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DPT 682 - Pathophysiology > Immune System > Flashcards

Immune System Flashcards

Discuss the function of immune system / Compare and contrast the innate and adaptive immunity / Discuss the cells involved in innate and adaptive immunity / Discuss the etiology, pathogenesis, clinical manifestations of HIV & AIDS / Discuss other immune disorders like hypersensitive disorders

1
Q

Immune System

Any foreign substance that does not have the characteristic cell surface markers of an individual and is capable of eliciting an immune response = ?

A

Antigens: Any foreign substance that does not have the characteristic cell surface markers of an individual and is capable of eliciting an immune response.

  • Antigens are recognized by specific receptors present on them by lymphocytes/ antibodies
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2
Q

Immune System

Produced in response to an antigen, are protein molecules structured in such a way that they only interact with the antigen that induce their synthesis = ?

A

Antibody: Produced in response to an antigen, are protein molecules structured in such a way that they only interact with the antigen that induce their synthesis

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3
Q

Immune System

Two distinct and specialized processes of immunity= ?

A

(1) Innate immunity (natural/ native)

  • First responders to insult
  • Response is rapid and same at all times
  • Nonspecific: does not distinguish between different types of invaders (bacteria, virus)
  • Non adaptive: does not remember the previous encounter

(2) Acquired / adaptive immunity

  • Slower response; when reintroduced then rapid and intense immune response
  • Diversity: Recognize and destroy foreign material like bacteria, fungi
  • Specificity: targeted response to a distinct antigen
  • Memory: when same organism enters again, body respond’s more rapidly to it and with a stronger reaction
  • Self and non-self-recognition
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4
Q

Immune System

How can adaptive immunity be acquired ?

A

Active adaptive immunity can be acquired in different ways:

  • Active acquired immunity
  • Development of antibodies in response to an antigen
  • Introduction of antigen by either naturally from environmental exposure or artificially by vaccination

Passive acquired immunity:

  • When antibodies produced by one person are transferred to another person either naturally (mother to fetus) or inoculation of antibody

Adaptive / Acquired Immunity

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5
Q

Immune System

How does passive acquired immunity occur ?

A

Passive acquired immunity:

  • When antibodies produced by one person are transferred to another person either naturally (mother to fetus) or inoculation of antibody

Adaptive / Acquired Immunity

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6
Q

Immune System

T and B cells migrate throughout the body through ?

A
  • Humoral = B cells
  • Cell mediated = Tcells
  • Response from these two types of immunity overlap andinteract considerably.
  • T and B cells migrate throughout the body via blood, lymph, and lymph nodes.

Adaptive / Acquired Immunity

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7
Q

Immune System

Humoral / B Cells = ?

A

Humoral / B Cells:

  • Involving antibodies / immunoglobulins
  • B lymphocytes: originate and mature in bone marrow
  • B cells are very effective against organisms that are free floating in the body that can very easily be reached and neutralized.
  • B lymphocyte-plasma cellcan produce5 types of antibodies
    • IgG
    • IgM
    • IgA
    • IgD
    • IgE
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8
Q

Immune System

T lymphocytes originate in ?

A

(a) T lymphocytes:

  • Originate in bone marrow andmature in Thymus
  • T cells can recognize the hidden organisms, searchthem out and destroy on acell-to-cellbasis
  • Helper T cells (T4 lymphocyte, CD4 lymphocyte), 75% of T cells
  • Assist B cells to mature and produce antibodies
  • Activating macrophages and helping them destroy large bacteria
  • Helping other T lymphocytes (cytotoxic T cells/ CD8 cells) recognize and destroy virally infected cells
  • HIV destroys these helper T cells and leaves the body at risk of infections
  • Suppressor T cells: suppresses the activation of immune system
  • Cytotoxic T cells (CD8): Toxic to the antigens; killing the antigens
  • Memory T cells: Remember what they crossed paths with in the body

Cell Mediated Immunity: T Cells

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9
Q

Immune System

Factors altering the immune system = ?

A
  • Aging
  • Nutrition:
    • Deficits in calories, protein intake or vitamins like A and E can cause deficiency in T cell function and numbers.
    • Zinc deficiency: impairs T and B cell function
  • Burns:
    • Decrease external defense, decrease neutrophil function, decreased cell mediated and humoral responses
  • Sleep disturbances
  • Presence of concurrent illness and disease like malignancy, diabetes, HIV infection
  • Drugs:
    • Immunosuppressive drugs, cancer chemotherapeutic drugs suppress the immune response
  • Surgery / anesthesia:
    • Suppresses T and B cell function up to 1 month post operatively (Splenectomy).
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10
Q

Immune System

Central immune structures include bone marrow and the thymus.

  • What are their functions in regard to immune defense = ?

Function of Immune Defense Components

A

Bone Marrow:

  • Production of lymphocytes
  • Maturation of B lymphocytes

Thymus:

  • Gland located in the mediastinum
  • Differentiation and maturation of lymphocytes
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11
Q

Immune System

Peripheral immune structures include lymphnodes, spleen, and other lymphatic mucosal tissues such as the tonsils, peyer patches, appendix.

  • What are their functions in regard to immune defense = ?
A

Lymphnodes:

  • Round masses of lymphatic tissue
  • Spread out among lymphatic vessels

Spleen:

  • Site of lymphatic migration

Lymphatic mucosal tissue (tonsils, peyer patches, appendix):

  • Site of lymphatic aggregation
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12
Q

Immune System

The primary cellular components involved in immune defense include T Lymphocytes and B Lymphocytes.

  • What are their functions in regard to immune defense = ?
A

T Lymphocytes:

  • Matured in thymus
  • Essential in adapative cell-mediated immunity
  • Desctruction of cellular antigens
  • Promote antibody production by B Lymphocytes
  • Account for 60% of blood lymphocytes.

B Lymphocytes:

  • Matured in bone marrow
  • Essential in mediating adaptive humoral immunity
  • Production of antibodies/immunoglobulins
  • Account for 10-20% of blood lymphocytes
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13
Q

Immune System

Accessory cellular components involved in immune defense include:

  • Macrophages
  • Neutrophils
  • Dendritic cells

What are their functions in regard to immune defense?

A

Macrophages:

  • Essential in mediating innate immunity

Neutrophils:

  • Bind invading microbes to cell surface receptors

Dendritic cells:

  • Process and present antigen to T and B lymphocytes, stimulating adaptive immune response.
  • Phagocytosis to prevent colonization, entry, and spread of microbes
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14
Q

Immune System

What should we know about exercise immunology?

A
  • Depending upon the intensity, activity or exercise can enhance or suppress the immune function.
  • Moderate intensity exercise- enhances immune system = 50-70% of the maximal heart rate.
  • Strenuous/ intense/ long duration exercise impairs the immune system= Leave host open to microbial agents during open window
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15
Q

Immune System

Impact of exercise on:

  • Neutrophils
  • NK cells, and
  • Lymphocytes
A

Neutrophils:

  • Exercise: rise in blood levels of neutrophils.
  • After brief gentle exercise- count returns to baseline.
  • After strenuous exercise- return to normal may take 6-24 hours.

NK cells:

  • Once the person is accustomed to a given exercise level, the NK enhancement falls off.
  • After intense exercise, number and activity of NK cells decline, maximum reduction occurs 2-4 hours after the exercise, return to baseline soon

Lymphocytes:

  • Increase but decrease below normal for several hours after intense exercise
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16
Q

Immune System

Primary and secondary immunodeficiency disorders result from ?

A

(a) Immunodeficiency disorders:

  • Immune response is absent / depressed
  • B cell, T cell, combined B and T cell deficiency, NK cells, phagocyte cells.

(b) Primary: Defect involving the cells

  • Genetic

(c) Secondary: Results from an underlying disease / factor:

  • HIV-AIDS
  • Malnutrition/ alcoholism
  • Ageing
  • Autoimmune disease
  • Cancer
  • Steroids
  • Chemotherapy
  • Radiation therapy
17
Q

Immune System

AIDS = ?

  • What does it infect?
A
  • Infection of immune system, resulting in progressive and profound immune suppression
  • Infects selectively CD4 (cluster of differentiation) helper T lymphocytes, dendritic cells and macrophages
  • Characterized by progressive destruction of T cell mediated immunity and changes in humoral immunity
  • Resultant immunodeficiency- opportunistic infections including unusual cancers, tuberculosis
18
Q

Immune System

AIDS Pathophysiology

A
  • Transmitted through blood-blood contact, sexual contact (semen, vaginal secretions), perinatally (amniotic fluids, breast milk)
  • Infection can occur across mucosal surfaces including vagina, cervix and anus

(a) High risk behaviors =

  • Unprotected anal/ oral / vaginal sex
  • Sexual activity with someone known to carry HIV
  • Injecting drugs
  • Blood transfusions

(b) Risk factors

  • Poverty
  • Illegal drug use
  • Not good access to health care system
19
Q

Immune System

HIV is a _ virus?

(genetic material in RNA)

A
  • HIV is a retrovirus (genetic material in RNA).
  • Attacks CD4+ T lymphocytes cells, destroys and inactivates them; macrophages and dendritic cells are also affected.
  • HIV has high mutation rate even within a single individual, to fight for survival.

Pathogenesis

20
Q

Immune System

9 steps in HIV Pathogenesis = ?

A
  1. Binding of virus to CD4+ cells after it enters the blood steam
  2. Fusion and contents of the viral core enter host cells
  3. Reverse transcription, genetic information of the virus from viral RNA to double stranded DNA, Reverse transcriptase
  4. Integrated into host DNA and replicated many times
  5. Transcription: double stranded DNA to single stranded RNA
  6. Translation: proteins
  7. Assembly: new HIV proteins and RNA assemble and move to the surface of the cells
  8. Budding and release of mature virion
  9. HIV replication: killing of CD4+ cells- release of HIV copies into the bloodstream- viral particles invade other CD4+ cells- infection progresses
21
Q

Immune System

HIV infection involves full spectrum illness:

  • Asymptomatic HIV seropositive CD4 count = ?
  • Symptomatic HIV count = ?
  • HIV advanced disease (AIDS) count = ?
A

(a) HIV infection involves full spectrum illness:

  • Asymptomatic HIV seropositive (positive for HIV antibodies; CD4 count > 500 cells/mm^3
  • Symptomatic HIV (CD4 count between 200-500 cells/mm^3
  • HIV advanced disease (AIDS) < 200 cells/mm^3

(b) CDC definition of AIDS =

  • HIV-1 (type 1 retrovirus) and CD4 lymphocyte count below 200 (normal: 600-1200)
  • Development of opportunistic infections
22
Q

Immune System

Asymptomatic HIV disease: CD4 > or = ?

A

(a) Asymptomatic HIV disease: CD4 > or = 500 cells/mm3

  • Positive for antibodies
  • Asymptomatic between 1-20 years
  • Clinically healthy, normal ADLs, unrestricted level and duration of exercise
  • Fatigue, swollen and firm lymph glands
23
Q

Immune System

Symptomatic HIV disease
CD count between = ?

A

(a) Symptomatic HIV disease

  • CD count between 200-500 cells/mm3.
  • Viral load goes up and CD4 count goes down
  • Generalized adenopathy (swollen lymph nodes)
  • Nonspecific symptoms like diarrhea, weight loss, fatigue, night sweats, fever, report fatigue that limits physical and exertional activities, opportunistic infections as cell mediated immunity is low, pneumonia
24
Q

Immune System

HIV advanced disease (AIDS), CD4+ cell count = ?

A

(a) HIV advanced disease (AIDS)

  • CD4+ cell count = <200 cells/mm3

(b) Neurologic involvement (central, peripheral, autonomic)

  • HIV encephalopathy (gait disturbances, intention tremors)
  • HIV associated dementia (apathy, lethargy, social withdrawal, depression, memory impairment)
  • Peripheral neuropathies: pain, sensory loss, motor deficits, gait disturbances

Opportunistic infections:

  • P. carinii pneumonia (fungal infection of lungs, risk for pneumonia, cough, shortness of breath, fever)
  • Malignancies (Kaposi sarcoma, lymphoma)
25
Q

Immune System

Clinical manifestations of HIV advanced disease (AIDS) include ?

A

(a) Dermatologic conditions:

  • Hair loss
  • Rash
  • Delayed wound healing
  • Bacterial, viral infection, fungal infections, dry flaking skin, thinning of skin/ hair

(b) Kaposi Sarcoma:

  • Cancer that forms in the lining of blood and lymph vessels
  • lesions to grow in the skin, lymph nodes, internal organs, and mucous membranes lining the mouth, nose, and throat
  • Painless purplish spotsare common signs
    • Pain associated with HIV infection, immunosuppression, opportunistic infections, comorbidities

(c) Pain syndromes:

  • Painful peripheral neuropathy, arthralgia’s (joint pain/ swelling)
  • Myalgias (muscle aches/pain)
  • Abdominal pain, chest pain.
    • Musculoskeletal pain syndromes associated with HIV wasting syndrome unwanted weight loss of more than 10 percent of a person’s body weight
  • weight loss, diarrhea, weakness, fever, mineral/ vitamin deficiencies

(d) Neuro-musculoskeletal diseases: osteomyelitis, myositis, arthritis, myopathy

(e) Lipodystrophy:

  • Defective fat metabolism, dyslipidemia (elevated cholesterol/ fat), insulin resistance, visceral and central fat deposition in abdomen, breasts, back; loss of fat in arms, legs and face.
  • Side effect of treatment
26
Q

Immune System

Antigen produced with HIV infection= ?

A

P24 is the antigen produced with HIV infection.

27
Q

Immune System

HIV/AIDS treatment = ?

A
  • No cure, current medications decrease the amount of virus in the body.
  • HAART: highly active antiretroviral therapy – recommended
  • Disease went from death sentence to chronic illness
  • Resistance to drug therapy is the primary concern
  • According to the symptoms NSAIDS and pain medications
  • Vaccines under investigation
28
Q

Immune System

Keys to HIV and rehabilitative therapy = ?

A

(a) Management of physical dysfunctions

  • Functional capacity is reduced
  • Low intensity exercise
    • Regular exercise encouraged

(B) Collaborate with physician

  • Pain control
  • Energy conservation
  • Maximize functional ability

(c) Address impairments / limitations

  • Progressive resistance exercise
  • Avoid strenuous exercise
  • Recovery periods will be longer
  • Monitor the response to exercise
  • Acute polymyositis/ myopathy: avoid strenuous/ resisted exercise
  • Acute inflammatory arthralgia- joint protection and rest
  • Individual with advanced HIV – immuno-deficient- prevent infection for that person
29
Q

Immune System

Post exposure prophylaxis

A

(a) Occupational exposure:

  • Urgent medical concern
  • Call CDC/ state health, medical evaluation, counselling, antiretroviral medications, follow up.

(b) PEP:

  • Consist of 28 day course of HAART, initiated within hours.
  • Advised to use precautions to prevent secondary transmission esp, during the first 6-12 weeks of post exposure (avoid blood/ tissue donations, breastfeeding or pregnancy).
30
Q

Immune System

Abnormal and excessive response of the activated immune system that causes injury and damage to the tissues = ?

A

Hypersensitivity Reactions / Allergy:

  • Abnormal and excessive response of the activated immune system that causes injury and damage to the tissues.
  • Response varies from mild, to severe, and potentially life threatening.
  • Allergens = pollen, dust, food products, drug components.
31
Q

Immune System

4 classifications of hypersensitivity disorders = ?

A

4 classifications of hypersensitivity disorders:

Type 1:

  • IgE mediated

Type 2:

  • IgG, IgM mediated

Type 3:

  • IgG, IgM mediated
  • Antigens and antibodies
  • Lupus

Type 4:

  • T cell mediated
  • TB skin test reactions
32
Q

Immune System

Classifications of Hypersensitivity Disorders:

  • Type 1 = ?
A

Classification of Hypersensitivity Disorders:

Type 1: IgE mediated

  • Most common, immediate
  • Develops rapidly upon exposure (first-second exposure), classic allergic response (inflammation - histamine released - dilation and bronchospasm - edema, rash, difficulty breathing, asthma, diarrhea, allergic rhinitis, itchy watery eyes).
  • Severe - anaphylactic shock - BP drops and airways narrow.
  • Treatment: antihistamines, corticosteroids, epinephrine (Epipen, constrict blood vessels).
33
Q

Immune System

Classifications of Hypersensitivity Disorders:

  • Type 2 = ?
A

Classifications of Hypersensitivity Disorders:

Type 2: IgG, IgM mediated

  • Antibody mediated
  • Directed against target antigens on specific host cell tissues
  • Basis of autoimmune diseases

Autoimmune Disorders - Type 2:

  • Addison’s disease: A disorder where the adrenal glands don’t produce enough hormones, leading to symptoms like fatigue, weight loss, and low blood pressure.
  • Crohn’s disease: An inflammatory bowel disease causing inflammation in the digestive tract, leading to symptoms like abdominal pain, diarrhea, and weight loss.
  • Type 1 diabetes mellitus: A chronic condition where the pancreas produces little to no insulin, requiring lifelong insulin injections for blood sugar control.
  • Polymyositis/dermatomyositis: Autoimmune diseases causing inflammation of muscles (polymyositis) and skin (dermatomyositis), leading to muscle weakness and skin rashes.
  • Thyroiditis: Inflammation of the thyroid gland, affecting thyroid function and potentially causing symptoms like fatigue, weight changes, and mood swings.
  • Ulcerative colitis: An inflammatory bowel disease causing inflammation and ulcers in the colon, leading to symptoms like abdominal pain and bloody diarrhea.
  • MS (Multiple Sclerosis): A neurological condition where the immune system attacks the protective covering of nerves, causing communication problems between the brain and the rest of the body.
  • MG (Myasthenia Gravis): A neuromuscular disorder causing muscle weakness and fatigue, often affecting the eyes and facial muscles.
  • RA (Rheumatoid Arthritis): An autoimmune disease causing joint inflammation, pain, and deformity.
34
Q

Immune System

Classifications of Hypersensitivity Disorders:

  • Type 3 = ?
A

Classifications of Hypersensitivity Disorders:

Type 3: IgG, IgM mediated; complement mediated:

  • Example: formation of antigen-antibody immune complexes in the blood stream, later deposited in vascular epithelium or extravascular tissues.
  • Massive inflammatory response - injury.

Systemic Lupus Erythematosus (SLE):

  • Type 3 systemic reaction, autoimmune disease - autoantibodies against self antigens - binding of antigens with antibodies.
  • Antigen antibody complex deposition and inflammation.
  • Chronic systemic disease that can damage a wide range of cell types and locations, symptoms depend upon location.
  • Women common.
35
Q

Immune System

Classifications of Hypersensitivity Disorders:

  • Type 4 = ?
A

Classifications of Hypersensitivity Disorders:

Type 4: T cell mediated:

  • Delayed (TB skin test)
  • Transplant rejection
36
Q

Immune System

Systemic Lupus Erythematosus:

  • Clinical features = ?
  • Treatment = ?
A

Systemic Lupus Erythematosus (SLE):

  • There are exacerbations and quiescence( = inactivity or dormancy).

Common organs affected:

  • Skin
  • Kidneys
  • MSK

Less commonly affected:

  • Neurologic
  • Pulmonary
  • Cardiac

Clinical Features (C/F):

  • Joint pain
  • Swelling
  • Arthritis
  • Skin rashes (butterfly rash)
  • Pericarditis
  • Pericardial effusion
  • Pleural effusion

Treatment:

  • Anti-inflammatory: NSAIDs
  • Immunosuppressive: corticosteroids

DPT 682 - Pathophysiology (16 decks)

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