the immunocompromised host

Question 1

classic features of inflammation

Answer 1

1. rubor (redness)
2. calor (heat)
3. tumor (swelling
4. dolor (pain)
   - doesn’t always mean infection but allows for analysis of issue

Question 2

immune status is important bc

Answer 2

it shapes the way you approach their care

Question 3

innate immunity includes

Answer 3

fever, skin, dendritic cell, macrophage
chemical: saliva, stomach acid, blood flow, menstrual flow

Question 4

macrophage/phagocytes

Answer 4

big eater - among innate defenses bc they are programmed to eat everything they do not need direction or priming

Question 5

NK-cell job

Answer 5

induces cell death of infected or malignant host cells “natural killer cells”

Question 6

innate immunity - complement system

Answer 6

• holes in the plasma membrane
• series of proteins that have a step by step procedure to kill organisms and create an inflammatory response when an unfamiliar pathogen is identified

Question 7

adaptive immunity includes

Answer 7

b-cell, plasma cell, antibodies (antibody mediated /humoral immunity), t helper, and t killer (cell-mediated immunity)

Question 8

adaptive vs innate immune system

Answer 8

innate: first and fast non-specific response
adaptive: slower, highly specific response that allow for targeted responses and future protection

Question 9

primary immunodeficiencies

Answer 9

genetic

Question 10

secondary immunodeficiency

Answer 10

acquired, anything that has led to immunodeficiency later in life:
infection, chemo, pregnancy, steroids, etc.

Question 11

health care caused conditions

Answer 11

iatrogenic
ex. splenectomy

Question 12

genetic complement deficiencies

Answer 12

deficiencies of components of the immune system result in “gaps” in the defenses
complement deficiencies:
- may occur as a result of lack of any of the complement components
- causes failure of the cascade
- loss of early components result in increased staphyl/stepto coccal infections
- loss of late components results in increased neisseria infections

Question 13

genetic defects in phagocytic cell function

Answer 13

these predispose to bacterial infections
- inability to kill organisms that have been ingested is typical of chronic granulomatous disease

Question 14

genetic lymphocyte function

Answer 14

there is a variety of syndromes where there is deficiency in lymphocytes including (SCID)
- these patients will present w fungal and viral infections, as the maternal immunity transferred at birth wears off - live vaccines may cause severe disease

Question 15

genetic b cell deficiency

Answer 15

tend to get bacterial infections

Question 16

genetic t cell deficiencies

Answer 16

tend to get infection w viruses, especially herpes family, intracellular bacteria, and fungi

Question 17

CGD =

Answer 17

chronic granulomatous disease, it is ineffective phagocytes which leads to uncontrolled infections

Question 18

SCID =

Answer 18

severe combined immunodeficiency disease
- it is a lack of t cells and b cells which leads to no resistance to any type of infection, leading to rapid death

Question 19

secondary/acquired immunodeficiency chemotherapy

Answer 19

many of these agents affect lymphocytes particularly
- they act by interfering w cell division and therefore, inhibit regeneration of cells that have a rapid turnover
- after treatment with these agents, often the numbers of PMN (neutrophils) will drop and may remain depressed for weeks depending on the therapy, during which time there is a greatly increased risk of infection and death (due to neutropenia)

Question 20

secondary/acquired immunodeficiency steroids

Answer 20

damp down inflammation by many mechanisms including:
- PMN are unable to migrate to the site of infection
- reduced macrophage migration and antigen presentation
- reduction in t lymphocytes
- decrease antibody responses
results in increased viral, bacterial and fungal infection

Question 21

secondary/acquired immunodeficiency post transplant

Answer 21

commonly used agents include cyclosporinA, tacrolimus, and serolimus which inhibit cytokine production and t lymphocyte function
- result in immunosuppression w a predispo. to infections of t cell deficiency

Question 22

secondary/acquired immunodeficiency - splenectomy

Answer 22

• spleen is the main site of production of opsonizing antibody
• it removes circulating microorganisms, immune complex, old blood cells
• immunization is recommended for patients undergoing splenectomy to s. pneumoniae, h. influenza and n. meningitidis

Question 23

ppl who underwent a splenectomy should be vaccinated against…

Answer 23

s. pneumoniae, h. influenza and n. meningitidis
- a bite by an animal also requires antibiotics every single time

Question 24

secondary/acquired immunodeficiency - HIV/AIDS

Answer 24

untreated HIV leads to AIDS
- aids is primarily a disease of poor t cell production/function (CD4+ cells)
- the opportunistic infections affecting people with AIDS reflect the lack of CD4+ t cells

Question 25

bacteria may evade the immune response by:

Answer 25

- destroying complement components - destroying immunoglobulin - preventing phagocytosis - preventing intracellular killing

Question 26

evasion of the immune response once bacteria gets in

Answer 26

bacteria growing inside the cytoplasm of cells are protected from antibody or detection by the immune system ex. listeria - bacteria may change their surface antigens rapidly