Stage of Life and Infectious Disease - Hunter Flashcards
1
Q
hematopoietic stem cells originate in the (blank) of the embryo
A
yolk sac
2
Q
Stem cells migrate into the fetal liver and finally into the (blank)
A
bone marrow
3
Q
t/f: hematopoeisis continues throughout life
A
true
4
Q
t/f: hematopoiesis decreases with age
A
true
5
Q
infants are born with a selectively (blank) immune system compared to adults
A
selectively
6
Q
(blank) results in immunosenescence
A
aging
7
Q
what the difference between prenatal/antepartum vs. perinatal/intrapartum?
A
prenatal/ante: during fetal dev
perinatal/intra: during labor and passage through the birth canal
8
Q
What are the TORCH infections?
A
Toxoplasmosis Other (syphilis, VZV, parvo) Rubella CMV Herpes simplex
9
Q
What are some non-torch maternally acquired infx?
A
Strep agalactiae
E. coli
STDs (herpes, chlamydia, Neisseria)
10
Q
t/f: congenital CMV can result from primary maternal infection during pregnancy or as a reactivation
A
true
11
Q
primary maternal infection with CMV is the most damaging during which trimester?
A
first
12
Q
t/f: most women don’t show symptoms with primary CMV infx
A
true
13
Q
what types of symptoms may show with primary CMV infx?
A
mono-like
14
Q
t/f: maternal immunity to CMV has no affect on transplacental transmission of CMV
A
false!; decreased transmission!
15
Q
A newborn showing low birth weight, microcephaly, seizures, petechial rash, and moderate HSM with jaundice most likely has….
A
congenital CMV
16
Q
What types of samples are taken from the newborn to test for CMV?
A
urine
saliva
blood
17
Q
what lifelong impariments will an infant have who had congenital CMV?
A
hearing loss
vision loss
mental and physical retardation
18
Q
preterm birth is birth before how many weeks?
A
37 weeks
19
Q
what percent of births globally are preterm?
A
11%
20
Q
preterm birth accounts for what percent of newborn death?
A
35%
21
Q
Preemies are especially fragile because of an underdeveloped…
A
immune system
22
Q
Intrauterine (blank) is a major contributor to preterm birth and causes premature immune system activation and cytokine production
A
intrauterine inflammation
23
Q
25% of all preterm births were caused by (blank, both with and without intact membranes
A
intrauterine infection
24
Q
The earlier the gestational age at delivery, the higher the frequency of….
A
intra-amniotic infections (chorioamnionitis)
25
The earlier the gestational age at delivery, the higher the frequency of....
intra-amniotic infections (chorioamnionitis)
26
What are the most common bugs that cause intrauterine infection?
```
Ureaplasma urealyticum
Mycoplasma hominis
Gardnerella vaginalis
Trichomonas
Neisseria
Chlamydia
```
27
What is the dominant bug found bacterial vaginosis?
Gardnerella vaginalis
28
What is the only Ig class that can cross the placenta?
IgG
29
What is the receptor that transports IgG across the placenta?
FcRN (fetal receptor)
30
At what week of gestation does IgG transport begin?
22nd week
31
Describe IgG levels and antigen specficity in a newborn compared to an adult
THE SAME!! it's all comparable to mom and will last for 6 months
32
Which Ig class is produced at birth?
IgM
33
which ig class is not produced until 6 months after birth?
IgG
34
What is the half life of maternal IgG?
2-3 weeks
35
At what month after birth is there a lowpoint in total serum Ig?
4-5months; INCREASED RISK OF INFX
36
At what age after birth do the humoral immunodef's appear
at 4-5 months( coincides with low total serum Ig)
37
when is IgA produced?
6 months afer birth
38
IgA is present in what form in breast milk?
colostrum
39
t/f: maternal IgA is capable of entering fetal circulation
false
40
what is the most common cause of meningitis and septicemia in neonates?
group B strep
41
GBS is transferred vertically tot the neonate during birth from the vagina after GBS has already established an infection in the maternal....
intestine
42
neonatal meningitis can be a result of GBS exposure during birth or...
in utero!
43
Why is there no maternal protection against GBS?
we don't normally make Abs to GBS?!?!
44
A neonate, several days after birth develops an infection. From the mother's vagina, a gram positive, B-hemolytic, CAMP postive coccus was isolated from the mother's vagina. What is the bug?
GBS
45
What fluid sample can you take from the baby to determine GBS meningitis?
CSF
46
Adult B cells respond well to thymus (dependent/independent) ags while infant B cells respond well to thymus (dependent/independent) ags
adult: independent
infant: dependent
47
what are thymus independent ags?
stuff like LPS
48
what are thymus dependent ags?
protein ags
49
What is linked recognition?
Conjugation of polysaccharide to an immunogenic protein allows B cells to receive help from helper T cells
50
What is linked recognition?
Conjugation of polysaccharide to an immunogenic protein allows B cells to receive help from helper T cells
51
what are the cell types affeted by immunosenescence?
```
hematopoietic stem cells
lymphoid progenitor cells
bone marrow
thymus
mature lymphocytes in the peripheral blood/2ry lymphoid organs
innate immune systems
```
52
t/f: immunosenescence reduces the effectiveness of vaccines
true
53
t/f: immunosenescence reduces the effectiveness of vaccines
true
54
what cells arise from the myeloid line?
```
erythrocytes
platelets
basophils
eosinophils
neutrophils
monocytes
macrophages
mast cells
dendritic cells
```
55
what cells arise from the lymphoid line?
b lymphos
t lymphos
NK cells
56
what cells arise from the lymphoid line?
b lymphos
t lymphos
NK cells
57
what happens to the mass of hematopoietic tissue with aging?
it decreases
58
What are the changes to the hematopoietic microenvironment that decrease stem cell mass?
alteration of hormone production disturbs self-renewal and commitment of HSC
59
Is the myeloid or lymphoid lineage more compromised with age?
lymphoid
60
Changes to what parts of the body are the cause of the lympohid degeneration with age?
lower bone marrow mass=fewer b cells
| fat involution of the thymus=fewer mature t cells
61
Changes to what parts of the body are the cause of the lympohid degeneration with age?
lower bone marrow mass=fewer b cells
| fat involution of the thymus=fewer mature t cells
62
is complement affected by aging?
nope
63
is humoral immunity altered by aging?
nope
64
despite neutrophil numbers remaining constant, what changes in them with aging?
their function; decreased phagocytic capacity as well as decreased bactericidal activity (oxidative burst)
65
what receptor on macrophages has an altered expression with aging?
TLRs
66
what causes a decrease in the ag-presenting function of mac's and DCs with age?
decreased expression of MHC II and defects in activation of CD4 T cells
67
What characteristic of neutrophils INCREASES with age?
membrane viscosity
68
Describe the change in the number of NK cells with age
they INCREASE, but their cytotoxic activity decreases
69
Which cyotkines increase with age?
TNF-a
Il-1b
IL-6
70
elevated plasma concentrations of which cytokines are predictive markers of functional disability and mortality?
TNF-a
IL1-b
IL6
71
elevated plasma concentrations of which cytokines are predictive markers of functional disability and mortality?
TNF-a
IL1-b
IL6
72
what are some of the major age-related diseases d/t inflammaging?
osteoporosis
neurodegeneration
cancer
atherosclerosis
73
when does involution of the thymus begin?
40-50
74
What two cell types suffer the greatest changes in thymus involution?
T cell precursors
| Thymic stromal cells
75
What happens to the number of naive t cells in the thymus with aging?
decreased
76
despite decreased naive t cells in oldies, does the size of the mature t cell pool change?
nope, stays stable
77
describe the changes in proportion of t cells in elderly pts?
increased effector
decreased naive
about the same to fewer memory
78
The loss of (blank) within naive t cells in oldies leads to a reduced ability to cope with bugs
diverity of naive t cells
79
Effector and memory t cells have (extended/limited) diversity
limited
80
What particular virus tends to get over-protected against in oldies?
CMV
81
which co-stimulatory molecules decreased with age?
CD28 and CD40L
82
which co-stimulatory molecules decreased with age?
CD28 and CD40L
83
What are 6 changes to T cells with aging?
1. dec naive cells
2. dec diversity
3. dec. expression of co-stim molecules
4. dec proliferative capacity
5. dec t cell signaling
6. dec. activation of potential naive cells
84
with regard to the thymus, what might reduce immunosenescence?
thymic regeneration; cryopreserve T cells in early adulthood then expand the selected populations or deplete the highly differentiated clones
85
what can be done to immunodominant bugs like CMV to prevent the accumulation of highly differentiated clones that replace naive cells?
vaccination or treatment
86
what can be done to immunodominant bugs like CMV to prevent the accumulation of highly differentiated clones that replace naive cells?
vaccination or treatment
87
Describe the changes in B cells that result in limited b cell receptor diversity
fewer B2 cells
more B1 cells (limited diversity)
fewer naive B cells
88
describe the changes to the antibodies themselves with aging
Ab response is weaker
Ab levels drop faster
Abs bind with lower affinity
INCREASED autoAbs
89
Aged CD4 cells produce less IL(blank) and less of what CD molecule?
IL2 and CD40L
90
What do T helper cells play in the activation of B cells?
isotype switching and affinity maturation; decreased in aging leads to diminished high-affinity Ab response
91
what happens to germinal centers with aging?
increase in number and size
92
Which costimulatory molecule on B cells decreases with aging?
CD40
93
Which costimulatory molecule on B cells decreases with aging?
CD40
94
serious infections may be heralded by what systemic changes?
declines in function, mental status, or anorexia, or exacerbation of comorbidities (CHF)
95
What is the most common sign that triggers the search for an infx?
fever
96
what is the most cost effective method of preventing infection?
vaccination
97
how many different bugs can we now protect against using vax?
25
98
what are the particular vaccines we give to oldies?
influenza
pneumococcus
zoster
99
t/f: the flu vaccine reduces hospitalization and death in the elderly
true
100
which particualar pnuemonia vax is recommended for oldies?
23-valent polysaccharide strep pneumo
101
by what percent is the incidence of pneumococcal dz decreased oldies who get pneumovax?
65%!!
102
what is the effect of underlying comorbidities on vaccine effectiveness?
lower protection
103
pneumococal pneumonia in oldies often happens secondary to a....
viral infection
104
t/f: high fever is not common in older adults for infection
true!
105
t/f: high fever is not common in older adults for infection
true!
106
t/f: even with the vaccine, you can still get pneumococcal dz
true
107
what particular type of VZV vaccine is given to oldies?
attenuated live vaccine; give after 60
108
by what percent is herpes neuralgia reduced with the VZV vaccine?
50-67%
109
describe the shingles rash
papules, vesicles, crusting scabs and a dermatomal distribution
110
What is the primary source of infection that causes reactivation of shingles?
chickenpox
111
where does the VZV stay while it is latent?
ganglion cells
112
VZV recurrence is tied with a decreased in what cell type immunity?
T cell
113
do CONJUGATE vaccines given to kids enhance adult immune responses?
nope
114
What types of vaccines should we give to keep vaccine efficacy high in old age?
immungenic live-attenuated in early life followed by booster vaccination with better adjuvants for the elderly and shorter intervals
115
What particular type of malnutrition is present in up to 60% of pts older than 65 who present to the hospital?
protein energy malnutrition
116
Protein malnutrition is linked to what problems?
```
delayed wound healing
pressure ulcer formation
increased risk of nosocomial infx
extended length of stay
inc mortality
```
117
What is the serum albumin level that reflects PEM?
3-3.5g/dL
118
what is the correlation between PEM and vaccine effectiveness?
decreased response and diminished responses to immune stimuli
119
higher rates of CAP is associated with what social factor?
lower SES
120
what environmental triggers increases the risk to infection?
poor nutritional status
frequent air pollution or tobcco exposure
inadequate vaccination
121
Long-term care residents have a high incidence of what type of infection?
respiratory infections
