Immunity 2 Flashcards
All of the following are mediators released by mast cells upon an antigen binding to IgE on their surface, except\_\_\_?\_\_\_ . A Prostaglandins B Histamine C Leukotrienes D Cytokines E Antibodies
Antibodies
- Type I Immune Mediated Disease
- Unexplained periodic swelling –may involve lip or be around the eye
- “Quincke disease”, “angioneurotic edema”
- Rapid, recurring, diffuse, edematous swelling of subcutaneous or submucosal soft tissues –frequently the lips
- May involve gastrointestinal or respiratory tract mucosa
- The common clinical presentation of a group of conditions with different pathogenesis
Angioedema
- IgE-mediated hypersensitivity–Type I hypersensitivity reaction–Mast cell degranulation and histamine release
- Physical stimuli
- Contact allergy
- Responds to antihistamines
Allergic angioedema
Which T helper cell is involved in hypersensitivities?
Th2
•High prevalence of atopic disease in developed countries (20%) compared to developing countries
•Individuals living in a more “hygienic” (Western) environment
–Precludes early and extensive antigen exposure
–Leads to a higher likelihood of a Th2 response to antigens
Hygiene hypothesis
•Type __Hypersensitivity Reaction:
Antibody-Mediated Hypersensitivity
•Tissue damage mediated by antibodies IgG, IgM
Type II
What 2 cells are the targets of type 2 hypersensitivity reactions?
Erythrocytes
Platelets
What is the cell surface receptor that is the target of Type 2 hypersensitivity rxns?
Acetylcholine receptor
What are the 2 ECM materials that are the targets of type 2 hypersensitivity reactions?
Laminin
Desmoglein
ABO mismatch leads to ______
Intravascular hemolysis
An individual who has blood Type O has: A The ability to be a universal donor B The ability to be a universal recipient C Type A and B antigens D Antibodies to Type O blood
The ability to be a universal donor
- Antibody blocks acetylcholine receptor
* Antibody mediated inhibition of cell function
Myasthenia gravis
•Antibody-mediated stimulation of cell function
•Antibody stimulates TSH receptor
Antibody mediated stimulation of cell function
Graves disease
- Autoantibodies to basement membrane antigens–BP180–Laminin5 (epiligrin)
- Nikolsky sign
- Hemidesmosomes
- Sub-epithelial splitting process
Mucous membrane pemphigoid
- Autoantibodies against desmosomal proteins
- Desmoglein-3, a glycoprotein component of desmosomes
- Nikolsky sign
Pemphigus Vulgaris
Myasthenia gravis is an example of:
A Antibody mediated stimulation of cell function
B Antibody mediated inhibition of cell function
C A Type I immune reaction
D Immediate hypersensitivity
Antibody mediated inhibition of cell function
What antibodies are seen in type 2 and 3 hypersensitivities?
IgM and IgG
•Type ____ hypersensitivity: antibodies are directed against antigens and get phagocytosed or lysed
Type II
•Type ____ hypersensitivity: Antigen-antibody complexes that circulate and activate complement
Tissue damage in multiple organ systems in both mild and severe forms
Type III
Type ____ hypersensitivity:
–Immediate onset
–IgE
–Rash, cough, difficulty breathing happens immediately
Type 1
Type ____ hypersensitivity:
–Delayed onset
–Antibody independent
–Takes days
Type 4
- Pharyngitis caused by certain strains of Streptococci (“Strep throat”) –exogenous antigen
- Antigen excess Immune complexes
- Immune complexes filter out in renal glomeruliComplement
- Glomerulonephritis –proteinuria, hematuria, hypertension, fever, lower back pain
Post-streptococcal glomerulonephritis
•A multisystem autoimmune disease most common in adult women in child-bearing years
•Type III Hypersensitivity
-Immune Complex Disease
•Autoantibodies–anti-nuclear antibodies (ANA)
•Butterfly rash
Lupus Erythematosus
The following organs are involved in \_\_\_\_\_\_ •Skin •Joints •Kidney •Heart: Libman-Sacks endocarditis •Pericarditis, pleuritis •Central nervous system •Arthritis, arthralgia, anemia, bone marrow depression, vasculitis, skin rashes
Systemic lupus erythematosus
- Most common form of lupus
- Highest morbidity–Glomerulonephritis renal failure
- Butterfly rash 50%–Malar area and nose, aggravated by sunlight
- Libman-Sacks endocarditis
- Arthritis, arthralgia, heart and lung involvement, anemia, bone marrow depression, vasculitis, skin rashes
Systemic lupus erythematosus
- Non-bacterial endocarditis
- Systemic lupus erythematosus
- Mitral valve
- Small, sterile vegetations
- Risk for infective endocarditis
Libman-Sacks Endocarditis
If you have four or more of the following, you have _____
•Facial erythema (especially butterfly rash)
•Skin rash
•Raynaud phenomenon (cold sensitivity in hands and feet)
•Alopecia (loss of hair)•
Photosensitivity
•Anemia, leukopenia, thrombocytopenia
•Arthritis
•Oral, nasal or pharyngeal ulcers
Lupus
•Type III Hypersensitivity -Immune Complex Disease
•Sometimes follows infections or drugs
-Only mucosal surfaces
•An immunologically mediated self-limited, mucocutaneous disease
•Young adults
•Sudden onset of widespread, painful superficial mucosal ulcers and target lesions of skin
•Hemhorragic crusted ulcers on lips
•Targetoid“bullseye” lesions on skin
•May be recurrent
•May follow infection -herpes simplex, mycoplasma pneumoniae
•May follow drug exposure –antibiotics, analgesics
•“Drugs and Bugs”
•Prodromal symptoms
•Sudden onset of mucocutaneous lesions
•Self-limiting disease–Lasts 2-6 weeks–Avoid dehydration
•Recurrent episodes
•Lesions may be limited to oral mucosa
Erythema Multiforme
What type of lesion is a tell-tale sign of erythema multiforme?
Bullseye lesion
- Type III Hypersensitivity -Immune Complex Disease
- Reaction to proteins in antiserum derived from a non-human animal source–occurs 5–10 days after exposure–Immunization with vaccine developed from horse/mouse serum
- Immune complexes form and settle out in tissues
- Synovial membranes –arthritis, fever, rash, arthralgia
Serum sickness
- Type III Hypersensitivity -Immune Complex Disease
- Local reaction
- Antigen-antibody complexes trigger complement cascade and sterile vasculitis at site of injection
Arthus reaction
The following autoimmune diseases involve _____ organs:
•Autoimmune thyroiditis (Hashimoto disease)
•Autoimmune thyroiditis (Graves disease)
•Autoimmune (Idiopathic) thrombocytopenic purpura (ITP)
•Myasthenia gravis
•Autoimmune atrophic gastritis in pernicious anemia
Single Organs
The following autoimmune diseases involve \_\_\_\_\_ organs: •Systemic lupus erythematosus •Systemic sclerosis (scleroderma) •Rheumatoid arthritis •Sjogren syndrome
Multiple organs
•Type IV delayed hypersensitivity reaction to protein from M. tuberculosis
•Intracutaneous tuberculin injection
•T-cells sensitized by prior infection recruited to area
induration
Mantoux Tuberculin Skin Test
____ immunological tolerance
–Developing T cells
•deletion of self-reacting T cells in the thymus–Developing B cells
•receptor editing or deletion of self-reacting B cells in the bone marrow
•Central tolerance
____ immunological tolerance
Peripheral tolerance–Anergy= functional inactivation
–Suppression by regulatory T cells
–Deletion by activation-induced cell death
Peripheral tolerance
- Chronic, systemic inflammatory disease–joints, skin, blood vessels, lungs, muscles–Vs. Osteoarthritis(degenerative joint disease –DJD)
- not a systemic disease
- Genetic susceptibility
- Environmental arthritogen
- white blood cells attack synovium–membrane the body uses to protect and line the joints.
Rheumatoid Arthritis
________ is an autoantibody–Antibody against an antibody
•IgM autoantibody to the Fc portion of IgG
•+ in 80% with rheumatoid arthritis
Rheumatoid factor
–Not diagnostically specific
–Associated with other autoimmune diseases
•Antinuclear Antibodies (ANAs)
–Also non-specific
–Useful in monitoring disease activity
•Erythrocyte Sedimentation Rate (ESR)
•Autoimmune disease of adults, predominately females –excessive fibrosis
•May be limited to the skin or be widespread affecting various organ systems
•May be associated with other autoimmune diseases
-Fibrosis stiffness deformity
-Ischemia atrophy and ulceration
Systemic sclerosis
The following are oral findings in \_\_\_\_\_\_\_\_\_ •Microstomia •Ankyloglossia •Xerostomia •Generalized widening of PDL space •Mandibular resorption
Systemic sclerosis
- Arterial spasm in response to cold or emotional stress •Pallor, cyanosis and then erythema
- Numbness, tingling or pain on recovery
Raynaud Phenomenon
What are the 5 components of the CREST SYNDROME
Calcinosis cutis Raynaud Phenomenon Esophageal dysfunction Sclerodactly Telangiecstasia
•Chronic, systemic autoimmune disease–may be associated with other autoimmune diseases
•Middle-aged females (9:1)
•Benign lymphoepithelial lesion (BLEL)salivary gland enlargement
•Dry eyes and dry mouth (sicca syndrome
•Increased risk of lymphoma
•Autoantibodies to ribonucleoproteins
–Anti-SS-A (anti-Ro)–Anti-SS-B (anti-La)
•Rheumatoid factor (RF) –IgM autoantibody to the Fc portion of IgG–70%
•Anti-nuclear antibodies (ANA)–50-70%
•Anti-salivary duct antibodies
Sjogren syndrome
CREST syndrome is associated with all of the following except:
A Systemic Sclerosis
B Reynaud phenomenon
C Telangiectasias on the skin
D Autoimmune destruction of beta cells of the pancreas
Autoimmune destruction of beta cells of the pancreas
