Immunodeficiency Disorders Flashcards
Abscesses, adenitis, severe bacterial infections, poor wound healing and periodontal disease are caused by disorders of these
Phagocytes
Failure to thrive, severe viral infections, pneumocystis, candida and low TRECs are caused by disorders of these
T cells
Recurrent sinopulmonary infections, Enteroviral meningoencephalitis, Bronchiectasis and Recurrent gastroenteritis are caused by disorders of these
B cells
Neisseria, Early-onset Lupus and Encapsulated bacterial infections are caused by disorders of these
Complement
Disease that characteristically results from complement disorders
Neisseria
Neisseria is characteristically the result of this type of disorder
Complement
X linked disorder caused by lack of immunoglobulin due to defective B cell maturation
Defective btk gene prevents Ig gene rearrangement
Bruton X-linked Agammaglobulinemia
Bruton X-linked Agammaglobulinemia involves a lack of this
Immunoglobulin
Bruton X-linked Agammaglobulinemia involves a lack of immunoglobulin due to defective this
Defective B cell maturation
Due to defect btk gene (bruton tyrosine kinase) that prevents Ig gene rearrangement
In Bruton X-linked Agammaglobulinemia, B cell maturation stops at this stage
Pre-B stage
So very low B cells circulating in blood since this stage occurs in the bone marrow
What age does Bruton X-linked Agammaglobulinemia present?
After 6 months of age, some as late as teens
(protected from birth to 6 months due to passive immunity from mother)
Condition that is vulnerable to live vaccines
Bruton X-linked Agammaglobulinemia
Bruton X-linked Agammaglobulinemia patients are vulnerable to this type of vaccine
Live vaccines
Does Bruton X-linked Agammaglobulinemia affect cell-mediated immunity?
No; cell-mediated immunity is intact
Still resistant to protozoal, fungal, intracellular virus
Laboratory values of antibodies in Bruton X-linked Agammaglobulinemia
No/low antibodies of all classes
Laboratory values of B cells in Bruton X-linked Agammaglobulinemia
No/low B cells in peripheral blood
Laboratory values of T cells in Bruton X-linked Agammaglobulinemia
High/normal T cells in peripheral blood
Recurrent mucosal infections (otitis, sinusitis, bronchitis), Pyoderma, meningitis, sepsis, some viral infections (hepatitis, enterovirus, polio), and lymphoid hypoplasia (tonsils, lymph nodes) are clinical symptoms of this condition
Bruton X-linked Agammaglobulinemia
Condition caused by an inability to produce IgA
Very common in Europeans
Selective IgA deficiency
Laboratory values of B cells in Selective IgA deficiency
Normal
Laboratory values of Ig classes that are not IgA in Selective IgA deficiency
Normal
Laboratory values of IgA in Selective IgA deficiency
Low
Condition caused by impaired differentiation of naive B cells that causes impaired class switching to IgA plasma cells
Selective IgA deficiency
Selective IgA deficiency is common in people of this descent
European
Less common in Asia/Africa
Usual clinical symptoms of Selective IgA deficiency
Usually asymptomatic
Usually asymptomatic, increased respiratory, GI, GU infections, increased rates of allergy and autoimmune disorders, risk of anaphylaxis with blood products
Selective IgA deficiency
Patients with Selective IgA deficiency have risk of this with blood products
Anaphylaxis
Condition involving defective humoral immunity due to defective class switching
Hyper-IgM Syndrome
Two mechanisms that may cause Hyper-IgM Syndrome
Defective CD40L on CD4 T cell (X-linked)
CD40 or genes on B cell, macrophage, DC
Levels of immunoglobulins in Hyper-IgM Syndrome caused by defective CD40L on CD4 T cell
Normal IgM
Very low IgG and IgA
Levels of immunoglobulins in Hyper-IgM Syndrome caused by CD40 or genes on B cell, macrophage, DC
High polyclonal IgM
Very low IgA and IgG
Inheritance pattern of Hyper-IgM Syndrome caused by defective CD40L on CD4 T cell
X-linked
Inheritance pattern of Hyper-IgM Syndrome caused by CD40 or genes on B cell, macrophage, DC
Autosomal Recessive
Defective CD40L on CD4 T cell or CD40 or genes on B cell, macrophage, DC can cause this syndrome
Hyper-IgM Syndrome
Condition characterized by normal/increased IgM with low/absent IgG, IgA, IgE
Hyper-IgM Syndrome
Hyper-IgM Syndrome most commonly has this inheritance pattern
X-linked
Lymphoid counts in Hyper-IgM Syndrome
Normal
Absent germinal centers
State of germinal centers in Hyper-IgM Syndrome
Absent
2 treatments for Hyper-IgM Syndrome
IVIG
Bone marrow transplant
Recurrent pyogenic infections due to decreased opsonization, pneumocystis or Histoplasma pneumonia (due to macrophage dysfunction), and Cryptosporidium enteritis are clinical symptoms of this condition
Hyper-IgM Syndrome
Condition characterized by normal B cell numbers but no plasma cells
All Ig classes affected
Common variable immune deficiency
Onset of Common variable immune deficiency
Late childhood/teen onset
Recurrent sinopulmonary infections, meningoencephalitis, diarrheal illnesses (Giardia commonly), often with splenomegaly and lymphadenopathy are clinical symptoms of this condition
Common variable immune deficiency
Numbers of B cells in Common variable immune deficiency
Normal
(no B cell differentiation so no plasma cells)
Number of plasma cells in Common variable immune deficiency
None
Normal B cell numbers but no B cell differentiation
Splenomegaly and lymphadenopathy are characteristic of this syndrome
Common variable immune deficiency
B cell proliferation but no plasma cell differentiation
Condition characterized by B cell proliferation but no plasma cell differentiation
Common variable immune deficiency
Condition involving defective T cell function due to thymic hypo/aplasia
DiGeorge Syndrome
DiGeorge Syndrome involves anomalies of these pharyngeal pouches
3rd and 4th
Condition characterized by cardiac anomaly, parathyroid and hypocalcemia, thymic hypoplasia (T cell deficiency), abnormal face (micrognathia, slanted ears and eyes, cleft palate), and opportunistic infections
DiGeorge Syndrome
Micrognathia, slanted ears and eyes, and cleft palate are characteristic facial abnormalities of this condition
DiGeorge Syndrome
Hypocalcemia is characteristic of this condition
DiGeorge Syndrome
Thymic hypoplasia that leads to mild T cell deficiency (tends to improve) or Thymic aplasia that leads to severe T cell deficiency is characteristic of this condition
DiGeorge Syndrome
5 characteristic effects of DiGeorge Syndrome
CATCH-22
Cardiac (especially aortic arch, ASD, VSD)
Abnormal face (micrognathia, slanted ears and eyes, cleft palate)
Thymic hypoplasia (T cell deficiency)
Cleft Palate
Hypocalcemia (parathyroid)
Hereditary immunodeficiency due to defective cell mediated and humoral immunity
Severe combined immunodeficiency
X-linked form of Severe combined immunodeficiency
Mutation of gamma chain of interleukin receptor (IL-2, 4, 7, 9, 15)
Result: absent T cell maturation in thymus (IL-7 mediated)
Autosomal recessive form of Severe combined immunodeficiency
Mostly adenosine deaminase deficiency
Result: DNA synthesis inhibition, especially affects lymphocyte proliferation and gene rearrangements
Prognosis of Severe combined immunodeficiency
Death by 1 year
Form of Severe combined immunodeficiency that involves a mutation of gamma chain of interleukin receptor (IL-2, 4, 7, 9, 15)
X linked
Form of Severe combined immunodeficiency that is mostly adenosine deaminase deficiency
Auto recessive
Form of Severe combined immunodeficiency that results in absent T cell maturation in thymus
X linked
Form of Severe combined immunodeficiency that results in DNA synthesis inhibition, especially affects lymphocyte proliferation and gene rearrangements
Auto recessive
Treatment for Severe combined immunodeficiency
Bone marrow transplant
Condition characterized by frequent infections in early infancy and often develop graft vs host disease
Severe combined immunodeficiency
Condition where attenuated vaccines cause productive infections
Severe combined immunodeficiency
In Severe combined immunodeficiency, this type of vaccine leads to productive infections
Attenuated
Condition characterized by very low lymphocyte numbers
Small thymus with no lymphocytes or Hassal’s corpuscles
Severe combined immunodeficiency
Small thymus with no lymphocytes or Hassal’s corpuscles is characteristic of this condition
Severe combined immunodeficiency
X-linked condition caused by a defect in WASP gene product
Wiskott-Aldrich syndrome
What causes Wiskott-Alrich syndrome?
X-linked defect in WASP gene product
T cell counts in Wiskott-Aldrich syndrome
Low
(defective T cell survival)
Wiskott-Aldrich syndrome leads to defective survival of these
T cells
State of the thymus in Severe combined immunodeficiency?
Small
With no lymphocytes or Hassal’s corpuscles
State of the thymus in Wiskott-Aldrich syndrome
Normal at birth, early atrophy
Levels of IgM in Wiskott-Aldrich syndrome
Low
Levels of IgG in Wiskott-Aldrich syndrome
Normal
Levels of IgE and IgA in Wiskott-Aldrich syndrome
Both high
Levels of Antibodies (IgM, IgG, IgE, IgA) in Wiskott-Aldrich syndrome
Low IgM
Normal IgG
High IgE and IgA
Immunodeficiency, thrombocytopenia, and atopic dermatitis is a triad characteristic of this condition
Wiskott-Aldrich syndrome
Triad characteristic of Wiskott-Aldrich syndrome
Immunodeficiency (frequent infections with encapsulated bacteria)
Thrombocytopenia (bleeding disorder)
Atopic dermatitis
Prognosis of Wiskott-Aldrich syndrome
Early death without stem cell treatment
Condition involving an autosomal recessive defective DNA repair enzyme ATM
Ataxia-Telangiectasia
What causes Ataxia-Telangiectasia?
Autosomal recessive defective DNA repair enzyme ATM
Inheritance pattern of Wiskott-Aldrich syndrome
X-linked
Inheritance pattern of Ataxia-Telangiectasia
Autosomal recessive
Progressive ataxia (with other neurologic deficits), Oculocutaneous Telangiectasis, and Immunodeficiency (due to defective Ig rearrangement) is a triad characteristic of this condition
Ataxia-Telangiectasia
Triad characteristic of Ataxia-Telangiectasia
Progressive ataxis
Oculocutaneous Telangiectasis
Immunodeficiency
Levels of immunoglobulins in Ataxia-Telangiectasia
Low
Treatment for Ataxia-Telangiectasia
IVIG
Persistence of this in C1 Inhibitor Deficiency (aka hereditary angioedema) leads to recurrent episodes of edema
Bradykinin
C1 inhibitor inhibits C1r and C1s, as well as these other two molecules
Bradykinin
Hagemann Factor
In C1 Inhibitor Deficiency (aka hereditary angioedema), this type of involvement may be fatal
Laryngeal
Condition characterized by edema of skin, genitals, intestinal tract, larynx, others
Non-painful, non-pruritic, non-pitting
C1 Inhibitor Deficiency (aka hereditary angioedema)
Immunodeficiency involving lymphoid hypoplasia
Bruton X-linked Agammaglobulinemia
Immunodeficiency involving recurrent mucosal infections
(otitis, sinusitis, bronchitis)
Bruton X-linked Agammaglobulinemia
Immunodeficiency that may have increased respiratory, GI, GU infections (Giardia especially)
Selective IgA deficiency
Immunodeficiency with increased rates of allergy and autoimmune disorders (SLE and RA especially, Celiac disease)
Selective IgA deficiency
Immunodeficiency involving recurrent pyogenic infections due to decreased opsonization
Hyper-IgM syndrome
Immunodeficiency with Recurrent sinopulmonary infections common, Meningoencephalitis, Diarrheal illnesses (Giardia commonly)
Common variable immune deficiency
T cell counts in DiGeorge syndrome
Low
Ig levels in DiGeorge syndrome
Normal
Patients with this have GVHD risk with blood transfusion
DiGeorge syndrome
Immunodeficiency characterized by frequent infections in early infancy
Severe combined immunodeficiency
Patient with Ataxia-Telangiectasia have increased tumorigenesis, especially this
Lymphomas