Mosby's Micro/Path: Immune System and Antibiotics Flashcards
Name the cells involved in the acute inflammation stage of the innate immune response
neutrophils (polymorphnuclear leukoctyes) basophils mast cells natural killer cells (T cells) that kill tumor/viruses
Explain the inflammation types in the innate immune response
Acute inflammation
Chronic inflammation
Granulomatous inflammation (a form of chronic inflammation characterized by the presence of granulomas)
The result of acute inflammation is
a. complete resolution
b. scarring
c. abscess formation
if abscess enters soft tissue it is called
cellulitis
2 dentally significant formations of cellulitis include
Ludwig’s angina and cavernous sinus thrombosis
granulomas are areas the immune system walls off if phagocytes fail to destroy particles or microbes present in them.
- Tubercles are associated with granulomas involved in what infection ___
- Gumma are granulomas associated with what infection?
- TB Mycobacteria
2. Syphilis (treponema pallidum)
- Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm. They are also called _____ because of the varying shapes of the nucleus, which is usually lobed into ___segments. This distinguishes them from the mononuclear agranulocytes. In common parlance, the term polymorphonuclear leukocyte often refers specifically to neutrophil granulocytes,the most abundant of the granulocytes; the other types (eosinophils, basophils, and mast cells) have lower numbers. Granulocytes are produced via granulopoeisis in the bone marrow.
polymorphonuclear leukocytes (PMN, PML, or PMNL) three
monocytes are granular/agranular? how many lobes?
agranular and one lobe.
name the monocytes
All WBCs: macrophages, lymphocytes: T, B, natural killer cells,
the 2 types of acquired (specific) immunity are
cell mediated - t lymphocytes
humoral immunity- mediated by antibodies made by B cells
CD4+ T cells are __ cells
helper cells
CD8 T cells are __ cells
cytotoxic cells
- natural killer cells are found in __ immune system
2. cytotoxic T cells are found in __ immune system
1 innate
2. acquired
(CD4) helper t cells release which interleukins after it interacts with MHC class II
IL-4 and IL-5. This stimulates B cells and growth = to make antibodies.
CD8 cytotoxic and suppressor T cells recognize which MHC class
class I MHC molecules on antigen presenting cells
CD __ T cells are mainly for the recognition of bacterial antigens
CD4
CD __ T cells are mainly for the recognition of viral antigens
CD8
T cells are made in __ and mature in __
made by haematopoietic stem cells in the bone marrow
most mature in thymus, some in tonsils
mononuclear cells: called __ in the blood and __ in the tissues
monocytes in blood and macrophage in tissue. when monocytes enter into tissue they mature into macrophages
mononuclear cells are produced in the
bone marrow
the presence of macrophages indicates __ inflammation
chronic
the body has an extensive network of ___ known as the reticuloendothelial system.
macrophages (REL system)
reticuloendothelial system: macrophage in the ___ are called dust cells/heart-failure cells
lungs
reticuloendothelial system: macrophage in the ___ are called Kupffer cells
liver
reticuloendothelial system: macrophage in the ___ are called microglia
CNS
reticuloendothelial system: macrophage in the ___ are called mesangial
kidneys
reticuloendothelial system: macrophage in the ___ are called macrophages
lymph nodes
reticuloendothelial system: macrophage in the ___ are called monocytes
blood
reticuloendothelial system: macrophage in the ___ are called histocytes
CT
reticuloendothelial system: macrophage in the ___ are called spleenocytes
spleen
Mast cells have surface antigen receptors including __ antibody receptor
IgE
IgE plays important role in type _ hypersensitivity rxn
1
Histamine released by mast cells causes __ (vaso__)
and broncho ___
vasodilation and bronchoconstriction
There are two kinds of Histamine receptors:
- H1 receptors cause
- H2 receptors play role in
- bronchoconstriction and vasodilation
2. gastric acid and pepsin secretion
Prostoglandins and leukotrienes are mediators of inflammatory response. The are metabolites of __
arachidonic acid
Prostoglandins and leukotrienes are produced by __ pathways
cyclooxygenase (prostaglandins) and lipoxygenase (leukotrienes) pathways
Prostoglandins and leukotrienes cause broncho___
bronchoconstriction and vasodilation
Macrophages release this cytokine: IL-#
IL-1 stimulate activity/production of cells including lymphocytes, macrophages, endothelial cells. also cause fever
Helper T cells release cytokine: IL -# that activates other helper T cells and cytotoxic T cells
IL2
Activated T cells release IL# that stimulates production of RBC in bone marrow
IL3
Helper T cells secrete IL # stimulates B cell growth and production of IgE and IgG
IL-4
Helper T cells IL # stimulate B cell differentiation into plasma cells and activity of eosinophils and production of IgA
IL-5
Name the two types of cytokines
interleukins (ILs) and interferons (INFs)
- ___ are cytokines (mediators) that affect lymphocytes
3. __ are cytokines that are important for antiviral immunity
- inteleukins
2. interferons
opsonin is
any molecule that enhances phagocytosis by marking an antigen for an immune response
the most abundant immunoglobulin we have
IgG (75%)
The first responder immunoglobulin
IgM
The second responder immunoglobulin
IgG
the only immunoglobulin that can cross the placenta and is present in newborns
IgG
which antibody activates complement and therefore plays a key role in pathogenesis of adult periodontitis
IgG
list the antibodies in order or abundance
IgG (75%) > IgA (15%) > IgM (9%) > IgD (0.2%) > IgE (0.004%) GAMDE
which antibody is associated w immunity of mucous membranes, found in mucous secretions in respiratory tract, intestinal tract, genitourinary, tears, saliva, and colostrum (mammary glands)
IgA
Which antibody is associated w body’s primary immune response?
IgM
which immunoglobulin acts as an antigen receptor for B cells that induces B cell activation
IgM
which antibody acts as a receptor for granulocytes including basophils and mast cells and stimulates their degeneration
IgE
IgE plays an impt role in type _ hypersensitivity reaction
1
treatment of anaphylaxic shock
epinephrine (vasoconstrictor and bronchodilator) or antihistamine
what antibody is involved with type I hypersensitivity reactions
IgE - histamine release…anaphylaxis…asthma hayfever
what antibody involved with type II hypersensitivity rxn
IgM and IgG = complement system, MAC
ex erythroblastosis fetalis, blood transfusions
what antibody involved with type III hypersensitivity rxn
IgG
in type __ hypersensitivity, the antigen antibody interactions form immune complexes that become trapped along vascular walls damaging BV’s from phagocytosis by reticuloendothelial system
3
Arthus reaction (injecting antigen into patient with high IgG already in blood), serum sickness (injection of drug serum/antigens), Rheumatoid arthritis, systemic lupus are all type __ hypersensitivity reactions
type 3
erythroblastosis fetalis and blood transfusion can cause type __ hypersensitivity reactions
type 2
there are NO antibody mediators in which type of hypersensitivity reaction
type 4.
in type 4 delayed cell mediated hypersensitivity reactions, __ are the main mediators
Helper T cells (CD4) think CD4 = type 4
List the antibody mediators:
- type 1 hypersensitivity
- type 2 hypersensitivity
- type 3 hypersensitivity
- type 4 hypersensitivity
- type 1 hypersensitivity = IgE (think asthma)
- type 2 hypersensitivity = IgG and IgM (think 2 means 2 antibodies)
- type 3 hypersensitivity = IgG
- type 4 hypersensitivity = no antibody. helper T cells
Bruton’s agammaglobulinemia =
- deficiency/low levels of ____
- ___ immunity is unaffected
- these patients get recurrent __ infections
- treatment is
- low antibodies
- cell mediated not affected. It is a failure of B cells to differentiate = low level of plasma cells and antibody production
- bacterial/pyogenic
- administer IgG
think Bruton’s = B cell problem
Transient hypogammaglobulinemia =
- seen in infants/adults
- decreased amount of __
- treatment is
- infants
- antibodies bc slow production of antibody
- administer IgG after the first 6 months
Di George’s Syndrome:
- deficiency in __ cells
- results from a failure of the __ brachial (pharyngeal pouches) to develop
- symptoms include
- T cells
- 3rd and 4th = leads to a lack of thymus and parathyroid development. mandibular development is also affected.
- tetany
recurrent viral and fungal infections
What disease is characterized by a deficiency in both T and B cells, severe, recurrent opportunistic infections common in infants. Treatment bone marrow transplant/gene therapy
severe combined immunodeficiency (SCID)
what disease causes microstomia of the mouth (decreased opening of the mouth), abnormal deposition of collagen leading to development of fibrosis in certain organs which can result in organ failure.
Scleroderma
systemic sclerosis
what disease is characterized by the presence of antinuclear antibodies (ANA). These ANA’s include anti-DNA, anti-RNA, and anti-Sm antigen.
Systemic lupus erythematous (SLE)
most significant problems with SLE
- kidney = most sig bc can lead to kidney failure
- skin - butterfly rash along the malar and nose area
- heart - increased risk of endocarditis due to vegetations found on heart valves
- joints - causing arthritis like symptoms
what disease causes butterfly rash
Lupus
most ___ plaque made of aerobes and facultative anaerobes
suprgingival
most __ plaque made of anaerobes
subgingival
Bacteria shapes:
- cocci =
- streptococci
- staphylococci
- diplococcic
- round/circular
- circular and appear in chains
- circular and appear in clusters
- circular and occur in pairs
bacteria shape:
bacilli are
rods
spirochetes are __ shape
spiral shaped
pleomorphic bacteria
appear with different inconsistent shapes
gram ____ bacteria stain blue
positive (thick) holds stain
gram __ bacteria stain red
negative
gram staining is used for what 2 purposes
determining what antibiotic to use and for identification purposes
How we gram stain:
- we stain with ___. this causes ALL bacteria to turn blue
- we use a __ solution- all bacteria retain the blue color
- we then rinse with __ or __
- when we rinse with the alcohol/acetone gram ___ will lose it’s color because it is thin
- then we stain with ___
- crystal violet
- iodine
- acetone or alcohol
- negative (gram positive stays blue bc thick)
- safranin - gram - turn red (take up color), gram + stay blue
How we acid-fast stain:
- used for __
- stain with ___ all bacteria stain red
- wash with __
- stain with ___
- mycobacteria will be what color
- mycobacteria which cant be gram stained
- carbolfuchsin
- acid alcohol
- methylene blue
- mycobacteria will stain red (retain the carbolfucshin color). all others will stain blue
In the first step of ___stain we use crystal violet.
in the first step of __ stain we us carbolfuchsin
- gram stain (all bacteria turn blue)
2. acid fast stain (all bacteria turn red)
After we wash the bacteria we use safranin in ___ stain
and use methylene blue in ___stain
gram stain
acid fast stain
all bacteria are surrounded by a cell wall except:
mycoplasma
mycobacteria?
MYCOPLASMA! Don’t confuse with mycobacteria (TB)
Cell wall of gram +/- bacteria contains teichoic acid. what is the purpose?
positive (think + = t-eichoic = thick peptidoglycan)
it is an antigen.
it is outside the Thick peptidoglycan wall)
- The periplasm is a space bordered by two selective permeable barriers, the inner membrane (i.e., cytoplasmic membrane) and the outer membrane in Gram-___ bacteria.
negative:
inner cytoplasmic membrane ==> cell wall in the periplasmic space ==> outer membrane ==> LPS attached to outer membrane
there is no periplasmic space in Gram-positive bacteria because there is only
1 biological membrane, the cytoplasmic membrane.
some gram ___ bacteria have ____ in the periplasmic space that will degrade penicillins
beta lactaminases
LPS is found in the ___ of gram negative bacteria (endotoxin).
outer membrane
the toxicity of LPS is attributed to the presence of
lipid A
the outer membrane of the LPS contains the __antigen
O
LPS is found in dental __ and inflammation
plaque
Mycolic acid in acid-fast bacteria are able to resist __
decolorization with acid alcohol therefore they can’t be gram stained.
name a bacteria that can’t be gram stained
mycobacterium tuberculosis
Capsule: gelatinous layer surrounds the cell walls of certain bacteria. generally made of polysaccharides, functions:
antiphagoctyic, identification purposes (when treated with antiserum they swell - allowing identification) and adherence to
tooth surfaces (caries)
spore forming bacteria include the genus
bacillus and clostridium
nucelocapsid are seen in
viruses: NUCLEO: viral genome nucleic acid DNA OR RNA, CAPSID (protein coat)
some viruses have envelopes. which one are more sensitive to environmental conditions
enveloped more sensitive bc can dry out and pop. non enveloped (naked) are hardy
the virus binds to the host via ___
specific surface proteins
the virus enters the host cell by __
receptor-mediated endocytosis, or by fusing its viral envelope with the host membrane, or translocation of the entire virus across host membrane
detection of viral growth:
1. ___ This lasts for 10-12 hours, and it corresponds to the period during which the input virus becomes uncoated. As a result, no infectious virus can detected during this time. no progeny virons are assembled. The period of time between infection by a virus and the appearance of the mature virus within the cell
eclipse
___ period is the time bw the initial viral infection to when the virus can be detected
latent
fungi are dimorphic meaning they can exist as
mold or yeast
mold/yeast:
- __ grows as long filaments in a free living state at ambient temperature (room temp)
- __ grow as single cells in host tissue at body temperature
- mold
2. yeast
Some fungi are spore producing. Medically significant spores:
- blastospores formed by
- chlamydospores have thick walls making them resistant to environment changes
- arthrospores-formed from the ends of __
- sporangiospored formed by __
- budding
- hyphae
- mold
Penicillins are bactericidal and inhibit what enzyme that catalyzes the final crosslinking in peptidoglycan cell wall
transpeptidase
fungal infections generally initiate a type __hypersensitivity reaction
IV delayed (cell mediated)
formation of ___ is common in response to fungal infections
granulomas
adverse reactions to what antibiotic include allergic (hypersensitivity), seizures, and platelet dysfunction
penicillin
___ penicillin is effective against gram + bacteria and gram - cocci. limited aeffect against gram negative bacilli bacteria
natural penicillins
penicillin G and V are what type of penicillin
natural (good for gram +) and (gram - cocci)
which penicillin would you use for gram negative bacilli because they are more effective.
extended spectrum penicillins
ex. amoxicillin and ampicillin
- Penicillin V and G are ___ penicilins
2. ampicillin and amoxicillin are __ penicilins
- natural (gram + and gram - cocci)
2. extended spectrum (gram - bacillus)
are natural and extended spectrum penicillin susceptible to beta lactaminase?
yes
penicillin resistant penicilins are called
antistaphylococcal penicillins - resistant to degradation by beta lactaminases.
penicillin resistant penicillins are used to treat
staph aureus (produce penicillinase)
name the penicillin resistant penicilins
cloxacillin, dicloxacillin, methicillin nafcillin oxacillin
- Penicillin V and G are ___ penicilins
- ampicillin and amoxicillin are __ penicilins
- cloxacillin, dicloxacillin, methicillin nafcillin oxacillin
- natural (gram + and gram - cocci)
- extended spectrum (gram - bacillus)
- penicillin resistant penicilins (bacteria that make penicillinase) -staph aureus
cephlasporins are __ cidal like penicillin
bactericidal
cephlasporins are __ spectrum
broad
cephlasporins action?
similar to penicillin but more resistant to beta lactaminases than penicilin
adverse rxn w/cephlasporins
with alcohol - disulfiram-like rxn
can patient who are allergic to penicillin be cross allergic to cephlasporins
yes. 10% are
name cephlasporins
cephalexin, cefadroxil, and cefazolin
Bacitracin is inhibitor of
cell wall synthesis (like cephlasporins and penicillin)
Bacitracin can only be used
topically because highly nephrotoxic if given systemically
what bactericidal antibiotic is produced by streptococcus orientalis
Vancomycin
Vancomycin is effective against gram _ bacteria
positive (think V - positiVe)
Vancomycin has limited effect on gram negative bacteria except
Flavobacterium
which antibiotic is used for multi-drug resistant bacteria like methicillin-resistant Staph aureus or treatment of endocarditis
Vancomycin
- Penicillin V and G are ___ penicilins
- ampicillin and amoxicillin are __ penicilins
- cloxacillin, dicloxacillin, methicillin nafcillin oxacillin
- vancomycin
- all of them are inhibitors of __
- natural (gram + and gram - cocci)
- extended spectrum (gram - bacillus)
- penicillin resistant penicilins (bacteria that make penicillinase) -staph aureus
- gram + - MRSA and endocarditis
- cell wall synthesis
- Aminoglycosides are antibiotics that inhibit
- they are effective against aerobic/anaerobic bacteria
- they are also useful for many gram __ rods and enterococci
protein synthesis of bacteria (block 30S)
- aerobic, ineffective against anaerobic
- negative (tuberculosis)
the aminoglycoside named Streptomycin is used for
TB
the aminoglycoside named gentamicin is used for
enterococci
Aminoglycosides are administered by
IM injection or IV
adverse reactions to aminoglycosides may be
ototoxicity = toxic to the ear(via damage to CN 8) = may cause deafness
nephrotoxicity - kidney damage
- penicillin, cephalosporins, aminoglycosides are all bacteri___
- tetracycline is bacteri
- cidal
2. static
tetracycline blocks
30S protein synthesis
tetracycline is __ spectrum and targets
broad (like cephlasporins)
gram + and - and other organisms such as Rickettsia, mycoplasma and chlamydiae
tetracycline should be avoided in
pregnant women and young children
adverse tetracycline reaction to
liver - hepatotoxic
- MRSA give
- TB give
- Rickettsia, chlamydiae, mycoplasma
- staph aureus
- endocarditis
- Vancomycin
- aminoglycoside = streptomycin
- tetracycline (think to treat all 3) c and r in the name
- oxacillin/methicillin/dicloxacillin/cloxacillin/naflacillin (CD-MON)
- vancomycin
Someone with liver failure, pregnant, or young child don’t give
tetracycline
for someone with kidney failure don’t give
aminoglycosides (streptomycin = TB), gentamicin
- erythromycin and clarithromycin are ___ and are bacteriostatic
- for gram
- macrolides.
2. positive
don’t give an alcoholic
cephlasporin
which antibiotics treat both gram positive and gram negative
- penicillin, tetracycline, chloramphenicol
only gram positive antibiotics
erythromycin, clarithromycin, vancomycin (except flavobacterium is gram -),
- which antibiotic is effective against aerobic bacteria
2. which is for anaerobic
- aminoglycosides: gentamicin, streptomycin
2. clindamycin
clindamycin is for gram
positive and negative anaerobic bacteria
clindamycin is bacteriostatic/cidal
both. cidal at higher concentrations
which would you give to treat Bacteriodes Fragilis and Fusobacterium
clindamycin
pseudomembranous colitis is caused by what bacteria
clostridium difficile in the gut
which antibiotic has an adverse reaction that may cause pseudomembranous colitis
clindamycin (C = clindamycin, clostridium difficile)
Chloramphenicol is broad spectrum against
gram positive and negative aerobic and anaerobic
chloramphicol is used as a last resort bc
severe adverse reactions and toxicity: anemia, aplastic anemia, reversible anemia, gray baby syndrome which can lead to death
both bacteria and humans require __ for DNA synthesis
folate
unlike bacteria humans cant make their own folate. we rely on exogenous folate. This is why __ drugs have affect on bacteria and not our cells
sulfa drugs block metabolic folic acid synthesis in bacteria
Sulfonamides (sulfa drugs) are bacterio__
static
quinolones inhibit __ and are bacterio__
inhibit DNA replication. static. inhibit DNA gyrase (topoisomerase) include
ciprofloxacin is a
quinolone
the only FDA approved mouthwash that has been shown to decrease __ and __ associated with gingivitis is Chlorhexidine
supragingival plaque and gingival inflammation = antimicrobial affect
after rinsing some stays in mouth and is gradually released over time.
