Lecture 4: How organisms evade immune system Flashcards

1
Q

How organisms evade immune response?

A
  • Change in major B cell or T cell epitope, to escape immunological memory
  • A large number of serotypes, varying in key determinants
  • Bacterial capsule inhibits phagocytosis:
  • Products which inhibit immune system:
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2
Q

what is an antigenic drift?

A

A minor genetic change from random point mutation that occurs as viruses replicate and evolve. Often results in changes in antigenic structure (e.g., hemagglutinin and neuraminidase in influenza virus) that cause epidemics.

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3
Q

what is an antigenic shift?

A

An abrupt, major change in a viral genome caused by exchange of genetic segments (reassortment) when two subtypes of a virus infect the same cell. Can increase the potential of a virus to cause pandemics, particularly if human pathogenic and animal pathogenic viruses exchange genetic information.

  • -Two subtypes of viruses infect the same cell and exchange genetic segments (reassortment) to create new subtypes (e.g., H3N1 → H2N1).
  • -Occurs in particular when human pathogenic and animal pathogenic influenza viruses exchange genetic information
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4
Q

what is the viral reassortment

A

Occurs in viruses with segmented genomes (e.g., influenza, rotavirus)
Exchange of genetic material between segments of two viruses from the same strain
Causes antigenic shift, which significantly increases the potential of a virus to cause pandemics

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5
Q

how EBV inhibits multiple immune functions?

A
  • Produces IL-10-like protein.
  • Inhibits Th1 & CTL development
  • Polyclonal B cell expansion
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6
Q

what is the opsonization?

A

A process by which pathogens and immune complexes are marked with an opsonin (e.g., complement factor C3b) for phagocytosis, after which the pathogen can be eliminated by phagocytes that express opsonin receptors, e.g., Fc receptor and complement receptor 1.

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7
Q

what are the decoy molecules that help to evade the immune system?

A

MALARIA & DECOY MOLECULES
• Malaria proteins secreted
• “Mops up” antibody
• Complement activated at a safe distance from the organism
• Antibody bound to decoy does not kill or opsonize organism

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8
Q

what is the Antigenic variation during the life cycle of microorganisms that helps to evade immune system?

A

Antigenic variation or antigenic alteration refers to the mechanism by which an infectious agent such as a protozoan, bacterium or virus alters the proteins or carbohydrates on its surface and thus avoids a host immune response. Antigenic variation not only enables the pathogen to avoid the immune response in its current host but also allows re-infection of previously infected hosts. Antigenic variation can result from gene conversion, site-specific DNA inversions, hypermutation, or recombination of sequence .cassettes.

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9
Q

what microorganisms display antigenic variation?

A
Trypanosoma brucei
Plasmodium falciparum
Influenza
HIV
flaviviruses
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10
Q

how microorganisms Inhibition of complement deposition:

A
  • Gram+ have a thick outer coat
  • The capsule can prevent C3 binding receptor
  • Cleavage of complement components
  • Long-chain peptidoglycans - complement activated at a safe distance
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11
Q

what is the role of long-chain peptidoglycans in evading immune system?

A

complement is activated at a safe distance

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12
Q

what are the other ways by which the organism evades the immune response?

A
  • Inhibition of complement deposition
  • The organism remains latent in the immunologically-privileged site (HSV in trigeminal ganglion)
  • Attack the immune system:
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13
Q

example of a virus that establishes latency to evade the immune system

A

HSV in trigeminal gnaglion

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14
Q

what is the immune difference in lepromatous vs tuberculoid leprosy?

A

1)lepromatous
Th2 response →
Reciprocal inhibition of Th1 response →inadequate cell-mediated immune response → many lepra bacilli
↑ Antibody production (hypergammaglobulinemia);
Nerve lesions are the result of the M. leprae invasion.
M. leprae grows best at cool sites in the body (skin, mucous membranes, peripheral nerves, anterior chamber of the eye, upper respiratory tract, testes).
2)tuberculoid
Th1 response →
Strong cell-mediated immune response → granuloma with epithelioid cells and lymphocytes but few or no lepra bacilli
Nerve demyelination is the result of a T-cell mediated response.

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15
Q

in what kind of infections investigate for immunodeficiency?

A

Serious
Persistent
Unusual organism/site
Recurrent

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16
Q

when to investigate for immunodeficiency?

A

1) Family history:
- Known immunodeficiency,
- excess infections,
- unexplained deaths,
- history associated features
2) HIV Risk factors
- Sexual history
- Transfusions
- IV drug use

17
Q

what are the conditions in infants that require investigation for immunodeficiency?

A
  • Failure to thrive/Weight loss
  • Lymphopenia in infants (<2.8 x 109/L)
  • Reactions to live vaccines
  • Associated congenital malformations
  • Lymphoid malignancies
18
Q

what are the 6 warning signs for adults that obligate to investigate for immunodeficiency?

A
  • 4 or more infections requiring antibiotics within 1 year (otitis, bronchitis, sinusitis, pneumonia)
  • Recurring infections or infection requiring prolonged antibiotic therapy
  • Two or more severe bacterial infections (osteomyelitis, meningitis, septicemia, cellulitis)
  • Two or more radiologically proven pneumonia within 3 years
  • Infection with unusual localization or unusual pathogen
  • PID in the family
19
Q

what are the primary vs secondary immunodeficiencies?

A

Primary immunodeficiencies are the result of genetic defects, and secondary immunodeficiencies are caused by environmental factors, such as HIV/AIDS or malnutrition.

20
Q

viral/fungal and protozoal infections are usually caused by a deficiency of what cells?

A

T-cells

21
Q

B cell deficiency usually results in what infections?

A

B cells

22
Q

neutrophil deficiency cause…

A

boils and abscesses eg S.aureus

23
Q

complement deficiency usually predisposes to?

A

recurrent meningitis

lupus-like disease

24
Q

give examples of primary vs secondary immunodeficiency syndrome where T cells are affected

A

SCID vs HIV

25
Q

give examples of primary vs secondary immunodeficiency syndrome where B cells are affected

A

X- linked hypogammaglobulinemia (Bruton’s), CVID
vs
hypogammaglobulinemia, CLL

26
Q

give examples of primary vs secondary immunodeficiency syndrome where neutrophils are affected

A

chronic granulomatous disease
vs
DM

27
Q

give examples of primary vs secondary immunodeficiency syndrome where complement system is affected

A

recurrent meningitis vs

anti-C5a for PNH (paroxysmal nocturnal hemoglobinuria)

28
Q

what is the PNH?

A

A rare, acquired hemolytic anemia caused by mutation in the gene encoding the membrane-bound glycosylphosphatidylinositol-anchoring protein (GPI anchor; anchors CD55 and CD59) that makes erythrocytes susceptible to destruction by complement and thereby causes intravascular (mainly) and extravascular hemolysis. Presents with Coombs-negative hemolytic anemia, hemoglobinuria, and jaundice. Can cause venous thromboemboli and pancytopenia.
Acquired mutation on the PIGA gene located on the X chromosome → GPI anchor loses its protective effect → RBC destruction by complement and reticuloendothelial system → intravascular and extravascular hemolysis

29
Q

what is the asplenia?

A

The absence of normal spleen function (functional asplenia) or of the spleen itself (anatomic asplenia). Most commonly due to sickle cell disease or splenectomy. Causes increased risk of infection by encapsulated bacteria, so patients with asplenia require immunization against Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type B.

30
Q

why asplenia increase the risk of infection with encapsulated organisms?

A

Encapsulated pathogens are normally opsonized with antibodies and afterward phagocytosed by specialized macrophages in the spleen. Asplenic patients lack this defense mechanism. They are thus prone to developing asplenic sepsis.

31
Q

what are the causes of hyposplenism?

A

1) Acquired asplenia
- –Anatomic asplenia: due to splenectomy, which may be indicated in
- Thrombocytopenia (e.g., refractory idiopathic thrombocytopenic purpura)
- Severe hemolytic anemias (e.g., spherocytosis)
- Splenic rupture (e.g., from blunt abdominal trauma)
- Hypersplenism with splenomegaly
2) Functional asplenia
- Autosplenectomy: sickle cell anemia
- Splenic infarction (splenic artery thrombosis)
3) Congenital asplenia (very rare)

32
Q

what are the hematologic changes in asplenic patients?

A

1) Peripheral blood smear
- Howell-Jolly bodies (Basophilic spots are visible within the red blood cells)
- Target cells
2) Lymphocytosis (Due to a loss of sequestration of lymphocytes in the spleen)
3) Neutrophilia
4) Decreased production of immunoglobulins (IgG, IgM): leads to decreased complement activation and C3b opsonization
5) Reactive thrombocytosis: usually for the first weeks to months after splenectomy (The spleen stores approx. ⅓ of all circulating platelets and filters old platelets from the bloodstream; once the spleen has been removed, the platelet count increases temporarily.)

33
Q

what is the Overwhelming post-splenectomy infection (OPSI)

A

Fulminant sepsis that develops in asplenic individuals as a result of infection by encapsulated organisms (e.g., Streptococcus pneumoniae). The risk of OPSI is highest among children under the age of 6 years. Patients initially have flu-like symptoms (e.g., fever, malaise), but rapidly deteriorate within hours.
Etiology: encapsulated bacteria e.g., Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae
Therapy: immediate IV antibiotic therapy with vancomycin plus ceftriaxone or cefotaxime

34
Q

what are the microorganisms involved in OPSI?

A
•	Encapsulated bacteria
•	Strep. pneumoniae
•	Haemophilus influenza
•	Neisseria meningitides
•	Others	- E. coli, Malaria, etc
•	Timing:- most OPSI within 1-2 yrs (65%)
- > 5 yrs (30%)
- Reports > 20 yrs
35
Q

what is post-splenectomy management?

A
  • Vaccination – Pneumovax, HiB, Meningococcal
  • Antibiotic prophylaxis
  • Advice against travel, animal bites
  • Medic Alert