Immune responses Flashcards
(178 cards)
1
Q
Actue-phase reactants are mainly produced by
A
liver
2
Q
APR are induced by
A
IL-6
3
Q
Opsonin that fixes complement and facilitates phagocytosis
A
C-reactive protein
4
Q
Function of ferritin
A
Binds and sequesters iron to inhibit microbial iron scavenging
5
Q
APR that correlates with ESR
A
Fibrinogen
6
Q
APR that dicreases iron absorption by degrading ferroportin and iron release from macrophages
A
Hepcidin
7
Q
Acute phase reactants: upregulated
A
C reactive protein Ferritin Fibrinogen Hepcidin Serum Amyloid A Procalcitonin
8
Q
Prolonged elevation can lead to amyloidosis
A
Serum amiloyd A
9
Q
Acute phase reactants: downregulated
A
Albumin
Transferrin
10
Q
System of hepatically synthesized plasma proteins that play a role in innate immunity and inflammation
A
Complement
11
Q
Membrane attack complex defends against
A
Gram - bacteria
12
Q
Pathways of complement activation
A
- Classic pathway: IgG or IgM mediated
- Alternative pathway: microbe surface molecules
- Lectin pathway: mannose or other sugars on microbe surface
13
Q
C3b function
A
Opsonization: C3B Binds Bacteria
14
Q
C3a, C4a, C5a function
A
Anaphylaxis: A
15
Q
C5a function
A
Neutrophil chemotaxis
16
Q
C5bC9 function
A
Cytolisis by membrane attack complex
17
Q
Opsonins
A
C3b: binds bacteria
IgG
18
Q
Opsonin function
A
Greek: prepare for eating=enhance fagocytosis
19
Q
Secondary function of C3b
A
Clearing immune complexes
20
Q
Inhibitors of complement, preventing complement activation on self cells
A
DAF: decay accelerating factor: CD55
C1 esterase inhibitor
21
Q
C3 deficiency
A
- Increases risk of severe recurrent pyogenic sinus and respiratory tract infections
- Susceptibility to type III hypersensitivity reactions
22
Q
C5-C9 deficiencies
A
Susceptibility to recurrent Neisseria bacteriemia
23
Q
C1 esterase inhibitor deficiency
A
Hereditary angioedema due to unregulated activation of kallikrein that increases bradykinin
Low C4 levels
ACE inhibitors are contraindicated (bradykinin causes dry cough)
24
Q
CD55 (DAF) deficiency
A
Complement mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria
25
Hereditary angioedema
C1 esterase inhibitor deficiency
26
Inerleukines: hot t-bone steak
```
Il1: fever
IL2: stimulates T cells
IL3: stimulates bone marrow
IL4: Stimulates IgE production
IL5: Stimulates IgA production
IL6: Stimulates akute-phase protein production
```
27
Major chemotactic factor for neutrophils
IL-8
28
IL-12 functions
Induces differentiation of T cells into Th1 cells
| Activates NK cells
29
Tumor necrosis factor alpha function
Activates endothelium
WBC recruiment
Vascular leak
30
Causes cachexia in malignancy
Tumor necrosis factor alpha
31
Maintains granulomas in Tuberculosis
Tumor necrosis factor alpha
32
Cytokines secreted by macrophages
1, 6,8,12,TNFalpha
33
IL that funcitions like GM-CSF
IL.3
34
Secreted by T cells in response to antigen/IL-12 from macrophages; stimulates them to phagocyte pathogens; Inhibits differentiation of Th2 cells
Interferon gamma
35
Attenuate immune response
TGF beta
| IL-10
36
Enhances class switching to IgE and IgG
IL-4 (Th2)
37
```
Enhances class switching to IgA
Stimulates eosinphils
```
IL-5
38
Increases MCH expression and antigen presentation by all cells
Interferon gamma
39
Respiratory (oxidative burst)
Activation of phagocyte NADPH oxidase complex which utilizes 02 releasing ROS
40
Deficiency of NADPH oxidase
Chronic granulomatous disease
41
Patients with NADPH oxidase are at risk of
Infection by catalase positive species:
- S.aureus
- Aspergillus
42
Protein in P aeruginosa that generates ROS to kill competing microbes
Pyocyanin
43
Part of innate host defense against RNA and DNA viruses, synthesed by virus infected cells that act locally on uninfected cells
Interferon alpha and beta
44
Binds do B7 of APC
CD28 in T cells
45
Cytotoxic T cells coreceptors for HIV
CXCR4
| CCR5
46
Co receptor for EBV in B cells
CD21: you can drink beer at the bar when you are 21
47
Marker for NK
CD56
48
Hematopoietic stem cells, cell surface marker
CD34
49
State during which a cell cannot become activated by exposure to its antigen
Anergy
50
T and B cells become anergic when
Exposed to their antigen without costimulatory signal
51
Bacteria that can produce superantigens
S pyogenes
| S aureus
52
Superantigens effect
Cross-link te beta region of the T cell receptor to the MHC class II on APCs: activate Cd4+: massive release of cytokines
53
Antigenic variation examples
1. Bacteria: salmonella, Borrelia recurrentis (relapsing fever), N gonorrhoeae (pilus protein)
2. Viruses: inflenza, HIV, HCV
3. Parasites: trypanosomes
54
Receiving preformed antibodies is a form of
Passive immunity
55
Treatment in non-vaccinated After exposure to:
| Tetanus toxin, Botulinum toxin , HBV, Varicella, Rabies virus, diphteria
Preformed antibodies (passive)
56
Duration of passive immunity
Short span of antibodies: 3 weeks
57
Vaccines are a for of ____ immunity
Active: humoral (B cells) or cellular (T cells)
58
Types of vaccine
1. Live attenuated vaccine
| 2. Inactive or killed vaccine
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Live attenuated vaccines that can be given to HIV patients who have a CD4 account >200/mm3
MMR: triple vírica
| Varicella
60
Examples of Live attenuated vaccine
```
BCG: Bacilo Calmette-Guerin: tbc
Measles
Mups
Polio: Sabin
Rotavirus
Rubella
Varicella
Yellow fever
```
61
Live attenuated vaccine induce a
Cellular and humoral response
62
Inactivated or killed vaccine induce a
Humoral response
63
Examples of inactivated vaccines
```
Rabies
Influenza
Polio: Salk
Hepatitis A
RIP always
```
64
Hypersensitivity types
```
ACID
Type I: Anaphylactic and Atopic:. antigen-IgE
Type II: Citotoxic: antibody mediated
Type III: Immune complex
Type IV: Delayed, cell mediated
```
65
Hypersensitivity antibody mediated types
I, II, III
66
Free antigen cross links IgE on presintized mast cells and basophils
Hypersensitivity type I
67
Antibodies bind to cell surface antigens
Hypersensitivity type II
68
Hypersensibility type I tests
Skin test
| Blood test: ELISA
69
Hypersensibility type II tests
Direct Coombs test
| Indirect Coombs test
70
Direct coombs test detects
Antibodies Directly attached to RBC
71
Indirect Coombs test detects
Presence of unbound Antibodies in the serum
72
Type II hypersensibility reactions
1. Cellular destruction
2. Inflamation
3. Cellular dysfunction
73
Examples of type II Hs cellular destruction
Hemolytic disease of the newborn
Immune thrombocytopenic purpura
Transfusion reactions
Autoinmune-hemolytic anemia
74
Examples of type II Hs cellular inflamation
Goodpasture syndrome: Ab anti-GBM
Rheumatic fever
Hyperacute transplant rejection
75
Examples of type II Hs cellular disfunction
Myasthenia gravis
| Graves disease
76
Immune complex antigen-antibody (IgG) are responsable for hypersensitivity reaction type
III
77
Hypersensitivity reaction type III
Immune complex antigen antibody activates complemente which attrack netrophils that release lysosomal enzymes
78
Examples of hypersensitivity reaction type III
SLE
Polyarteritis nodosa
Postestreptococcal glomerulonepfritis
79
Serum sickness
hypersensitivity reaction type III
Antibodies to foreign proteins (drugs) are produced
Fever, urticaria, arthalgia, proteinuria, lymphadenopathy
80
Arthus reaction
hypersensitivity reaction type III
Intradermal injection of antigen into presensitized individual leads to immune complex formation in the skin
Edema, necrosis, complement activation
81
hypersensitivity reaction type IV mecanisms
Direct cell cytotoxicity CD8+
| Delayed type hypersensitivity: CD4+
82
Examples of hypersensitivity reaction type IV
```
Type 1 DM: CD8
Contact dermatitis
Graf versus hostage
PPD and patch tests
4Ts: transplant rejections, T cells, TB skin tests, touching (contact dermatitis)
```
83
Blood transfusion reactions
1. Allergic/anaphylactic reaction
2. Febrile nonhemolytic transfusion reaction
3. Acute hemolytic transfusion reaction
4. Transfusion-related acute lung injury
84
Transfusion to IgA deficient individuals
Blood products without IgA
85
Allergic anaphylactic reaction to blood transfusion
Type 1 hypersensitivity
86
Febrile nonhemolytic transfusion reaction
Type 2 hypersensitivity reaction
87
Acute hemolytic transfusion reaction
Type 2 hypersensitivity reaction
88
Donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells
Transfusion related acute lung injury
89
Autoantibody implicated in Miastenia gravis
Anti Ach Receptor
90
Autoantibody implicated in Goodpasture syndrome
Anti glomerular basement membrane
91
Autoantibody implicated in antiphospholipid syndrome
Anti beta2 glycoprotein
92
Autoantibodies implicated in SLE and antiphospholipid syndrome
Anticardiolipin
| Lupus anticoagulant
93
Autoantibody implicated in CREST syndrome
Anticentromere
94
Autoantibody implicated in penfigus vulgaris
Anti-desmoglein (desmosome)
95
Autoantibody implicated in DM1
Anti-glutamic acid decarboxylase
| Islet cell cytoplasmic antibodies
96
Autoantibody implicated in polymiositis and dermatomyositis
Antisynthetase: anti Jo1
Anti SRP
Antihelicase: anti mi 2
97
Autoantibody implicated in Hashimoto thyroiditis
Antimicrosomal
Antithyroglobulin
Anti thyroid peroxidase
98
Autoantibody implicated in 1º biliary cirrosis
Antimitochondrial: AMA
99
Autoantibody implicated in Pernicious anemia
Antiparietal cell
| Anti intrinsic factor
100
Autoantibody implicated in 1º membranous nephropathy
AntiPLA2 Rc
101
Autoantibody implicated in Slcerodermia
Anti-Scl-70 (Dna topoisomerase I)
102
Disease in which autoantibody Anti-smooth muscle has an active role
Autoimmune hepatitis type I
103
Autoantibody implicated in Sjögren syndrome
Anti-SSA
Anti-SSB
Sjögren syndrome: SS
104
Autoantibody implicated in Graves disease
Anti TSH receptor
105
Autoantibody implicated in Lambert Eaton myasthenic syndrome
Anti presynaptic voltage gated CALCIUM channel
106
Autoantibody implicated in Celiac disease
IgA anti endomysial
IgA anti-tissue transglutaminase
If IgA deficient individual: IgG
107
p-ANCA diseases
- Churg-strauss
- Microscopic polyangiitis
- Ulcerative colitis
108
c-ANCA diseases
Wegner granulomatosis
109
Autoantibody implicated in reumathoid arthitis
Reumatoid factor: IgM vs IgG Fc region
| Anti-CCP
110
Autoantibody implicated in SLE
ANA
Anti dsDNA
Anti Smith
111
Autoantibody implicated in drug-induced lupus
Anti-histone
112
Autoantibody implicated in mixed connective tissue disease: SLE, sclerodermia, polymyositis
Anti-U1 RNP
113
B cell immunodeficiencies
Bruton (X-linked) agammaglobulinemia
Selective IgA deficiency
Common variable immunodeficiency
114
X linked (Bruton) agammaglobulinemia: deffect
Deffect in BTK : B cell tyrosine kinase
No B cell maturation
X linked recessive: higher prevalence in boys
115
Recurrent bacterial and enteroviral infections after 6 months from birth
X linked (Bruton) agammaglobulinemia: No more maternal IgG is left
116
Absent B cells in peripheral blood
Low Ig of all isotypes
Absent/scanty lymph nodes and tonsils
Life vaccines contraindicated
X linked (Bruton) agammaglobulinemia
117
Most common 1ary immunodeficiency
Selective IgA deficiency
118
Presentation of Selective Ig A deficiency
- Majority are asymptomatic
- Airway and GI infections
- Atopy
- Anaphylaxis to IgA containing products: blood
119
Selective Ig A deficiency has increased susceptibility to
Giardiasis
120
Defect in B cell differentiation
Common variable immunodeficiency
121
Low count of plasma cells and immunoglobulins
Common variable immunodeficiency
122
Increased risk of autoimmune disease, bronchiectasis, lymphoma and sinopulmonary infections
Common variable immunodeficiency
123
T cell immunodeficiencies
1. Thymic aplasia: DiGeorge syndrome
2. IL-12 receptor deficiency
3. Autosomal dominant hyper-IgE syndrome: Job syndrome
4. Chronic mucocutaneous candidiasis
124
22q11 deletion
DiGeorge syndrome: Di=22
125
DiGeorge syndrome
Failure to develop 3rd and 4th pharyngeal pouches: absent thymus and parathyroids
126
DiGeorge findings
```
T disease:
Tetany: hipocalcemia
T cell deficiency: recurrent infections
ConoTruncal abnormalities: Tetralogy of Fallot, truncus arteriosus
Chromosome Twenty Two
Thymic aplasia
Hypertelorism
```
127
IL-12 Rc deficiency: consequence and inheritance
Low Th1 response
| Autosomal recessive
128
Autosomal dominant hyperIgE syndrome: Job syndrome: deficiency
Deficiency of Th17 cells due to STAT3 mutation: impared recruiment of neurophils
129
isolated Low IFN gamma (immunodeficiency)
IL12 receptor deficiency
130
```
Coarse Facies
Cold staphlococcal abscesses
Retained primary teeth
High IgE
Dermatologic problems
Bone fractures from minor trauma
```
Autosomal dominant hyperIgE syndrome: Job syndrome: deficiency
131
High IgE
Low IFN gamma
High Eosinophils
Immunodeficiency
Autosomal dominant hyperIgE syndrome: Job syndrome: deficiency
132
Absent in vitro T cell proliferation in response to Candida agents
Chronic mucocutaneous candidiasis
133
B and T cell immunodeficiencies
1. Severe combined immunodeficiency
2. Ataxia telangiectasia
3. Hyper IgM syndrome
4. Wiskott-Aldrich syndrome
134
Severe combined immunodeficiency defect
Deffective IL-2R gamma chain (X linked, most common)
| Deffective adenosine deaminase (AR)
135
Treatment of Severe combined immunodeficiency
Avoid live vacines
Antimicrobial prophylaxis and IVIg
Bone marrow transplant curative with no concern for rejection
136
Absence of thymic shadow in CXR, germinal centers (lymph node biopsy) and T cells (flow citometry)
Severe combined immunodeficiency
137
low T cell receptor excision circles (TRECs)
Severe combined immunodeficiency
138
Failure to thrive, chronic diarrea and thrush
| Recurrent viral, bacterial, fungal and protozoal infections
Severe combined immunodeficiency
139
Deffect in ataxia telangiectasia
ATM gene: failure to repair DNA double strand breaks: cell cycle arrest
140
ataxia telangiectasia triad
1. Ataxia
2. Angiomas: telangiectasia
3. Ig A deficiency
141
high AFP in immunodeficiency
ataxia telangiectasia
142
High risk of lymphoma and leukemia in immunodeficiency
ataxia telangiectasia
143
Defective CD40L on Th cells
HyperIgM syndrome: class switching deffect
144
HyperIgM syndrome inheritance
X linked recessive
145
Wiskott Aldrich syndrome: defect
WASp gene: leucocites and platelets unable to reorganise actin cytoskeleton: deffective antigen presentation
146
Wiskot Aldrich syndrome presentation
```
WATER
Wiskott aldrich
Thrombocytopenia
Eczema
Recurrent pyogenic infections
```
147
Wiskott Aldrich syndrome inheritance
Xlinked recessive
148
X linked recessive immunodefficiencies
Xlinked Bruton Agammaglobulinemia
Severe combined immunodeficiency IL-2R gamma chain
Hyper IgM syndrome
Wiskott Aldrich syndrome
149
Phagocyte disfunction diseases
1. Leukocyte adhesion deficiency type 1
2. Chédiak.-Higashi syndrome
3. Chronic granulomatous disease
150
Defect in Leukocyte adhesion deficiency
LFA 1 integrin (CD18)
151
Findings in Leukocyte adhesion deficiency
high neutrophils
| Absence of neutrophils at infection sytes (impaired migration and chemotaxis)
152
Delayed separation of umbilical cord
Leukocyte adhesion deficiency
153
Chédiak-Higashi syndrome defect
LYST: lysosomal trafficking regulator gene: microtubule disfunction in phagosome-lysosome fusion
154
Partial albinism
Chédiak-Higashi: melanosoma
155
Giant granules in granulocytes and platelets
Pancytopenia
Coagulation defects
Chédiak-Higashi
156
Chronic granulomatous disease defect
Defect of NADPH oxidase: less reactive oxigen species and less respiratory burst in neutrophils
157
Nitroblue tetrazolium dye reduction test fails to turn blue
Chronic granulomatous disease
158
Abdnormal dihydrodamine test: less green fluorescence
Chronic granulomatous disease
159
Bacterial infections in B cell immunodeficiency
Encapsulated: Some Killers Have Pretty Nice Capsules
1. Streptococcus pneumoniae, Group B streptococcus, Salmonella
2. Klebsiella pneumoniae
3. Haemophillus influenzae type B
4. Pseudomonas aeruginosa
5. Neisseria meningitidis
6. Criptoccoccus neoformans
160
Bacterial infections in T cell immunodeficiency
Sepsis
161
Bacterial infections in patents with low granulocytes
1. Staphylococcus
2. Burkholderia cepacia
3. Pseudomonas aeruginosa
4. Serratia
5. Nocardia
162
Bacterial infections in complement deficiency
1. Early complement deficiencies: Encapsulated
| 2. C5-C9 deficiency: Neisseria
163
B cell deficiencies tend to produce recurrent _____ infections
Bacterial
164
T cell deficiencies tend to produce recurrent ___ and ____ infections
Viral
| Fungal
165
Syngenic graft (isograft)
From twin or clone)
166
Allograft
From nonidentical individual of the same species
167
Xenograft
From different species
168
Types of transplant rejection
1. Hyperacute: type II HS
2. Acute: type IV HS (cellular/humoral)
3. Chronic: type IV and II HS
4. Graft vs host disease: tupe IV
169
Pathogenesis of hyperacute transplant rejection
Pre existing recipient antibodies react to donor antigen (type II hypersensitivity reaction), activate complement
170
Features of hyperacute Transplant rejection
Widespread thrombosis of graft vessels: ischeima/necrosis
| Graft must be removed
171
Types of acute transplant rejection
Type IV hypersensitivity reaction:
1. Cellular: T cells CD8+ against donor MHC
2. Humoral: B cells: similar to hyperacute, except antibodies develop after transplant
172
Features of acute transplant rejection
1. Vasculitis of graft vessels with dense intersticial lympocytic infiltrate
2. Prevent or reverse with immunosupressants
173
Pathogenesis of chronic transplant rejection
CD4+ T cells respond to recipient APCs presenting donor peptides, including allogenic MHC
174
Features of chronic transplant rejection
Recipient T cells react and secrete cytokines: proliferation of VSM, parenchymal atrophy and intersticial fibrosis
Atteriosclerosis
175
Organ-specific examples of Chronic transplant rejection
1. Lung: bronchiolitis obliterans
2. Heart: accelerated atheriosclerosis
3. Kidney: Chronic graft nephropathy
4. Liver: Vanishing bile duct syndrome
176
Grafted immunnocompetent T cells proliferate in the immunocompromised host and reject host cells with foreign proteins
Graft vs host disease
177
In what situation is graft vs host disease considered beneficial?
Bone marrow transplant for leukemia
178
Graft vs host disease is more frequent in ____ and ____ transplants
Bone marrow
Liver
(more lymphocytes)
