Normal Immune Responses ___ and ___
protect the host from invading pathogens and aids in eliminating disease
Define The Innate Immune System
Exists prior to infection and is not enhanced by repeated exposure; inflammation is the immediate response to injury
The Innate Immune System is not enhanced by
repeated exposure
The Innate Immune System: ____ is the immediate response to injury
inflammation
Innate Immune System: Mechanical - (2 things)
skin, mucus
Innate Immune System: Biochemical - (4 things)
antimicrobial peptides and proteins, complement, interferons, free radicals
Innate Immune System: Cellular components - (4 things)
neutrophils, monocytes, natural kills cells (NK), natural killer-T-cells (NKT)
Adaptive Immune System: Responds to a variety of
antigens
Adaptive Immune System: Responds to prior
antigen exposure (memory response)
Adaptive Immune System: Memory response results in the production of
antibodies
Abnormal Immune Responses:
Hypersensitivity - Type I
Type II
Type III
Type IV
Abnormal Immune Responses: Hypersensitivity - Type I -
Antibody mediated (IgE)
Abnormal Immune Responses: Hypersensitivity - Type I - Immediate reaction -
mast cells or basophils release mediators (for example histamine)
Hypersensitivity - Type I - Mediators: H___
Histamine
Hypersensitivity - Type I - Mediators: S___
Serotonin
Hypersensitivity - Type I - Mediators: L___
Leukotrienes
Hypersensitivity - Type I - Mediators: Pros___
Prostaglandins
Hypersensitivity - Type I - Mediators: B___
Bradykinins
Hypersensitivity - Type I - Mediators: Prot___
Proteases
Hypersensitivity - Type I - Mediators: E___
Eosinophil chemotactic factor
Hypersensitivity - Type I - Mediators: N___
Neutrophil chemotactic factor
Hypersensitivity - Type I - Mediators: Effects: S___
Smooth muscle contraction
Hypersensitivity - Type I - Mediators: Effects: V___
Vasodilation
Hypersensitivity - Type I - Mediators: Effects: Increased ___
Increased vascular permeability
Hypersensitivity - Type I - Mediators: Effects: P____
Platelet aggregation
Hypersensitivity - Type I - Mediators: Effects: C____
Complement activation
Hypersensitivity - Type I - Mediators: Effects: M____
Mucus secretion
Hypersensitivity - Type I - Clinical Symptoms of the body’s response: A___
Asthma
Hypersensitivity - Type I - Clinical Symptoms of the body’s response: H___ F___
Hay fever
Hypersensitivity - Type I - Clinical Symptoms of the body’s response: S___ R___
Skin rashes
Hypersensitivity - Type I - Clinical Symptoms of the body’s response: L___ A___
local anaphylaxis
Hypersensitivity - Type I - Clinical Symptoms of the body’s response: S__ A__
Systemic anaphylaxis
Hypersensitivity - Type II -
antibody mediated (IgM or IgG)
Hypersensitivity - Type II - Results from
formation of antigen-antibody complexes between foreign antigen and IgM or IgG immunoglobulins
Hypersensitivity - Type II - Results from formation of antigen-antibody complexes between foreign antigen and IgM or IgG immunoglobulins. 2 examples:
Blood transfusions and Rh discordance between mother and fetus
Hypersensitivity - Type II - Rh (rhesus) positive people have the
Rh antigen (rhesus factor, D antigen) on the surface of their red blood cells. Rh negative people do not.
When an Rh-____ mother carries an Rh-____ baby, and some of the baby’s blood enters the mother’s bloodstream, this is called Rh-incompatibility.
negative mother
positive baby
When the mother is Rh negative and baby is Rh positive,
The mother’s immune system sees the baby’s red blood cells as “foreign” and will try to eliminate them as invaders.
Rh-incompatibility usually does not affect the mother’s ___ baby
first
Rh-incompatibility usually does not affect the mother’s first baby, but once she has produced an immune response (called “Rh-sensitization”), all future Rh-positive babies are at risk for developing
hemolytic disease of the fetus and newborn (HDFN)
For the newborn, HDFN (hemolytic disease of the fetus and newborn) is a serious condition that may cause a____, j____, h___ f___, b___ d____
anemia, jaundice, and in severe cases, heart failure and possible brain damage.
Rho(D) Immune globulin should be administered to the mother after the first
discordant pregnancy
Rho(D) Immune globulin should be administered to the mother after the first discordant pregnancy. The dose should be administered to the mother within
the first 72 hours of delivery.
Rh incompatibility- Antepartum: Prophylaxis at __ weeks gestation
26 to 28
Rh incompatibility- Antepartum: Prophylaxis at 26 to 28 weeks gestation. Administer within 72 hours of ______ resulting from:
Amniocentesis, chorionic villus sampling (CVS) and percutaneous umbilical blood sampling (PUBS)
Abdominal trauma or obstetrical manipulation
Ectopic pregnancy
Threatened pregnancy loss after 12 weeks gestation with continuation of pregnancy
Pregnancy termination (spontaneous or induced) beyond 12 weeks gestation
suspected or proven exposure to Rh-positive red blood cells
Rho(D)
a medication used to prevent RhD isoimmunization in mothers who are RhD negative
If Rho(D) Immune globulin is administered early in pregnancy (before 26 to 28 weeks), there is an obligation to
maintain a level of passively acquired anti-D by administration of immune globulin at 12-week intervals until birth
Type III - Antibody mediated
Elevated levels of antigen-antibody complexes in the circulation deposits on basement membranes in tissues and vessels
Type III - Antibody mediated: Elevated levels of antigen-antibody complexes in the circulation deposits on basement membranes in tissues and vessels resulting in
skin rashes, glomerulonephritis or arthritis.
Type III - Antibody mediated: Time of onset
3-4 days
Type IV - Delayed hypersensitivity examples
TST and poison ivy (3 to 4 days onset)
The tuberculin most widely used for intradermal testing is
purified protein derivative (PPD)
The tuberculin most widely used for intradermal testing is purified protein derivative (PPD) which is derived from
cultures of M. tuberculosis.
After intradermal injection of 5 tuberculin units, a pale wheel, ___mm in diameter should be seen.
6 to 10
TST: ____ sensitized by prior exposure produce local induration through local vasodilation, edema, and inflammatory cells.
T-cells
TST: Macrophages are activated and cause
tissue damage associated with delayed hypersensitivity
TST: The peak reaction to the antigen exposure will occur more than __ hours from time of injection
24
TST: The formation of vesicles, bullae, or necrosis at the test site indicate higher degrees of sensitivity and presence of
active disease
Autoimmunity
Body mounts an immune response against itself
Immunodeficiency Diseases- Results from an inadequate function in the immune system. Consequences include increase susceptibility to infections as well as
prolonged duration and severity of disease.
2 causes of Immunodeficiency Diseases
- Congenital
2. Derived from extrinsic factors - bacterial or viral infections, drug treatment
Autoimmune diseases: Rheumatoid arthritis: Step 1
IgM antibodies (rheumatoid factors) are produced
Autoimmune diseases: Rheumatoid arthritis: Step 2
IgM reacts with IgG and may form immune complexes that activate the complement cascade
Autoimmune diseases: Rheumatoid arthritis: Step 3
The result is chronic inflammation of the joints and kidneys.
Autoimmune diseases: Systemic lupus erythematosus
antibodies are made against DNA, histones, red blood cells, platelets, and other cellular components.
Autoimmune diseases: Multiple sclerosis
cell-mediated autoimmune attack that destroys myelin surrounding nerve cells
Autoimmune diseases: Insulin-dependent diabetes mellitus (type 1 diabetes): cell-mediated autoimmune attack that
destroys insulin-producing islet beta cells of the pancreas
Autoimmune diseases: Insulin-dependent diabetes mellitus (type 1 diabetes): activated CD4 TDTH cells that infiltrate the islets of Langerhans and recognize self islet beta cell peptides are thought to
produce cytokines that stimulate macrophages to produce lytic enzymes, which destroy islet beta cells.
Vaccines: Active Immunization: Two facts
- Administration of antigen to host to produce antibody response
- May require time to develop antibodies
Vaccines: Passive Immunization: definition
Use of preformed immunological products (immunoglobulins) to transfer immunity to the host
Vaccines: Passive Immunization: May be derived from
either animals or humans
Vaccines: Passive Immunization: May be directed against
a specific antigen
Vaccines: Passive Immunization: may contain antibodies found in
the general population
Vaccines: Passive Immunization: Products of the ___ have also been used
cellular immune system (interferons)
Live Vaccines contain
modified and weakened live virus
Live Vaccines: Contraindicated in:
Immunosuppressed
pregnancy
children less than 1 year old
MMR Varicella Zoster Rotavirus Intranasal Influenza Oral Polio (unavailable in US)
Live, attenuated vaccines
Diphtheria, tetanus, pertussis Polio (injection) Hepatitis A Hepatitis B Influenza (injection) HPV Rabies
Inactivated vaccines
Inactivated vaccines: cannot
replicate in the body
Since Inactivated vaccines cannot replicate in the body,
they usually require several doses
Pure Polysaccharide vaccines should not be administered to
children less than 2 years old.
Pure Polysaccharide vaccines should not be administered to children less than 2 years old because
Due to the immaturity of their immune system, they cannot yet form an immune response.
Pure Polysaccharide vaccines, 2 examples
Pneumococcal Polysaccharide vaccine (PPSV23)
Meningococcal polysaccharide vaccine (MPSV4)
How many vaccines can be given in one visit
unlimited
Live, attenuated injectable vaccines must be separated by
at least 4 weeks (if not administered at same visit)
vaccines administered in a series: Increasing interval will
not diminish effect of vaccine, but will delay time to achieve full protection
vaccines administered in a series: Decreasing the interval between administration
may interfere with the immune response
vaccines administered in a series: vaccines may be administered up to ___ before the next scheduled dose
4 days
attenuated vaccines
MMR
Oral Polio (unavailable in US)
Rotavirus
Intranasal Influenza
Varicella
Zoster
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