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Pathophysiology I > Immunodeficiency > Flashcards

Immunodeficiency Flashcards

1
Q

what are immunodeficiency disorders?

A

abnormality(es) of the immune system that predisposes to diseases normally eradicated by a functional system

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2
Q

examples of types of disease that immunodeficient patients are at higher risk for

A

infections

neoplasms

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3
Q

three causes of immunodeficiency disorders

A

hereditary
infectious
iatrogenic

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4
Q

systemic diseases that can also produce immunodeficiency

A 
alcoholism/malnutrition
diabetes
renal failure
cushing's syndrome
cancer
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5
Q

iatrogenic causes of immunodeficiency disorders

A

steroid therapy
cancer therapy
immunosuppressive drugs for transplant
surgical or functional splenectomy

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6
Q

how many primary immunodeficiency disorders known?

A

over 100

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7
Q

common types of inheritance of primary immunodeficiency disorders

A

autosomal recessive inheritance

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8
Q

what other types of disorders have increased risk for autoimmune disease?

A

disorders that affect T cells

loss of tolerance

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9
Q

cell-mediated defects appear

A

soon after birth

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10
Q

examples of cell-mediated defects

A

T cell (intracellular pathogens)
oral candida
other fungal infections
intracellular parasites

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11
Q

examples of intracellular parasites

A

cytomegalovirus
herpesvirus
pneumocystis
mycobacteria

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12
Q

humoral defects appear

A

several months after birth, fetus is protected by maternal antibodies

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13
Q

examples of humoral defects

A 
B cell (extracellular pathogens)
bacterial infections-staph, strep, hemophilus, giardia lamblia
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14
Q

asplenic defects

A

encapsulated bacterial infections-pneumonia, meningitis, flu, salmonella

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15
Q

AIDS

A

full manifestation of infection by human immunodeficiency virus-1 (HIV)

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16
Q

what does AIDS infect?

A

Th cells and dendritic cells (APCs)

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17
Q

what does AIDS produce defect in?

A

cell-mediated immunity

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18
Q

defects in cell-mediated immunity lead to predisposition to

A

opportunistic infections-pathogen doesn’t normally cause a problem in people with competent immune system
cancers (normally lymphomas)
nervous system damage

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19
Q

what represents the final stage of HIV infection?

A

AIDS

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20
Q

how is AIDS transmitted?

A

sexual contact
bloodborne
perinatal

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21
Q

classic risk factors for HIV: 4 H’s

A

homosexual men
Haitians
heroin users
hemophiliacs

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22
Q

what poses the greatest risk for HIV?

A

receptive anal sex

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23
Q

does HIV cross placenta?

A

yes, is present in breast milk

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24
Q

how is HIV not spread?

A

casual contact
bites
mosquitoes
toilets

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25
Q

rare examples of HIV transmission

A

needlesticks

blood transfusions

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26
Q

transmission percentages of HIV

A

46%: homosexual contact
15%: IV drug abuse
4%: homosexual contact and IV drug abuse (both present)
33%: heterosexual contacts of the above

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27
Q

seven things that have been proven to reduce transmission of HIV

A
  • HIV testing of blood products/coagulation factors
  • anti-retroviral prophylaxis before and during childbirth by HIV-positive mothers
  • condom distribution and use
  • needle exchange programs
  • male circumcision
  • formula feeding instead of breast feeding by HIV positive mothers
  • early anti-retroviral treatment for an HIV-positive member of a serodiscordant couple
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28
Q

HIV structure

A

encapsulated retrovirus

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29
Q

what does HIV core contain?

A 
SS RNA (two copies)
protease
integrase
reverse transcriptase
p24 protein
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30
Q

what is p24 in humans?

A

antigenic, evokes immune response

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31
Q

what does HIV envelope contain?

A

gp120 and gp41 proteins

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32
Q

what is the basis for antibody detection of HIV?

A

p24

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33
Q

what does reverse transcriptase do?

A

converts RNA to DNA upon infection

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34
Q

what does HIV infection require?

A

binding of virus to CD4 receptor

gp120 co-binds another receptor

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35
Q

what is gp120 necessary for?

A

virus to bind to T helper cells

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36
Q

what happens once the HIV virus is internalized?

A

RNA is converted into DNA by reverse transcriptase

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37
Q

what is the problem with reverse transcriptase?

A

not accurate, inconsistent DNA production across viruses

results in genomic changes

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38
Q

what happens once DNA is produced by reverse transcriptase?

A

DNA is inserted into T cell genome using integrase enzyme

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39
Q

what happens after viral DNA is transcribed/translated?

A

new viral parts are made

new viral RNA can be re-incorporated to make new viruses

40
Q

what does protease do?

A

cleaves immature protein into mature protein, makes functional parts

41
Q

what happens with new virus particles?

A

they bud from infected T cell

42
Q

how can T cells pass virus?

A

from one cell to another

43
Q

why is direct cell-cell transfer bad?

A

it escapes immune attack

cannot be recognized and attacked by antibodies

44
Q

what happens to free gp120 from lysed Th cells?

A

they bind and block CD4 receptors of other Th cells

45
Q

what does binding of gp120 to CD4 receptors produce?

A

weak cell-mediated and humoral response, ineffective

46
Q

how do antiviral drugs work?

A

they act on different steps of infection
-can attack adhesion, reverse transcription, integration
multiple steps are affected by different drugs

47
Q

HIV primary infection timeline

A

weeks to months

48
Q

what does primary HIV infection resemble?

A

infectious mononucleosis

49
Q

sx primary HIV infection

A

fever, fatigue, myalgias, lymphadenopathy, etc.

50
Q

what is primary HIV infection characterized by?

A

high viral load

51
Q

HIV latency phase timeline

A

years to decades

52
Q

what is HIV latency phase characterized by?

A

gradual decrease in Th (CD4) counts
controlled viral load
persistent generalized lymphadenopathy

53
Q

what are the criteria for AIDS?

A

CD4 count less than 200 and/or AIDS defining illness

54
Q

what is AIDS characterized by?

A

increased viral load

55
Q

what is HIV infection CDC classification based on?

A 
CD4 counts (1-3) 
clinical sx (A-C)
56
Q

what CDC categories have AIDS?

A

all category 3 and C

57
Q

is CDC classification used clinically?

A

no

categorized for epidemologic purposes

58
Q

what do many AIDS defining illnesses have in common?

A

many opportunistic infections

59
Q

opportunistic infections-pneumocystic carinii (jirovecii)

A

serious pneumonias

prophylaxis-Bactrim

60
Q

opportunistic infections-candida

A

affects mucosal surfaces

can cause more severe infections

61
Q

opportunistic infections-HSV

A

extensive full-thickness burns of the epidermis or necrotizing encephalitis

62
Q

opportunistic infections-cytomegalovirus (CMV)

A

intractable colon problems (diarrhea), lung/brain infections

63
Q

opportunistic infections-toxoplasmosis (protozoan)

A

severe encephalitis

64
Q

opportunistic infections-tuberculosis

A

major health risk that HIV-infected people pose to healthy people

65
Q

opportunistic infections-atypical mycobacterial infections (M. avium, M. intracellulare, M. kansaii)

A

untreatable

66
Q

opportunistic infections-histoplasmosis (fungus)

A

disseminated infection

common, everyone exposed

67
Q

examples of opportunistic infections group 1

A 
pneumocystis carinii (jairovecci)
candida
HSV
CMV
toxoplasmosis
TB
atypical mycobacterial infections
histoplasmosis
68
Q

opportunistic infections-cryptococcus (fungus from pigeon droppings)

A

pneumonia

encephalitis

69
Q

opportunistic infections-aspergillosis (fungus from HS bio)

A

pneumonia

70
Q

opportunistic infections-cryptosporidiosis (protozoan)

A

intractable diarrhea

71
Q

JC papovavirus

A

progressive multifocal leukoencephalopathy

72
Q

epstein barr virus or herpesvirus 8

A

tumors or pseudotumors

  • lymphomas
  • kaposi sarcoma (infectious disease)
73
Q

examples of opportunistic infections group 2

A 
cryptococcus 
aspergillosis
cryptosporidiosis
JC papovavirus
epstein barr or herpesvirus 8-lymphomas, kaposi sarcoma
74
Q

what are opportunistic infections?

A

mostly intracellular parasites that escape humoral and innate immune defenses

75
Q

diagnosis HIV-what test is used for screening?

A

ELISA-enzyme-linked immunosorbent assay

76
Q

what does ELISA test for?

A

antibodies to p24 and other antigens

77
Q

how long does it take for an ELISA test to be positive after exposure?

A

6-8 weeks after exposure, may take 6 months

78
Q

ELISA pro

A

cheaper

79
Q

ELISA con

A

false positives and negatives

80
Q

what is always used to confirm a positive ELISA test?

A

western blot

81
Q

what does a western blot do?

A

tests for antibodies, higher specificity

82
Q

what is used to follow patients with HIV?

A

PCR

83
Q

what does PCR do?

A

polymerase chain reaction
detects and quantifies viral DNA
“viral load”

84
Q

how long does it take for a PCR to be positive following HIV exposure?

A

7 days

85
Q

how do antiretroviral drugs treat HIV?

A

block viral replication at different points

86
Q

what type of antiretroviral drugs are there?

A

reverse transcriptase inhibitors
protease inhibitors
integrase inhibitors
entry inhibitors

87
Q

reverse transcriptase inhibitors (nucleoside and non-nucleoside varieties)

A

prevent viral DNA formation

88
Q

protease inhibitors

A

prevent formation of viral proteins

89
Q

integrase inhibitors

A

prevent integration of viral DNA into host

90
Q

entry inhibitors

A

prevent viral attachment and/or entry into T cell

91
Q

what is HIV combination therapy called?

A

HAART

92
Q

what has HAART accomplished?

A

significantly improved lifespan and quality

93
Q

is HIV curable

A

no, only treatment not curative

remains uncurable

94
Q

reasons we do not have a HIV vaccine

A

humans develop no effective natural immunity
virus changes rapidly-even with the same host
antibodies don’t protect well
populations who need it most cannot afford it
all previous attempts have been failures

95
Q

what populations would be most benefitted from a HIV vaccination?

A

IV drug abusers

third world countries

Pathophysiology I (10 decks)

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