Immunity and Immunologic Oral Lesions- ash Flashcards
How does the immune response differ from the inflammatory response?
The immune response has the capacity for memory, allowing it to recognize and respond faster to pathogens it has encountered before, while the inflammatory response does not have memory.
What are the key features of innate immunity (natural, native)?
- First line of defense, immediate
- Always present, ready to provide defense against microbes and to eliminate damaged cells
- does NOT memory or antigen specificity
What are the components of innate immunity?
- Epithelium provides mechanical barrier
- Phagocytic cells (neutrophils and macrophages) in the blood that can be recruited
- Dendritic cells in the epithelium, lymphoid organs, and most tissue
- Natural killer cells
- Several plasma proteins
What are the key features of adaptive immunity (acquired, specific)?
- stimulated by microbes and can recognize microbes
- More powerful than innate immunity in fighting infections
- Has MEMORY, leading to increased responsiveness upon re-exposure to the same invader
- Primary white blood cells involved are lymphocytes: T cells, B cells, and natural killer (NK) cells
what are antigens?
An antigen is a foreign substance, such as proteins on microorganisms, that triggers the immune system to defend the body.
What is the goal of the immune system?
The goal is to identify self from non-self to protect the body.
How can transformed human cells become antigenic?
Transformed human cells, such as neoplastic (cancer) cells or virus-infected cells, can become antigenic, triggering an immune response.
What is an autoimmune disease?
It’s when the body’s immune system mistakenly identifies parts of its own body as antigens and attacks them.
What is immunodeficiency?
It’s when the body’s immune system doesn’t recognize certain antigens as foreign, leading to a weak immune response.
What is a hypersensitivity reaction?
It’s when the body overreacts to something it sees as foreign
What is the role of the bone marrow in the immune system?
The bone marrow is a primary lymphoid organ, serving as the birthplace of immune cells and the “factory” for B cells.
What type of cells are found in the bone marrow?
The bone marrow contains pluripotent hematopoietic stem cells, which can differentiate into various types of blood cells, including immune cells.
Where is bone marrow located, and how does it change with age?
Bone marrow is found in the hollow shafts called medullary cavities. As a person ages, red marrow converts to yellow marrow, which contains more fat cells. In adults, red marrow is mainly found in the central skeleton, such as the pelvis, sternum, ribs, and vertebrae.
What is the role of the thymus in the immune system?
The thymus is a primary lymphoid organ and serves as the “T-cell factory.” Lymphocytes migrate here from the bone marrow to mature into T cells.
What is the role of the spleen in the immune system?
The spleen is a secondary lymphoid organ that acts as a filter for the circulatory system and responds to antigens in the blood.
What is the largest lymphatic organ in the body?
spleen
What is the function of the spleen in terms of filtering and lymphocytes?
The spleen is a filtering organ that filters the blood and contains 25% of the body’s mature lymphocytes.
How do lymph nodes and the spleen differ in terms of their response to influences?
Lymph nodes respond primarily to regional influences, while the spleen responds to systemic influences.
How long do T cells and B cells take to travel through the body?
The transit time for T cells is about 5-6 hours, while B cells take longer to travel.
What are the main components of the spleen?
The spleen is encapsulated and contains two main parts:
- White pulp, which contains lymphoid cells and is involved in immune responses.
- Red pulp, which is the blood-filtering system that removes old or damaged blood cells.
What is the role of lymph nodes in the immune system?
Lymph nodes are secondary lymphoid organs that act as mini regional filters in the lymphatic system, filtering lymph and responding to local infections or antigens.
What does Mucosal-Associated Lymphoid Tissue (MALT) consist of?
MALT consists of non-encapsulated clusters of lymphatic tissue found in various submucosal sites throughout the body. It is populated by lymphocytes, plasma cells, and macrophages, which are ready to encounter antigens trying to pass through mucosal surfaces
Where is Mucosal-Associated Lymphoid Tissue (MALT) found?
MALT is found at the gateways to the body, including:
- Waldyer’s ring in the oropharynx
- Peyer’s patches in the small intestines
- Gut-associated lymphoid tissue (GALT) along the gastrointestinal tract.
Where do T-cell lymphocytes develop, mature, and reside?
T-cell lymphocytes develop in the bone marrow, mature in the thymus, and reside in lymphoid tissue and blood.
How do T cells recognize antigens?
T cells use a special receptor called the T-cell receptor (TCR) on their surface to recognize antigens. All processed antigens are presented to T cells via the major histocompatibility complex (MHC) expressed on antigen-presenting cells (APCs).
What is the function of T helper (CD4+) cells?
T helper (CD4+) cells increase the functioning of B cells.
What is the function of T cytotoxic (CD8+) cells (natural killer T cells)?
T cytotoxic (CD8+) cells (natural killer T cells) destroy virus-infected cells and tumor cells.
What is the function of T suppressor (T regulatory) cells?
T suppressor (T regulatory) cells suppress the functioning of B cells.
What is the function of T memory cells?
T memory cells retain the memory of antigens to provide a faster immune response in the future.
Where do B-cell lymphocytes develop and mature?
B-cell lymphocytes develop in the bone marrow and mature in lymphoid tissues such as the spleen, lymph nodes, and tonsillar tissue.
What is the function of B memory cells?
B memory cells retain the memory of the antigen for a quicker response if encountered again.
What is the function of plasma cells?
Plasma cells make antibodies, which are called immunoglobulins when circulating in the blood.
What is the function of B suppressor (B regulatory) cells?
B suppressor (B regulatory) cells are immunosuppressive, helping to regulate immune responses.
What is an antibody?
An antibody is a protein molecule or immunoglobulin secreted by plasma cells that reacts with a specific antigen.
What are the five classes of antibodies?
The five classes of antibodies are IgA, IgD, IgE, IgG, and IgM.
What is an immune complex?
An immune complex is the combination of an antigen and an antibody.
Where are natural killer (NK) cells located?
NK cells are located in the microcirculation.
Where do natural killer (NK) cells originate?
NK cells are derived from bone marrow stem cells.
What role do natural killer (NK) cells play in the immune system?
NK cells play a more significant role in the innate immune system rather than the adaptive immune system.
What do natural killer (NK) cells destroy?
NK cells destroy irreversibly stressed and abnormal cells, such as virally infected cells and tumor cells.
Where are dendritic cells located?
in the skin and mucosa.
What is the function of dendritic cells in the immune system?
are antigen-presenting cells (APCs) that present antigens to initiate the adaptive immune response.
What happens when dendritic cells are activated?
Once activated, dendritic cells migrate to lymph tissue to interact with T and B cells, helping to initiate the adaptive immune response.
What is the Langerhans cell?
The Langerhans cell is a specialized type of dendritic cell found in the skin.
Where do macrophages originate?
Macrophages are derived from monocytes in the blood.
Where are macrophages found?
Macrophages are found in the tissue.
What role do macrophages play in the immune system?
Macrophages play a role in inflammation, active phagocytosis, and serve as antigen-presenting cells (APCs).
What cells are considered antigen-presenting cells (APCs)?
macrophages, B cells, and dendritic cells.
Can T cells recognize free or soluble antigens?
No, T cells cannot recognize or respond to free or soluble antigens. They can only recognize and respond to antigens that are processed and presented on MHC molecules.
What are some specific types of cytokines?
- interferons
- interleukins
- lymphotoxin
- macrophage-activating factor
- macrophage chemotactic factor
- migration inhibitory factor
- tumor necrosis factor.
What are cytokines?
Cytokines are messenger molecules produced by any cell that help in communication between cells in the immune response.
What is passive immunity, and how does it work?
Passive immunity involves the use of antibodies produced by another person to protect an individual against infectious diseases.
For example, antibodies are passed from mother to baby during pregnancy or breastfeeding.
What is active immunity, and how does it work?
Active immunity involves the production of antibodies by one’s own body to protect against infectious diseases.
What is an example of natural active immunity?
Natural active immunity occurs when a pathogenic microorganism causes disease and the host gains protection against further attacks.
How does vaccination provide active immunity?
In vaccination, a person is injected with an altered pathogenic microorganism or its products, which act as an antigen to stimulate the body’s immune system and protect against future infections.
What is immunization/vaccination?
Immunization/vaccination is a deliberate method of introducing antigens or weakened pathogens to stimulate an immune response, developing protective immunity against the organism without causing the person to become sick.
what are the types of vaccines?
Killed- type
Attenuated
Molecular
New approach: DNA vaccine
What is herd immunity?
Herd immunity is indirect protection from an infectious disease that occurs when a large percentage (70-90%) of the population becomes immune through vaccination or exposure and recovery.
simple: Herd immunity happens when most people in a community are immune to a disease, either through vaccination or recovery, making it harder for the disease to spread. This helps protect those who aren’t immune.
what is Immunopathology?
Diseases caused by malfunctioning of the immune system
What are hypersensitivity reactions?
are exaggerated immune responses to an antigen, causing tissue damage and immune system-related problems.
What are allergens?
are antigens that cause hypersensitivity or allergic reactions.
What is a Type 1 hypersensitivity reaction?
is an immediate (anaphylactic) reaction, where symptoms occur within minutes of exposure to a previously encountered allergen.
What are some examples of Type 1 hypersensitivity reactions?
include hay fever, asthma, and anaphylaxis.
How does a Type 1 hypersensitivity reaction occur?
IgE antibodies bind to mast cells, causing them to release histamine, which triggers the allergic reaction.
What is a Type 2 hypersensitivity reaction?
an antibody-dependent cytotoxic reaction, where antibodies bind to antigens on the surface of tissue cells.
What is an example of a Type 2 hypersensitivity reaction?
An example of Type 2 hypersensitivity is Rh incompatibility.
What is a Type 3 hypersensitivity reaction?
is an immune complex-mediated reaction, where immune complexes are deposited in various tissues, causing an acute inflammatory response.
What is an example of a Type 3 hypersensitivity reaction?
systemic lupus erythematosus (SLE), an autoimmune disease.
What is a Type 4 hypersensitivity reaction?
is a cell-mediated (delayed-type) reaction, where T cells cause damage to tissue cells and it takes 2-3 days to develop.
What are some examples of Type 4 hypersensitivity reactions?
include the tuberculin skin test, rejection of tissue grafts, and organ transplants.
How can drugs cause hypersensitivity?
Drugs can act as allergens and cause hypersensitivity or allergic reactions in some individuals.
Who is more likely to have allergic reactions to drugs?
Patients with multiple allergies are more likely to also have allergic reactions to drugs.
What happens in autoimmune disease?
the immune system treats the body’s own cells as foreign antigens, attacking them.
How extensive can autoimmune diseases be?
can involve a single cell type or organ, or they may be more extensive, affecting multiple organs.
What is the nature of autoimmune diseases?
tend to be chronic, often with relapses and remissions, and the damage is usually progressive.
Can autoimmune diseases have oral manifestations?
Yes, autoimmune diseases can have oral manifestations.
What is immunodeficiency?
Immunodeficiency is when the immune system is compromised or entirely absent, making a person more susceptible to infections and neoplasms.
Can immunodeficiency be congenital or acquired?
Yes, immunodeficiency can be either congenital (present at birth) or acquired (developing later in life).
What is an example of an immunodeficiency with oral manifestations?
AIDS from HIV infection
What are aphthous ulcers?
are painful sores that affect about 20% of the population and usually start in childhood.
what are aphthous ulcers known as?
canker sores
what is this?
aphthous ulcer
What causes aphthous ulcers?
The cause varies from person to person, but common triggers include toothpaste with sodium lauryl sulfate, NSAIDs, and trauma.
How long do aphthous ulcers take to heal?
typically heal within 7-10 days.
Are aphthous ulcers recurrent?
yes
location?
size?
aphthous ulcer
location: non-keratinized, non-bound down
size: 0.5-1.0cm
What is the purpose of prescription topical corticosteroids for aphthous ulcers?
They reduce inflammation and accelerate healing. Apply 2–4 times daily directly to the ulcer.
How does topical anesthetic lidocaine viscous 2% help with aphthous ulcers?
It provides temporary pain relief by numbing the area. Apply before meals to ease discomfort while eating.
What is the role of chlorhexidine gluconate 0.12% rinse for aphthous ulcers?
It helps reduce the risk of secondary infection and promotes oral hygiene. Rinse 2–3 times daily.
How do protective barriers/patches help with aphthous ulcers?
They form a protective layer over the ulcer to shield it from irritation. Apply as directed to create barrier
What additional recommendations help manage aphthous ulcers?
- Avoid spicy, acidic, or abrasive foods.
- Maintain good oral hygiene to prevent infections.
- Identify and avoid triggers like stress, trauma, and certain foods.
What is Behcet Syndrome?
a chronic, recurrent, multisystem autoimmune disease.
What type of inflammation is associated with Behcet Syndrome?
It involves systemic vasculitis, which is inflammation of the blood vessels throughout the body.
What are common symptoms of Behcet Syndrome?
Symptoms include aphthous-like oral ulcers, genital ulcers, and ocular (eye) inflammation.
How can nutritional deficiencies affect oral health?
Vitamin deficiencies can cause aphthous-like ulcerations in the mouth.
Which nutrient deficiencies are linked to aphthous-like ulcers?
Deficiencies in iron, folate, zinc, vitamin B1, B2, B6, and B12 can lead to these ulcers.
What is celiac disease?
is an illness caused by an immune response to eating gluten.
How does celiac disease affect oral health?
Patients with celiac disease can develop aphthous-like ulcerations in the mouth.
What are urticaria and angioedema?
They are skin and mucosal hypersensitivity reactions.
How does angioedema present?
It presents as diffuse edema (swelling) under the skin or mucosa.
What are the characteristics of urticaria (hives)?
Urticaria appears as multiple well-demarcated areas of erythema and edema, usually with itching (pruritus).
Are urticaria and angioedema self-limiting?
Yes, both are self-limiting, meaning they often resolve on their own.
Is the cause of urticaria and angioedema always known?
No, in many cases, the cause may not be identified.
What is the treatment for urticaria and angioedema?
The treatment is usually antihistamines to reduce symptoms.
What is allergic contact mucositis?
It’s a lesion caused by direct contact of an allergen with the oral mucosa.
What type of hypersensitivity reaction is allergic contact mucositis?
It is a Type 4 hypersensitivity reaction (cell-mediated, delayed response).
What are common allergens that can cause allergic contact mucositis?
Preservatives in local anesthetics, components of topical medications, acrylics, metals, resins, flavoring agents, mouthwash, and toothpaste.
How does allergic contact mucositis appear clinically?
The mucosa becomes erythematous (red), edematous (swollen), with burning and pruritus (itching).
How is allergic contact mucositis diagnosed?
Diagnosis can involve allergy testing to identify the specific allergen.
What is plasma cell gingivitis?
It’s a condition with diffuse erythematous (red) and edematous (swollen) gingiva that bleeds easily.
What causes plasma cell gingivitis?
It’s a hypersensitivity reaction to a product in contact with the gingival tissue
What are common triggers of plasma cell gingivitis?
Toothpaste, mouthwash, and mints are common triggers.
What are fixed drug eruptions?
Lesions that appear in the same site each time a drug is introduced.
What type of hypersensitivity reaction causes fixed drug eruptions?
Type 3 hypersensitivity reaction (immune complex-mediated).
What are common drugs that can cause fixed drug eruptions?
Barbiturates, chlorhexidine, lidocaine, penicillamine, sulfonamides, and tetracycline.
What is erythema multiforme?
An acute, self-limiting disease that affects the skin and mucous membranes.
What causes erythema multiforme?
The cause is not clear, but it’s generally considered a hypersensitivity reaction.
Who is most commonly affected by erythema multiforme?
Young adults under 30.
What are common triggers for erythema multiforme?
Herpes simplex virus, mycoplasma pneumoniae, and drug exposure.
What is a characteristic skin lesion in erythema multiforme?
Target lesions (also known as “bull’s-eye” lesions).
How long does erythema multiforme take to heal?
Typically heals in 2–4 weeks.
erythema multiforme
What is lichen planus?
A chronic inflammatory disease affecting the skin and oral mucosa.
What are the characteristic white lines seen in lichen planus?
Radiating, lace-like white lines called Wickham striae.
What is reticular lichen planus?
A form with a white component only, showing the lace-like Wickham striae.
What is erosive lichen planus?
A form with erythema, erosions, and ulcers.
How is lichen planus diagnosed?
Based on clinical appearance and microscopic (biopsy) features.
erosive/ reticular Lichen Planus
What is Sjogren Syndrome?
A chronic, systemic autoimmune disease that affects the salivary and lacrimal glands, leading to a decrease in saliva and tears.
What are some oral manifestations of Sjogren Syndrome?
Dry mouth (xerostomia), erythematous, sticky mouth, cracked lips, loss of tongue papillae, difficulty eating, high caries risk, oral candidiasis, and parotid gland enlargemen
How is Sjogren Syndrome diagnosed?
By performing a biopsy of minor salivary glands and conducting laboratory tests.
How is Sjogren Syndrome treated?
Treatment is symptomatic, focusing on alleviating dry mouth and related symptoms.
What is systemic lupus erythematosus
A chronic and acute inflammatory autoimmune disease.
Who is more commonly affected by systemic lupus erythematosus?
women
What are the most common signs of systemic lupus erythematosus?
Skin lesions are the most common sign.
Which organs can be affected by systemic lupus erythematosus?
The disease can affect the kidneys and cardiac system.
What causes the tissue damage in systemic lupus erythematosus?
Antigen-antibody complexes are deposited in various organs, causing damage.
What type of oral lesions are commonly seen in lupus?
Lichen planus-like lesions in the mouth, which may appear as white striae or erosions.
What is pemphigus vulgaris?
A severe, progressive autoimmune disease that affects the skin and mucous membranes.
What causes the symptoms in pemphigus vulgaris?
he breakdown of adhesions between epithelial cells, leading to blisters and ulcers.
Where do oral lesions appear in pemphigus vulgaris?
Oral lesions are often the first to appear and the last to heal.
How is pemphigus vulgaris diagnosed?
Through biopsy with immunofluorescence to detect specific antibodies.
How is pemphigus vulgaris treated?
treatment typically involves steroids or other immunosuppressive drugs to manage the condition.
What is the Nikolsky sign?
The separation of the epithelium with lateral pressure, indicating fragility of the skin or mucous membranes.
What does a positive Nikolsky sign suggest?
A positive Nikolsky sign suggests the presence of blistering diseases like pemphigus vulgaris.
What is mucous membrane pemphigoid?
A chronic autoimmune disease that affects the oral mucosa, conjunctiva, genital mucosa, and skin.
What is the most significant complication of mucous membrane pemphigoid?
The most significant complication is scarring of the eyes, which can lead to vision problems.
What oral condition is commonly seen in mucous membrane pemphigoid?
Desquamative gingivitis, a condition where the gingiva becomes red, inflamed, and peels.
How is mucous membrane pemphigoid diagnosed?
It is diagnosed through a biopsy with immunofluorescence to detect tissue damage and antibodies.
How is mucous membrane pemphigoid treated?
Treatment includes topical steroids and systemic medications to manage inflammation and control symptoms.
Ruptured bullae
