Immunological Flashcards
What is a primary immunodeficiency?
a group of more than 300 rare, chronic disorders in which part of the bodies immune system is missing or functions improperly.
What are the signs of a primary immune deficiency?
- increased susceptibility to infections
- more frequent infections
- longer lasting infections
- opportunistic infections
what is an opportunistic infection?
an infection a person with a healthy immune system likely wouldn’t get
other symptoms of opportunistic infection?
- affects natural immune system
- cannot initiate -inflammatory response
- bacterial, fungal, viral infections
- recurring abscesses, bronchitis and sinusitits.
what type of cells cannot reach the vascular system with a PI?
neutrophils unable to reach site of infection, and remain in the vascular system
What is HIV?
human immune deficiency virus
What type of infection is HIV classified as?
a chronic infection, treated as outpatient
what is AIDS?
autoimmune deficiency syndrome
what type of infection is AIDS classified as?
Acute, maybe requiring hospitalization
what body fluids can HIV-1 be transmitted through?
blood seminal fluid vaginal secretions amniotic fluid breastmilk
how soon after exposure to AIDS/HIV should antivirals be started?
within 72 hours of exposure
what are stages of HIV based on?
stages based on clinical condition and CD4+T cell count
how soon are antibodies produced after infection?
antibodies are produced usually within 3-12 weeks after infection
What tests detect antibodies?
Blood test, EIA
if EIA is positive; Western blot assay confirms seropositivity
what company uses saliva to perform an EIA?
OraSure
what do you do when you are exposed to HIV/AIDS?
wash area with soap and water, flush splashes to the nose, mouth, or skin with water
report incident to your supervisor
immediately seek medical treatment
manifestations of HIV?
can include any system
infection, malignancy of body tissue
what are the respiratory issues with HIV and AIDS?
pneumocystitis pneumonia
Tuberculosis
oral candidiasis
what is the most common respiratory condition with HIV and AIDS?
pneumocystis pneumonia
80% without prophylactic treatment
how does pneumocystis pneumonia present?
initially vague symptoms, progress to significant pulmonary impairment and respiratory failure
how is pneumocystis pneumonia diagnosed?
sputum, bronchial-alveolar lavage, transbronch biopsy
tuberculosis with HIV/AIDS?
often latent disease, 10% risk developing active
how common is oral candidiasis with HIV and AIDS?
occurs in almost all patients
symptoms of GI problems with HIV/AIDS?
- loss appetite, N/V, oral and esophageal candidiasis, chronic diarrhea
- related to direct affect of virus or tx protocol
- weight loss, progressive tissue wasting
oncologic s/s r/t HIV and AIDS?
kaposi’s sarcoma
lymphoma
invasive cervical cancer
what is kaposi’s sarcoma?
- endothelial layer blood and lymphatic vessels
- localized cutaneous lesions to disseminated multi organ
- prognosis depends on extent of tumor, other HIV infections, CD4+ count
lymphoma with AIDS?
b-cell lymphoma 2nd most common malignancy with HIV and AIDS
-often aggressive growth and resistance to tx
neurologic r/t HIV and AIDS?
Related to action HIV on nervous system tissue, opportunistic infections,
neoplasms, cerebrovascular changes, encephalopathies, treatment complications. Includes inflammation,
atrophy, demyelination, necrosis
neuro conditions r/t HIV and AIDS?
- peripheral neuropathy
- HIV encephalopathy
- cryptococcus neoformans meningitis
- progresive multifocal leukoencephalopathy
integumentary conditions r/t HIV and AIDS?
kaposi herpes zoster molluscum contagiousum seborrheic dermatitis generalized folliculitis
endocrine conditions r/t HIV and AIDS?
infiltration and destruction of endocrine glands
gynecologic conditions r/t HIV and AIDS?
recurrent candidiasis
ulcerative STDs
HPV
what are the s/s of diffuse connective tissue disease?
- chronic
- inflammation and degenerative connective tissue
what is the diffuse connective tissue disease?
rheumatoid arthritis
what is the autoimmune reaction in synovial tissue?
- degenerative changes in muscle fibers
- loss tendon and ligament elasticity and contractile power
what gender is RA more common in?
females 2:1 versus males 4:1
s/s of RA?
- joint pain, swelling, warmth, erythema, lack of function, deformity depending on disease stage and severity
- joint stiffness in AM
- deformities in hands and feet
where does joint pain begin with RA?
small joints, hands, wrists and feet
where does RA progress to?
knees, shoulders, hips, elbows, ankles, cervical spine, and TMJ
How is RA diagnosed?
- rheumatoid nodules
- exam
- x-rays
- presence rheumatoid factor (75%)
- elevated ESR
- low RBC and C4 complement
- positive CRP, antinuclear antibody
management of RA?
education (balance, rest and exercise)
salicylate and NSAIDS
management in first two years improve outcomes
methotrexate successful preventing joint destruction and long term disability
what are the classifications of RA?
- moderate erosive RA
- Advanced unremitting RA
- persistent Erosive RA
what is the tx for moderate erosive RA?
-formal program OT/PT
cyclosporine immunosuppressant may be added to medication regimen, enhances methotrexate
what is the tx for advanced unremitting RA?
immunosuppressant agents- affect antibody production at cellular level
high dose methotrexate
may cause bone marrow suppression, anemia, GO disturbance, rashes
tx of persistent erosive RA?
reconstructive surgery, when pain is not controlled, interferes with independence. Synovectomy, tenorrhaphy, arthrodesis, arthroplasty
corticosteroids-low dose use while slower acting meds take effect
What is SLE?
systemic lupus erythematosus (SLE), an autoimmune disease in which the bodys immune sytem mistakenly attacks healthy tissue in many parts of the body
what systems can lupus effect?
can affect any system
what does lupus do to the skin?
- arthralgia, arthritis
- papulosquamous or annular lesions
- chronic rash with erythematous papules or plaques that can scar.
- butterfly shaped rash on bridge of nose and cheeks
- oral lesions
what does lupus do to the cardio system?
pericarditis and artherosclerosis
what does lupus do to the renal system?
hypertension
what does lupus do to the neuro system?
varied and frequent, subtle behavior and cognitive changes
common symptoms of lupus?
- swollen joints
- fever
- chest pain
- hair loss
- mouth ulcers
- swollen lymph nodes, fatigue
- red rash most commonly on the face
how is lupus diagnosed?
-exam, H and P, blood tests
-skin assessment rashes, hyper or depigmentation
sensitivity to sunlight or ultraviolet light
alopecia
oral ulcers
-pericardial, pleural infiltrates
-positive ANA
-moderate to severe anemia
-thrombocytopenia, leukocytosis, leukopenia
tx for lupus?
NSAIDS
corticosteroids
immunosupressives (cyclophosphamide, azathioprine, cyclosporine)
what is the most important med for treatment of lupus?
corticosteroids
topical for cutaneous
low dose oral for minor disease activity
high dose oral or IV for major disease activity
what is scleroderma?
excessive accumulation of collagen in tissues
what does scleroderma start as?
skin involvement
initially inflammation causes edema, taut, smooth, shiny skin appearance
how common is scleroderma and what causes it?
relatively rare, and the cause is unknown
what changes after the initial phase of scleroderma?
undergoes fibrotic changes, loss of elasticity and movement
tissue becomes nonfunctional
what other body parts does scleroderma occur in?
blood vessels
major organs
body systems
how does scleroderma begin?
with Raynaud’s phenomenon and swelling of hands
manifestations of scleroderma?
- increasing hardness and rigidity of skin
- wrinkle and lines
- obliterated
- extremities stiffen, lose
- mobility
- mask like face and rigid mouth
- left ventricular heart failure, hard esophagus, scarred lungs, hardened intestinal mucosa
- progressive renal failure
what is CREST?
a calcinosis, raynauds phenomenon, esophageal hardening, sclerodactyly, telangiectasia
diagnostics for scleroderma?
no definitive test
- skin biopsy ID cellular changes
- pulmonary studies show VP abnormalities
- EKG
- esophageal study
- positive ANA
management of scleroderma?
- depends on presentation
- pain management
- limit disability
- moderate exercise to avoid contracture
- avoid extreme temperature
- lotion
treatment of scleroderma?
calcium channel blockers to improve raynaud’s
-anti-inflammatory agents control stiffness, arthralgia, general discomfort
