Immunodeficiency Flashcards
what are the two categories of immunodeficiency?
Acquired and congential
which out of acquired and congenital causes of immunodef is more rare?
congenital
what is an example of congenital causes of immunodef?
wiskott-aldrich syndrome
cyclic neutrpaenia
what is wiskott aldrich syndrome?
x linked recessive disease asscioated with exczema, bloody diorrhoea, thrombocytopaenia and immunnodef
what is cyclic neutropaenia?
absolute reduction in circulating neutrophils
cyclic depression in neutrophils from the blood and bone marrow
AD
what are the signs and symptoms of cyclic neutropaenia?
fever, malaise, lymphadeonpathy, infections and oral ulcers on non keratinzed tissue, prone to sevre perio
what are acquired conditions associated with Immunosuppression?
steroid therapy malignancy chemotherapy organ transplant Viral: HIV
which cells are affected in immunodef?
t cells
b cells
plasma cells
mixed
what is the normal range for neutrophils?
2.0-7.5 x 10^9
what do activated lymphocytres produce and what is this product used for?
lymphokines
used to activate macrophages
which organisms are macrophages mostly involved fighting against?
mycobacteria
fungi
viruses
which types of diseases would be treated with immunosupressive therapy?
lymphopoliferative neoplasms
transplant recipients
connective tissue diseases
autoimmine diseases
which immunosupressive agents are there and what are their side effects?
Corticosteriods: multiple system issues Cicllosporin: nephro/hep/tox and gingival hper Tacroliumus: cardiomyopathy Myocphenalate: marrow supression Azothioprine: marrow supression Cylcophsohamide: marrow supression Colchicine: amrrow supression Dapsone: hameolysis Thalidomide: ATNF teratogenic and neurotoxic
what are the side effects of steroids?
predisposition to diabetes wieght gain increased susceptibilty to oppurtunitics infections and cataracts hypertension osteoporosis adrenal supression gastric ulceration
what are the dental implications of steroid usage?
hypotensive crisis underlying disease process oppurtunistic infections delayed healing osteroporosis avoid NSAID and aspirin
how can a steroid crisis arise?
HPA axis becomes supressed by long term steriod usage, during periods of stress body fails to cope and goes into shock
What effect do chemotherapeutics have on the bone marrow?
they cause bone marow supression, leukopaenia,
anaemia, thrombocytopaenia, neutropaneia
what should all patients prior to having chemo have?
dental screen, get rid of any hopeless teeth
in the immunocompromised pt if neutrophil count is less than ? what should you do?
if likely to induce a bacteriamia and if less than 1.5 x 10^9 need to give antibiotics
when is the best time to treat pateints undergoing chemoitherapy?
just before chemo just after (2-3) days
ALWAYS CHECK PLATELET AND NEUTROPHIL COUNT
what type of bone marrow transplants exist?
stem cell transplant
Bone marrow transplant
when are stem cell transplants used?
high dose chemo
when are bone marrow transplants used?
treatment of some malignancies and genetic disorder eg sickle cell anaemia
what are people following bone marrow transplants susceptible to getting?
GvHD
what is GvHD?
people that have undergone an allogenic BMT
HLA matched donor used to replace BM in recipient
if HLA not exact then recipeint develops GvHD
what types of GvHD are there?
acute and chronic
acute occurs within 100 days of allogenic BMT
(50%) of epople will develop this
CHronic is after 100days
what are the symptoms of acute GvHD?
GI problems, skin rash, livr problems
what are the symptoms of chronic GvHD?
white reticulated lesions, candida, burning mouth and xerostomia
how do you manage GvHD?
good HLA matching
immunosupressives
PUVA (Psoralen and UV therapy)on cutanous lesions
when should treatment be performed in patients that have had BMT?
avoid treatment within the first three months following transplant
after three months, use ab if likely to induce bacteramia
what is a viral cause of immunodef?
HIV
what is HIV?
a progressive disease impairing the function of the CD4 helper cells
which receptor does HIV bind onto on the CD4 cells?
gp120
what are the lase symptoms of HIV?
weight loss lethargy malaise night sweats diarrhoea poor apaetite
what three incfections can occur once the CD4 count drops below 200?
CMV
toxoplasmosis
Pneumocysitis pneumonia
what is different about pneumocystis pneumonia compared to other types of pneumonia?
caused by fungua
usually pneumocysistis jiroveci
what other fungal infection is seen i people with HIV?
oesophageal candida
what are the symptoms of oesophageal candida
sore throat
dysphagia
restrosternal pain
what are the signs and symptoms of pneumocysitisis pneuomnia
fatigue
cough
dysponea
what is the normal CD4 count in health?
> 600mm^3
what is AIDS?
when CD4 count is less than 200mm^3
WHat are the 5 groups of drugs used to manage HIV?
Non nuceloside reverse transcirpatse inhibitors work
protease inhibitors
Nucleoside reverse transcripatse inhibitors
Fusion inhibitors
integrase inhibitors
how do NRTI work?
prevent HIV from copying its geentic materal
how do protease inhibitors work?
they prevent HIV from assembling its orotective coat before they leave CD4 cell
how do NNRTI?
similar to NRTI but fewer side effects
when are fusion inhibitors used?
used for those whose disease is no lonfger managed by other drugs
how do integrase inhibitors work?
they prevent HIV inserting viral DNA into host DNA since integrase is one of the three enzymes it needs to replicate
which antifungals can you consider in patients with HIV for prophylaxis against infection?
not really advised to but can give
fluconazole and itraconazole
which antivirals can you consider in patients with HIV for prophylaxis against infection?
FAG
foscarnet
aciclovir
ganciclovir
which antibacterials can you consider in patients with HIV for prophylaxis against infection?
septrin and pentamidine
which anti TB can you consider in patients with HIV for prophylaxis against infection?
RIES
rifampicin
isonizid
ethamputal
streptomycin
which infections are people with HIV predisposed to?
viral
fungal
mycobacterial
which neoplasms are people with HIV predisposed to?
kaposis sarcoma
lymphoma
which autoimmune diseases are people wtih HIV predisposed to?
idiopathic thrombocytopenic purpura
what are the common extra oral manifestations of HIV?
cervical lymph node enlargement salivary gland enlargement skin disorders (molluscum contagiosum, dermatitis, papillomas, zoster)
what are the common I/O manifestations of HIV?
candida hairy leukoplakia kaposi sarcoma ulceration ANUG papillomas Non hodgkin
how do you treat candida in patients with HIV?
if CD4 count less than 250 use systemic
how do you treat kaposis sarcoma?
local radiotherapy
intralesional chemi
systemic chemo
combination therapy
which periodontal diseases are associated with HIV?
linear gingival erythema
NUG
NUP
What is the two causative agents in hairy leukoplakia in HIV?
HIV and EBV
What can you give to the patient to try and resolve the hairy leukoplakia?
Systemic aciclovir
How does hairy leukoplakia resolve in HIV?
Following HAART
What are the names of the protease inhibitors?
Saquinivir
Ritonivir
Indinvir
Nelfanivir
What are the NRTIs?
AZ is a DLS AZT Zalciatbine Didanosine Lamuvidine Stavudine
Name the NNRTI
Efavirenz
Nevirapine
Name the fusion inhibitors
Enfuviritide
Maraviroc
What is the name of the intefrase inhibitor?
Raltefravir
Which agent is implicated in HIV gingivitis and perio?
CMV
What are the oral complications of human stem cell transplant?
Mucosots Infection Ulceration (neutropenia) Bleeding Hypos Hypo salivation Malignancy
