Infection and immunology Flashcards

1
Q

What is the consequence of the GI tract having such a large surface area

A
  • It has a massive antigen load
  • Resident microbiota bacteria
  • Dietary antigens
  • Exposure to pathogens
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2
Q

what does the immune system of the gut have to be in a state of?

A

State of “restrained activation” - Tolerance to food and commensual bacteria vs. active immune response – Dual immunological role.

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3
Q

How was it shown that we require microbiota for a healthy immune system

A
  • we used germ free mice, with no microbiota

- and the development of T cells is fewer, and B cells

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4
Q

what does the microbiota consist of and what happens when our body is in equilibruim and when it isn’t?

A
  • Symbionts: symbiotic relationship, important for regulation of our body
  • commensals: prevent the adhesion of pathogens and bactera in the endothelial lining
  • pathiobionts: can cause inflammation

All these are balanced when our body is in equilibruim.

Dysbiosis – Altered microbiota composition
This is what happens when the components are imbalanced, regulation is disrupted which causes inflammation.

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5
Q

what factors play a role in causing dysbiosis?

A
  • Infection or inflammation
  • diet
  • xenobiotics
  • hygeine
  • genetics
  • healthy microbiota

These can go and affect all over the body

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6
Q

what is the first defence mechanims in the mucosa?

A
Mucus layer - Goblet cells
Epithelial monolayer - Tight junctions
Paneth Cells (small intestine)
-Bases of crypts of Lieberkühn.
-Secrete Antimicrobial peptides (defensins) and lysozyme.
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7
Q

what happens if the bacteria go through the first line defence mechanism?

A

We have immunological defence mechanisms.

  • MALT (mucosa associated lymphoid tissue)
  • GALT (gut associated lymphoid tissue)
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8
Q

where are MALT found?

A
  • Found in the submucosa below the epithelium, as lymphoid mass containing lymphoid follicles (collection of T and B lymphocytes)
  • Follicles are surrounded by HEV postcapillary venules, allowing easy passage of lymphocytes

Found mainly in the mouth e.g. tonsils (M cells) which can initiate an immune response
MALT is a umbrella term for many immunological tissues

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9
Q

where about is GALT found?

A
  • As you go down, you have the GALT
  • Responsible for both adaptive & innate immune responses through generation of lymphoid cells & Abs

GALT is presented in 2 forms.

  • Not Organised
    Intra-epithelial lymphocytes – Make up one-fifth of intestinal epithelium, e.g., T cells, NK cells. lymphocytes below basolateral membrane of the epithelium of the gut

Lamina propria lymphocytes—-IgA secreting B cells

Organised:
Peyer’s patches (small intestine)
Caecal patches (large intestine)
Isolated lymphoid follicles
Mesenteric lymph nodes (encapsulated)
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10
Q

Describe how the different lymphoid tissue are organised?

A
  • intra-epithelial lymphocytes
  • below epithelium: peyers Patch

All these drain into the mesenteric lymph nodes

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11
Q

where is peyers patches found?

A
  • Found in small intestine, mainly distal ileum
  • Aggregatedlymphoid follicles covered with follicle associated epithelium (FAE).
  • Mucus contains naiive B cells and T cells
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12
Q

what are the features of the FAE?

A

FAE - no goblet cells, no secretory IgA, lack microvilli

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13
Q

where are the tran-epithelial dendritic cells?

A
  • between epithelial cells, through the peyers patch
  • this however does not compromise the tight junctions and still functions to not let any pathogens through the tight junctions.
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14
Q

How is the epithelium above Peyer’s patches different to normal gut epithelia?

A

It is Follicle Associated Epithelium (FAE) - there are no goblet cells, no microvilli and no secretory IgA

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15
Q

In which layer of the gut wall are Peyer’s patches found?

A

Lamina Propria

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16
Q

Where do activated T and B cells go to proliferate?

A

Superior Mesenteric Lymph Nodes

17
Q

What is the role of secretory IgA?

A

Prevent attachment and entry of pathogens

18
Q

What immune cell makes up 1/5 of intestinal epithelium?

A

Intraepithelial lymphocytes

19
Q

What is the difference between conventional and unconventional T cells?

A

Conventional - migrate from other tissues

Unconventional - resident

20
Q

what other innate cells are involved?

A

NK cells

21
Q

What three signals determine the T cell response?

A

Presentation of antigen on MHC
Costimulation
Cytokines

22
Q

what are the mechanisms of immune tolerance?

A

Anergy
Deletion
Regulation (Tregs)

23
Q

What is Crohn’s disease?

A

Inflammatory thickening of the bowel wall - leads to ulceration, diarrhoea and pain

24
Q

Name 4 structures where GALT is ORGANISED

A

Cryptopatches
Peyer’s Patches
Isolated lymphoid follicles
Mesenteric lymphoid follicles

25
Q

Name 2 places where GALT isn’t organised

A

Intra-epithelial lymphocytes

Lamina propria lymphocytes

26
Q

State three infections of the GIT.

A

Oral candidiasis
Helicobacter pylori
Traveller’s Diarrhoea

27
Q

What does H. pylori cause?

A

Increased acid secretion

28
Q

State three causes of Traveller’s Diarrhoea.

A

Escherichia coli
Salmonella
Shigella

29
Q

Name a superbug.

A

Clostridium difficile

30
Q

What is the treatment for C. difficile?

A

Metronidazole and Vancomycin

31
Q

What components make up mucosal defence?

A

Anatomical and chemical barriers
Commensal bacteria
GALT and MALT

32
Q

What makes up the epithelial barrier?

A

Goblet cells, Paneth cells, antimicrobial peptides, secretory IgA

33
Q

What is GALT and what does it do?

A

Collections of T and B cells which generate lymphoid cells and antibodies
Produces secretory and interstitial IgA, IgM, IgG and cell mediated immunity

34
Q

What do Peyer’s Patches consist of?

A

naïve T and B cells

35
Q

what is cholera?

A

Cholera is an acute bacterial disease caused by Vibrio cholerae.
The bacteria reaches the small intestine where on making close contactwith the epithelium releasescholera toxin.
Cholera toxin on entering the epithelial cell, starts a series of biochemical reactions resulting in exit of ions such as Na+, K+, Cl- and water from the epithelial cell.

36
Q

How is cholera diagnosed, treated and transmitted?

A

Transmitted through faecal-oral route,

: bacterial culture from stool sample on selective agar is the gold standard, rapid dipstick tests also available.

Treatment: oral-rehydration is the main management

37
Q

what are the causes of diarrrhoea?

A

Viral
Bacterial
Protozoal parasitic

38
Q

how does rotavirus cause dirrahoea?

A

RNA virus, replicates in erythrocytes. 5 types A – E, type A most common in human infections