Immunology and basic Microbiology Flashcards
Immune system
organs (2nd)
2° organs: Allow immune cells to interact with antigen
P - Peyer patches L - lymph nodes a T - tonsils S - Spleen
Lymph node Medulla Consists of
- medullary cords (closely packed lymphocytes and plasma cells) and medullary sinuses.
- Medullary sinuses communicate with efferent lymphatics and contain reticular cells and macrophages.
Internal iliac nodes drain the…
Lower rectum to anal canal (above pectinate line), vagina (middle third), prostate.
(bladder, cervix- both)
External iliac drain the…
body of uterus
cervix, bladder in both Internal iliac and External iliac
Both Internal iliac and External iliac. drain the…
cervix, bladder in both Internal iliac and External iliac
Cervical supraclavicular drain the…
Head and neck (URI, Mono, Kawasaki - KUM)
Mediastinal drain the…
Trachea and esophagus
Primary lung cancer
Granulomatous disease
Hilar drain the…
Lungs
Granulomatous disease
Para-aortic drain the…
Testes. ovaries. kidneys. uterus -> Metastasis
Popliteal nodes drain the:
Dorsolateral foot posterior calf -> Lateral foot/ leg cellulitis
Superficial inguinal nodes drain the_____
Anal canal (below pectinate fine skin below), umbilicus (except popliteal area). scrotum. vulva
Hassal corpuscules are part of…
and contain
Hassal corpuscules are located in the thymus medulla along with mature t-cells and reticular cells.
Thymoma- neoplasm of the thymus.
associated with
myasthenia gravis, superior vena cava
syndrome, pure red cell aplasia, Good
syndrome.
MS Pure & Good
PAMPS are..
LPS
N.A. (Virus)
Flagellin
Spleen white pulp has
Follicules (B cells)
PALS (T cells)
Spleen red pulp has
Sinusoids - long, vascular channels in reed pulp with fenestrated “barrel hoop” basement membrane.
Spleen marginal zone has
BAM! presentation!
B cells
APC
Macrophages
Postsplenectomy blood findings:
- Howell-Jolly bodies (nuclear remnants)
- Target cells
- Thrombocytosis (loss of sequestration and removal)
- Lymphocytosis (loss of sequestration)
HLA SUBTYPE A3
DISEASE
Hemochromatosis
HLA SUBTYPE B8
DISEASE
Addison disease, myasthenia gravis, Graves
disease
Bate (B8) Addison to Graves(2)
HLA SUBTYPE B27
DISEASE
Psoriatic arthritis, Ankylosing spondylitis,
IBD-associated arthritis, Reactive arthritis
PAIR
HLA SUBTYPE C
DISEASE
Psoriasis
P”C”riasis
HLA SUBTYPE DQ2/DQ8
DISEASE
Celiac disease
HLA SUBTYPE DR2/3
DISEASE
SLE
HLA SUBTYPE DR2
DISEASE
Multiple sclerosis, hay fever, SLE,
Goodpasture syndrome
Multiple hay pastures are dirty (DR2).
HLA SUBTYPE DR3/5
DISEASE
Hashimoto
HLA SUBTYPE DR3
DISEASE
DM type I, SLE, Graves disease, Addison disease
Addison in front of 1 grave
HLA SUBTYPE DR4
DISEASE
Rheumatoid arthritis, DM type 1, Addison
disease
Addison in 1 room
Natural killer cells Activity enhanced
by IL-2, IL-12, IFN-alfa , and IFN-beta.
T -cell subset Th1
secrets
IL 2
IFN gamma
T -cell subset Th2
secrets
IL 4,5,6,10,13
T -cell subset Th17
secrets
IL 17, 21, 22
T -cell subset Treg
secrets
TGF beta
IL 10, 35
T -cell subset Th1
induced by
IL 12
IFN gamma
T -cell subset Th2
induced by
IL 2,4
T -cell subset Treg
induced by
TGF beta
IL2
T -cell subset Th17
induced by
TGF-beta
IL 6, 1
T -cell subset Th1
inhibited by
IL 4
IL 10
T -cell subset Th2
inhibited by
IFN gamma
T -cell subset Th17
inhibited by
IL 4
IFN gamma
T -cell subset Treg
inhibited by
IL-6
Important cytokines
SECRETED BY MACROPHAGES
Acute (IL- I, IL-6, TNF-a), then recruit (IL-8, IL-12).
interleukin-1
F - fever
A - acute inflammation.
C - chemokine secretion - recruit WBCs.
E - endothelium activation - express adhesion molecules.
Also known as an osteoclast-activating factor.
interleukin-6
Causes fever and stimulates the production of acute-phase
proteins.
Tumor necrosis
factor-a
W - WBC recruitment
E - endothelium( Activation)
L - leak (vascular)
lnterleukin-8
Major chemotactic factor for neutrophils.
lnterleukin-12
Induces differentiation ofT cells into Th I cells.
Activates NK cells.
Important cytokines
SECRETED BY ALL T CELLS
lnterleukin-2
lnterleukin-3
lnterleukin-2
Stimulates growth of helper, cytotoxic, and
regulatory T cells, and NK cells.
nterleukin-3
Supports growth and differentiation of bone
marrow stem cells. Functions like CM-CSF.
Cell surface proteins
T cells
TCR (binds antigen-Ml IC complex)
CD3 (associated with TCR for signal transduction)
CD28 (binds B7 on APC)
Cell surface proteins
Helper T cells
CD4, CD40L, CXCR4/CCR5 (co-receptors for HIV)
Cell surface proteins
Cytotoxic T cells
CD8
Cell surface proteins
Regulatory T cells
CD4,CD25
Cell surface proteins B cells
lg (binds antigen)
CDl9, CD20, CD21 (receptor for Epstein-Barr virus), CD40
MHC II, B7
Cell surface proteins
Macrophages
CDl4 (receptor for PAMPs, eg, LPS), CD40
CCR5
MHC II, B7 (CD80/86)
Fc and C3b receptors (enhanced phagocytosis)
Cell surface proteins
NK cells
CDl6 (binds Fe of lgG), CD56 (suggestive
marker for NK)
Cell surface proteins
Hematopoietic stem cells
CD 34
Passive immunity for
After exposure to Tetanus toxin, Botulinum
toxin, IIBV, Varicella, Rabies virus, or
Diphtheria toxin, unvaccinated patients are
given preformed antibodies (passive)- “To Be
Healed Very Rapidly Before Dying”
live attenuated
vaccine
Adenovirus (nonattenuated, given to military recruits}, Typhoid (Ty21a, oral}, Polio (Sabin}, Varicella (chickenpox}, Smallpox, BCC, Yellow fever, Influenza (intranasal}, MMR, Rotavirus "Attention Teachers! Please Vaccinate Small, Beautiful Young Infants with MMR Regularly!"
Killed or inactivated
vaccine
Rabies, influenza (injection), Polio (Salk}, hepatitis A, typhoid (Vi polysaccharide, intramuscular) Sa lK = Killed RIP At Times
Subunit vaccine
HBV (antigen = HBsAg), HPV (types 6, 11, 16, and 18), acellular pertussis (aP}, Neisseria meningitidis (various stra ins), Streptococcus pneumoniae, Haemophilus influenza type b. Be PP SHIN
Arthus reaction
a local subacute immune
complex-mediated hypersensitivity reaction.
intradermal injection of antigen into a
pre-sensitized (has circulating IgG) individual
leads to the immune complex formation in the
skin. Characterized by edema, necrosis, and
activation of complement.
Type I
hypersensitivity Phases
Anaphylactic and atopic-two phases:
• Immediate (minutes)
• Late (hours)
Type I
hypersensitivity
Immediate (minutes):
antigen crosslinks
preformed lgE on presensitized mast cells
- immediate degranulation - release of
histamine (a vasoactive amine} and tryptase
(a marker of mast cell activation}.
Type I
hypersensitivity
ILate (hours}:
chemokines (attract inflammatory cells, eg, eosinophils) and
other mediators (eg, leukotrienes} from mast
cells - inflammation and tissue damage.
Common variable
immunodeficiency
PRESENTATION
Usually presents after age 2 and may be considerably delayed;
dec. Plasma cells, dec. Igs
LABS L - Lymphoma, A - Autoimmune disease B - Bronchiectasis S - Sinopulmonary infections
Autosomal dominant
hyper-lgE syndrome
(Job syndrome)
PRESENTATION
FATED Facies/Fractures Abscesses (cold) Teeth (baby) Eosinophils/IgE Dermatologic eczema/dominant.
Ataxia-telangiectasia
PRESENTATION
Lymphoma and leukemia. AFP inc. Lymphopenia, cerebellar atrophy. IgA dec LALA
Hyper-lgM syndrome
X-linked recessive.
Failure to make gerMinal
centers.
Wiskott-Aldrich
syndrome findings
gAmE (Ig- caps inc, lower case dec.)
WATER: Wiskott-Aldrich:
thrombocytopenia, Eczema, Recurrent (pyogenic) infections.
Chediak-Higashi
syndrome
PLAIN: Progressive neurodegeneration,Lymphohistiocytosis, Albinism (partial), recurrent pyogenic Infections, peripheral Neuropathy.
Infections in immunodeficiency
- Bacteria (no T-cells)
Sepsis
Infections in immunodeficiency
- Viruses (no T-cells)
CMV, EBV, JC
virus, VZV, chronic
infection with
respiratory/GI viruses
Infections in immunodeficiency
- Fungi/parasites (no T cells)
Candida (local), PCP, Cryptococcus
Infections in immunodeficiency - Bacteria (no B-cells)
Encapsulated (Please SHINE my SKiS): Pseudomonas aeruginosa, Streptococcus pneumonia, Haemophilus Influenzae type b, Neisseria meningitis, Escherichia coli, Salmonella, Klebsiella pneumoniae, Group B Streptococcus
Infections in immunodeficiency - Viruses (no B-cells)
Enteroviral encephalitis, poliovirus (live vaccine contraindicated)
Infections in immunodeficiency - Fungi/parasites (no B-cells)
GIgiardiasis (no IgA)
Infections in immunodeficiency - Bacteria (no GRANULOCYTES)
Staff Break Pseudo! Not serious: Staphylococcus, Burkholderia cepacia, Pseudomonas aeruginosa, Nocardia, Serratia
Infections in immunodeficiency - Fungi/parasites (no GRANULOCYTES)
Candida (systemic),
Cryptococcus
Aspergillus
Mucor
infections in immunodeficiency - Bacteria (no complement)
Encapsulated species with early complement deficiencies Neisseria with late complement (C5- C9) deficiencies
Alemtuzumab
TARGET
CLINICAL USE
CD52
CLL, MS
Bevacizumab
TARGET
CLINICAL USE
VEGF
Colorectal cancer, renal cell
carcinoma, non-small cell
lung cancer
Also used for neovascular age-related macular degeneration, proliferative diabetic retinopathy, and macular edema
CoLoREtaL
Rituximab
TARGET
CLINICAL USE
CD20 CRIB =B-cell non-Hodgkin lymphoma, CLL, rheumatoid arthritis, ITP, MS Risk of PML in patients with JC virus
Trastuzumab
TARGET
CLINICAL USE
HER2
Breast cancer, gastric cancer
Adalimumab,
infliximab
TARGET
CLINICAL USE
Soluble TNF-a
PAIR=IBO, rheumatoid arthritis,
ankylosing spondylitis,
psoriasis
Etanercept is a
decoy TNF-a receptor and not a
monoclonal antibody
Eculizumab
TARGET
CLINICAL USE
Complement protein C5
Paroxysmal nocturnal
hemoglobinuria
Natalizumab
TARGET
CLINICAL USE
a4-integrin MS, Crohn disease a4-integrin: WBC adhesion Risk of PML in patients with JC virus
Denosumab
TARGET
CLINICAL USE
RANKL
Osteoporosis; inhibits osteoclast maturation
(mimics osteoprotegerin)
Omalizumab
TARGET
CLINICAL USE
IgE
Refractory allergic asthma;
prevents IgE binding to FceRI
Palivizumab
TARGET
CLINICAL USE
RSV F protein
RSV prophylaxis for high-risk infants
Ustekinumab
TARGET
CLINICAL USE
IL-12/IL-23
Psoriasis, psoriatic arthritis
Periplasm location and significance
Space between the cytoplasmic membrane
and outer membrane in gram neg bacteria.
(Peptidoglycan in middle.)
Accumulates components exiting gram
neg cells, including hydrolytic enzymes
(eg, beta-lactamases).
Pleomorphic bacteria
Have no rigid cell walls.
Examples include Anaplasma, Ehrlichia, Chlamydiae, Rickettsiae, Mycoplasma, Ureaplasma.
U-CREAM
These bugs do not Cram stain well…
Treponema, Leptospira,Mycobacteria, Mycoplasma, Ureaplasma, Legionella, Rickettsia, Chlamydia, Bartonella, Anaplasma, Ehrlichia
TeLL MUM B CLEAR
Giemsa stain bugs
Rickettsia, Chlamydia, Trypanosomes,
Plasmodium, Borrelia, Helicobacter pylori
Ricky got Chlamydia as he Tried to Please the
Bored Ilot “Geisha.”
Periodic a cid- Schiff
stain
Stains glycogen, mucopolysaccharides; used
to diagnose Whipple disease (Tropheryma
Whipple
Ziehl-Neelsen stain
carbol fuchsin
Acid-fast bacteria (eg, Mycobacteria,
Nocardia; stains mycolic acid in the cell wall);
protozoa (eg, Cryptosporidium oocysts)
Auramine-rhodamine stain is more often used for screening (inexpensive, more sensitive).
India ink stain
Cryptococcus neoformans; mucicarmine
can also be used to stain thick polysaccharide
capsule red
Silver stain
Fungi (eg, Coccidioides, Pneumocystis
Jiirovecii), Legionella, helicobacter pylori
F His Life
Fluorescent antibody stain
Used to identify many bacteria, viruses,
Pneumocystis Jirovecii, Giardia, and
Cryptosporidium.
Thayer-Martin agar has
Selective ly favors growth of Neisseria by
inhibiting the growth of gram (+) organisms
with Vancomycin, gram (-) organisms except
Neisseria with Trimethoprim and Colistin,
and fungi with Nystatin
Vice City News Team
Aerobes
Nocardia, Pseudomonas
aeruginosa, Mycobacterium tuberculosis, and
Bordetella pertussis.
Anaerobes
Clostridium, Bacteroides,
Fusobacterium, and Actinomyces israelii
AminO2glycosides are
ineffective against anaerobes because these
antibiotics require O2 to enter into bacterial
cell.
Facultative anaerobes
Streptococci, staphylococci, and enteric gram (-)
bacteria.
Obligate intracellular bacteria
Rickettsia, Chlamydia, Coxiella. Rely on host
ATP.
Stay inside (cells) when it is Really Chi lly and
Cold.
Facultative
intracellular
bacteria
Salmonella, Neisseria, Bruce/la, Mycobacterium,
Listeria, Francisella, Legionella, Yersinia pestis
Bruces List SNM FacultativeLY.
Urease-positive organisms
Proteus, Cryptococcus, H pylori, Ureaplasma, Nocardia, Klebsiella, S epidermidis, S saprophyticus. Urease hydrolyzes urea to release ammonia and C02 - inc. pH
Predisposes to struvite (ammonium magnesium phosphate) stones, particularly Proteus.
Pro CHUNKSS.
Catalase-positive
organisms
Nocardia, Pseudomonas, Listeria,
Aspergillus, Candida, E coli, Staphylococci,
Serratia, B cepacia, H pylori.
PS BLANCHES
Type Ill secretion
system
Needle-like protein appendage fac ilitating d irect delivery of toxins
(eg, Pseudomonas, Salmonella, Shigella, E coli)
PuShES
Sporicidal Disinfection & sterilization
Chlorine Autoclave Ethylene oxide Hydrogen peroxide Iodine and iodophors (maybe) EACH I
Non-Sporicidal Disinfection & sterilization
Quaternary amines
Chlorhexidine
Alcohols
Quarters Are Cool
Early complement
deficiencies (C1-C4)
Increased risk of severe, recurrent pyogenic sinus and respiratory tract infections.
Increased risk of
SLE.
Oxidative burst also leads to…
K+ influx, which releases lysosomal enzymes.
Pyocyanin of P aeruginosa generates…
ROS to kill competing pathogens.
Lactoferrin is a protein found in_____(2) that inhibit microbial growth via______
secretory fluids and
neutrophils
iron chelation.
Combined passive and active immunizations
can be given for… (2)
hepatitis B or rabies exposure
AUTOANTIBODIES for Polymyositis, dermatomyositis
Antisynthetase (eg, anti-Jo-I)
anti-SRP
antihelicase (anti-Mi-2)
AUTOANTIBODIES for SLE
Anticardiolipin lupus anticoagulant Antinuclear (ANA) Anti-dsDNA anti-Smith
AUTOANTIBODIES for Antiphospholipid syndrome
Anticardiolipin
lupus anticoagulant
Anti-beta 2 glycoprotein I
Endotoxin
ENDOTOXINS: Edema Nitric oxide DIC/Death Outer membrane TNF-a O -antigen + core polysaccharide + lipid A eXtreme ly heat stable IL-I and IL-6 Neutrophil chemotaxis Shock
Three main effects: macrophage activation
(TLR4/CDl4), complement activation, and
tissue factor activation.
Pseudomonas aeruginosa Produces
Produces PEEP:
Phospholipase C (degrades cell membranes); Endotoxin (fever, shock); Exotoxin A (inactivates EF-2); Pigments: pyoverdine and pyocyanin (blue-green pigment)
False-Positive results on VDRL with:
Pregnancy
Viral infection (eg, EBV, hepatitis}
Drugs
Rheumatic fever
Lupus and leprosy
