Immuno Flashcards
anti hemagglutinin (IgG and IgA)
hemagluttinin promotes Influenza viral entry into the cell
these antibodies in circulation and mucous account for decrease in reinfection
recurrent sinus/airway infection, lymphoid hyperplasia
hyper IgM
-def in isotype/class switching
either def in CD40R on B cell or CD40 ligand on T cell,
tx: IVIG
proximal muscle weakness, endomysial infiltration with Macrophages and CD8+, MHC overexpression, anti Jo, increased CK anti SRP, anti Mi2
polymyositis
recurrent skin infections without pus, delayed umbilical cord attachment, poor wound healing
leukocyte adhesion deficiency (type 1)
lack CD 18 and no formation of Beta 2 integrins necessary to leukocyte tight adhesion with integrin ligand ICAM
+bleeding complications=LAD type 3 (caused by impaired cytokine signaling which prevents integrin activation)
IgA protease
cleaves IgA at hinge region
produced by N. gonorrhea and N meningitid, prevent IgA from binding pili/fimibriae and preventing mucosal penetration
recurrent sinopulm/Gi infections, anaphylaxis wtih blood products
IgA deficinecy
have IgG against IgA
CD 19, 20, 21
B cell surface markers
low in agammaglobulinemia
(Bruton)
common otitis media organisms
strep pneumo
moraxella
H flu
clustered gram + with polar granules that stain deeply with aniline dyes
Corynebacterium diptheriae -non-motile unencapsulated, produces AB exotoxin B: binding-binds heparin-binding epidermal growth factor on cardiac an neural tissue A: inhibits cell protein synthesis
superantigens
produced by staph and strep, bind to t cells and MHC II causing widespread T cell activation
Botulinum toxin
blocks release of Ach causing cranial and peripheral nerve palsies
tetanus toxin
inhibts the release of inhibitory GABA and glycine neurotransmitters
ETEC, camplyobacter jejnia, vibiocholera, yersinia entercolitica
have tAB exotoxins that activate electrolyte transport
alpha toxin/lecithinase/phospholipase C
a cytolytic toxin that is released by clostridium perfringens that degrades cell membrane phospholipids, causing cell destruction
increases platelet aggregation and adherence molecule expression
nitroblue tertrazolium testing
characteristic of CGD
-susceptible to catalase + organisms
impaired intracellular killing by neutrophils and macrophages
omalizumab
anti IgE antibody used for moderate to severe persistent asthma, sensitivity to perennial allergen and incomplete response with steroiids,
bilateral hilar adenopathy, high ace, high Ca
sarcoid
- non caseating graulomas
- granulomas produce ACE and vita D
- predominance of CD4+ cells in bronchoalveolar lavage fluid
hypersensitivity pneumonitis
expsure to birds
high predominance of CD8+ cells in bronchoalveolar lavage
acute hemolytic transfusion reaction
wihtin minutes to hours
-fever/chills hypotension, dyspnea, chest and/or back pain, and hemoglobinuria
type II antibody mediated
-complement activated leading to cell lysis
ABO blood group incompatibility or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs)
green metallic sheen on EMB agar
organism that can ferment lactose ie E. COli
anti ANA
anti dsDNA
anti SM
SLE
anticardiolipin antibody
beta 2 glycoprotein I antibody
antiphospholipid antibody syndrome
-paradoxical aPTT prolongation (although actually hypercoaguable)
FALSE RPR
can be primary or secondary to SLE
defects in interferon gamma signaling pathway
lead to increased mycobacterial infections in infancy or early childhood, patients require lifelong treatment with anitmycobacterial agents (also disseminated infection by the bcg vaccine strain if administered)
recurrent pyogenic infections, albinism, nystagmus, peripheral/cranial neuropathy
chediak higashi defect in neutrophil phagosome lysosome fusion
- abnormal giant lysosomal inclusions seen on light microscopy of peripheral blood smear
- abnml melanin storage in melanocytes
- recurrent staph/strep infections
- defective neutrophil funciton
- autosomal recessive
immunodeficinecy, eczema, thrombocytopenia
wiskott-aldrich syndrome
X linked
-combined t and B disorder
neurological sx (nystagmus, ataxia), superficial blanching nests of distended capillaries, recurrent pulmonary infections
ataxia telangiectasia
-due to deficiency in DNA break repair mechanisms, highly sensitive to radiation causing DNA breaks
-immunodef, usually manifests as IgA def
increased risk of hematologic malignancies
ATM gene
defect in expression of HLA class II antigens on surfaces of APCs
bare lymphocyte syndrome
-
HIV viral entry into cell
HIV gp120 binds CD4 protein + CCR% chemokine co receptor
- deletion of both CCR5 receptors renders individuals resistant to HIV
- one deled copy get symptoms later
persistent fever, splenomegaly, anterior and posterior cervical LAD
infectious mono due to EBV-which infects B lymphocytes via CD21+ cel surface receptor
-CD8+ clonally expand in response to virus
stellar cells with intracytoplasmic granules haveing the shape of a tennis racket, found on epidermis and interact closely with T cells
Langerhans cell, skin dendritic cell
kupffer cells
macrophage derived cells that present int the liver-remain in the hepatic sinuisoids
urethritis, conjunctivits, mono-oligoarticular arthritis
reactive arthritis
-seronegative HLA b27
sx 1-4 week safter infection causing urethritis or enteritis
caused by an autoimmune reaction initiated by the infecting pathogen
-keatderma blennorrhagicum (hyperkeratotic vesicles on the palsm and soles)
IgM antibody specific for the Fc component of self IgG
rheumatoid factor
- binds IgG and forms immune complexes that circulate in the serum
- cartilage activate CD4+ which stimulate B cells cells to make Rf
antiinflammatory cytokine
IL 10 and TGF beta
cytokines critical to granuloma formation
Il12, infgamma tnfalpha are crucial in recruiting macrophages and forming a granuloma to wall off an infection ie mycobacterium
interluekin involved in pus formation
IL 8
responsible for neutrophil chemotaxis
bradykinin
causes vasodilation, increased vasc permeability, stimulates nonvascular smooth muscle contraction, mediates pain
inflammatory anaphylotoxins in complement pathway
C3a, C4a, C5a
Interleukin that stimulates hematopoiesis
IL 3
leukotriene C4
triggers intense vasoconstriction, increased vascualr permeability, bornchospasm
chemotactic agents
interleukin 8, n forylated peptides, leukotrience B4, 5HETE (a leukotrience precursor) and complement component 5a
lysozyme
hydrolyzed peptidoglycan walls of bacterial organisms
lymph node drain of head and neck
cervical
LN drainage of lungs
hilar
LN drainage of trachea and esophagous
mediastinal
LN drainage of upper limb, breast, skin above umbillicus
axillary
LN drainage of upper duodenum, liver, pancreas, stomach, spleen
Celiac
LN drainage of Lower duodenum, jejunum, iluem, colon to splenic flexure
superior mesenteric
LN drainage of colon from splenic flexure to upper rectum
inferior mesenteric
LN drainage from lower rectum to anal canal (above pectinate line,) bladder, vagina (middle third), prostate
internal iliac
LN drainage from testes, ovaries, kidneys, uterus
para-aortic
LN drainage of anal canal (below pectinate line), skin below umbilicus (except popliteal territory), scrotum
superficial inguinal
Ln drainage of dorsolateral foot, posterior calf
popliteal
end of Lymphatic drainage
right lymphatic duct drains everything on right side above the diaphragm, thoracic duct drains everything else into the junction of the left subclavian and internal jugular veins
encapsulated organisms
Strep pneumo Hib Neisseria Menigitidis E coli Salmonella Klebsiessa GB Strep
antibody dependent cellular toxicity
mech of killing parasite infested cells, EOS help IgE mediate damage.destruction of parasites
multiple nuclei organized peripherally in the shape of a horseshoe
formedby actiated macrophages (epitheliod cells)
macrophages are stimulated by CD4 Th1 hefcells and give them the ability to kill intracellular M tuberculosis orgnaisms
CD14
marker of themonocyte/macrophage lineage
CD7
mulitchain complex T cell markeer
HBeAg
marker of infectivity and viral replication
newborn of all mothers with active Hep B
passively immunized at birth with Hep B immune globin folowed by activae immunization with recombinant HBV vaccine
diagnosis of acute hepatitis B
IgM and anti-HBc (once HBs has cleared and anti Hbs has not been formed yet )
superantigens
like TSS, enterotoxin, exfoliative toxin –> cause a large inflammatory response through the activaion of Th cells through MHC II antigen presentation, bind beta region of T cell receptor the large immune response is responsible for the effects of the superantigens
athralgias, fever, pruritic rash, LAD, small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration, hypocomplementemia
Serum sickness caused by tissue depoisiotn of circulating immune complexes
Type III hypersensitivity
occurs after exposure to chimeric monoclonal antibodies (rituximan or infliximab) or nonhuman immunoglobulins (venom antitoxins) can also occur with penicillin or bactrim
nitrobluetetrazolium test
tests amount of nuetrophil superoxide production
- used to diagnose CGD
- also can use dihydrorhodamine test
palpable purpura, arthralgias, abdominal pain
Henoch Schonlein Purpura
-a preceding infection (usually URI) causes formation of IgA and C3immune complexes which deposit on blood vessel walls, in renal mesagnium,
have elevated IgA
why does isoimmunization not occur due to AB mismatch?
antibodies against specific bloody types are IgM and do not cross the placenta
-can occur with type O because they have IgG antibodies (Anti-A and Anti B)
third and fourth pharyngeal pouch deformity
DiGeorge syndrome
mechanism of injury in hepatitic B reaction
CD8+ lymph response to viral antigen on the cell surface result in hepatocyte damage
acute sore throat, fever, lymphadenopathy, upper airway dyspnea, gray pharyngeal exudate odynophagia in pt without vaccination
Diptheria
- corynebacterium diphtheriae causes pseudomembranous pharyngitis
- produces exotoxin AB that is specific for neural and cardiac tissue
- treatment includes :
1. diptheria antitoxin: inactivates circulating toxin
2. Penicillin or erythromycin: kills bacteria and prevents further release of exotoxin
3. DPT vaccine
pseudomembransous pharyngitis
corynebacterium diphtheriae
IgA and C3 deposition presentation
skin rash and abdominal pain
-Leukocytoclastic angiits, HSP
-acute glomerulonephritis is a possible complication
common in male children aged 3-11
saddle nose and oliguria
granulomatosis with polyangiits
wegener’s
associated with C ANCA (cytoplasmic staining antineutophil cytoplasmic antibodies)
C anca target neutophil-3 proteinase
Il-1, Il-6, TNF alpha
mediators of shock
facial swelling, difficulty breathing, recently started on ACEi
angioedema-swelling og tongue, lips or eyelide with larygneal edema and difficulty breathing
due to bradykinin accumulation (bradykinin normally broken down by ACE) bradykinin potent vasodilator
HLA3
hemochromatosis
HLA B27
seronegative arthopathies Psoriatic arthritis Ankylosing arthritis Ibd associated arthritis Reactive arthritis
HLA DQ2/DQ8
celiac disease
types of cells killed by CD8+
tumor, viral infected, donor graft cells -induce apoptosis via perforin and granzymes
HLA DR2
HLA DR3
HLA DR4
HLA DR5
2: Multiple sclerosis, Hay fever, SLE, Good pastures
3: Diabetes, SLE, Graves disease, Hashimoto
4: Rheumatoid arthritis, Diabetes Mellitus
5: Pernicious anemia(B12 def), Hashimoto,
CD3 CD4 CD25 FOXP3
regulatory T cells-suppress CD4 CD8
can pro duce anti inflammatory cytokine IL10, TGF beta
two signals necessary for T cell activation
antigen must bind TCR and B7 on APC must bind CD 28 on T cell
two signals necessary for B cell activation
MCH II/antigen must bind TCR on Th, CD40 on B cell must bind CD40L on Th
3 mechs of antibodies
opsonization, neutralization, complement activation
acute phase reactants
produced in liver
elevated:
ferritin (binds free iron and prevents microbial scavenging),
hepcidin (keeps iron bound to ferritin), fibrinogen (repairs endotheial breaks),
CRP (opsonin, fixes complement, facilitates phagocytosis)
serum amyloid A (prolonged elevated can lead to amyloidosis)
decreased:
albumin (to save protein for upregulated reactants)
transferrin (to sequester iron stores)
PAMPS
pathogen associated molecular pattern
CD14 on macrophages-TLR recognizes LPS-on outer membrane of gram - and activates immune system via NFKbeta
C3a, C4a, C5a
complement products that cause anaphylaxis, mast cell degraulation
C5a also neutrophil chemotaxis
MAC
C5b-9
C3b, IgG
primary opsonins
decay accelerating factor/CD55
prevent complement from occuring on self cells ie RBCs
works with Cl esterase
C3 deficiency
increased risk of severe pyogenic sinopulomary infections (less opsonization), increased susceptibility to type III hypersensitivity reactions
recurrent Neisseria bactermia
C5-9 deficinecy
no MAC
paroxysmal nocturnal hemoglobinuria
complement mediated RBC lysis due to decay accelerating factor DAF deficiency (nmly prevents complement from affecting RBCs)
HOT T-BONE stEAK
IL 1-(hot) fever IL 2-T cell stimulation IL 3-bone-hematopoiesis IL 4- igE IL 5- IgA IL 6-aKute phase reactants
pyocyanin
made from P auruginosa and generates ROS to kill compting microbes
CD34
hematopoietic stem cells
CD16, Cd56
NK cells
16 binds FC of IgG
CD56 NK unique marker
CD14, 40
macrophages
calssic antigenic variation examples
salmonella-2 flagellar variants borrelia-recurrent fever n gonorrhoeae-pilus protein viruses-influenza, HIV, HCV parasites-typanosomes
passive immunity
IgA in breast milk, IgG from placenta, antitoxin, humanized monoclonal antibodies
-shorter duration of action
when to used antitoxin
To Be Healed Very Rapidly -tetanus -Botulinium -HBV -Varicella -Rabies (also corynea diptheriae)
only live attenuated virus given to HIV pts
MMR
live vax
MMR, polio, intranasal influenza, varicella, yellow fever
-cellular and humoral response
inactivated vax
RIP A
-Rabies, Influenza, Polio, hepatits A
only humoral response
fever, hypotension, hemoglobinuria, tachypnea, tachycardia, flank pain, jaundice
acute hemolytic transfusion reaction
-antibodies against donor RBC or ABO incompatibility or foreign antigen
fever, chills, headache, flushing
febrile nonhemolytic transfucion reaction
dyspnea, bronchospasm, hypotension, resp arrest, shock
anaphylactic reaction
treat with epi
defect in BTK
agammaglobinulinemia
defective B receptor tyrosine kinase-no B cell maturation
decreased plasma cells, decreased immunoglobulins
common variable immunodeficiency
-unown cause, can be acquired
icnreased risk of autoimmune disease, bronchieectasis, lymphoma, sinopulmonary infections
coarse faces, cold inflamed staph abscesses, retained primary teeth, increased IgE, dermatologic problems
Job, hyper IgE syndrome
increased IgE, decreased IFN gamma
-STAT 3 mutations def of th17 cells–>impaired recruitment of neutrophils
