Secondary Immunodeficiencies Flashcards Preview

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Flashcards in Secondary Immunodeficiencies Deck (33):
1

Differentiate between primary and secondary immune deficiencies

Primary immunodeficiencies are caused by defects which originate in the immune system itself.
Secondary immunodeficiencies are due to insufficiency of a supporting component of the immune system or an external or "secondary" depleting factor.

2

How does diabetes impair the immune system?

Hyperglycemia affects neutrophil function
Poor circulation leads to skin ulceration, less delivery of immune cells to wounds

3

In diabetes, the defect in ______ function is most prominent

Neutrophil

4

List common infections that are seen with increased severity and frequency in diabetics

Pneumonia
UTI
Cellulitis
Diabetic foot ulcers
Candida

5

List some unusual infections that can be complications of diabetes

Deep candida infections
Rhinopulmonary zygomycosis (mucormycosis)
Malignant otitis media due to Pseudomonas aeruginosa

6

_______ is better explained as a state of immune modulation than immune deficiency

Pregnancy

7

Give some mechanisms for altered immunity in pregnant women

Progesterone has been shown to inhibit lymphocyte proliferation in vitro.
Uromodulin is a pregnancy-specific serum factor which has
also been shown to inhibit B cell activity (antibody responses are generally preserved)
Depressed T cell responses

8

List infections that pregnant women are at increased risk for

HAV, HBV
influenza
herpesviruses
chlamydia/ gonococcus
listeria
campylobacter
TB
malaria

9

How does protein-calorie malnutrition affect immune function

global metabolic and hormonal disturbances of
starvation.
low levels of leptin may be involved in the immune dysregulation
deficient intake of protein, fat, vitamins, and minerals, particularly nutritional deficiencies of zinc, iron, folate, pyridoxine, and vitamin A.

10

Malnutrition leads to a 10x risk of mortality from ____ and a 30x increased risk of mortality from _____

pneumonia and gastroenteritis

11

Older people are at risk of ______ reactivation due to changes in lymphocyte development and function

zoster

complication= post-herpetic neuralgia

12

Older adults can have a decrease in _______ function and thus an increase in auto-reactivity

Suppressor cell

13

How do trauma and critical illness affect immunity?

Massive release of inflammatory cytokines, activation of monocytes and macrophages

14

_____ are particularly immunosuppressive due to the massive loss of protein and disruption of physical barriers

Burns

15

How does stress impact immunity?

Reduced NK cell activity
Depressed lymphocyte mitogen responses
Endogenous glucocorticoids

16

In ESRD, shunting of portal blood reduces the ability of ______ to clear opsonized material and can also cause hypocomplementemia. Furthermore, decreased hepatic metabolism of __________ is likely immune suppressive

Kupffer cells
decreased metabolism of endogenous glucocorticoids

17

List unusual infections assocaited wiht cirrrhosis

Cryptococcal infection
Candidal infection
Infection with vibrio vulnificus

18

Gastritis and any other protein losing condition can result in ________. Examples include nephritic syndrome, IBD, Celiac, massive lymphedemia, peritoneal dialysis, burns

hypogammaglobulinemia

19

List hematologic/ oncologic conditions associated with B cell deficiency

Multiple myeloma
Waldenstrom’s macroglobulinemia
Chronic lymphocytic leukemia
Well differentiated lymphomas

20

List hematologic/ oncologic conditions associated with T cell deficiency

Hodgkins
Advanced solid tumors

21

How does sickle cell anemia act as an immune suppressive condition?

Functionally asplenic--> increased risk of infection with encapsulated organisms

22

The immune suppression associated with blood transfusions is not seen in _____-____ blood

leukocyte-depleted

23

Describe the immune suppressive effects of measles infection

possibility of superinfection
- T cell lymphopenia with depletion of T-dependent areas of lymph nodes and spleen
- Cutaneous anergy
- Diminished in vitro T cell proliferation with mitogens or alloantigens
- Diminished antibody production

24

How does HTLV-1 cause immune suppession?

can produce adult T cell leukemia/lymphoma.
Patients with ATL present with severe immune defects and multiple opportunistic infections

25

_____ infection places transplant patients at risk for other opportunistic infections like PCP, aspergillosis, organ rejection

CMV

26

How to bacterial superantigens modulate the immune system?

- bind simultaneously to MHC class II antigens and to the non-antigen-binding region of T cell receptor variable regions, thereby stimulating massive numbers of T cells.
- These T cells then produce inflammatory cytokines, which lead to a syndrome resembling septic shock with multisystem organ failure.
- After “hyper activation” these T cells become anergic and can no longer become activated.

27

How do mycobacteria inhibit the immune system

Replicated within monocytes and macrophages, inhibit the ability of the infected cell to kill invaders and coordinate the immune response
Increased risk of secondary infection

28

Malaria + EBV=

Burkitt lymphoma

29

List some rheumatologic conditions associated with increased susceptibility to infection, even in the absence of immune suppressing medications

SLE, RA, granulomatosis with polyangiitis

30

Patients receiving ______ have reduced T cell function, diminished antibody production, and deficient neutrophil function

hemodialysis

31

List three renal functions associated with immune suppression

nephrotic syndrome
ESRD
Uremia

32

List some drugs that have immunesuppressing effects

Glucocorticoids
Signal transduction inhibitors: cyclosporine, tacrolimus, sirolimus
Purine synthesis inhibitors: azathioprine, mycophenolate mofetil
Antibodies: TNF inhibitors

33

Use of TNF inhibitors places patients at increased risk of:

granulomatous infections like mycobacteria and endemic fungi