Immunity Flashcards
What are the characteristics of the acquired immune response?
- Defend the body against injury
-Memory capability
-Responds quicker than inflammatory response
-Involved network of WBCs
-May result in increased tissue damage and disease as it fights
What are antigens?
Foreign substances that the body will react to
What components of the body can act as antigens?
Tumor cells
Cells infected with viruses
Organ transplant
Tissue graft
Incompatible blood transfusion
Cells of our own body: autoimmunity
What are auto immune diseases?
When the immune system recognizes a body cell as an antigen
What do we call it when the immune system has an overreaction to antigens
Hypersensitivity
What are the cells involved in the immune response?
Cytokines
Lymphocytes: B-cell, T-cell, NK cells
Macrophages
Dendritic cells
What are the primary WBCs involved in the immune response?
Lymphocytes
Characteristics of antibody-mediated immunity
-Production of antibodies
-Protection against bacteria and viruses
-B cells are the primary cells
Characteristics of cellular immunity
-T cells are the primary cells
-Regulates both major immune responses
What is passive immunity?
Can be natural or acquired
Uses antibodies created by another person to prevent infectious disease
Natural= mother to fetus
Acquired= injection
What is active immunity?
Can be natural or acquired
Immunity which results from the production of antibodies by the immune system in response to the presence of n antigen
What is immunopathology?
The study of immune reactions involved in disease; the study of diseases caused by the malfunctioning of the immune system
Ex: Hypersensitivity, autoimmune disease, immunodeficiency
What is Type I Hypersensitivity?
Immediate (Anaphyylactic)
Reaction occurs within minutes
Plasma cells produce IgE- release histamine
Reactions can range
What is Type II Hypersensitivity?
Cytotoxic type- antibodies combine w/ an antigen bound to the surface of tissue cells, usually RBCs
Tissues that have the antigen on the surface are destroyed
What is Type III Hypersensitivity?
Immune complex type (serum sickness)
-Immune complexes are formed between microorganisms and antibodies in circulating blood
-Tissue destruction occurs after phagocytosis by neutrophils
What is Type IV Hypersensitivity?
Cell-Mediated Type (delayed)
-T-cells previously introduced to an antigen cause damage to tissue cells or recruit other cells
-Responsible for the rejection of tissue grafts and organ transplants
Drugs acting as antigens
Topical appliction may cause MORE reactions
Parenteral route may cause more widespread and severe reactions
What is the difference between immunologic tolerance and autoimmune disorder?
In immunologic tolerance the body learns to distinguish the body’s cells from invading antigens
In autoimmune disorders that recognition breaks down and some cells are treated as foreign objects with the body attacking itself
What is immunodeficiency?
- Condition in which there is a deficiency in number, function or interrelationships of the involved WBCs
- May be congenital or acquired
What are some examples of oral immunoligic lesions and diseases?
- Aphthous ulcers
- Urticaria and angioedema
- Contact mucositis and contact dermatitis
- Erythema multiforme
- Lichen planus
- Reactive arthrisis (Reiter Syndrome)
What are aphthous ulcers?
Painful oral ulcers with an unclear cause
-Trauma is most comon precipitating factor but may also be caused by stress, certain foods or systemic diseases
What may cause recurrent aphthous ulcers (canker sores/aphthous stomatitis)?
- Trauma
- Perceived food associations
- Menstruation
- Systemi diseases
Characteristics of MINOR aphthous ulcers
- Discrete, round or oval
- On movable mucosa
- Up to 1cm in diameter
- Erythematous halo surrounding a yellowish-white fibrin surface
- May have single or multiple lesions
- May have prodrome of 1-2 days
Characteristics of MAJOR aphthous ulcers
- Larger than minor- >1cm
- Deeper and longer lasting
- Very painful
- Occur more often in the posterior of the mouth
- May requrie several weeks to heal
- May require biopsy
What are the 3 forms that aphthous ulcers occur in?
- Minor
- Major
- Herpetiform
Characteristics of herpetiform ulcers
- Tiny- 1 to 2mm
- Resembles herpes simplex
- Painful, generally occur in groups
What are some systemic diseases that aphthous ulcers can b an early manifestation of?
- Chronic GI symptoms
- Crohn’s Disease
- Celiac
- IBD
- Intestinal lymphoma
- Ulcerative colitis
- Arthritis
- Skin lesions (Behcet Syndrome)
- Childhood periodic fevers)
What is the treatment for aphthous ulcers?
- Topical corticosteroids
- Topical nonsteroidal anti-inflammatory drugs (NSAIDS)
- Pain relief: lidocaine, benzocaine
- Systemic steroids
- Nicotine replacement therapy
What is urticaria?
Hives
Appear as multiple areas of well-demarcated edema and erythema of the skin
May be itchy
What is angioedema?
Lesions caused by diffuse swelling as a result of increased permeability of deeper BV
-Skin appears normal
-Usually does not itch
What are the causes of urticaria and angioedema?
- Idiopathic
- Infection
- Trauma
- Emotional stress
- Systemic disease
- Ingested allergens
What is the treatment for urticaria and angioedema?
- Antihistaminic drugs
- Epinephrine
What is allergic contact mucositis and dermatitis?
- Lesions that result from contact of an allergen with skin or mucosa
- Involves T cells in a cell-mediated immune response
- Type IV hypersensitivity
Possible causes of contact mucositis and dermatitis
- Preservatives in LA
- Topical meds
- Acrylics
- Metal-based alloys
- Epoxy resins
- Flavoring agents
- Gloves
Treatment for contact mucositis an contact dermatitis
- Topical corticosteroids
- Systemic corticosteroids
What is erythema multiforme?
Acute, self-limited disease that affects skin and mucous membranes
Cause is not clear
Target or bullseye lesion
How is Erythema Multiforme diagnosed?
Diagnosis is made based on clinical features and exclusion of other diseases
Lesions on the eyes may lead to blindness
What is treatment for erythema multiforme?
- Remove cause, if possible
- Topical or systemic corticosteroids
- Systemic antiviral medications
What is Stevens-Johnson Syndrome?
- Variant of toxic epidermal necrolysis
- Extensive and painful oral lesions
- Gentical mucosa and mucosa of eyes may be involved
- Lips generally are encrusted and bloody
What is lichen planus?
Benign, chronic disease affecting the skin and oral mucosa
Unknown cause
Lesions are lace-like
Most commonly on buccal mucosa
What are the types of lichen planus?
- Reticular lichen planus (most common)
- Erosive and bullous lichen planus (epithelium separates from CT)
- Desquamative gingivitis
Treatment for lichen planus
- Treated when symptomatic
- Topical corticosteroids
- Meticulous oral hygiene
- Discontinuation of drugs causing condition
- Regular oral examination
- Biopsy necessary due to increased risk of development of squamous cell carcinoma
What are the oral manifestations of reactive arthritis/Reiter Syndrome?
May see aphthous ulcers, erythematous lesions, and geographic tongue-like lesions
Autoimmune diseases with oral manifestations
- Sjogren Syndrome
- Systemic lupus erythematosus
- Pemphigus Vulgaris
- Mucous membrane pemphigoid
- Bullous pemphigoid
- Behcet Syndrome
What is Sjogrens Syndrome?
Afefcts the salivary and lacrimal glands
Results in a decrease in saliva and tears causing drymouth and dry eyes
Affects both major and minor salivary glands
What are some symptoms of Sjorgren syndrome?
- Oral discomfort caused by dry mouth
- Lips are cracked and dry
- May see loss of filiform papillae on the dorsum of tongue
- High risk for caries, perio disease and oral candidiasis
How is diagnosis of Sjogren syndrome?
3 components must be present:
* Xerostomia confirmed by measurement of salivary flow
* Keratoconjunctivitis confirmed by eye exam
* Rheumatoid arthritis
How is Sjogren Syndrome treated?
- Treated symptomatically with nonsteroidal antiinflammatory agents for arthritis
- Saliva substitutes for xerostomia
- Glasses and/or artirficial tears to protect eyes
- Good oral hygiene
- Fluoride
- Frequent re-care appointments
Characteristics of systemic lupus erythematosus
- Acute and chronic inflammatory autoimmune disease w/ no known cause
- Affects women 8x more than men, mostly during childbearing years
- Wide range of disease activity- periods of remission and exacerbation
- May have a genetic component
What are some clinical features of systemic lupus erythematosus?
- Skin lesions occur in 85% of individuals
- “Butterfly” rash on bridge of nose
- Lesions may be present on fingertips
- Arthristis and arthralgia are common
- Oral lesions accompany skin lesions in 25% of pts
How is systemic lupus erythematosus diagnosed?
Based on multi organ involvement and presence of antinclear antibodies in serum
How is systemic lupus erythematosus treated?
Aspirin and antiinflammatory drugs
Hydroxychloroquine and corticosteroids along with immunosuppresive agents
What is pemphigus vulgaris?
Severe, progressive autoimmune disease affecting the skin and mucous membranes
How is pemphigus vulgaris characterized?
- Intraepithelial blister formation resulting from acantholysis (breakdown of cellular adhesion btw epithelial cells)
- First signs of disease occur in the oral cavity in >50% of cases
- May be shallow ulcers, fragile vesicles, bullae
How is pemphigus vulgaris treated?
- High doses of corticosteroids and may include immunosuppressive drugs
- 8%-10% mortality rate in 5 years due to complications from steroid use
Characteristics of benign mucous membrane pemphigoid
Desquamative gingival lesions
Rubbing with a finger will produce a bulla
What is Nikolsky sign?
When rubbing with a finger can produce a bulla
Treatment for mucous membrane pemphigoid
- Topical corticosteroid for mild cases
- Systemic corticosteroids may be required for severe cases
- Eye lesions can lead to eye damage
Occurance of bullous pemphigoid
- Thought to be a variant of the same disease as mucous membrane pemphigoid
- Occurs mostly in patients over 70 years old
- Oral lesions are less common
- Treatment with systemic corticosteroids
What is Behcet Syndrome?
- Chronic, recurrent autoimmune diease
- Primarily oral and genital ulcers and ocular infammation
- Similar in appearance to aphthous ulcers
How is a diagnosis made for Behcet syndrome?
- Requires two of three types of lesions presnt: oral, genital, ocular
- Pustular lesion after needle puncture
How is Behcet syndrome treated?
- Systemic and topical corticosteroids
- Chlorambucil used for ocular lesions
What are the two categories of immunodefieciency diseases?
- Primary and secondary
- Signs and symptoms will depend on the degree of defiecieny and type of immune response
What are 3 types of primary immunodeficiencies?
- Isolated IgA deficiency
- X-linked congenital agammaglobulinemia (Bruton disease)
- Thymic hypoplasia (DiGeorge Syndrome)
What is isolated IgA deficiency?
Most common primary immunodefieciency
Characterized by low levels of both serum and secretry IgA
What is x-linked dongenital agammaglobulinemia (Bruton Disease)?
Disorder in which b-cell precursors stop maturing before they complete immunoblobulin gene development
What is thymic hypoplasia (DiGeorge Syndrome)?
- Disorder in which the thymus is deficient or lacking
- Infants and children xtremely susceptible to fungal and viral infections and bacterial infections that require t-cell and b-cell cooperation
What does severe combined immunodeficiency mean?
Group of genetically inherited syndromes that have defects in both humoral and cell-mediated immune response
What is leukocyte adhesions deficiency?
Primary immunodeficiency characterized by defects in function of neutrophils
What are secondary immunodeficiencies?
- Those that occur as a result of an underlying disorder
- Much more common than primary
