Tbl Flashcards
1
Q
dyspnea
A
Difficult breathing
2
Q
hemoptysis
A
Coughing blood
3
Q
pruritis
A
Itching
4
Q
purpuric maculopapular
A
Purple rash
5
Q
Disseminated varicella infection is a rare disease seen in
A
immunocompromised
patients
6
Q
Disseminated infection with varicella presents as
A
pneumonia, hepatitis, intravascular coagulopathy, encephalitis
7
Q
Themortalityrateofdisseminatedvaricellainfectionis
A
55%
8
Q
A depletion in the body’s natural immune system, or in some component of it.
A
Immunodeficiency
9
Q
Having an immune system that has been impaired by disease or treatment
A
Immunocompromised
10
Q
Having the capability to suppress the immune system, capable of immunosuppression.
A
Immunosuppressive
11
Q
Any infection that arises subsequent to a pre- existing infection; but especially a nosocomial infection
A
Secondary infection
12
Q
Nosocomial
A
A disease originated in a hospital
13
Q
is a state in which the immune system’s ability to fight infectious disease is compromised or entirely absent
A
Immunodeficiency (or immune deficiency)
14
Q
…………..Deficiencies more frequent than……………
A
Acquired deficiencies
primary immune deficiencies
15
Q
problems of the immune system that are not genetic and which are caused by external factors.
A
Secondary immune deficiencies or acquired deficiencies
16
Q
A person who is undergoing immunosuppression or whose immune system is weak for other reasons is said to be
A
immunocompromised
17
Q
Reasons for weak immune system
A
chemotherapy, HIV, and Lupus
18
Q
Distinction between primary versus secondary immunodeficiencies are based on
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whether the cause originates in the immune system itself or is it due to insufficiency of a supporting component of it or an external decreasing factor of it
19
Q
In most acquired cases, withdrawal of the external condition causing the deficiency can result in
A
restoration of immune function
20
Q
most serious Acquired immunodeficiency is
A
HIV
21
Q
most frequent causes of secondary immunodeficiencies in developed countries are
A
cancers involving the bone marrow and various therapies
22
Q
……. results in deficiencies of virtually all components of the immune system and is a common cause of immunodeficiency in developing countries.
A
Protein-calorie malnutrition
23
Q
Immunosuppressive drugs used to prevent ……and drugs for……, including some of the newer therapies (e.g……..&……) are causes of acquired immunodeficiencies
A
graft rejection
inflammatory diseases
TNF antagonists, costimulation blockade
24
Q
How does human immunodeficiency virus infection (HIV) cause acquired immunodeficiency
A
Depletion of CD4+ helper T cells
25
How do irradiation and chemotherapy cause acquired immunodeficiencies
Decreased bone marrow precursors for all leukocytes
26
How dos immunosuppressives for graft rejection and inflammatory diseases cause acquired immunodeficiency
Depletion or functional impairment of lymphocytes
27
How does involvement of bone marrow by cancers cause acquired immunodeficiency
Reduced site of leukocyte development
28
How does proteins calories malnutrition causes acquired immunodeficiency
Metabolic derangements inhibit lymphocyte malnutrition and function
29
How does removal of spleen cause acquired immunodeficiency
Decreased phagocytosis of microbes
30
Bone marrow affecting cancer
Metastases, leukemia
31
Iatrogenic
Illness caused by medical examination or treatment
32
Iatrogenic immunosuppression is most often due to
drug therapies that kill or functionally inactivate lymphocytes or block the function of cytokines made by innate immune cells and lymphocytes.
33
The most commonly uses anti inflammatory and immunosuppressive drugs are
corticosteroids and cyclosporine, respectively
34
Widely used immunosuppressive
Anti cytokines antibodies
35
Various chemotherapeutic drugs are administered to patients with cancer, and these drugs are usually....... to proliferating cells, including.......
Cytotoxic
mature and developing lymphocytes as well as other leukocyte precursors.
36
Cancer chemotherapy is almost always accompanied by
y a period of immunosuppression and risk for infection.
37
Many specific diseases directly or indirectly cause immunosuppression, like :
• Many types of cancer, particularly those of the bone marrow and blood cells
(leukemia, lymphoma, multiple myeloma),
• Certain chronic infections.
38
Bone marrow tumors, including cancers metastatic to marrow and leukemias that arise in the marrow, may interfere with....... In addition, tumors may produce substances that interfere with.......
the growth and development of normal lymphocytes and other leukocytes
lymphocyte development or function.
39
Viruses that impair immune responses
Measles, human T cell lymphotropic virus 1 (HTLV-1)
| They both do so by infecting lymphocytes
40
cancer treatment that can temporarily affect bone marrow.
Radiotherapy
41
Chronic infections with Mycobacterium tuberculosis and various fungi frequently result in
anergy to many antigens
42
Chronic parasitic infections may also lead to ...... for example......
immunosuppression
| depressed T cell function, in chronic malarial infections
43
Reasons for spleenectomy
treatment of certain hematologic diseases such as autoimmune hemolytic anemia and thrombocytopenia, in which red cells and platelets, respectively, are destroyed by phagocytes in the spleen, or infarction in sickle cell disease.
44
Patients without spleens are more susceptible to infection by some organisms, particularly bacteria such as.....&....... which have ..............rich capsules and are normally cleared by.......
pneumococci and meningococci,
polysaccharide-rich capsules
opsonization and phagocytosis.
45
One secondary immunodeficiency that has been recognized for some time but has an unknown cause is
hypogammaglobulinemia
46
hypogammaglobulinemia is confused with
CVID, a condition that shows genetic predisposition
| Common variable immunodeficiency
47
Symptoms of hypogammaglobulinemaia
recurrent infection
48
hypogammaglobulinemaia typically manifests in
young adults who have very low but detectable levels of total immunoglobulin with normal T-cell numbers and function (some cases do involve T cells defects which grow more severe)
49
natural factors in immune function
Extremes of age
The very young and elderly suffer from impairments to immune function not typically seen during the remainder of the life span
50
How can diabetes result in an immunodeficiency disorder
because white blood cells do not function well when the blood sugar level is high
51
Other Causes of immunodeficiency
```
• Trauma
• Injections
• Operative and other incisions
• Internal foreign bodies
• Major surgery
• Monoclonal antibodies and related small molecules
• Transfusion (which may lead to iron overload)
• Environmental toxins
• Excess weight
. Chronic disease
. Chronic mental stress
. Lack of sleep
```
52
How does Chronic mental stress cause immunodeficiencies
Stress releases hormones like cortisol that suppresses inflammation (inflammation is initially needed to activate immune cells) and the action of white blood cells.
53
How does lack of sleep cause immunodeficiencies
Sleep is a time of restoration for the body, during which a type of cytokine is released that fights infection; too little sleep lowers the amount of these cytokines and other immune cells.
54
Protein-calorie malnutrition is associated with
impaired both innate and adaptive immunity
55
Much of the morbidity and mortality in malnourished people is due to
infections
56
hypoproteinemia is associated with depression in
T-cell numbers and function
57
Primary malnutrition leads to
atrophy of the lymphoid organs, profound T-lymphocyte deficiency, and increased susceptibility to pathogens, reactivation of viral infections, and development of opportunistic infections.
58
imbalance between the nutrients the body needs and the nutrients it gets.
Malnutrition
59
types of malnutrition
overnutrition
| Under nutrition
60
Animal studies have found that deficiencies in .......can alter immune responses
zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E
61
Examples of Secondary Immunodeficiencies
Endocrine
Gastrointestinal
Hematologic
Diabetes millitus
Hepatic insufficiency, hepatitis, intestinal lymphangiectasia, protein-losing enteropathy
Aplastic anemia, cancers (eg, chronic lymphocytic leukemia, multiple myeloma, Hodgkin lymphoma), graft-vs-host disease, sickle cell disease, splenectomy
62
Examples of Iatrogenic immunodeficiencies
Certain drugs, such as chemotherapeutic drugs, immunosuppressant's, corticosteroids; radiation therapy; splenectomy
63
Examples of nutritional immunodeficiencies
Alcohol use disorder, undernutrition
64
Physiologic reasons of immune deficiency
Physiologic immunodeficiency in infants due to immaturity of the immune system, pregnancy
65
Renal examples of immunodeficiencies
Nephrotic syndrome, renal insufficiency, uremia
66
Rheumatologic examples of immunodeficiency
Systemic lupus erythematosus
67
Infectious reasons of immunodeficiency
Viral infections (eg, cytomegalovirus, Epstein-Barr virus, HIV, measles virus, varicella- zoster virus), bacterial infections, rare bacterial infections with superantigens (antigens that can activate large numbers of T cells, resulting in massive cytokine production, most notably from Staphylococcus aureus), mycobacterial infections
68
Barrier defects of the mucous membranes are critical for the pathogenesis of respiratory, gastrointestinal, and urinary tract infection. This is associated with changes in
microbial flora.
69
T-cell defects and thymic function in malnutrition are similar to that seen in
congenital thymic aplasia
70
Primary immunodeficiencies (PIDs) are now included under the term
inborn errors of immunity
| IEI
71
How many defined IEI
450 genetically defined diseases.
72
transient or persistent impairment of the function of cells or tissues of the immune system, caused by factors that are not intrinsic to the immune syste
Secondary immunodeficiency
73
In the last five decades, the most studied secondary immunodeficiency has been.... that’s caused by .....
acquired immunodeficiency syndrome (AIDS)
| HIV
74
HIV infected individuals who receive..... retain their immune function and do not develop AIDS
antiretroviral therapy
75
individuals who receive antiretroviral therapy can still get
chronic inflammation that contributes to
the development of comorbidities: non-AIDS malignancies, cardiovascular events, renal
and hepatic diseases, bone disorders and neurocognitive impairment.
76
is the most prevalent cause of immunodeficiency worldwide
Malnutrition
77
Laboratory testing indicated in the assessment of immunodeficiency includes
blood cell counts and lymphocyte phenotyping to measure neutrophils, monocytes, T cells, B cells and NK cells. Measurement of serum immunoglobulins G, A, M and E levels and antibody responses to prior immunizations for humoral immunity and Serum albumin and total protein level.
78
Serum albumin and total protein levels tests are useful to identify......, which raises the suspicion of either......
malnutrition or hypoproteinemia
| protein-losing diseases.
79
The management of a patient with secondary immunodeficiency should be focused on
improvement of the primary condition, and when possible, the removal of the offending environmental factor
80
when protein-losing enteropathy leads to hypogammaglobulinemia, what should be treated
treatment of the enteropathy restores normal serum immunoglobulin levels.
81
General measures to consider for the patient with a secondary immunodeficiency include measures to
reduce exposure to infections, antibiotic prophylaxis, and immunoglobulin replacement and immunizations.
82
Examples of antiinflammatory and immunosuppressive small molecule agents
corticosteroids, methotrexate, cyclosporin
83
Groups of immunosuppressive medications
1. antiinflammatory and immunosuppressive small molecule agents
2. protein kinase inhibitors and biological agents
84
Examples of protein kinase inhibitors and biological agents
anti- CD20 antibodies
85
Glucocorticoids is a type of
corticosteroids
86
representatives of immunosuppressive anti inflammatory medications and kinase inhibitors/biological agents respectfully
glucocorticoids and rituximab
87
Glucocorticoids are widely used because of their
potent anti-inflammatory action that results in reduction of symptoms in autoimmune and allergic disease
88
........&..........are two of the most used medications of antiinflammatory and immunosuppressive small molecule agents
Prednisone and dexamethasone
89
Prednisone and dexamethasone immunosuppressive action is mediated by multiple molecular mechanisms, such as
inhibition of NFK beta pathways, followed by the suppression of the proinflammatory cytokines IL-1, IL-2, IL-6, TNF-α and IFNγ, and prostaglandins.
90
glucocorticoids induce......, increased .....and release of ....from the bone marrow, which is translated into lymphopenia and neutrophilia. Glucocorticoids reduce ......and other mediators of allergic disease.
anergy and apoptosis of lymphocytes
neutrophil detachment from the endothelium into the peripheral blood
immature neutrophils
histamine secretion, IgE, IL-4, IL-5
91
Immunosuppression is proportional to...
the duration of treatment and to the dose.
92
Side effects of glucocorticoids
cataracts, osteoporosis, adrenal axis suppression, hypertension, Cushing syndrome and diabetes mellitus.
93
The use of topical forms of glucocorticoids, such as...... significantly reduce the risk of these adverse effects because of
ointments and nasal sprays
their minimal systemic bioavailability
94
biological agents might be classified in
monoclonal antibodies and competitive inhibitors of receptor binding.
95
most prescribed biological agents.
Anti-CD20 antibodies and tumor necrosis factor (TNF)-alpha inhibitors
96
Six anti-CD20 monoclonal antibodies have been developed:
rituximab, veltuzumab, ocrelizumab, ofatumumab, binutuzumab and ublituximab.
97
first agent of this group to be developed for clinical use.
Rituximab
98
Side effects of Rituximab
hypogammaglobulinemia and increased risk of infections
99
....% patients in a tertiary care center receiving at least one dose of rituximab developed infections.
....% had low serum IgG level and....% had persistently low B cell counts one year after stopping rituximab.
47.9%
13.7%
51%
100
clinical indication for the use of rituximab, such as refractory autoimmune cytopenia might represent
manifestation of an IEI.
101
the assessment of humoral immunity before rituximab treatment has been suggested to rule-out a....
preexisting antibody deficiency.
102
Before taking rituximab......... should be considered in patients with recurrent infections or a severe depression of the humoral immune function.
antibiotic prophylaxis and immunoglobulin supplementation
103
.....monoclonal antibodies binding TNF-alpha and..... fusion protein TNF- alpha receptor antagonist have been approved for the treatment of...
4, 1
| inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis and psoriasis.
104
major concern with the use of these biological agents is
the central role of TNF-alpha in anti-mycobacterial immunity.
105
To reduce their risk of tuberculosis reactivation and severe disease, patients receiving TNF-alpha inhibitors are recommended to undergo
tuberculosis screening before treatment and receive antibiotic prophylaxis if the screening is positive.
106
Other drugs are associated with harmful effects in the immune system that are not clearly related to the pharmacologic activity of the molecule
antiepileptic medications -phenytoin, carbamazepine, levetiracetam- may cause antibody deficiency
107
persistent antigen stimulation induces decreased T cell effector functions, a condition known as
T cell exhaustion.
108
HIV Targets ..... and induces....
CD4 T cells
| T cell lymphopenia
109
HIV infection targets CD4 T cells and induces T cell lymphopenia through several mechanisms:
HIV-induced apoptosis, apoptosis caused by nonspecific immune activation, viral cytopathic effect, T cell cytotoxicity to HIV-infected cells and autophagy
110
Because of advances in......, HIV infection can now be controlled but not eradicated
anti-retroviral therapy
111
HIV infects other cells expressing CD4, such as....... which become.........
microglial cells, liver Kupffer cells and renal tubular epithelial cells
viral reservoirs(pools)
112
HIV patients receiving anti-retroviral therapy often have
Incomplete immune-reconstitution of CD4 T cells with a predominant proportion of activated cells
113
In most treated HIV patients chronic inflammation is common, leading to
development of malignancies, metabolic syndrome and cardiovascular disease
114
Measles virus
| Measles is a highly infectious virus shown to result in immunosuppression that can persist for
months to years after initial infection in immunocompetent hosts
115
Proposed mechanisms of measles immunosuppression include
T and B cell lymphopenia, inhibition of lymphocyte proliferation, skewing towards T helper 2 cytokine responses and decreased B cell and T cell memory cells
116
immunosuppressive effect of measles was initially demonstrated over a hundred years ago, when
it was noted a loss of the tuberculin skin test positive response during the acute phase of measles infection
117
Mycobacterium tuberculosis infection affects .....%
one third of world’s population
118
..... leading cause of mortality by an infectious disease.
Mycobacteria
119
In Mycobacterium tuberculosis Apoptosis and necrosis of antigen presenting cells are accelerated due to
mycobacteria replication
120
Patients with mycobacterial infection demonstrate decreased........, increased production of .....and suppression of.......
lymphoproliferative responses
IFN-γ
IL-17+ CD4 T cells
121
Furthermore, damaging inflammatory reactions induces significant regulatory T cell activity, which attenuates the ability of
monocyte-derived and alveolar macrophages to restrict mycobacterial growth
122
The COVID-19 pandemic, caused by
severe acute respiratory syndrome coronavirus 2
123
Several changes in the immune system have been reported in patients with severe SARS Cov-2 infection like
impaired IFN-alpha signaling, reduced number and function of NK cells, and peripheral CD4 and CD8 T cell lymphopenia.
124
In severe COVID19 cases, a massive inflammatory response develops in .... with .... cytokines increase which causes...
The lungs
Serum
T cell exhaustion, lung tissue destruction and hypoxia,
125
The infant mortality due to sepsis is..... per 100,000 live births in the United States
16.1
126
all immune parameters are lower at birth than in adulthood except for
lymphocyte and neutrophil cell count
127
Neonatal adaptive immunity is biased towards the...... immune phenotype rather than ....phenotype.
T helper 2 (TH2)
| TH1
128
Peripheral blood mononuclear cells from newborns demonstrate reduced ........responses with decreased production of......
Tolllike receptor (TLR)
pro-inflammatory cytokines.
129
Neutrophils from neonates have decreased expression of surface adhesion molecules leading to......
impaired tissue migration,
130
Impaired production of IL-12p70 in neonates results in
non-productive activation and failure to differentiate into effector cytotoxic T cells
131
The protective maternal IgG that is mostly transferred during the
third trimester is limited in the premature
132
responses to scheduled immunizations for pre term neonates are adequate, with exception of the
hepatitis B vaccine for newborns under 2000g
133
Immune system changes due to aging, or immunosenescence, include
decreases in the TLR function, chemotaxis, phagocytosis and cytokine production
134
NK cells from elderly population are predominantly the mature CD14+CD56+bright subset with reduced
cytotoxicity function, cytokine function and migration capacity.
135
Aging of the adaptive immune system is often described as a shift from
naïve to memory T and B cells
136
infections lead to malnutrition as result of
limited food intake and absorption
137
Direct effects of malnutrition in lymphoid organs include
thymic atrophy, thymocyte apoptosis, decreased levels of secretory IgA and reduced cellularity in the spleen and lymph nodes.
138
Children with protein energy malnutrition (PEM) have shown reduced serum levels of
IL-1, IL-6, TNF-and complement system components and impaired neutrophil chemotaxis and function, NK cell cytotoxicity and dendritic cell maturation.
139
malnourished individuals show reduced numbers of
memory and effector T cells, reduced delayed type hypersensitivity, impaired T cell responses and fewer circulating B cells.
140
Protein-losing enteropathy (PLE) occurs secondary to
gastrointestinal (GI) loss of protein
141
We consider IgG replacement for patients with low
Less than 2 standard deviations below the mean
| IgG level or absent responses to pneumococcal immunization
142
Uremia causes dysfunction in dendritic cells which causes
Decreased antigen presentation and co stimulaton
143
Uremia causes dysfunction in monocytes which causes
Decreased phagocytosis
144
Uremia causes dysfunction in nk which causes
Decreased Activation
145
Uremia causes dysfunction in neutrophils which causes
Increased apoptosis, TLR2, TLR4 expression
146
Uremia causes dysfunction in B cells which causes
Decreased naive B cells population, B cells activation, increased apoptosis
147
Uremia causes dysfunction in T cells which causes
Decreased function of effector T cells, decreased naïve t cell population, decreased IL2 Production, increased CD4+ CD28 T cell population
148
Vitamin D deficiency causes
Increased risk of respiratory infections in children
149
Vitamin E deficiency causes
Reduced infections of the elderly
150
Vitamin c deficiency causes
Exaggerated inflammation in murine models
151
Vitamin a deficiency causes
Impaired epithelial barrier function
| Reduced CD4 & CD8 T cells
152
Zinc deficiency leads to
```
Thymus apoptosis
Lymphopenia
Reduced Th1 cytokines
Impaired phagocytosis
Impaired mucousal immunity
```
153
hypogammaglobulinemia is treated by
immunoglobulin therapy
154
hypoproteinemia is associated with
depression in T-cell numbers and function
155
the profound fall in cell - mediated immunity that accompanies measles infection has been attributed to specifi c suppression
of
IL - 12 production by viral cross - linking of monocyte surface CD46
156
Spleen function
antibody production
| Acts as a filter to remove pathogens through phagocytic cells
157
Infections associated with asplenia include
sepsis with encapsulated bacteria, namely, S. pneumoniae and H. influenzae, and with Babesia, a protozoan that infects erythrocytes and causes fever and hemolysis with asplenia, malaria infection can be more severe
158
Diabetes Mellitus usually affects.... system and it causes
Innate
Effects in neutrophil functions and NET formation
Low cytokines production
159
Space travel causes
CD4 and CD8 T cell lymphopenia and impaired CD4 T cell function
160
Thymectomy in infants results in
T cell lymphopenia, with CD4 T cells typically affected more than CD8 T cells
