q

What are components of antibody mediated immunity

A

B- cells
Plasma cells
Antibodies

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9
Q

What are components of cell mediated immunity

A

T helper and T killer cells

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10
Q

What are the two immunodeficiency states

A

Primary and secondary

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11
Q

Describe primary immunodeficiency

A

Genetic

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12
Q

Describe secondary immunodeficiency

A

Acquired such as infection, splenectomy,malignancy etc

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13
Q

What are some examples of genetic immunodeficiencies

A 
Complement deficiencies 
Defects in phagocytic cell function 
Lymphocyte function (SCID)
B-cell deficiency 
T cell deficiency
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14
Q

Describe complement deficiencies

A

Loss of early components as result in increased staph and strep
Loss of late components results in increased neisseria (meningitis)

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15
Q

Describe phagocytic defects

A

Predispose to bacterial infections

Inability to kill organisms that have been ingested is typical of chronic granulotamous disease

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16
Q

Describe subacute combined immune deficiency (SCID)

A

Lymphocyte deficiency

Genetic defects may result in failure of development of B cells, T cells, or NK lymphocytes
Patients present with fungal and viral infections as maternal immunity weans
Live vaccine can cause severe disease

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17
Q

What happens if you have a B cell deficiency

A

Patients tend to get encapsulated bacterial infections

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18
Q

What happens if you have T cell deficiencies

A

Tend to get infections with viruses especially herpes; intracellular bacteria and fungi

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19
Q

What are primary immunodeficiency diseases

A

Chronic granulomatous (ineffective phagocytes = uncontrolled infections)

SCID (lack of T/B-cells = no resistance to infection leading to rapid death)

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20
Q

What are some examples of secondary/acquired deficiencies

A 
Chemo
Corticosteroids 
Post transplant 
Splenectomy 
HIV/AIDS
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21
Q

Describe chemotherapy

A

Inhibit regeneration of cells that have a rapid turn over (neutrophils)
These PMN drop and remain depressed for 1-4 weeks in which case there is increased risk of death and infection due to neutropenia

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22
Q

Describe corticosteroids

A

Steroids
PMN unable to migrate to infection
Reduced macrophage migration
Reduction in T lymphocytes

This can result in increased viral, bacterial and fungal infection

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23
Q

Describe post transplant

A

Commonly used agents inhibit cytokine (messengers for immune system) production and T lymphocyte function

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24
Q

Describe the spleen

A

Kind of our biggest lymph node
The main site of opsonizing antibody which is very important for destroying capsulated bacteria
W/o spleen capsulated bacteria can take over

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25
Q

Describe a splenectomy

A

Removal of spleen can result in increase of life threatening disease including strep, staph and neisseria
Infections progress rapidly
Immunization strongly recommended for these patients to combat s.pneumoniae, H.influenzae and N.meningitidis

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26
Q

Describe HIV/AIDS

A

AIDS is primarily a disease of poor T cell function and production
Opportunistic infections affecting people with AIDS reflect the lack of CD4 + T cells

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27
Q

How can bacteria invade the immune response

A 
Destroying complement (strep) 
Destroying immunoglobulin (neisseria producing IgA protease)
Preventing phagocytosis (encapsulated organisms)
Preventing intracellular killing
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28
Q

How else can bacteria invade the immune system

A

Bacteria growing inside the cytoplasms if cells are protected from antibody or detection

Bacteria may change their surface antigens rapidly (borrelia)

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29
Q

What is immunization

A

The use of a specific immune response to prevent or lessen the severity of disease
Immune system learns adaptive immunity

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30
Q

What are the objectives of immunization

A

Individual protection from infection
Herd immunity
Elimination of infecting organism

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31
Q

Describe the action of antibodies in immunization

A
  • Bind to antigen and block biological activity (neutralizing)
  • Coat bacterium and make it more easily phagocytosed (opsonization)
  • Bind to organism to activate complement and cause lysis, recruit immune cells to area
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32
Q

What is opsonization

A

Macrophage cells eat bacteria, happens mainly in the spleen

Improves clearance if organisms

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33
Q

Describe B cells

A

Antibodies produced by B lymphocytes are activated to become plasma cells

  • When stimulated by infection B cell clone multiplies
  • Some become B memory and long lived to provide rapid response to subsequent exposure
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34
Q

Describe T cells

A

Specific T lymphocytes also survive as memory T cells which regulate the immune response
On reexposure they multiply and shorten time to a response

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35
Q

What is passive immunization

A

Host receives antibody produced by another host

Protection is short lived (2-3 months) and no long term protection generated

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36
Q

What are examples of passive immunization

A

IVIG, HBIG, VZIG, RSV and Rabies Ig

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37
Q

How does passive immunization take place

A

Naturally occurring: transplacentally or in colostrum

Therapeutic: immunoglobulin or IG given; provides rapid protection,lessen severity

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38
Q

What is active immunization

A

Generation of immunity by administering an antigen to elicit an immune response in the host

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39
Q

What was the first type of active immunization

A

Jenner administered cowpox virus in order to prevent small pox

40
Q

What are types of active immunization

A 
Live attenuated (MMRV)
Virus vectors 
Inactivated whole cell , subunit, virus like particles 
DNA/RNA
Toxoid
41
Q

Describe live attenuated vaccines

A
  • Use organisms which are limited in their ability to cause disease
  • Attenuated organisms are repeatedly cultured until they lost their virulence
  • Administration may mimic natural route of infection
  • Give stronger long term immunity
42
Q

What are disadvantages of live attenuated vaccines

A

Virulent for immunosuppressed
May revert to the virulent form
Must be handled properly (refrigerated) to maintain viability

43
Q

What are some examples of live attenuated

A

BCG (TB)
MMRV
Sabin Polio vaccine

44
Q

Describe Replicating virus vectors

A

Viruses that don’t cause human disease are engineered to express target virus protein
Allows immune response to the target virus without infection by it

45
Q

What are non replicating viral vectors

A
  • A carrier virus (ex. Adenovirus) is treated so that it can not replicate if cause disease
  • A gene from the target virus is added to the carrier virus so that it expressed the target virus protein
  • easily transported and stored than replicating virus
46
Q

What are those of inactivated vaccines

A

Whole cell, subunit and virus like particles

47
Q

Describe inactivated vaccines

A
  • Often given with a substance that increases immunogenicity
  • conjugation of polysaccharide to protein improves response
  • boosters required to maintain effectiveness
48
Q

Describe the nuts and bolts of inactivated vaccines

A

Given by injection
Require multiple doses at specific intervals
Give immunity that wanes over time
Give antibody response but not cell mediated immunity

49
Q

What are examples of inactivated vaccines

A

Influenza, Hep A

50
Q

What are subunit vaccines

A

Vaccines made with purified antigens derived from pathogen
Less prone to side effects

Ex.
Hep B,
haemophilis influenza, pneumococcal and meningococcal (meningitis causing bacterias)

Pertussis

51
Q

Describe virus like particles

A

Prepared from viral proteins that self assemble to form particles
No nucleic acid; look like disease without causing disease

Ex. HPV and Hep B

52
Q

Describe RNA vaccines

A

Made of mRNA that instructs cells to produce a viral protein from the target virus

RNA is unstable so needs to be kept in lipid envelope and stored in low temp

53
Q

Describe DNA Vaccines

A

Similar to RNA but more stable
Plasmid injected which includes gene for a target virus protein
Potential for oncogenicity

54
Q

Describe Toxoids

A

Inactivated toxins protects from action of the toxin
Multiple doses given
Very effective
Ex. Tetanus and diphtheria

55
Q

Who makes recommendations for vaccinations

A

National advisory committee on immunizations (NACI)

56
Q

Why do vaccine programs fail?

A

Missed opportunities to immunize by health care workers
Improper vaccine storage
Vaccine hesitancy

57
Q

What are the current vaccine targets

A

Diphtheria/ tetanus/ pertussis

Often combined with poliovirus and haemophilis influenza type B

Diphtheria toxoid and tetanus toxoid booster (14-16yrs) less diphtheria toxoid for adverse reactions

58
Q

Describe the polio vaccine

A

Salk = injection (inactivated)
Sabin = oral (live)
Shedding in GI tract offered opportunity for vaccine associates infections

Immunized at 2,4,6 months boosters at 18 mo and 4-6 years

59
Q

Why is the oral polio vaccine no longer used

A

Vaccine associated paralytic polio

60
Q

Describe haemophilus B vaccine

A

Used to be most common meningitis cause
Vaccine consists of polysaccharide conjugated to a protein
Conjugation activates T-cell dependent immunity

61
Q

Describe measles mumps and rubella (MMR) vaccine

A

Live attenuated vaccine
Given 12-15 months
Contraindications: severe acute illness or immunosupression

62
Q

Describe the influenza vaccine

A

Inactivated whole or split virus vaccine

Contains TWO influenza A strains and TWO influenza B strains

63
Q

What does split virus vaccine mean

A

Multiple types in it

64
Q

Who typically receives the influenza vaccine

A

High risk groups
Health care workers
>65 years
Chronic Conditions

65
Q

Describe Hepatitis B vaccine

A

Hep B has higher risk if cirrhosis and carcinoma

Purified HBsAg

3 doses at 0,1 and 6 months

Booster not recommended

66
Q

What are the 2 types of pneumococcal vaccines

A

Polysaccharide

Conjugate

67
Q

Describe pneumococcal polysaccharide vaccine

A

23- valent; 90% of pneumonia strains covered
80% effective
> 65 yrs or those without spleen, sickle cell disease or CSF leaks

68
Q

Describe pneumococcal conjugate vaccine

A

13 valent (conjugated to diphtheria toxoid)
Provides better immunity in small children
Improved memory via cell mediated immunity
May decrease carriage
May result in fewer infections in elderly

69
Q

Describe varicella vaccine

A

Live attenuated Virus vaccine
12 months
Recombinant VZV used in 60+ to reduce shingles
<5% of children develop lesions as a side effect

70
Q

Describe the HPV vaccine

A

Subunit vaccine containing protein of up to 9 types of HPV
Given in 3 doses 0,2,6 months @ age 9-13
hopes to decrease incidence of warts and cervical cancers

Less effective after sexually active

71
Q

Describe the Covid 19 vaccine

A

RNA
Non replicating viral vector
Highly effective

72
Q

How can immunity be conferred

A

Natural infection
Passively via administration of antibody
Active immunization

73
Q

True or false: current vaccine schedule has greatly increased childhood morbidity and mortality

A

FALSE it has greatly REDUCED morbidity and mortality

74
Q

What does the immunogenicity of a vaccine depend Kim

A

Multiple factors and can be enhanced by adjuvants and happen conjugates

75
Q

What are polyclonal antibodies

A

Used in diagnostic purposes

Animals repeatedly immunized to develop high antibody levels (organism or interest, protein or human antibodies)

76
Q

What are monoclonal antibodies

A

Used for diagnostic purposes
Antibodies developed when animal spleen cells are fused with malignant myeloma cells
Cells are selected that produce only one kind of antibody in a very pure and high amount

77
Q

What are IgM antibodies

A

Used to detect infection
Usually a reflection of a recent infection
Ex. Measles, Hep A

78
Q

What do rising levels of IgG antibodies indicate

A

Often indicate recent infection

Ex. Respiratory viruses

79
Q

What is used to determine immunity

A

Any IgG antibody

Ex. Rubella, hepatitis A

80
Q

How is IgG better than IgM

A

Take longer to make (IgM rapidly present at initial infection)
Part of memory immune system
More effective
Can determine immunity
IgM wanes over time IgG better longer lasting protection

81
Q

How does the enzyme immune assay work?

A

Coat well with antigens from organism of interest
Add patient serum
Wash well to remove antibodies not bound to antigen
Add store bought antibody to patients anti body
Wash well to remove any unbound antibodies

82
Q

In EIA how do you develop a reaction

A

If patient had antibody it will also have secondary antibody bound to it also with the enzyme
Add substrate for the enzyme
Measure amount of colour
More colour = more enzyme = more antibody
No colour = no antibody

83
Q

Describe fluorescence microscopy

A

Put specimen on slide
Dry and fix specimen
Add antibody to antigen you are looking for
Antibody labelled with fluorescent tag
Wash it off
Unattached antibody is washed away
Look under a special microscope to see if the cells are fluorescent

84
Q

How might fluorescence microscopy be used

A

To detect influenza or RSV
To detect herpes from unroofed ulcers
To detect varicella zoster from base of chicken pox lesion
To detect pneumocystis

85
Q

Describe mini EIA kits

A

Throat swab
Treat to extract the strep antigens
Put drop in device
Let diffuse along filter, it will bind here
Add enzyme tagged antibody to sandwich antigen
Add drop of substrate and observe colour change

86
Q

Describe mini ELISA kits

A

Detect pregnancy using urine sample
Let diffuse along filter until It comes up to the antibody, if positive it will stop here and bind to HCG antigen
Add substrate and observe colour change

87
Q

What does the c mean on a rapid test

A

Control

Shows the test worked and can be read

88
Q

What does the T mean on a rapid test

A

The test

Gives test result

89
Q

What can particle agglutination tests be used for

A

Patient specimens ex CSF

Identification of bacteria in lab

90
Q

Describe particle Agglutination tests

A

Specimen mixed with tiny beads which are coated with specific antigen
If specimen contains the right antigen particles clump together making substance go from milky to granular

91
Q

How can particle agglutination be used to detect antibodies

A

Instead of costing beads with antibody coat them with antigen
Add patient serum and if patient has antibodies the particles clump together

Ex, mono, syphilis

92
Q

What does skin testing use

A

Cellular immune response

93
Q

Describe TB skin test

A

Tb ANTIGENS injected into skin
Over 48 hours cells migrate towards antigen if TB antigens recognized
Produces swelling (induration)
Individuals WITHOUT past TB exposure have no induration

94
Q

What should asplenic patients be vaccinated against?

A

H. Influenza
N. Meningitidis
S. Pneumoniae

95
Q

What does iatrogenic mean

A

Secondary immunodeficiency caused by a healthcare professional
Ex. Removal of spleen

MICI Module 3 (3 decks)

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