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Host and Defense > Week 16 > Flashcards

Week 16 Flashcards

1
Q

Transplants are a solution for organ failure. What are three fundamental problems associated with it?

A

Transplant must perform its functions

Transplant and recipient health must be retained

Recipient immune system must not reject the transplant

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2
Q

What is an autologous transplant type?

A

Donor and recipient are the same individual

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3
Q

What is a syngeneic transplant type?

A

Donor and recipient are genetically identical (identical twins)

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4
Q

What is an allogeneic transplant type?

A

Donor and recipient are genetically different but of the same species

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5
Q

What is a xenogeneic transplant type?

A

Donor and recipient are of different species

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6
Q

Organ rejection limits allogeneic transplant survival. List the three types of organ rejection.

A

Hyperacute

Acute

Chronic

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7
Q

What is a hyperacute organ rejection?

A

Type 2 hypersensitivity

Occurs minutes to hours

Blood type alloantibodies

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8
Q

What is an acute organ rejection?

A

Type 4 hypersensitivity

CD4 and CD8 T cells

HLA mismatches (HLA genes code for MHC)

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9
Q

What is a chronic organ rejection?

A

Type 3 hypersensitivity

Chronic transplant inflammation

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10
Q

____ between the donor and recipient is the biggest predictor of transplant success

A

Histocompatibility

Depends on blood type, major, and minor HLA genes

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11
Q

___ and ___ improve survival rates of organ transplantation

A

Donor matching

Immunosuppressants

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12
Q

True or false… erythrocytes do not express MHC 1 or 2 (no HLA matching). This makes it less complicated to match the donor to recipient

A

True

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13
Q

How often can you donate whole blood, plasma, and platelets?

A

Whole blood: every 56 days

Plasma: every 28 days

Platelets: every 15 days

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14
Q

What blood type is considered the universal donor?

A

O negative

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15
Q

What blood type is considered the universal recipient?

A

AB +

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16
Q

In regards to blood rejection, what type of hypersensitivity reaction occurs?

A

Type 2

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17
Q

Some transplants can be taken form live healthy patients. Name two of this type

A

Kidney (because everyone has 2)

Liver (you can remove up to 60% of the liver and it will still regenerate)

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18
Q

The degree of matching varies with tissue type. Describe the type of matching that must occur for the cornea, liver, and kidney

A

Cornea - no matching or immunosuppression necessary

Liver - only blood type match

Kidney - HLA and blood type match

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19
Q

Pre-existing blood type antibodies cause a ___ rejection

A

Hyperacute

-this is a type two hypersensitivity that occurs within minutes, resulting in irreversible organ loss. Prevented by compatibility assessment

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20
Q

What is direct allorecognition? How does it cause rejection?

A

Transplant dendritic cells activate recipient T cells, which then go on to kill the transplant tissue

This occurs days to weeks

This is a type 4 hypersensitivity

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21
Q

Direct allorecognition causes ___ rejection

A

Acute

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22
Q

True or false… allogeneic MHC activates T-cells directly (antigen is largely irrelevant)

A

True

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23
Q

Antibodies against transplant MHC1 causes ___ rejection. Explain how.

A

Alloantibodies that cause chronic rejection of organ transplants are the result of an immune response stimulated by the indirect pathway of allorecognition

Immune complexes form and are deposited in the blood vessel walls of transplanted organ recruit inflammatory cells. Immune cells enter blood vessel wall to cause it to constrict and lead to progressive loss of blood to the organ. It may take years for the organ to die.

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24
Q

Hematopoietic transplants can cause ___vs. ___ disease. Describe this.

A

Graft vs. host disease

Transplant adaptive immune cells (T cells) target and kill recipient tissue (GI, liver, skin problems most severe)

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25
Q

Alloreactive NK cells can kill recipient ____

A

Leukemia

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26
Q

Immunosuppressants may help in transplantation acceptance. Corticosteroids suppress __ transcriptional activity. It does this by increasing ___ production, which inhibits ___.

A

NF-kB

IkBa

NF-kB

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27
Q

Immunosuppressants inhibit T cell activation by interfering what three signals? For example, belatacept binds to CD28 to prevent the activation of ___.

A

Activation, survival, proliferation

Calcineurin (the second signal)

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28
Q

Name two immunosuppressants that inhibit T cell activation

A

Cyclosporin

Tacrolimus

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29
Q

____ and ___ prevent T cell survival and proliferation

A

Baletacept (prevents the second signal)

Anti-CD25

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30
Q

What are autoimmune diseases?

A

Loss of tolerance leading to hypersensitivity reactions

Adaptive immune targeting to self

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31
Q

Autoimmune diseases are caused by genetics, the environment and both. Are they more common in men or women? Only about ___% of predisposed individuals actually develop the autoimmune disorder

A

Women’s

20%

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32
Q

___ genes are associated with susceptibility in __% of autoimmune diseases. Class ___ alleles are most frequently implicated. ___ T cells are also closely tied to AD development

A

HLA

2

CD4

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33
Q

True or false… in a type 2 hypersensitivity autoimmune disease, the antibodies may act as agonists or antagonists

A

True

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34
Q

rheumatic fever is caused by ___. Two bacterial species, __ and ___ have antigens that are similar to human antigen causing the AD

A

Molecular mimicry

Streptococcus pyogenes

Staphylococcus aureus

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35
Q

Describe how grave’s disease works

A

Antibody binding causes metabolic dysfunction

Antibodies act as TSH agonists causing excessive thyroid hormone release

The antibodies themselves do not cause overt tissue damage.

This is a CD4 Th2 response

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36
Q

What are the signs of hyperthyroidism?

A

Weight loss

Heat intolerance

Anxiety and irritability

Exophthalamos

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37
Q

Describe how newborns can be born with Graves’ disease. How can this be cured?

A

Mother with Graves’ disease makes anti-TSHR antibodies. Since its IgG, it crosses placenta into fetus. Newborn suffers from Graves’ disease

Plasmapheresis (filtering of plasma) to removal mother anti-TSHR can cure this

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38
Q

What is hashimoto’s disease?

A

Destruction of normal thyroid tissue

CD4 Th1 response

Causes hypothyroidism

Ectopic lymphoid tissue formed in the thymus

Enlarged thyroid present, swallowing difficulty

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39
Q

Hashimoto’s disease is hypothyroidism whereas Grave’s disease is hyperthyroidism. Describe the different oral manifestations seen in them

A

Hypothyroidism: salivary gland enlargement, comprised periodontal health, macroglossia and thick lips, mouthbreathing, anterior open bite.

Hyperthyroidism: increased susceptibility to caries, burning mouth syndrome, maxillary and mandibular osteoporosis

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40
Q

What is Sjögren’s syndrome?

A

Progressive destruction of the exocrine glands

One of the most common ADs

Type 2 hypersensitivity

Form periodontal aggregates that are germinal center like aggregates

Dry eyes, dry mouth, and arthritis

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41
Q

What is systemic lupus erythematos?

A

Widespread self-antigen targeting and complex deposition

Complexes deposit in blood vessels, kidneys and joints

Epitope spreading leads to intracellular antigen targeting

Mouth ulcers and plaques (not necessarily painful at the onset)

42
Q

SLE causes intermolecular epitope spreading. Describe what this is.

A

This is different antigens being targeted because they are associated with the same macromolecular complex as another antigen

Slowly expanding adaptive response

Loss of tolerance

43
Q

What in intramolecular epitope spreading?

A

This is when a small conserved region of a self-antigen shares an epitope with a pathogenic antigen. When you develop antibodies against the pathogenic antigen, it will also target the self antigen. .. it is called intramolecular epitope spreading because soon the other epitopes located on the self antigen will also be targeted.

44
Q

True or false… thymic involuntion is tied to increased AD incidence

A

True (celiac disease)

45
Q

Describe autoimmunity in type 1 diabetes

A

CD4 and CD8 T cell response kills beta cells

HLA-DR3/4 linkage

Viral cross-reactivity model

Molecular mimicry

Stress

Epitope spreading

46
Q

What are four oral manifestations of diabetes?

A

Reduced salivary flow

Altered saliva composition

Impaired wound healing

Sweet breath

47
Q

Periodontitis is tied to ___ and ___

A

Rheumatoid arthritis

Epitope spreading

48
Q 
What are the expected survival rates at 5 years for the following organs? 
Kidney
Liver
Heart
Lungs
Bone marrow
A

Kidney - 90%

Liver - 75%

Heart - 70%

Bone marrow - 60%

Lungs - 50%

49
Q

Name five major classes of immunosuppressants used for organ transplants

A

Calcineurin inhibitors

MTOR inhibitors

Antiproliferative agents

Antibodies

Corticosteroids

50
Q

What are the two stages of rejection in host vs. graft reaction?

A

Sensitization stage (recognition of alloantigens)

Effector stage (inflammatory response to the injury, antibody production, cell recruiting)

51
Q

What are the two different pathways in the sensitization stage? Describe them

A

Direct pathway - host T cells recognize allo-MHC molecules as non-self

Indirect pathway - T cells recognize processed alloantigen presented by self-APCs

52
Q

What are the three phases for post HSCI?

A

Phase 1 (pre engraftment) (day0-30) - prolonged neutropenia, damage to mucocutaneous barriers

Phase 2 (post-engraftment) (day31-100) - impaired cell-mediated immunity. - GVHD

Phase 3 (late) (day>100) - depends on immunosuppression

53
Q

Name 7 pre-transplant dental care procedures

A

Dental prophylaxis/cleaning

Treat all active dental disease

Remove all potential sources of acute or chronic disease

Remove all non-restorable teeth

Reinforce oral hygiene and home care

Perform necessary denture adjustments

Daily use of antibacterial mouthwash

54
Q

Name 5 things that should be included as part of pre-transplant care

A

Consultation with MD

Educate patient about oral hygiene

Perform dental prophylaxis

Careful with certain drugs

Evaluate dental status and treat as indicated

55
Q

True or false… if the patient has severe leukopenia and thrombocytopenia, the patient should avoid flossing

A

True

They should also disinfect and rinse toothbrush and change tooth brush regularly

56
Q

What is mucositis and what is it commonly caused by?

A

Mucosal damage (including lower GI) affecting the nonkeratinized mucosal surfaces in mouth. Intense pain and discomfort

Most frequent complication post-BMT

Radiation/chemotherapy

57
Q

What drug may cause gingival hyperplasia?

A

Cyclosporine

58
Q

How long does the peak immunosuppression last post-transplantation?

A

3-6 months

59
Q

What are the two types of HIV? Which may be less virulent and have a longer latency period?

A

HIV-1 and HIV-2

HIV-2 may be less virulent and have a longer latency period

60
Q

Which is more predominant worldwide, HIV-1 or HIV-2?

A

HIV-1

HIV-2 is mostly in west Africa

61
Q

How are both types of HIV (1 and 2) transmitted?

A

Sexual contact

Through blood and body fluids

From mother to child during the perinatal period

62
Q

What three cells are infected by HIV?

A

CD4 T cells ***

Monocytes

Macrophages/dendritic cells

63
Q

What are the two most effective HIV treatments?

A

HAART (highly active antiretroviral therapy)

CART (combined antiretroviral therapy)

64
Q

Describe the HIV life cycle. What drugs can be used to interfere with each step?

A

Binding (CCR5 antagonist)

Fusion (fusion inhibitors)

Reverse transcription (NNRTIs, NRTI)

Integration (integrate inhibitors)

Assembly

Budding (protease inhibitors)

65
Q

What is the current HAART (cART) therapy?

A

Usually 3 or more drugs combined

Two nucleoside analogue RT inhibitors

And one of the following…

NNRTI (non-nucleoside reverse transcriptase inhibitor), or protease inhibitor, or integrate strand transfer inhibitor

66
Q

What are the four goals of HAART (cART) therapy?

A

Decrease viral load

Increase CD4s

Improvement of quality of life

Reduction of morbidity and mortality

67
Q

HIV can now be considered a ___ infection. However, HAART therapy cannot be considered an ___ success

A

Chronic

Unqualified

68
Q

True or false… HAART is associated with lots of adverse effects

A

True

69
Q

What is lipodystrophy?

A

Peripheral fat wasting more associated with NRTIs

Central fat accumulation more associated with PIs

Direct effects of HIV

70
Q

What is hyperlipidemia?

A

Elevations in total cholesterol, LDL, and triglycerides

Which leads to hypertension, coronary artery disease, increase myocardial infarction

71
Q

What is included in the “three way street”? Where does HAART come into play?

A

Obesity (HAART affects this)

Diabetes

Periodontal disease

72
Q

HAART is associated with osteonecrosis, even though the mechanism is unknown, what things increase osteonecrosis?

A

Corticosteroid treatment

Alcohol abuse

Hemoglobinopathies

Hyperlipidemia

Hypercoagulable states

73
Q

True or false… the HAART era occurrence of oral manifestations markedly decreased

A

True, however not all patients get HAART

74
Q

HAART has caused an overall ___ of oral lesions, with significant ___ in HL and NUP. __ significant change has occurred in the incidence of oral candidiasis, oral ulcers, and kaposi’s sarcoma. There has been an __ in salivary gland disease and incidence of oral warts

A

Reduction

Reduction

No

Increase

75
Q

Name four predisposing factors for oral lesions

A

Low CD4 count

High viral load

Xerostomia

Poor oral hygiene

Smoking

76
Q

What is a zoonotic pathogen?

A

An infection that naturally occurs in an insect or animal host that can also subsequently infect humans

77
Q

True or false… most newly identified pathogens are zoonotic

A

True

78
Q

What is an emerging pathogen?

A

A new infection, never seen before. Or maybe an infection that is known, but newly emerging in new hosts or geographical locations. Or maybe an infection that has always been there but not tested for

79
Q

Describe how the following pathogens are transmitted.
Microsporidia and cryptosporidium

Naegleria fowleri

Ebola virus

SARS (severe acute respiratory syndrome)

Dengue virus

A

Microsporidia/cryptosporidium - contaminated water

Naegleria fowleri- lake water exposure in nostrils

Ebola virus - infected human body fluids and animals

SARS - human to human respiratory via animal exposure

Dengue - mosquito

80
Q

What kind of a virus is the chikungunya virus?

A

Positive sense, ssRNA virus

In the togaviridae virus family

O’nyong’nyong is a closely related, serologically cross-reactive virus

81
Q

What family of virus is the chikungunya virus? What family are most other viruses associated with mosquitoes in?

A

Togaviridae

Flavivirus

82
Q

In the chikungunya virus, over half of cases result in long-lasting relapsing ___

A

Arthralgia

83
Q

What mosquito is the vector for dengue, Zika, and yellow fever viruses, and chikungunya?

A

Aedes aegypti

84
Q

What kind of a virus is the Zika virus? What family is it in? What mosquito is it spread in?

A

Positive sense ssRNA

Flavivirus

Aedes spp. Of mosquito

Discovered in the Zika forest of Uganda

85
Q

What are the common symptoms of Zika?

A

Fever, rash, joint pain,

**conjunctivitis

86
Q

What are the mechanisms of transmission for Zika?

A

Infected mosquito bite

**blood transfusions

Sexual transmission

Congenital infection (maternal blood to placenta to fetus)

87
Q

Congenital transmission of Zika can cause what? How does the virus get to the fetus?

A

Microcephalic

Brain malformation

Ocular/auditory defects

Growth retardation

-virus from maternal bloodstream is found in fetal brain samples, cord blood, and placental tissue

88
Q

True or false… Zika can be spread person to person without sexual contact

A

True

89
Q

What is the diagnostic test for Zika?

A

MAC-ELISA

IgM Antibody Capture ELISA

90
Q

What is cyclospora cayetanensis? Describe its route of transmission?

A

It is an emerging gastrointestinal pathogen

It is a coccidian protozoa, diagnosed in stool by stain or autofluorescence

Humans are the only vector (fecal oral route)

91
Q

What is the hallmark symptom of cyclospora? True or false… oocytsts are infective when shed

A

Watery diarrhea

False.. oocysts not infective when shed (no direct human-to-human contact)

92
Q

What is the best treatment for cyclospora cayetanensis?

A

Trimethoprim sulfamethoxazole

93
Q

What kind of a virus is the Middle Eastern Respiratory Sydnrome Virus?

A

Positive sense, ssRNA virus

coronavirus family.

94
Q

How is MERS likely spread? What are its symptoms?

A

Spread through respiratory secretions

Symptoms: fever, cough, shortness of breath

95
Q

True or false… MERS has a high risk for the dental clinic

A

True

96
Q

True or false… the following less pressing emerging zoonotic pathogens have no direct human-to-human transmission. … avian flu, borrelia miyamotoi, anaplasma, and ehrlichia

A

True

97
Q

What family of virus is the Ebola virus? How is it spread?

A

Filovirus

Associated with African bush meat

Patient body fluids are also highly infectious (including blood and saliva, so this is a danger in dentistry)

98
Q

Some emerging pathogens are too virulent and kill themselves off. Give three examples of these

A

SARS, MERS, Ebola

99
Q

What is the respiration of parasitic protozoa?

A

Facultative anaerobic

100
Q

How to parasitic protozoa reproduce?

A

Via binary fission

Host and Defense (17 decks)

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