Immune System Flashcards
Malaria- The 5 Causative Organisms
- Plasmodium falciparum- (most severe- causes CEREBRAL MALARIA)
- Plasmodium ovale/ Plasmodium vivax- may lie dormant in the LIVER as HYPNOZOITES
- Plasmodium malariae
- Plasmodium knowlesi (very rare)
Signs and symptoms of Malaria
- Night sweats
- ANAEMIA
- SPLENOMEGALY
- Seizures (CEREBRAL MALARIA or SECONDARY to FEVER)
- Diarrhoea/ nausea
- Flu-like symptoms
Investigations in Malaria
Real-time PCR
Blood film
Bloods- ESR/ CRP/ Creatinine
Treatment of Malaria (there are 6 functions)
1) Inhibit HAEM POLYMERASE-
CHLOROQUINE/QUININE
2) Blood SCHIZONTICIDE-
MEFLOQUINE/ PRIMAQUINE/ MALARONE
3) Inhibits PLASMODIUM PROTEIN SYNTHESIS-
DOXYCYCLINE
4) Inhibits DIHYDROFOLATE REDUCTASE-
PYRIMETHAMINE
5) Inhibits FALCIPARUM sarcoplasmic-endoplasmic reticulum calcium ATPase-
ARTEMETHER (always used with LUMEFANTRINE)
6) Inhibits haem metabolism-
LUMEFANTRINE
6 Malaria Treatments
1) Inhibit HAEM POLYMERASE
2) Blood SCHIZONTICIDE
3) Inhibits PLASMODIAL PROTEIN SYNTHESIS
4) Inhibits DIHYDROFOLATE REDUCTASE
5) Inhibits FALCIPARUM sarcoplasmic-endoplasmic reticulum calcium ATP-ase
6) Inhibits HAEM METABOLISM
Malarial treatments that inhibit HAEM POLYMERASE
Chloroquine
Quinine
Malarial treatments that are blood SCHIZONTICIDE
Mefloquine (Lariam)
Primaquine
Malarone
Malarial treatment that inhibit PLASMODIAL PROTEIN SYNTHESIS
DOXYCYCLINE
Malarial treatment that inhibit DIHYDROFOLATE REDUCTASE
Pyrimethamine
Malarial treatment that inhibit FALCIPARUM sarcoplasmic-endoplasmic reticulum calcium ATP-ase
ARTEMETHER (always use it with LUMEFANTRINE)
Malarial treatment that inhibit HAEM METABOLISM
LUMEFANTRINE
Causes of Tuberculosis
Mycobacterium tuberculosis (ACID-FAST bacteria)
Pathophysiology of PRIMARY Pulmonary TB (3 things)
- Initial TB infection
- GHON FOCUS formation in UPPER LOBES
Pathophysiology of SECONDARY Pulmonary TB (3 things)
- Occurs AFTER primary infection
- Dormant TB is REACTIVATED
- Fibrocaseous Lesions
Five other forms of TB
- Miliary
- Genitourinary
- MENINGITIS
- Bone (Pott’s disease of the spine)
- Peritoneal
Signs and Symptoms of TB
- Night Sweats
- HAEMOPTYSIS
- WEIGHT LOSS
- Cough/ Fever
Investigations in TB
- Sputum culture (OGAWA/ LOWENSTEIN medium)
- Sputum stain: ZIEHL-NEELSEN stain
- Transbronchial biopsy- GRANULOMAS are diagnostic
- Pleural fluid analysis and biopsy
- CXR for infiltrates and cavitations. Lesions described as MILLET SEEDS in MILITARY TB
Treatment for TB
RIPE
Rifampicin
Iconiazid
Pyrazinamide
Ethambutamol
Other drugs in therapy-
- Streptomycin/ Quinolones/ Amikacin/ Capreomycin
8 types of Human Herpes Virus
HHV-1- Herpes labialis
HHV-2- Herpes genitalia
HHV-3- VARICELLA ZOSTER
HHV-4- EPSTEIN-BARR
HHV-5- CYTOMEGALOVIRUS
HHV-6- Roseola Infantum
HHV-7- Closely related to HHV-6
HHV-8- Kaposki’s Sarcoma (associated with HIV)
Two Types of HIV
HIV 1-
- TYPE M-A-J- Prevalent in Europe, America, Australia, Sub-Saharan Africa
- TYPE O- Prevalent in Cameroon
HIV 2-
- WEST AFRICA
4 Transmissions of HIV
- Unprotected sex
- Contaminated Needles
- Contaminated blood transfusions
- Vertical transmission (via breast milk)
2 Antigens on HIV
Gp120- binds to CD4+ receptors on T cell-
- Produces conformational change and needs to bind to a coreceptor CCR5 or CXCR4
Gp41- binds to coreceptor
- Causes ‘six-helix bundle formation’ and fusion of viral and host membranes
Long terminal repeat sequences used by host cells to manufacture new HIV virions
TAT and REV
3 Genes required for viral replication in HIV
POL- encodes REVERSE TRANSCRIPTASE and INTEGRASE
ENV- encodes envelope proteins (Gp120)
GAG- encodes VIRAL STRUCTURAL PROTEINS
Investigations in HIV
Bloods-
- HLA-B*5701 status
- ELISA
- Western blot test
- Immunofluorescence assay
- Nucleic acid testing
Virology-
- Cytomegalovirus antibody
- Hepatitis Serology
- HIV antibody
- TB (if indicated)
Treatment for HIV
HIGHLY ACTIVE RETROVIRAL THERAPY (HAART)-
- 2NRTIs with 1 NNRTI
Or - 2NRTIS with 1 PI or 1 II
- Nucleoside Reverse Transcriptase Inhibitor (NRTI)
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
- Protease Inhibitor (PI)
- Integrase Inhibitor (II)
Examples for NRTI, NNRTI, PI, II (HIV Treatment)
NRTI- Zidovudine
NNRTI- Nevirapine
PI- Indinavir
II- Raltegravir
Complications of HIV
Increased risk of opportunistic infections-
- CMV (RETINITIS)
- Cryptococcal meningitis
- Pneumocystic JIROVECCI pneumonia
- Mycobacterium avium complex
Increased risk of malignancies-
- Non-Hodgkin’s Lymphoma
- Anal cancer
- Cervical cancer
- KAPOSKI’s sarcoma
Trichonomas vaginalis (STI)
(PROTOZOAN)
Symptoms-
Investigations-
Treatment-
Complications-
Symptoms-
- FISHY, BUBBLY THIN DISCHARGE
- Strawberry cervix is visible
Investigations-
- Cervical smear
- Rapid antigen testing
- PCR
Treatment-
- METRONIDAZOLE
- Intravaginal CLOTRIMAZOLE during pregnancy
Complications-
- Increased risk of:
1) HIV
2) Cervical cancer
3) PRETERM DELIVERY
Gardnerella vaginalis (NOT an STI)
(BACTERIAL VAGINOSIS)
Symptoms-
Investigations-
Treatment-
Symptoms-
- FISHY, GREY DISCHARGE
- CHALMYDIA
- GONORRHOEA
Investigations-
- Microscopy
Treatment-
- METRONIDAZOLE
- CLINDAMYCIN
Treponema pallidum (STI)
(SYPHILIS)
Symptoms-
Investigations-
Treatment-
Complications-
Symptoms-
- Three stages-
1) superficial ulceration
2) rash on palms and soles
3) CARDIAC and NEUROLOGICAL involvement
Investigations-
- VDRL
- RPR
- FTA
- Treponema Pallidum tests
Treatment-
- Procaine Penicillin G
- Doxycycline
- Erythromycin
- Azithromycin
- If the patient has NEUROSYPHILIS, give then prophylactic PREDNISOLONE to avoid JARISCH-HERXHEIMER reaction, which may occur after ANTIBACTERIAL TREATMENT as ENDOTOXINS are released
Chlamydia trachomatis
(CHLAMYDIA)
Investigations-
Treatment-
Complications-
Investigations-
- Chalmydia cell culture
- NAAT
- DFA
Treatment-
- AZITHROMYCIN
- or DOXYCYCLINE (7 days)
Complications-
- Pelvic inflammatory disease
- URETHRITIS
- Postpartum ENDOMETRITIS
- Infertility
Neisseria gonorrhoeae
(GONORRHOEA)
Investigations-
Treatment-
Complications
Investigations-
- NAAT
- Cultured in CHOCOLATE AGAR
Treatment-
- AZITHROMYCIN
- or CEFTRIAXONE
Complications-
- Pelvic inflammatory disease
- Infertility
- Dissemination of bacteria
GRAM POSITIVE BACTERIA staining
- stain blue and pink
- RETAIN color when washed with ETHANOL and WATER
- GRAM POSITIVE don’t retain color when washed with ETHANOL and ACETONE
GRAM POSITIVE 6 types
SS LAND
- Staphylococcal infections
- Streptococcal infections
- Listeriosis
- Anthrax
- Nocardia
- Diptheria
GRAM NEGATIVE 6 types
GN PPCW
- Granuloma inguinale
- Neisserial infections
- Pseudonomas infections
- Plague
- Chancroid
- Whooping cough
Staphylococcus aureus-
5 causes
3 virulence factors
EPOST-
- Endocarditis
- Pneumonia
- OSTEOMYELITIS
- Skin infections
- Toxic SHOCK syndrome
SET-
- Surface proteins for adherence
- Enzymes
- Toxins
GROW in CLUSTERS
Streptococcal infections-
2 Examples-
3 Virulence factors-
Streptococcus pneumoniae- ACQUIRED PNEUMONIA and MENINGITIS
Enterococci- UTI and ENDOCARDITIS
Virulence factors-
- Capsules which resist PHAGOCYTOSIIS
- M PROTEINS, which inhibits the alternative pathway of the COMPLEMENT SYSTEM
- PNEUMOLYSIN- destroys membrane of host cells
GROWS in PAIRS or CLUSTERS
Listeriosis
What does it cause?
Meningitis in ELDERLY
Meningitis in IMMUNOSUPPRESSANT
What does ANTHRAX release?
Spores
3 facts about NOCARDIA
- Aerobic
- Branched clusters
- Respiratory infections with CNS involvement
2 facts about Diphtheria
- ROD shaped
- EXOTOXIN causes damage to HEART and NERVES
The 2 Gram Negatives that cause ULCERATIVE GENITAL INFECTION
Granuloma inguinale (KLEBSIELLA GRANULOMATIS)
Chancroid
2 Neisserial infections
Meningitis
Gonorrhoea
TRANSIENT VIRAL INFECTIONS
MR WIMP
Measles
Rhinovirus
West Nile virus
Influenza
Mumps
Polio
What causes Measles rash?
Hypersensitivity to virus antigen within skin
Which virus causes common cold?
Rhinovirus
What does West Nile virus cause?
Meningitis
Encephalitis
- by invading CNS
- seen in elderly and immunocompromised
What does Mumps cause?
inflammation of Parotid glands
sometimes travels to CNS, pancreas and testes
Epstein-barr virus
- Associations
- Presentation
- what does it cause?
Associations-
- BURKITT’s Lymphoma
Presentation-
- Sore throat and fever
What does it cause?
- INFECTIOUS MONONUCLEOSIS
What is HPV associated with?
Cervical cancer
Advantages and Disadvantages of DNA viruses
Advantages-
- Plasmids are easily manufactured and DO NOT REPLICATE
- DNA is stable and sequencing may be changes
- Resists temperature changes so easy to store and transport
Disadvantages-
- Plasmids could integrate into host genome
- Immunological tolerance
Which vaccinations to avoid in IMMUNOCOMPROMISED PATIENTS and those living in TROPICAL AREAS
ATTENUTATED vaccinations-
- Polio
- MMR
- Varicella rotavirus
- YELLOW FEVER
