Alterations in Immunity and Inflammation Flashcards by Madeline Edwards

alloimmunity

examples?

alloimmunity: directed against beneficial foreign tissues (transfusions, transplants, transient neonatal alloimmunity)

transient neonatal alloimmunity: fetus expressing parental antigens not found in the mother (Rh factor)

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Type I Hypersensitivity

Receptors

s/s

IgE mediated, anaphylaxis (urticaria + bronchospasm), allergy

H1 & H2 receptors

H1 - bronchial constriction, edema, vasodilation
H2 - increased gastric secretions, decrease release of histamine from mast cells and basophils

angioedema, itching, conjunctivitis, rhinitis, bronchospasm, GI cramps

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allergic rhinitis

s/s

when allergies occur year round, otherwise called hay fever

conjunctivitis, rhinitis

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Type II hypersensitivity

How does it happen? Mediated by? Examples?

tissue specific, cytotoxic mediated

specific cell or tissue is the target of an immune response
mediated by IgG and IgM

Five mechanisms by which this occurs but one way is by antibody-dependent cell-mediated cytotoxicity

Examples: Graves disease, autoimmune hemolytic anemia, rheumatic fever

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Type II hypersensitivity that occurs 1wk to 6mo. after group A beta hemolytic streptococcal pharyngitis

s/s

Rheumatic fever

fever, migratory polyarthritis, carditis –> causes rheumatic heart disease (chronic)

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Type III hypersensitivity

immune (antigen-antibody) complex mediated

complexes are formed in the circulation and later deposited in vessel walls or extravascular tissues
IS NOT ORGAN SPECIFIC

Intermediate size complexes are the ones that are not cleared and get deposited in tissues

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Type III hypersensitivity has periods of remission and exacerbation…what are some examples?

serum sickness - affects blood vessels, joints, and kidney; Raynaud phenomenon

arthus reaction - deposit in walls of local blood vessels (causes vascular permeability, edema, clotting, etc.)

SLE

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Type IV - mediated by? destruction by?

Examples?

MS, skin test for TB, contact allergic reactions, DM 1, Hashimoto disease, Crohn’s disease

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Which of the hypersensitivities involves allergies?

all of them

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Type I allergens

pollen, molds, fungi
foods
animals 
certain drugs 
cig smoke, house dust

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Type II and III allergens

allergens are RARE in these, but can include abx like PCN, and antigens produced by Hep B

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Type IV allergens

plant resins, metals, acetylates; chemicals in rubber, cosmetics, detergents, and topical abx

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1 control of allergy is through

ANS - biochemical mediators (epi, acetylcholine) bind to appropriate receptors on mast cells and target cells of inflammation

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antigenic targets of type IV hypersensitivity reactions

Type IV: mostly haptens that react with normal self-proteins in the skin

result: allergic contact dermatitis (Poison Ivy)

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antigenic targets for type II and III

examples?

haptens that bind to the surface of cells and elicit an IgG or IgM response

drug allergy - type II

arthus reaction - type III

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SLE what type of hypersensitivity?

autoantibodies against?

type III

autoantibodies against: nucleic acids, RBCs, coagulation proteins, phospholipids, lymphocytes, platelets, and many others

*deposition of circulating immune complexes containing antibody against the host’s DNA

Clinical manifestations of SLE

joint pains, vasculitis and rash, renal disease, hematologic changes (anemia), cardiovascular disease

Eleven findings present in SLE, 4 = dx

presence of what antibodies?

malar rash (face), discoid rash, photosensitivity, mouth ulcers, nonerosive arthritis, serositis, renal disorders, neuro disorders, hematologic disorders, immunologic disorders, and…

presence of antinuclear antibodies (ANAs)

what type of hypersensitivity is a transfusion reaction

alloimmune type II hypersensitivity rxn (specific target - RBCs)

Universal donor

O- blood type (no antigens on surface) anti-A and anti-b antibodies

Universal recipient

AB+ (surface antigens A+B) and no antibodies

Rh-positive

expresses the D antigen on the RhD protein

hemolytic disease of the newborn

Rh- negative mother gives birth to a Rh+ infant

*Rh- individual makes anti-D antibodies if exposed to Rh+ RBCs

Graft rejection (alloimmune rxn) - 3 types

hyperacute - rare d/t pre-existing antibodies

acute - cell-mediated against unmatched HLA antigens

chronic - months to years; d/t weak cell-mediated response reaction against minor antigens

primary immune deficiency is.... secondary immune deficiency is... hallmark of immune deficiency?

primary is genetic (congenital) secondary is acquired (caused by illness) recurrent infections

recurrent gonorrhea suggests what deficiency

complement deficiency

recurrent viral infections suggests what deficiency

t-cell

recurrent microorganism requiring opsonization infection suggests

deficiency in B-cell and phagocytes

causes of secondary immune deficiencies (acquired)

stress, diet insufficient, malignancies, met disease, trauma, treatments, infections (AIDS)

erythema infectiosum (fifth disease) infection by which virus?

parvovirus B19 droplet up to 21 day incubation slapped cheek syndrome mild self-limiting viral disease - red macular rash first appearing on cheeks and ears -low grade fever, h/a, rash, cold-like symptoms

Hepangina caused by? s/s? transmitted how?

acute viral illness caused by enterovirus coxsackie A and B s/s: fever, ulcerative mouth lesions, cough, coryza, pharyngitis, high fever (up to 106), sore throat, n/v/d, fatigue, etc. tonsilor lesions - culture to r/o strep fecal-oral and oral-oral

Mono - transmitted how? Incubation? Screening?

EBV Transmission oropharyngeal route (saliva) or blood incubation 30-50 days monospot screening (check for antibody) and consider EBV antibody titer (esp in older pt)

influenza caused by? can undergo?

orthomyxovirus (ssRNA virus) that appears in Antigenic types A and B antigenic drift or mutation: change in surface molecules antigenic shift - recombination into a new virus from two different species

Measles also called? caused by? s/s? transmitted how? dx?

Rubeola RNA virus, paramyxovirus family s/s: fever, red maculopapular rash, cough, coryza, conjunctivitis, characteristic rash or oral mucus membranes (Koplik spots) transmitted by direct contact with infectious droplets, or less commonly by airborne spread (highly contagious) dx: detected from nasopharyngeal secretions, conjunctiva, blood, urine

Mumps (parotitis)

paramyxovirus or mumps virus symptoms: tender swollen parotid glands for 7-10 days, fever virus best collected in saliva

rubella (german measles)

mild viral disease also known as 3-day measles transmitted by direct or droplet contact with nasopharyngeal secretions rubella virus (RNA, togaviridae fam) s/s: maculopapular rash beginning on face and spreading to trunk that resolves by day 3 virus detected by nasal smear *infants w/congenital rubella may shed virus for 1 yr or more

varicella - also called? how is it spread? what virus? dx tests?

chickenpox usually mild acute viral disease, highly contagious caused by varicella zoster virus (herpes family) airborne, touch (rarely) can be contacted by someone who has shingles (herpes zoster) no dx tests indicated

west nile virus? s/s? how contracted? caused by what virus? dx

febrile, rash, arthritis, myalgia, weak, lymphadenopathy, meningoencephalitis, n/v, rash, h/a caused by arbovirus family Flaviviridae transmission: mos to bird, bird to mos to human CSF with IgM antibody; pleocytosis: increased number of lymphocytes in CSF

cytomegalovirus, transmitted how? s/s? remains in person? most common what?

DNA virus; herpesvirus direct contact immunocompromised at risk - think transplant most common congenital infection in the US at delivery (5-15% of all newborns) remains with person for life symptoms: mono-like w/fever, fatigue, pharyngitis, ulcerative lesions in mouth; loss of vision retinitis