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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
Alloreactive NK cells can kill recipient ____
Leukemia
26
Immunosuppressants may help in transplantation acceptance. Corticosteroids suppress __ transcriptional activity. It does this by increasing ___ production, which inhibits ___.
NF-kB IkBa NF-kB
27
Immunosuppressants inhibit T cell activation by interfering what three signals? For example, belatacept binds to CD28 to prevent the activation of ___.
Activation, survival, proliferation Calcineurin (the second signal)
28
Name two immunosuppressants that inhibit T cell activation
Cyclosporin Tacrolimus
29
____ and ___ prevent T cell survival and proliferation
Baletacept (prevents the second signal) Anti-CD25
30
What are autoimmune diseases?
Loss of tolerance leading to hypersensitivity reactions Adaptive immune targeting to self
31
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
Women's 20%
32
___ genes are associated with susceptibility in __% of autoimmune diseases. Class ___ alleles are most frequently implicated. ___ T cells are also closely tied to AD development
HLA 2 CD4
33
True or false... in a type 2 hypersensitivity autoimmune disease, the antibodies may act as agonists or antagonists
True
34
rheumatic fever is caused by ___. Two bacterial species, __ and ___ have antigens that are similar to human antigen causing the AD
Molecular mimicry Streptococcus pyogenes Staphylococcus aureus
35
Describe how grave's disease works
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
36
What are the signs of hyperthyroidism?
Weight loss Heat intolerance Anxiety and irritability Exophthalamos
37
Describe how newborns can be born with Graves' disease. How can this be cured?
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
38
What is hashimoto's disease?
Destruction of normal thyroid tissue CD4 Th1 response Causes hypothyroidism Ectopic lymphoid tissue formed in the thymus Enlarged thyroid present, swallowing difficulty
39
Hashimoto's disease is hypothyroidism whereas Grave's disease is hyperthyroidism. Describe the different oral manifestations seen in them
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
40
What is Sjögren's syndrome?
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
41
What is systemic lupus erythematos?
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
SLE causes intermolecular epitope spreading. Describe what this is.
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
What in intramolecular epitope spreading?
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
True or false... thymic involuntion is tied to increased AD incidence
True (celiac disease)
45
Describe autoimmunity in type 1 diabetes
CD4 and CD8 T cell response kills beta cells HLA-DR3/4 linkage Viral cross-reactivity model Molecular mimicry Stress Epitope spreading
46
What are four oral manifestations of diabetes?
Reduced salivary flow Altered saliva composition Impaired wound healing Sweet breath
47
Periodontitis is tied to ___ and ___
Rheumatoid arthritis Epitope spreading
48
``` What are the expected survival rates at 5 years for the following organs? Kidney Liver Heart Lungs Bone marrow ```
Kidney - 90% Liver - 75% Heart - 70% Bone marrow - 60% Lungs - 50%
49
Name five major classes of immunosuppressants used for organ transplants
Calcineurin inhibitors MTOR inhibitors Antiproliferative agents Antibodies Corticosteroids
50
What are the two stages of rejection in host vs. graft reaction?
Sensitization stage (recognition of alloantigens) Effector stage (inflammatory response to the injury, antibody production, cell recruiting)
51
What are the two different pathways in the sensitization stage? Describe them
Direct pathway - host T cells recognize allo-MHC molecules as non-self Indirect pathway - T cells recognize processed alloantigen presented by self-APCs
52
What are the three phases for post HSCI?
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
Name 7 pre-transplant dental care procedures
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
Name 5 things that should be included as part of pre-transplant care
Consultation with MD Educate patient about oral hygiene Perform dental prophylaxis Careful with certain drugs Evaluate dental status and treat as indicated
55
True or false... if the patient has severe leukopenia and thrombocytopenia, the patient should avoid flossing
True They should also disinfect and rinse toothbrush and change tooth brush regularly
56
What is mucositis and what is it commonly caused by?
Mucosal damage (including lower GI) affecting the nonkeratinized mucosal surfaces in mouth. Intense pain and discomfort Most frequent complication post-BMT Radiation/chemotherapy
57
What drug may cause gingival hyperplasia?
Cyclosporine
58
How long does the peak immunosuppression last post-transplantation?
3-6 months
59
What are the two types of HIV? Which may be less virulent and have a longer latency period?
HIV-1 and HIV-2 HIV-2 may be less virulent and have a longer latency period
60
Which is more predominant worldwide, HIV-1 or HIV-2?
HIV-1 HIV-2 is mostly in west Africa
61
How are both types of HIV (1 and 2) transmitted?
Sexual contact Through blood and body fluids From mother to child during the perinatal period
62
What three cells are infected by HIV?
CD4 T cells *** Monocytes Macrophages/dendritic cells
63
What are the two most effective HIV treatments?
HAART (highly active antiretroviral therapy) CART (combined antiretroviral therapy)
64
Describe the HIV life cycle. What drugs can be used to interfere with each step?
Binding (CCR5 antagonist) Fusion (fusion inhibitors) Reverse transcription (NNRTIs, NRTI) Integration (integrate inhibitors) Assembly Budding (protease inhibitors)
65
What is the current HAART (cART) therapy?
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
What are the four goals of HAART (cART) therapy?
Decrease viral load Increase CD4s Improvement of quality of life Reduction of morbidity and mortality
67
HIV can now be considered a ___ infection. However, HAART therapy cannot be considered an ___ success
Chronic Unqualified
68
True or false... HAART is associated with lots of adverse effects
True
69
What is lipodystrophy?
Peripheral fat wasting more associated with NRTIs Central fat accumulation more associated with PIs Direct effects of HIV
70
What is hyperlipidemia?
Elevations in total cholesterol, LDL, and triglycerides Which leads to hypertension, coronary artery disease, increase myocardial infarction
71
What is included in the "three way street"? Where does HAART come into play?
Obesity (HAART affects this) Diabetes Periodontal disease
72
HAART is associated with osteonecrosis, even though the mechanism is unknown, what things increase osteonecrosis?
Corticosteroid treatment Alcohol abuse Hemoglobinopathies Hyperlipidemia Hypercoagulable states
73
True or false... the HAART era occurrence of oral manifestations markedly decreased
True, however not all patients get HAART
74
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
Reduction Reduction No Increase
75
Name four predisposing factors for oral lesions
Low CD4 count High viral load Xerostomia Poor oral hygiene Smoking
76
What is a zoonotic pathogen?
An infection that naturally occurs in an insect or animal host that can also subsequently infect humans
77
True or false... most newly identified pathogens are zoonotic
True
78
What is an emerging pathogen?
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
Describe how the following pathogens are transmitted. Microsporidia and cryptosporidium Naegleria fowleri Ebola virus SARS (severe acute respiratory syndrome) Dengue virus
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
What kind of a virus is the chikungunya virus?
Positive sense, ssRNA virus In the togaviridae virus family O'nyong'nyong is a closely related, serologically cross-reactive virus
81
What family of virus is the chikungunya virus? What family are most other viruses associated with mosquitoes in?
Togaviridae Flavivirus
82
In the chikungunya virus, over half of cases result in long-lasting relapsing ___
Arthralgia
83
What mosquito is the vector for dengue, Zika, and yellow fever viruses, and chikungunya?
Aedes aegypti
84
What kind of a virus is the Zika virus? What family is it in? What mosquito is it spread in?
Positive sense ssRNA Flavivirus Aedes spp. Of mosquito Discovered in the Zika forest of Uganda
85
What are the common symptoms of Zika?
Fever, rash, joint pain, **conjunctivitis
86
What are the mechanisms of transmission for Zika?
Infected mosquito bite **blood transfusions Sexual transmission Congenital infection (maternal blood to placenta to fetus)
87
Congenital transmission of Zika can cause what? How does the virus get to the fetus?
Microcephalic Brain malformation Ocular/auditory defects Growth retardation -virus from maternal bloodstream is found in fetal brain samples, cord blood, and placental tissue
88
True or false... Zika can be spread person to person without sexual contact
True
89
What is the diagnostic test for Zika?
MAC-ELISA IgM Antibody Capture ELISA
90
What is cyclospora cayetanensis? Describe its route of transmission?
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
What is the hallmark symptom of cyclospora? True or false... oocytsts are infective when shed
Watery diarrhea False.. oocysts not infective when shed (no direct human-to-human contact)
92
What is the best treatment for cyclospora cayetanensis?
Trimethoprim sulfamethoxazole
93
What kind of a virus is the Middle Eastern Respiratory Sydnrome Virus?
Positive sense, ssRNA virus coronavirus family.
94
How is MERS likely spread? What are its symptoms?
Spread through respiratory secretions Symptoms: fever, cough, shortness of breath
95
True or false... MERS has a high risk for the dental clinic
True
96
True or false... the following less pressing emerging zoonotic pathogens have no direct human-to-human transmission. ... avian flu, borrelia miyamotoi, anaplasma, and ehrlichia
True
97
What family of virus is the Ebola virus? How is it spread?
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
Some emerging pathogens are too virulent and kill themselves off. Give three examples of these
SARS, MERS, Ebola
99
What is the respiration of parasitic protozoa?
Facultative anaerobic
100
How to parasitic protozoa reproduce?
Via binary fission

Host and Defense (17 decks)

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