immuno Flashcards
Type I IMME$IDATE Hypersensitivity Disorders
IgE Ab mediated disorder,
typically allergy or anti parasitic
Type I Immediate Hypersensitivity Disorders
activates what?
mast cells and
chemical mediators
that increase vessel permeability and alter smooth muscle tone
Type __ Immediate Hypersensitivity Disorders is often associated with
______- familiar predisposition for developing allergic reaction
I
ATOPY
s/s of type 1 immediate hypersensitivity
- allergic conjunctivis
- allergic rhinitis
- atopic dermatitis (eczema)
- diarrhea and cramping
Allergic rhinitis is
pale, boggle and blue nasal mucosa
what. type of reaction occurs with Hypersensitivity to bee/wasp/hornet sting
type 1 immediate hypersensitivity
anaphalyasic d/t bee sting was the MCC of death d/t venous bites
CV collapse (1) -> laryngeal swelling (2) most common causes of deat
tx for bee sting
SQ EPI
Type II Cytotoxic Hypersensitivity Disorders
Antibody-mediated cytotoxic reaction that involves complement activation.
Lysis follows.
Type II Cytotoxic Hypersensitivity Disorders involves recruitment of
inflammatory cells
NK cells
autoAB against receptors
what can cause Type II Cytotoxic Hypersensitivity Disorders
- ABO mismatch
- IgM mediated cold autoimmune hemolytic anemia
- Hyperacute transplant rejection
- goodpasteurs
- Rheumatic fever
- Newborn Rh/ABO hemolytic dz)
- Myasthania gravis
- Graves
Goodpasture’s Syndrome involves
Antiglomerular and pulmonary capillary basement membrane Ab
Rheumatic Fever
cross-reactivity of Ab and antigens on certain strains of group A streptococci)
Newborn Rh hemolytic disease (
anti-D IgG Ab from mom cross placenta and attach to +D-antigen fetal cells
Newborn ABO hemolytic disease
type O (anti-A & anti-B IgG Ab) from mom cross placenta and attach to A or B fetal cells)
Myasthenia gravis
antibodies against ACh receptors
Graves disease
(IgG thyroid stimulating immunoglobulin “Ab” against TSH receptor)
Type III Immunocomplex Hypersensitivity Disorders
Circulating complexes of antigen bound to IgG or IgM deposit in target tissue -> compliment activation -> activate neutrophils/macrophages which damage tissues.
Type III Immunocomplex Hypersensitivity Disorders
First exposure:
Second exposure
- exposed to antigen, form Ab
2. deposition of the ant-ab complex that deposits in tissue
Arthus reaction
immunocomplex disease that occurs 4-8 hours after Ant exposure. usually resolve in 1-3 days
key: pigeons, chicken coops, rodents, parakeets, fowl, rodents, hay,
what can cause Arthus reaction
- • Farmers lung – exposure to actinomyces antigen in the air causes antibodies to form in the lungs. Exposure to antigen causes local immunocomplex formation in lung
- Bird fanciers lungs d/t pigeons, parakeets, fowl, rodents
- serum sickness
what is serum sickness
allergic reaction d/t injection of serum: causes fever, urticarial, generalized lymphadenopathy, arthritis, glomerularnephritis, and vasculitits.
Type IV Hypersensitivity Disorders
T cell mediated = Cellular immunit
_____ are not required for Type IV disorders
ANTIBODIES because CD4 helper T cells cause delayed reaction hypersensitivity (DRH), CD8 cytotoxic T cells are cytolytic to target cells
what can cause Type IV Hypersensitivity Disorders
- Allergic Contact Dermatitis (Poison Ivy, Nickel, soaps) - pre-exposed and then re exposed
- PPD skin. test
- Cell mediated response to intracellular pathogens with granuloma formation (late phase dz of farmers lung)
Rheumatoid Arthritis (RA)
Onset:
Highest risk:
Presents as
any age; but peaks between 30-50
women, smokers and those with FH of dz
pain and stiffness in multiple joints, most often the wrists, PIPS and MCPs
_________ are not typically impacted by RA.
DIPS lumbar spine
in RA, ________ lasting more than one hour suggests an inflammatory etiology.
morning stiffness
ROS with RA
fatigue
weightloss
anemia
what can we see in exam
- Boggy swelling caused by synovitis
2. synovial thickening may be palpable on joint
doc use________ to differentiate the inflammatory
arthritis in RA from another
etiology, including lupus, systemic sclerosis,
psoriatic arthritis, sarcoidosis,
crystal arthropathy, and
spondyloarthropathy
history. and physical examination
RA first line of treatment
methotrexate
-DMARDS (disease modifying antirheutmic drugs, glucocorticoids is dz activity. is high
key. to tx RA
TREAT EARLY. waiting longer b4. tx = poorer prognosis
goal of RA tx
remission or the lowest disease activity possible.
To reach goal: Medications are titrated. and frequent physician visits are required to monitor response to therapy.
Juvenile Rheumatoid Arthritis (JRA)
Present as:
Diagnosis criteria:
It is a diagnosis of ____________, meaning
painless joint inflammation present in variable degrees and normal results on rheumotologic tests. kids will often have a limp .
chronic arthritis lasting 6 wks in at last 1 joint and exclusion of other causes of symptoms in a person under 16 or a classic cause of systemic onset.
diagnosis of exclusion: must rule out other causes of joint dz
do we use labs for JRA
lab tests do not rule in or out.
diagnosis is CLINICAL!
The primary morbidity associated with juvenile rheumatoid arthritis is caused by
idiopathic inflammatory eye disease.
thus, eye doc should screen kids with artitirst for silentt uvetis to help prevent morbidity
Systemic lupus erythematosus (SLE) is 2x as prevalent in ____ persons as in white persons, and it is 10 times more common in _____ than in ____
BLACK FEMALES
path of SLE
recurrent with periods of remission, followed by flares
Most common sx of SLE
fatigue, weight loss,
fever
arthralgia and myalgia (joint/muscle pain ARE PRESENT IN ALMOST ALL PTS WITH SLE)
Systemic lupus erythematosus (SLE)
ROS
autoimmune dz that affects many systems: skin, MSK, renal, neuropsych
pan +
SLE exam
Less common signs/symptoms include
malar rash (31%)
These 4 signs/symptoms provide the strongest evidence in favor of SLE
- discoid rash, coin shaped
- malar rash
- unexplained serizures or psychosis
- photosensitivity
Diagnostic Criteria of SLE
begins with.
- high amount of suscpecian
- must meet 4/11 diagnostic criteria to diagnose with 95%. specificity. and 85%. sensitibity
11 diagnostic criteria for SLE
malar or discoid rash; photosensitivity; oral ulcers;
arthritis; serositis; abnormal ANA titers; and renal,
neurologic, hematologic, or immunologic disorders
If we suspect SLE, wat do we do
- check to see if at least 4 ACR criteria are present -> dx
2. Check ANA: - -> very low prob. If high-> chance of SLE
tx SLE
- Hydroxychloroquine (Plaquenil) reduces arthritis pain associated
with SLE. - glucocorticoids +immunosuprresant to preserve renal function
- glucocorticoids +mycophenolate or cyclophosphamide is perf to achieve remission in patient with SLE nephritis
what I s Psoriasis
inflammatory skin condition that is often associated with systemic manifestations
hx: psoriasis
any age: most likely. between 15-30
1/3 of pts with this have a first. degree relative with it
assx with psoriasis
- smoking increase risk and severity
- obesity. and olcool are assx: not causitibve
- stress
- direct skin trauma (koebner phenomenon)
Psoriasis is associated with several comorbidities, including
CV disease,
lymphoma, and
depression
can HIV cause psoriasis
no.
but HIV can make psoriasis worse
psoriasis exam
Diagnosis is based on the _____
_____ psoriasis is the most common form
red, scaly. skin lesions with additional manifestations in nails and joints
PLAQUE
if you see a RASH OR NAIL PITTING. WYD?
joint exam
tx psoriasis
- corticosteroids, vitD analogs, tazarotene -> mild
- systemic bioicial tx
- TNF inhibits for psoriatic arthritis
Graves disease is the most common cause of hyperthyroidism in the United States
Autoimmune disorder in which
thyroid-stimulating antibodies activate thyroid-stimulating hormone (TSH) receptors,
Graves disease hx
risk factors
clinical presentations:
F and personal or FH of autoimmune disorder
hyperthyroidism can rage from asymptomatic-> thyroid storm
most common manifestations of hyperthyroidism
adrenergic symptoms (e.g., palpitations, heat intolerance, diaphoresis, tremor, stare [an appearance of a fixed look due to retraction of eyelids], lid lag, hyperdefecation
Treatment hyperthyroid disorders
beta blockers
methimazole (anti-thyroid meds)
______) is the MC form of thyroiditis
Chronic Autoimmune thyroiditis (Hashimoto thyroiditis)
what is hashimotos
immune cells attack your thyroid, limiting its production of thyroid hormone production.
Hashimoto presentation
w/wo non tenger goiter
hypothyroidism
leveled TPO antibody. level (more specific to Hashimoto)
Risk factors for Hasimoto’s thyroiditis include
F and personal or FH of autoimmune disorder
higher rates in: those with T1DM, Turner syndrome, ADDisons, Hep c
Exam - Symptoms & Signs of hashimoto
fullness in neck, fatigue, weight gain, cold intolerance, muscle pain
Treatment
_________ ameliorates the hypothyroidism and may reduce goiter size.
levothyroxine
most common types of 1ID. (primary immunodeficiency)
- Antibody ****
- combined B-cell and T-cell,
- phagocytic,
- complement disorders
Antibody Disorders (55% of 1ID Worldwide) Children with these diseases tend to hav
bacterial fungal infections with. unusual shit, severe or reccurent infections with common things
are the most common type of 1ID disease.
antibody disorders (55%
Antibody disorders can be broadly characterized by the
absence or presence of B cells.
When B cells are present, disorders are further characterized by whether the
quality. and quantity of B cells are normal
_______of 1ID is the strongest predictor of disease
FH
types of AB disorders
- Agammaglobulemia: (X-linked Bruton tyrosine kinase def): born absent of B cells, all Igs are decreased
- Hypogammaglobulinemia- low or def in IGs or abnormal response of Igs to vaccinations
In the United States, _____ deficiency is the most common type of B-cell disorder.
IgA
common sx of hypogammaglob
ear, sinus and pulmonary infections
T-Cell Disorders (10% of 1ID)
presence of absence of T cells. bc they. are. important for B cell functioning, most T cell def lead to combined T and. B cell disorder
T-cell disorders usually present _______.
Most serious form of T-cell disorder, S________presents in infants as an emergent condition with lifethreatening
infections.
EARLY IN LIFE
SCID (severe combined immunodeficiency)
Diarrhea, failure to thrive, opportunistic infections, and severe routine infections in a child younger than ________ should raise
suspicion for SCID and/or HIV.
3 months
Phagocytic disorders are the result of abnormalities in ______________/
.
CHRONIC GRANULOMATOUS DZ is the most common phagocytic disorder in the ESID registry. Usually diagnosed by _________
monocytes, neutrophils
- yo.
Chronic granulomatous disease: first manifestation could be ____.
Infections are related to what?
omphalitis (infection of umbilical stump)
inability. of our body. to kill catalase + organisms
Complement Disorders (2% of 1ID)- 25 proteins compliments the actions of Ab to kill bacteria.
These disorders involve infections with ______
def of C3 -> Def of C5-C9 -?
encapsulated organisms.
- C3-> S.pneumonia and H influence
- C5-C9: Neisseria meningitidis infections such as meningitis, sepsis, and arthritis.
why is it hard to identify kids who need eval for 1ID
The most common presentations of a primary immunodeficiency disease in children are recurrent ear, sinus, and pulmonary infections;
diarrhea; and failure to thrive. These conditions are also common in children who do not have an immunodeficiency disease
Three most helpful warning signs for primary immunodeficiency disease were:
- FH
- Diagnosis of sepsis tx with IV Abs
- failure. to thrive
who should be screened. for P1D?
- child with recurrent serious infection, who has a + FH OR is from an ethnicity assx with higher parental chances. (African American)
A child with recurrent infections in a single anatomic location is more likely to have an wha
what. about if two or. more sights?t
anatomic defect than an immunodeficiency.
2 or more. sites-> suspect immodeficiency
Acute HIV infection (aka primary HIV infection or acute retroviral syndrome)
period just after initial HIV infection, typically before seroconversion
Acute HIV infection (aka primary HIV infection or acute retroviral syndrome)
what is it
period just after initial HIV infection, typically before seroconversion
some pts asymptomatic, but often manifests with transient symptoms related. to high levels of HIV replication and subsequent immune response
-Misdiagnosis of HIV is common because symptoms
symptoms of acute HIV infection (e.g., fever, rash, malaise, sore throat) mimic other, more prevalent
conditions, such as influenza.
signs sx of acute HIV infection
fever, sore thoat, malaise/fatigue, weight loss, ulcers, rash, myalgia/ arthralhia
Differential Diagnosis of Acute HIV Infection
most common
Epstein-Barr virus , Influenza, Streptococcal pharyngitis, Viral/noninfectious gastroenteritis, Viral URI
Acute HIV infection is often described as __________, with the most prevalent symptoms being fever, fatigue,
myalgias/arthralgias, rash (typically an erythematous maculopapular exanthem), and headache.
mononucleosis-or influenza-like
should we diagnose anyone with acute HIV?
no.
be aware of the communities that do have it but retain a low threshold to consider cute infection in anyone presenting with sx. Exam should be thorough and assess activities that involve HIV exposure; INCLUDING HETEROSEXUAL sex
HIV clinically resembles a __________ and should be considered in newborns and adolescents who have
T-cell immunodeficiency disorders like SCID
diarrhea, failure to thrive, unusual opportunistic infections
Exam of acute HIV
big spleen
testing HIV
- HIV viral load: measures. HIV/ DNA or HIV RNA using RCR testing
- ELISA
time from infection -> detection: 11012 days
how can we diagnose type III
Arthus reaction
chicken, mushroom works, rodents, any type of farmer farming relating thing,
–> deposits in lungs
Type IV
- poison ivy- has linear vascular lesions
- PPD skin test
3.
