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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
rare examples of HIV transmission
needlesticks | blood transfusions
26
transmission percentages of HIV
46%: homosexual contact 15%: IV drug abuse 4%: homosexual contact and IV drug abuse (both present) 33%: heterosexual contacts of the above
27
seven things that have been proven to reduce transmission of HIV
- 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
28
HIV structure
encapsulated retrovirus
29
what does HIV core contain?
``` SS RNA (two copies) protease integrase reverse transcriptase p24 protein ```
30
what is p24 in humans?
antigenic, evokes immune response
31
what does HIV envelope contain?
gp120 and gp41 proteins
32
what is the basis for antibody detection of HIV?
p24
33
what does reverse transcriptase do?
converts RNA to DNA upon infection
34
what does HIV infection require?
binding of virus to CD4 receptor | gp120 co-binds another receptor
35
what is gp120 necessary for?
virus to bind to T helper cells
36
what happens once the HIV virus is internalized?
RNA is converted into DNA by reverse transcriptase
37
what is the problem with reverse transcriptase?
not accurate, inconsistent DNA production across viruses | results in genomic changes
38
what happens once DNA is produced by reverse transcriptase?
DNA is inserted into T cell genome using integrase enzyme
39
what happens after viral DNA is transcribed/translated?
new viral parts are made | new viral RNA can be re-incorporated to make new viruses
40
what does protease do?
cleaves immature protein into mature protein, makes functional parts
41
what happens with new virus particles?
they bud from infected T cell
42
how can T cells pass virus?
from one cell to another
43
why is direct cell-cell transfer bad?
it escapes immune attack | cannot be recognized and attacked by antibodies
44
what happens to free gp120 from lysed Th cells?
they bind and block CD4 receptors of other Th cells
45
what does binding of gp120 to CD4 receptors produce?
weak cell-mediated and humoral response, ineffective
46
how do antiviral drugs work?
they act on different steps of infection -can attack adhesion, reverse transcription, integration multiple steps are affected by different drugs
47
HIV primary infection timeline
weeks to months
48
what does primary HIV infection resemble?
infectious mononucleosis
49
sx primary HIV infection
fever, fatigue, myalgias, lymphadenopathy, etc.
50
what is primary HIV infection characterized by?
high viral load
51
HIV latency phase timeline
years to decades
52
what is HIV latency phase characterized by?
gradual decrease in Th (CD4) counts controlled viral load persistent generalized lymphadenopathy
53
what are the criteria for AIDS?
CD4 count less than 200 and/or AIDS defining illness
54
what is AIDS characterized by?
increased viral load
55
what is HIV infection CDC classification based on?
``` CD4 counts (1-3) clinical sx (A-C) ```
56
what CDC categories have AIDS?
all category 3 and C
57
is CDC classification used clinically?
no | categorized for epidemologic purposes
58
what do many AIDS defining illnesses have in common?
many opportunistic infections
59
opportunistic infections-pneumocystic carinii (jirovecii)
serious pneumonias | prophylaxis-Bactrim
60
opportunistic infections-candida
affects mucosal surfaces | can cause more severe infections
61
opportunistic infections-HSV
extensive full-thickness burns of the epidermis or necrotizing encephalitis
62
opportunistic infections-cytomegalovirus (CMV)
intractable colon problems (diarrhea), lung/brain infections
63
opportunistic infections-toxoplasmosis (protozoan)
severe encephalitis
64
opportunistic infections-tuberculosis
major health risk that HIV-infected people pose to healthy people
65
opportunistic infections-atypical mycobacterial infections (M. avium, M. intracellulare, M. kansaii)
untreatable
66
opportunistic infections-histoplasmosis (fungus)
disseminated infection | common, everyone exposed
67
examples of opportunistic infections group 1
``` pneumocystis carinii (jairovecci) candida HSV CMV toxoplasmosis TB atypical mycobacterial infections histoplasmosis ```
68
opportunistic infections-cryptococcus (fungus from pigeon droppings)
pneumonia | encephalitis
69
opportunistic infections-aspergillosis (fungus from HS bio)
pneumonia
70
opportunistic infections-cryptosporidiosis (protozoan)
intractable diarrhea
71
JC papovavirus
progressive multifocal leukoencephalopathy
72
epstein barr virus or herpesvirus 8
tumors or pseudotumors - lymphomas - kaposi sarcoma (infectious disease)
73
examples of opportunistic infections group 2
``` cryptococcus aspergillosis cryptosporidiosis JC papovavirus epstein barr or herpesvirus 8-lymphomas, kaposi sarcoma ```
74
what are opportunistic infections?
mostly intracellular parasites that escape humoral and innate immune defenses
75
diagnosis HIV-what test is used for screening?
ELISA-enzyme-linked immunosorbent assay
76
what does ELISA test for?
antibodies to p24 and other antigens
77
how long does it take for an ELISA test to be positive after exposure?
6-8 weeks after exposure, may take 6 months
78
ELISA pro
cheaper
79
ELISA con
false positives and negatives
80
what is always used to confirm a positive ELISA test?
western blot
81
what does a western blot do?
tests for antibodies, higher specificity
82
what is used to follow patients with HIV?
PCR
83
what does PCR do?
polymerase chain reaction detects and quantifies viral DNA "viral load"
84
how long does it take for a PCR to be positive following HIV exposure?
7 days
85
how do antiretroviral drugs treat HIV?
block viral replication at different points
86
what type of antiretroviral drugs are there?
reverse transcriptase inhibitors protease inhibitors integrase inhibitors entry inhibitors
87
reverse transcriptase inhibitors (nucleoside and non-nucleoside varieties)
prevent viral DNA formation
88
protease inhibitors
prevent formation of viral proteins
89
integrase inhibitors
prevent integration of viral DNA into host
90
entry inhibitors
prevent viral attachment and/or entry into T cell
91
what is HIV combination therapy called?
HAART
92
what has HAART accomplished?
significantly improved lifespan and quality
93
is HIV curable
no, only treatment not curative | remains uncurable
94
reasons we do not have a HIV vaccine
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
what populations would be most benefitted from a HIV vaccination?
IV drug abusers | third world countries

Pathophysiology I (10 decks)

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