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Yr 3 > Immunology transition > Flashcards

Immunology transition Flashcards

1
Q

signs of immunodeficiency

A

SPUR
serious infections - unresponsive to oral antibiotics
persistent infections - early structural damage; chronic infections
unusual infections - unusual organisms/sites
recurrent infections - 2 major or 1 major + recurrent minor infections in one year

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2
Q

other features suggestive of immunodeficiency

A 
weight loss 
failure to thrive 
severe skin rash 
chronic diarrhoea 
mouth ulceration 
unusual autoimmune disease 
family history
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3
Q

physiological conditions associated with secondary immune deficiency

A

ageing

prematurity

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4
Q

infectious conditions associated with secondary immune deficiency

A

HIV

measles

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5
Q

treatment interventions associated with secondary immune deficiency

A

immunosuppressants
anti-cancer
corticosteroids

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6
Q

malignant conditions associated with secondary immune deficiency

A

cancer of the immune system - lymphoma/leukaemia/myeloma

metastatic

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7
Q

biochemical/nutritional conditions associated with secondary immune deficiency

A

malnutrition
renal insufficiency/dialysis
diabetes
mineral deficiencies

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8
Q

most common cause of SCID

A

X linked (45%)
mutation of component of IL2 receptor
results in inability to respond to cytokines (T/NK failure, immature B cells)

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9
Q

clinical presentation of SCID

A

unwell by 3m
persistent diarrhoea
failure to thrive
infections - more severe, unusual, opportunistic, vaccine-associated
Graft vs Host disease - colonisation of infants empty bone marrow with maternal lymphocytes
Family history of early infant death

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10
Q

what are granulomas

A

organised collection of activated macrophages and lymphocytes

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11
Q

what does granuloma formation result in

A

non-specific inflammatory response triggered by diverse antigenic agents or by inert foreign materials
results in activation of T lymphocytes and macrophages
failure of removal of stimulus results in persistent production of activated cytokines
end result is organised collection of persistently activated cells

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12
Q

how do granulomas form

A

infected macrophages stimulated to produce IL12
IL12 induces T cells to secrete gIFN
gIFN feeds back to macrophages and neutrophils
stimulates production of TNF
activates NADPH

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13
Q

what is essential for functional granulomas

A

TNF

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14
Q

name some conditions which may result in granuloma formation

A 
sarcoidosis 
mycobacterium 
leprosy 
beryllosis 
silicosis 
chronic stage of hypersensitivity pneumonitis 
foreign bodies
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15
Q

how may antibody deficiencies present

A

recurrent bacterial infections - resp, GI

antibody mediated autoimmune disease - idiopathic thrombocytopenia, autoimmune haemolytic anaemia

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16
Q

features of CVID

A

low IgG, IgA, IgM
recurrent bacterial infections, especially resp
often associated with autoimmune disease

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17
Q

features of selective IgA deficiency

A

1 in 600 - very common
2/3 asymptomatic
1/3 recurrent resp infections
genetic component but cause unknown

18
Q

DDx of antibody deficiencies (primary)

A

CVID
specific antibody deficiencies
Bruton’s agammaglobulinemia (no B cells)

19
Q

DDx of secondary hypogammaglobulinaemia

A

protein loss - enteropathy, nephrotic syndrome

failure of protein synthesis - lymphoproliferative disease (CLL, myeloma, NHL)

20
Q

Type 1 hypersensitivity

A

immediate

IgE mediated

21
Q

Type 2 hypersensitivity

A

direct cell killing
antibody mediated - activation of complement leading to cell lysis; opsonisation leading to antibody mediated phagocytosis
e.g. autoimmune haemolytic anaemia, ITP, ABO transfusion reaction

22
Q

Type 3 hypersensitivity

A

immune complex mediated

e.g. SLE

23
Q

Type 4 hypersensitivity

A

delayed type hypersensitivity

24
Q

features of NK cells

A

kill cells that lack MHC
not specific
no long term memory

25
Q

consequence of defect in NK cells

A

recurrent VZV, HSV, CMV, HPV

26
Q

describe the innate recognition of invaders

A

TLR expressed on phagocytes and dendrites activation causes pro-inflammatory cytokines + Type 1 interferon secretion

27
Q

consequences of TLR dysfunction

A

can lead to immunodeficiency or autoimmunity

28
Q

action of TNF inhibitors

A

block pro-inflammatory cytokines

29
Q

hyperacute transplant rejection

A 
mins-hrs 
thrombosis + necrosis 
Type II 
preformed AB + complement fixation 
no treatment
30
Q

acute cellular rejection

A 
5-30d 
cellular infiltration 
Type IV 
CD4 + CD8 T cells 
Rx - immunosuppression
31
Q

acute vascular rejection

A 
5-30d 
vasculitis 
Type II 
de novo AB + complement fixation 
Rx - immunosuppression
32
Q

chronic allograft failure

A

> 30d
fibrosis + scarring
immune + non-immune
minimise drug toxicity, HTN, hyperlipidaemia

33
Q

problems with cyclosporin

A

nephrotoxicity

non-melanoma skin cancer

34
Q

features of vaccination

A

produces memory in B + T cells
long lived memory B cells can remain dormant for many years and rapidly reactivate in response to 2nd encounter with antigen
vaccination stimulates rare naive T cells, induces strong T response in 14-21d
some become effector T cells - mostly die by apoptosis, some become memory T cells and are maintained at low frequency

35
Q

features of inactivated vaccines

A

cannot replicate
generally not as effective as live
response antibody based
multiple doses needed to stimulate immune response

36
Q

pros of inactivated vaccines

A

made quickly
good AB response
easy to store
usually safe

37
Q

cons of inactivated vaccines

A

many don’t stimulate good response and need multiple dose

require adjuvants

38
Q

examples of inactivated vaccines

A

whole cell - polio, Hep A, rabies, cholera, plague
fractional - subunit - hep B, flu, pertussis, HPV, anthrax
-toxoid - diphtheria, tetanus
-pure polysaccharide - Hib

39
Q

pros of live attenuated vaccines

A

all relevant effector mechanisms elicited
localised, strong response
single dose

40
Q

cons of live attenuated vaccines

A

safety - may cause infection in immunosuppressed

fragile

41
Q

examples of live attenuated vaccines

A

viruses - MMR, chicken pox, yellow fever, rotavirus, small pox, polio
bacterial - BCG, oral typhoid

Yr 3 (8 decks)

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