Immunology Summary Flashcards
What are individuals with chronic granulomatous disease at risk of?
Staphlococcus infections
Name two broad spectrum antibiotics used for neutropenic prophylaxis
Penicillin and gentamicin
What does granulocyte stimulating factor do?
Stimulates bone marrow to make neutrophils
Name two antivirals used as prophylaxis for T cell deficient patients
Acyclovir and Gangcyclovir
List three causes of T cell deficiencies
Congenital T helper cell dysfunction
Drugs e.g. cyclosporin
Viruses e.g. HIV
What are hypogammaglobulinaemias?
Not enough antibodies
List three causes of hypogammaglobulinaemia?
Congential X linked
Multiple Myeloma
Burns
What are individuals with hypogammaglobulinaemias at risk of?
Strep Pneumoniae infections (encapsulated) Giardia Lambia (parasite)
Are compliment deficiencies common?
No
What bacteria are individuals with a compliment deficiency of C5 - C8 at risk of?
N.meningititdis and S.pnemonia
What are people who have had a splenectomy at risk of?
S.pnemonia, N meningitides and HIB
What do pattern recognition receptors on neutrophils and macrophages recognise?
PAMPS e.g. lipopolysaccharides
Give an example of a patter recognition receptor
Toll like receptors
What do TLR3 and TLR4 recognise
TLR3: Viral RNA (associated with HSV encephalitis)
TLR4: Lipopolysaccharides
What molecules are involved from TLR recognising PAMPS –> cytokine release?
IRAK4 and MYD88
What can deficiencies in IRAK4 and MYD88 result in
Poor inflammation réponse often with low CRP levels
What gene do neutrophils and macrophages require to make hydrochloric acid in the phagolysosome?
GP91 (phox)
What happens if neutrophils and macrophages don’t have GP91 (phox)?
You get a build up of non functioning macrophages (granuloma) = chronic granulomatous disease
Give two features of chronic granulomatous disease
Liver Bone and Lung abscesses
What are the common bacteria causing chronic granulomatous disease?
Staphlococcus and klebsiella
How is chronic granulomatous disease treated?
BM transplant
Give two ways to test for chronic granulomatous disease
Measure dihydrohadamine reduction
Nitro blue dye (healthy people will turn dye purple)
What does a deficiency in complement factors C2 and C4 result in?
SLE
What does a defect in Brutons Tyrosine Kinase cause?
X linked ammaglobulinaemia
What is Brutons Tyrosine Kinase needed for?
B cell signalling and maturation
Without B cell can’t leave bone marrow and mature
What is more serious low IgG or IgA
IgG requires IV antibiotics for life
What does rituximab target?
CD20 receptors on B cells
Are deficits in B cell or T cells more severe?
T cells as they are needed to signal B cells
Name two defects in T cells?
SCID (severe combined immune deficiency)
DOCK8
What is SCID
Defect in T cells
Paediatric emergency
Give two types of Immunomodulators
Monoclonal antibodies or Fusion Proteins
What is immunopotentiation
Enhancing the immune response
Give three general ways of immunopotentiation
Vaccination (active and passive)
Replacement Therapies
Immune Stimulants
Give five immunopotentiation replacement therapies
Alpha interferon (hep c) Beta interferon (MS) Gamma interferon (Chronic granulomatous disease) G-CSF (enocourages BM to increase neutrophils) Pooled human immunoglobulin (antibody deficiency states)
Give four general ways of immunosuppresion
Corticosteroids
Cytotoxic Agents
Anti proliferation agents
DMARDS
How do calcineurin inhibitors act as immunosuppressants with examples
Cyclosporin A and Tacrolimus (FK506)
Stop factors that stimulate IL2 and INFgamma
Means less T cell activation
How do M-TOR inhibitors act as immunosuppressants with examples
Siroliumus (Rapamycin) - Macrolide antibiotic
Inhibits M-TOR and therefor IL2 production
Stops T cell cycle arrest at G1-S phase
How do antimetabolites act as immunosuppressants with examples
AZA, Methotrexate and Cyclophosphamide
Interrupt metabolites needed for cell production so impaired DNA in T and B cells
What is AZA, methotrexate and Clyclophosphamide used for?
AZA: Automine and allograft
Methorexate: RA
Cyclophospamide: Wegners Vasculitis
What ILs can DMARDS target
IL1 and IL6
What does DMARD targeting TNF increase the risk of
TB
What type of drug is Rituximab
DMARD
Targets CD20 receptors on B cell surface so they can’t mature
Used in lymphomas and leukaemia
Give two examples of immunomodulators
Anti IgE: Omalizumab (used in asthma)
Anti IL5: Mepolizumab
What are ANAs
Antinuclear antibodies
Recognised structure of nucleus of body and attack it = AI disorder
What are ENAs?
Extractable nucelar agents
ANAs target
Give two examples of ENAs
RNP (ribonuclear protein) RO and LA
Double stranded DNA
What pattern do anti DNA ANAs show on fluorescence?
Homogenous pattern
What pattern do anti histone and DNP show on fluorescence?
Homogenous pattern
What pattern do anti RHO and LA show on fluorescence?
Speckled
What tests do you do to look for double stranded DNA antibodies
Cirthidia Luciae Assay
Farr assay
ELISA
What tests do you to do identify ENA
Immunoblots
ELISA
Combination agents
What antibodies is rheumatoid factor agaisnt
IgG
How specific and sensitive is RF test
70%
Where can RF also be seen
Hep B and vasculitis
How specific and sensitive is anti CCP test
95% specific 70% sensitive
What is ANCA
anti neutrophilic cytoplasmic antibody
What two types of ANCA can you have?
Cytoplasmic ANCA
Perinuclear ANCA
What do cytoplasmic ANCA and Perinuclae ANCA tagrte
CANCA: PR3 antigent
PANCA: MPO antigen
What diseases is ANCA present in?
Wegners granulomatosis (PR3) Micro Polyangitis (MPO) Churgstrauss Syndrom (MPO)
What is the gold standard for recognising weighers granulomatosis, micro polyagnitis and churgstrauss syndrome?
Histology
ANCA is good but not gold standard
What antibodies does primary billiary sclerosis show?
anti mictochorndiral antibodies
Give examples of class 1 and class 2 HLA
Class 1: HLA A, B , C
Class 2: HLA DR, DQ and DP
Where are class 1 and class 2 HLA found?
Class 1: all nucleated cells
Class 2: B and T cells
How are HLA’s categorised for transplants?
HLA (broad) for Tissue
HLA (Split)
HLA (allele) for BM
Describe Direct and indirect rejection in transplants
Direct: donor cells present themselves to recipients T cell
Indirect: B cells take up donor antigens and present them to T cells
Give two tests for donor matching
cRF (calculation reaction frequency)
Cross match test (donor lymphocytes and recipients serum and see if any binding)
