Secondary Immunodeficiencies

Question 1

Differentiate between primary and secondary immune deficiencies

Answer 1

Primary immunodeficiencies are caused by defects which originate in the immune system itself.
Secondary immunodeficiencies are due to insufficiency of a supporting component of the immune system or an external or “secondary” depleting factor.

Question 2

How does diabetes impair the immune system?

Answer 2

Hyperglycemia affects neutrophil function

Poor circulation leads to skin ulceration, less delivery of immune cells to wounds

Question 3

In diabetes, the defect in ______ function is most prominent

Answer 3

Neutrophil

Question 4

List common infections that are seen with increased severity and frequency in diabetics

Answer 4

Pneumonia
UTI
Cellulitis
Diabetic foot ulcers
Candida

Question 5

List some unusual infections that can be complications of diabetes

Answer 5

Deep candida infections
Rhinopulmonary zygomycosis (mucormycosis)
Malignant otitis media due to Pseudomonas aeruginosa

Question 6

_______ is better explained as a state of immune modulation than immune deficiency

Answer 6

Pregnancy

Question 7

Give some mechanisms for altered immunity in pregnant women

Answer 7

Progesterone has been shown to inhibit lymphocyte proliferation in vitro.
Uromodulin is a pregnancy-specific serum factor which has
also been shown to inhibit B cell activity (antibody responses are generally preserved)
Depressed T cell responses

Question 8

List infections that pregnant women are at increased risk for

Answer 8

HAV, HBV
influenza
herpesviruses
chlamydia/ gonococcus
listeria 
campylobacter
TB
malaria

Question 9

How does protein-calorie malnutrition affect immune function

Answer 9

global metabolic and hormonal disturbances of
starvation.
low levels of leptin may be involved in the immune dysregulation
deficient intake of protein, fat, vitamins, and minerals, particularly nutritional deficiencies of zinc, iron, folate, pyridoxine, and vitamin A.

Question 10

Malnutrition leads to a 10x risk of mortality from ____ and a 30x increased risk of mortality from _____

Answer 10

pneumonia and gastroenteritis

Question 11

Older people are at risk of ______ reactivation due to changes in lymphocyte development and function

Answer 11

zoster

complication= post-herpetic neuralgia

Question 12

Older adults can have a decrease in _______ function and thus an increase in auto-reactivity

Answer 12

Suppressor cell

Question 13

How do trauma and critical illness affect immunity?

Answer 13

Massive release of inflammatory cytokines, activation of monocytes and macrophages

Question 14

_____ are particularly immunosuppressive due to the massive loss of protein and disruption of physical barriers

Answer 14

Burns

Question 15

How does stress impact immunity?

Answer 15

Reduced NK cell activity
Depressed lymphocyte mitogen responses
Endogenous glucocorticoids

Question 16

In ESRD, shunting of portal blood reduces the ability of ______ to clear opsonized material and can also cause hypocomplementemia. Furthermore, decreased hepatic metabolism of __________ is likely immune suppressive

Answer 16

Kupffer cells

decreased metabolism of endogenous glucocorticoids

Question 17

List unusual infections assocaited wiht cirrrhosis

Answer 17

Cryptococcal infection
Candidal infection
Infection with vibrio vulnificus

Question 18

Gastritis and any other protein losing condition can result in ________. Examples include nephritic syndrome, IBD, Celiac, massive lymphedemia, peritoneal dialysis, burns

Answer 18

hypogammaglobulinemia

Question 19

List hematologic/ oncologic conditions associated with B cell deficiency

Answer 19

Multiple myeloma
Waldenstrom’s macroglobulinemia
Chronic lymphocytic leukemia
Well differentiated lymphomas

Question 20

List hematologic/ oncologic conditions associated with T cell deficiency

Answer 20

Hodgkins

Advanced solid tumors

Question 21

How does sickle cell anemia act as an immune suppressive condition?

Answer 21

Functionally asplenic–> increased risk of infection with encapsulated organisms

Question 22

The immune suppression associated with blood transfusions is not seen in _____-____ blood

Answer 22

leukocyte-depleted

Question 23

Describe the immune suppressive effects of measles infection

Answer 23

possibility of superinfection

• T cell lymphopenia with depletion of T-dependent areas of lymph nodes and spleen
• Cutaneous anergy
• Diminished in vitro T cell proliferation with mitogens or alloantigens
• Diminished antibody production

Question 24

How does HTLV-1 cause immune suppession?

Answer 24

can produce adult T cell leukemia/lymphoma.

Patients with ATL present with severe immune defects and multiple opportunistic infections

Question 25

_____ infection places transplant patients at risk for other opportunistic infections like PCP, aspergillosis, organ rejection

Answer 25

CMV

Question 26

How to bacterial superantigens modulate the immune system?

Answer 26

• bind simultaneously to MHC class II antigens and to the non-antigen-binding region of T cell receptor variable regions, thereby stimulating massive numbers of T cells.
• These T cells then produce inflammatory cytokines, which lead to a syndrome resembling septic shock with multisystem organ failure.
• After “hyper activation” these T cells become anergic and can no longer become activated.

Question 27

How do mycobacteria inhibit the immune system

Answer 27

Replicated within monocytes and macrophages, inhibit the ability of the infected cell to kill invaders and coordinate the immune response
Increased risk of secondary infection

Question 28

Malaria + EBV=

Answer 28

Burkitt lymphoma

Question 29

List some rheumatologic conditions associated with increased susceptibility to infection, even in the absence of immune suppressing medications

Answer 29

SLE, RA, granulomatosis with polyangiitis

Question 30

Patients receiving ______ have reduced T cell function, diminished antibody production, and deficient neutrophil function

Answer 30

hemodialysis

Question 31

List three renal functions associated with immune suppression

Answer 31

nephrotic syndrome
ESRD
Uremia

Question 32

List some drugs that have immunesuppressing effects

Answer 32

Glucocorticoids
Signal transduction inhibitors: cyclosporine, tacrolimus, sirolimus
Purine synthesis inhibitors: azathioprine, mycophenolate mofetil
Antibodies: TNF inhibitors

Question 33

Use of TNF inhibitors places patients at increased risk of:

Answer 33

granulomatous infections like mycobacteria and endemic fungi