Sheet4-表格 1 Flashcards
Define hyperacute transplant rejection.
Antibody-mediated due to the presence of preformed anti-donor antibodies in the transplant recipient. Occurs within minutes after transplantation.
Define Ig allotype.
Ig epitope that differs among members of the same species (on light or heavy chain)
Define Ig idiotype.
Ig epitope determine by the antigen-binging site (specific for a given antigen-binding site)
Define Ig isotype.
Ig epitope common to a single class of Ig (5 classes, determined by the heavy chain)
Give 3 classic examples of bacteria with antigen variation.
(1) Salmonella (2 flagellar variants)
(2) Borrelia (relapsing fever)
(3) Neisseria gonorrhoeae (pilus protein)
Give 3 examples of possibly causes for SCID?
(1) failure to synthesize class II MHC antigens
(2) defective Il-2 receptors
(3) adenosine deaminase deficiency
Goodpasture’s syndrome is associated with what kind of autoantibodies?
anti-basement membrane antibodies.
Helper T cells have CD(?) which binds to class (?) MHC on antigen-presenting cells.
CD4 binds to class II MHC
How does Bruton’s agammaglobulinemia usually present?
as bacterial infections in boys after about 6 months of age, when levels of maternal IgG antibody decline
How is active immunity acquired?
Active immunity is induced after exposure to foreign antigens. There is a slow onset with long-lasting protection.
How is passive immunity acquired?
by receiving preformed antibodies from another host. Antibodies have a short life span, but the immunity has a rapid onset.
IL-4 promotes the growth of B cells and the synthesis of what 2 immunoglobulins?
IgE and IgG
In what immune deficiency do neutrophils fail to respond to chemotactic stimuli?
Job’s syndrome
In what T-cell deficiency do the thymus and parathyroids fail to develop owing to failure of development of the 3rd and 4th pharyngeal
pouches?
Thymic aplasia (DiGeorge syndrome)
Job’s syndrome is associated with high levels of what immunoglobulin?
IgE
MHC I Ag loading occurs in __(1?)__ while MHC II Ag loadingoccurs in __(2?)__?
(1) in rER (viral antigens)
(2) in acidified endosomes.
Primary biliary cirrhosis has what kind of autoantibodies?
anti-mitochondrial antibodies
Role of TH1 cells?
produce IL-2 (activate Tc cells and further stimulate TH1 cell) and g-interferon (activate macrophages)
Role of TH2 cells?
produce IL-4 and IL-5 (help B cells make Ab)
Sensitized T lymphocytes encounter antigen and then release lymphokines which
leads to macrophage activation’ in what hypersensitivity reaction?
Type IV
TB skin test, transplant rejection, and contact
dermatitis are examples of what type of hypersensitivity reaction?
Type IV
The 3 kinds of MHC class I genes are…
A, B, and C
The 3 kinds of MHC class II genes are…
DP, DQ, DR
The Fc portion of immunoglobulins are at the __?__ terminal.
The carboxy terminal
What 2 cytokines are secreted by macrophages?
IL-1 and TNF-a
What 2 kinds of autoantibodies are specific for systemic lupus?
Anti-dsDNA and anti-Smith
What 3 cytokines are classified as ‘acute phase cytokines’?
IL-1, IL-6, and TNF-a
What 3 ways do interferons interfere with viral protein synthesis?
(1) alpha and beta interferons induce production of a second protein that degrades viral mRNA
(2) gamma interferons increase MHC class I expression and antigen presentation in all
cells
(3) activates NK cells to kill virus-infected cells.
What affect do the acute phase cytokines have on fat and muscle?
mobilization of energy reserves to raise body
temperature
What affect do the acute phase cytokines have on the bone marrow?
Incr. Production of Colony stim. Factor (CS) which leads to leukocytosis
What affect do the acute phase cytokines have on the hypothalamus?
increase body temperature
What antibody isotype can cross the placenta?
IgG
What are 3 types of antigen-presenting cells?
macrophages, B cells, and dendritic cells
What are the maim symptoms of serum sickness an at what period of time following Ag exposure?
fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after Ag exposure
What are the major symptoms of graft-vs-host disease?M
maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea.
What B- and T- cell deficiency, assoc. with IgA deficiency, presents with
cerebellar problems and spider angiomas?
ataxia-telangiectasia
What causes the tissue damage associated with Serum sickness?
formation of immune complexes of foreign
particles and Abs that deposit in membranes where they fix complement
What class of MHC proteins are the main determinants of organ rejection?
class II MHC
What complement components can cause
anaphylaxis?
C3a and C5a
What components of the alternative complement pathway make the C3
convertase?
C3b, Bb
What components of the alternative complement pathway make the C5
convertase?
C3b, Bb, and 3b
What components of the classic complement pathway make the C3 convertase?
C4b, C2b
What components of the classic complement pathway make the C5 convertase?
C4b, 2b, and 3b
What components of the complement pathway are deficient in Neisseria sepsis?
The MAC complex–(C5b, C6, C7, C8, C9)
What cytokines attract and activate neutrophils?
TNF-a and B
What disease is associated with a X-linked defect in a tyrosine-kinase gene associated with low levels of all classes of immunoglobulins?
Bruton’s agammaglobulinemia
What disease is associated with anti-epithelial cell autoantibodies?
Pemphigus vulgaris
What disease is associated with anti-microsomal autoantibodies?
Hashimoto’s thyroiditis
What does a deficiency of C1 esterase inhibitor cause (in the complement cascade)?
angioedema because of overactive complement
What does a deficiency of C3 cause (in the complement cascade)?
can lead to severe, recurrent pyogenic sinus and respiratory tract infections.
What does deficiency of decay-accelerating factor (DAF) in the complement cascade cause?
leads to paroxysmal nocturnal hemoglobinuria
PNH
What does Job’s syndrome classically present with?
recurrent ‘cold’ (noninflamed) staphylococcal abscesses
What does TNF-a stimulate dendritic cells to do during the acute phase response?
TNF-a stimulates their migration to lymph nodes and their maturation for the initiation of the adaptive immune response.
What elements of the complement cascade made the Membrane Attack Complex (MAC)?
C5b, C6, C7, C8, and C9
What Ig is found in secretions as a monomer or a dimer?
IgA
What Ig is found in secretions as a monomer or a pentamer?
IgM
What immune deficiency disease has an autosomal-recessive defect in phagocytosis that results from microtubular and lysosomal defects of phagocytic cells?
Chediak-Higashi disease
What immune deficiency is associated with elevated IgA levels, normal IgE levels, and
low IgM levels?
Wiskott-Aldrich syndrome
I L U~
I M U~
What immune deficiency presents with tetany owing to hypocalcemia, congenital defects of the heart and great vessels, and recurrent viral, fungal, and protozoal infections?
Thymic aplasia (DiGeorge syndrome)
What immunoglobulin isotype has the lowest concentration in serum?
IgE
What immunoglobulin isotype is involved in type-I hypersensitivity reactions?
IgE
What immunoglobulin isotype is produced in the primary response to an antigen and is
on the surface of B cells?
IgM
What immunoglobulin isotype mediates immunity to worms?
IgE
What immunoglobulin isotype prevents the attachment of bacteria and viruses to mucous membranes?
IgA
What immunoglobulins bind and activate the classic complement pathway?
IgG and IgM (the Fc portion)
What interleukin induces naive helper T-cells to become TH1 cells?
IL-12
What interleukin induces naive helper T-cells to become TH2 cells?
IL-4
What interleukin stimulates the growth of both helper and cytotoxic T-cells?
IL-2
What is Chronic mucocutaneous candidiasis?
T-cell dysfunction specifically against Candida albicans.
What is important about the CD3 complex?
It is a cluster of polypeptides associated with a T-cell receptor and is important in signal transduction.
What is the cellular process that causes type I hypersensitivity?
Ag cross-links IgE on presensitized mast cells and basophils, triggering the release of vasoactive amines.
What is the cellular process that causes type II hypersensitivity?
IgM, IgG bind to Ag on ‘enemy’ cell, leading to lysis (by complement) or phagocytosis (its cytotoxic).
What is the main antibody in the secondary immune response?
IgG
What is the most abundant immunoglobulin isotype?
IgG
What is the most common selective immunoglobulin deficiency?
selective IgA deficiency
What is the rise in temperature during the acute phase response help do (3 things?)
(1) increase specific immune response
(2) increase antigen processing
(3) decrease viral and bacterial replication
What is the triad of symptoms seen with Wiskott-Aldrich syndrome?
recurrent pyogenic infections, eczema, and
thrombocytopenia
What kind of autoantibodies are associated with CREST/Scleroderma?
anti-centromere antibodies
What kind of autoantibodies are known as rheumatoid factor?
anti-IgG antibodies
What kind of immunity (antibody-mediated or cell mediated) is involved in autoimmunity?
antibody-mediated immunity (B cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in graft and tumor rejection?
cell mediated immunity (T cells)
What kind of transplant rejection is reversible with immunosuppressants such as cyclosporin and OKT3?
acute transplant rejection
What kinds of adjuvants are included in human vaccines?
aluminum hydroxide or lipid
What kinds of cells have class II MHC proteins?
antigen-presenting cells (e.g. macrophages and dendritic cells)
What parasites have antigen variation?
trypanosomes (programmed rearrangement)
What symptoms characterize the Arthus reaction and what causes them?
edema, necrosis, and activation of complement due to the Ag-Ab complexes that
form in the skin following intradermal injection of Ag.
What type of cell secretes IL-3?
activated T-cells
What type of cells does gamma interferon stimulate?
macrophages
What type of hypersensitivity reaction is the Arthus reaction?
type III
Where does the alternative complement pathway occur?
On microbial surfaces
Where does the classic complement pathway occur?
antigen-antibody complexes
Where is the defect in SCID?
the defect is in early stem-cell differentiation, leading to B- and T-cell deficiency
Which interleukin causes fever?
IL-1
Which interleukin enhances the synthesis of IgA?
IL-5
Which interleukin stimulates the production and activation of eosinophils?
IL-5
Which interleukin supports the growth and differentiation of bone marrow stem cells?
IL-3
Which is the only type of cell-mediated hypersensitivity reaction, and thus not transferable by serum?
Type IV
Wiskott-Aldrich syndrome is a defect in the ability to mount what immune response?
an IgM response to capsular polysaccharides of bacteria.
With what disease are anti-histone autoantibodies associated?
drug-induced lupus
With what disease are anti-nuclear antibodies
associated?
systemic lupus
Aspiration pneumonia is usually caused by…
Anaerobes
Atypical pneumonia is usually caused by…
- Mycoplasma
- Legionella
- Chlamydia
Bug Hints: Branching rods in oral infection =
Actinomyces israelii
Bug Hints: Currant jelly sputum =
Klebsiella
Bug Hints: Dog or cat bite =
Pasteurella multocida
Bug Hints: Pediatric Infection =
H. influenzae (including epiglottitis)
Bug Hints: Pneumonia in CS, burn infection =
P. aeruginosa
Bug Hints: Pus, Empyema, Abscess =
S. aureus
Bug Hints: Sepsis/Meningitis in Newborn =
Group B strep
Bug Hints: Surgical wound =
S. aureus
Bug Hints: Traumatic open wound =
C. perfringens
Incidence of what cause of mengitis has decreased with a vaccine?
Incidence of H. influenze meningitis has decreased greatly with introduction of H.
influenzae vaccine in the last 10-15 years
Most osteomyelitis occurs in what age group?
children
Neonatal pneumonia is usually caused by…
- Group B streptococci
- E. coli
Nosocomial pneumonia is usually caused by…
- Staphylococcus
- gram-negative rods
PID includes what disorders in the body?
salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess
PID is likely caused by what two organisms? What are the characteristics of the disease
caused by each organism?
- Chlamydia trachomatis: subacute, often undiagnosed
- N. gonorrhoeae:acute, high fever
Pneumonia in immunocompromised
patients is caused by…
- Staphylococcus
- gram-negative rods
- fungi
- viruses
- Pnemumocystis carinii (with HIV)
Pneumonia in the alcoholic/IV drug user is usually caused by…
- S. pneumoniae
- Klebsiella
- Staphylococcus
Postviral pneumonia is usually caused by…
- Staphylococcus
- H. influenzae
Salpingitis is a risk factor for…
- ectopic pregnancy
- infertility
- chronic pelvic pain
- adhesions
UTIs are found in men in which 2 age groups?
Babies with congenital defects and Elderly with enlarged prostates
UTIs are mostly caused how?
by ascending infections
What’s the likely cause of osteomyelitis in a pt where you have no other information?
S. aureus
What 2 pathogens likely cause nosocomial infections associated with urinary catherization?
E. coli, Proteus mirabilis
What 2 pathogens likely cause nosocomial infections in the newborn nursery?
CMV, RSV
What 3 UTI-causing organisms are often
nosocomial and drug-resistant?
- Serratia marcescens
- Enterobacter cloacae
- Klebsiella pneumoniae
- Proteus mirabilis
- Pseudomonas aeruginosa
What 7 organisms are associated with UTIs?
- Serratia marcescens
- Staphylococcus saprophyticus
- E. coli
- Enterobacter cloacae
- Klebsiella pneumoniae
- Proteus mirabilis
- Pseudomonas aeruginosa
[HINT: SEEKS PP]
What abnormal lab result is often seen in osteomyelitis patients?
elevated ESR
What are 4 clinical findings of Pyelonephritis?
- fever
- chills
- flank pain
- CVA tenderness [c/c with UTI]
What are 4 clinical findings of UTIs?
- diysuria
- frequency
- urgency
- suprapubic pain [c/c with pyelonephritis]
What are the 2 most common causes of nosocomial infections?
- E. coli causes UTI
- S. aureus causes wound infection
What are the 3 most common causes of UTI in young ambulatory women?
- E. coli (50-80%)
- Staphylococcus saprophyticus (10-30%)
- Klebsiella (8-10%)
What are the common causes of hospital-acquired UTIs?
- E. coli
- Proteus
- Klebsiella
- Serratia
- Pseudomonas
What are the common causes of meningitis in 6-60y/o?
- N. MENINGITIDIS
- Enteroviruses
- S. pneumoniae
- HSV
What are the common causes of meningitis in 60+ y/o?
- S. PNEUMONIAE
- Gram-negative rods
- Listeria
What are the common causesof meningitis in children (6mo-6y/o)?
- S. pneumoniae
- N. meningitidis
- H. influenzae B
- Enteroviruses
What are the common causes of meningitis in HIV pts?
- Cryptococcus
- CMV
- toxoplasmosis (brain abscess) JC virus (PML)
What are the common causes of meningitis in newborns (0-6mos)?
- GROUP B STREPTOCOCCI
- E. COLI
- Listeria
What are the common causes of osteomyelitis in those with prosthetic replacements?
S. aureus and S. epidermidis
What are the common causes of pneumonia in adults 18-40 y/o?
- Mycoplasma
- C. pneumoniae
- S. pneumoniae
What are the common causes of pneumonia in adults 40-65 y/o?
- S. pneumoniae
- H. influenzae
- Anaerobes
- Viruses
- Mycoplasma
What are the common causes of pneumonia in children (6wk-18y)?
- Viruses (RSV)
- Mycoplasma
- Chlamidia pneumonia
- S. pneumoniae
What are the common causes of pneumonia in the elderly?
- S. pneumoniae
- Anaerobes
- Viruses
- H. influenzae
- Gram-neg. rods
What are the CSF findings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: incr.
- Cell type: incr. PMNs
- Protein: incr
- Sugar: decr
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: nl or incr.
- Cell type: incr. lymphocytes
- Protein: nl - Sugar: nl
What are the CSF finings in fungal/TB meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: incr.
- Cell type: incr. lymphocytes
- Protein: incr
- Sugar:decr.
What are the dominant normal florae in the colon?
B fragilis > E. coli
What are the dominant normal florae in the vagina?
Lactobacillus, colonized by E. coli and group B strep
What are the predisposing factors of UTIs?
- flow obstruction
- kidney surgery
- catherization
- gynecologic abnormailities
- diabetes
- pregnancy
What infections are dangerous in pregnancy?
- Toxoplasma
- Rubella
- CMV
- HSV/HIV
- Syphilis
[HINT: ToRCHeS]
What is chandelier sign?
Cervical motion tenderness associated with PID
What is the 2nd leading cause of community-acquired UTI in sexually active women?
Staphylococcus saprophyticus
What is the characteristic of Trichomonas on a slide?
motile on wet prep
What is the common cause of osteomyelitis in drug addicts?
Psudomonas aeruginosa
What is the common cause of osteomyelitis in most people?
S. aureus
What is the common cause of osteomyelitis in sickle cell pts?
Salmonella
What is the common cause of osteomyelitis in the sexually active?
N. gonorrhoeae
What is the common cause of osteomyelitis in the vertebra?
M. tuberculosis
What is the dominant normal flora contributes to dental plaque?
S. mutans
What is the dominant normal flora in the nose?
S. aureus
What is the dominant normal flora in the oropharynx?
viridans streptococci
What is the dominant normal flora on the skin?
S. epidermidis
What is the most common STD in the U.S.?
Chlamydia trachomatis causes 3-4 million cases per year
What organism can you presume is causing a
nosocomial infection if respiratory equipment or burns are involved?
Psudomonas aeruginosa
What organism is the leading cause of UTI and shows a metallic sheen on EMB agar?
E. coli
What pathogen is associated with hyperalimentation?
Candida albicans
What pathogen is associated with water (ie. aerosols)?
Legionella
What pathogen likely causes nosocomial infections in the renal dialysis unit?
HBV
What population does not have any flora?
Neonates delivered by csarean section have no flora but are rapidly colonized after birth
What ratio is UTIs found more in women vs. men? Why?
10 to 1 because women have short urethrae more likely to be colonized by fecal flora
What STD is associated with Argyll-Robertson pupil?
3’ Syphilis
What STD is associated with clue cells?
Garnerella
What STD is associated with Genital warts and loilocytes?
What is the causative agent?
- Condylomata acuminata
- HPV 6 and 11
What STD is associated with jaundice? What is the causative agent?
- Hepatitis B
- HBV
What STD is associated with opportunistic infections, Kaposi’s sarcoma, lymphoma? What is the causative agent?
- HIV
What STD is associated with painful penile, vulvar or cervical ulcers? What’s the causative agent?
- Genital Herpies - HSV-2
What STD is associated with painful ulcers,
lymphadenopathy, rectal structures? What is the causative agent?
- Lymphogranuloma venereum
- Chlamydia trachomatis
What STD is associated with urethritis, cervicitis, conjuntivitis, Reiter’s syndrome PID? What is the causative agent?
Chlamydia - Chlamydia trachomatis
What STD is associated with vaginitis? What is the causative agent?
- Trichomoniasis
- Trichomonas vaginalis
What STD is characterized by painful genital ulcer? What is the causative agent?
- chancroid
- Haemophilus ducreyi
What STD is likely in a patient with a painless chancre? What causes it?
- 1’ Syphilis
- Treponema pallidum
What STD is likely in a patient with fever, lymphadenopathy, skin rashes, condylomata
lata? What causes it?
- 2’ Syphilis
- Treponema pallidum
What STD is likely in a patient with gummas, tabes dorsalis, general paresis, aortitis, Argyll-Robertson pupil? What causes it?
- 3’ Syphilis
- Treponema pallidum
What STD is likely in a patient with urethritis, cervicitis, PID, prostatitus, epididymitis, arthritis? What organism causes it?
- Gonorrhea
- Neisseria gonorrhoeae
What UTI-causing organism has a bue-green pigment, fruity odor and is usually nosocomial and drug-resistant?
Pseudomonas aeruginosa
What UTI-causing organism is characterized by a large mucoid capsule and viscous
colonies?
Klebsiella pneumoniae
What UTI-causing organism is mobile, causing ‘swarming’ on agar and also produces urease and is associated with struvite stones?
Proteus mirabilis
What UTI-causing organism sometimes produces a red pigment, is often nosocomial
and drug-resistant?
Serratia marcescens
