Essentials of Human Diseases and Conditions 4th edition

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Essentials of Human Diseases and Conditions 4th
edition

• Margaret Schell Frazier
• Jeanette Wist Drzymkowski

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Chapter 3Immunologic Diseases and Conditions
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Learning Objectives

• Name the functional components of the immune
  system.
• Characterize the three major functions of the
  immune system.
• List examples of inappropriate responses of the
  immune system.
• Explain the difference between natural and
  artificial immunity.

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Learning Objectives (contd.)

• Trace the formation of T cells and B cells from
  stem cells.
• Explain how T cells and B cells specifically
  protect the body against disease.
• List the five immunoglobulins and explain
  complement fixation.
• Explain the ways that HIV is transmitted.

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Learning Objectives (contd.)

• List the guidelines for universal precautions and
  infection control.
• Describe the primary absent or inadequate
  response of the immune system in the following
  diseases
• Common variable immunodeficiency
• Selective immunoglobulin A deficiency
• Severe combined immunodeficiency disease

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Learning Objectives (contd.)

• Explain the destructive mechanisms in autoimmune
  diseases.
• Describe the symptoms and signs of pernicious
  anemia. Name the primary treatment.
• Describe the systemic features of SLE. Recall the
  diagnostic criteria.
• Detail the pathology of rheumatoid arthritis.

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Learning Objectives (contd.)

• Specify the primary objectives of the treatment
  for RA.
• Compare the pathology of multiple sclerosis to
  that of myasthenia gravis.
• List the distinguishing diagnostic features of
  ankylosing spondylitis.
• Describe the pathology of vasculitis in general
  terms.

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Chapter 3Lesson 3.1
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Orderly Function of the Immune System

• Functional components of the immune system
• lymphoid tissue
• Primary thymus, bone marrow
• secondary tonsils, adenoids, spleen, Peyer
  patches, appendix
• lymphocytes
• antibodies
• macrophages

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Orderly Function of the Immune System (contd.)

• Major functions of the immune system
• Protect the body against foreign organisms
• Maintain homeostasis by eliminating damaged cells
  (phagocytosis)
• Battles infection

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Orderly Function of the Immune System (contd.)

• Inappropriate responses of the immune system
• Hyperactive (allergic) excessive response
• Immunodeficient (e.g., AIDS) inadequate
  response
• Autoimmune (e.g., SLE) misdirected response
• Transplant rejection attack to beneficial
  foreign tissues

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Acquired Immunity
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Orderly Function of the Immune System (contd.)

• Cellular elements of natural immunity
• Natural killer cells (NK)
• Polymorphonuclear neutrophils (PMN)
• Macrophages
• Cellular elements of acquired immunity
• T lymphocyte cells
• B lymphocyte cells
• Phagocytes

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• T cell and
• B cell
• Formation

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Orderly Function of the Immune System (contd.)

• T lymphocyte cells include
• Cytotoxic T cells destroy virus-infected cells,
  tumor cells, or allograft cells
• Helper T cells stimulate B cells and activate
  cytotoxic T cells
• Suppressor T cells moderate the immune response
  by inhibiting B and T cells
• Memory T cells are reactivated only by
• re-exposure to previous antigen

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Orderly Function of the Immune System (contd.)

• B lymphocyte cells include
• Memory B cells reactivated only by re-exposure
  to previous antigen
• Plasma cells secrete antibodies that attach to
  antigens

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Orderly Function of the Immune System (contd.)

• Immunoglobulins
• IgG (7585)
• IgA (515)
• IgM (510)
• IgD (0.2)
• IgE (0.5)

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Orderly Function of the Immune System (contd.)

• Complement fixation.
• Activation of normally inactive proteins found in
  plasma or body fluids. Pathogens are destroyed by
  lysis of the cell membrane or by phagocytosis.

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Immunodeficiency Diseases

• Increased susceptibility to bacterial infections
  resulting from a B cell deficiency.
• Increased susceptibility to viral, fungal, and
  protozoan infections, usually from T cell
  deficiency.

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Immunodeficiency Diseases (contd.)

• Acquired Immunodeficiency Syndrome (AIDS)
• Caused by human immunodeficiency virus (HIV)
• Diagnosed by presence of HIV antibodies in the
  blood (common test ELISA confirmation Western
  blot)
• HIV attacks helper T lymphocytes
• Reduces cell-mediated immunity
• Attacks nervous system directly

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Immunodeficiency Diseases (contd.)

• HIV transmission is through direct contact with
  blood or semen of infected person
• sexual contact
• blood transfusions and other blood products
• contaminated shared needles (IV drug use, etc.)
• accidental needle sticks
• to fetus via placenta or during birth process
  from infected mother

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Immunodeficiency Diseases (contd.)

• AIDS treatment
• Highly active antiviral therapy (HART)
• Many drug combinations can be used
• Drug toxicity and side effects exist
• Prophylactic antibiotics
• Currently no cure

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Immunodeficiency Diseases (contd.)

• Universal Precautions
• Thorough and frequent hand washing.
• Personal protective equipment worn as required by
  specific task (e.g. gloves, gown, goggles, mask).
• Proper disposal of all sharps in designated
  biohazard containers.
• No needle recap prior to disposal.
• Caution in handling of laboratory specimens.
• Proper containment and disinfection of blood and
  body fluid spills.
• Use clean mouthpieces and resuscitation bags.

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Immunodeficiency Diseases (contd.)

• Common Variable Immunodeficiency
• acquired B cell deficiency
• Selective Immunoglobulin A Deficiency
• inadequate production of IgA
• Severe Combined Immunodeficiency
• ineffective development and function of both T
  cells and B cells

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Chapter 3Lesson 3.2
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Autoimmune Diseases

• Lymphocytes and antibodies are sensitized to
  develop against the bodys own organs or tissues.
• May be triggered by disease, injury, metabolic
  changes, or mutation in immunologically competent
  cells.
• May be caused by certain drugs or chemicals,
  trauma, or viral infection.

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Autoimmune Diseases (contd.)

• Pernicious anemia
• Impaired absorption of B12 and B12 deficiency due
  to decreased gastric production of hydrochloric
  acid and shortage of intrinsic factor.
• Treatment consists of monthly intramuscular
  injections of vitamin B12 during the persons
  entire lifetime.

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Autoimmune Diseases (contd.)

• Pernicious Anemia
• Symptoms weakness and tingling and numbness in
  extremities, altered vision, lightheadedness,
  tinnitus, palpitations, weight loss, digestive
  disturbances, sore tongue.
• Signs decreased red blood cell, white blood
  cell, and platelet counts increased red blood
  cell mean volume decreased hemoglobin levels
  jaundice optic nerve atrophy decreased amount
  of gastric acid.

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Autoimmune Diseases (contd.)

• Connective Tissue Diseases
• Systemic lupus erythematosus
• Scleroderma
• Sjogren syndrome
• Rheumatoid arthritis
• Juvenile rheumatoid arthritis
• Ankylosing spondylitis
• Polymyositis

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Autoimmune Diseases (contd.)

• Systemic Lupus Erythematosus (SLE)
• Inflammation of skin, joints, nervous system,
  kidneys, lungs, and other organs.
• Butterfly rash across face may be present.
• Other rashes may appear on other exposed skin
  areas.

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Autoimmune Diseases (contd.)
Systemic Lupus Erythematosus (SLE)

• Butterfly face rash
• Alopecia
• Photosensitivity
• Raynauds phenomenon
• Thrombocytopenia
• Discoid skin lesion
• Nasopharyngeal ulceration
• Polyarthritis

• Pleuritis or pericarditis
• Protein or casts in the urine
• Hemolytic anemia
• False-positive serology
• Abnormal blood antibodies
• LE cells (leukocytes) present in lab testing

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Autoimmune Diseases (contd.)

• Rheumatoid arthritis (RA)
• Chronic, inflammation and edema of the synovial
  membranes surrounding joints.
• Destruction of cartilage and adjacent bone.
• May produce weight loss, fever, and malaise.
• Joint pain and stiffness, especially in morning.
• Bilateral joint tenderness, edema, erythema,
  warmth.

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Autoimmune Diseases (contd.)

• Rheumatoid arthritis treatment aimed at
• Reducing inflammation and pain
• Preserving joint function
• Preventing joint deformities

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Autoimmune Diseases (contd.)

• Ankylosing spondylitis
• Inflammation and ossification of the joints
  leading to decreased range of motion and spinal
  bone fusion.
• Sacroiliac spine area is usually affected first
  and results in recurring low back pain and
  morning stiffness.
• History may include inflammatory bowel disease,
  heel pain, and family incidence of arthritic
  conditions

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Autoimmune Diseases (contd.)

• Multiple sclerosis (MS)
• Inflammatory disease of the central nervous
  system.
• Demyelination of nerves occurs in the brain and
  spinal cord.
• Signs and symptoms are primarily neurologic and
  related to areas of myelin destruction.

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Autoimmune Diseases (contd.)

• Myasthenia gravis (MG)
• Chronic progressive neuromuscular disorder.
• Autoantibodies produced to acetylcholine receptor
  in muscle cells.
• Ineffective nerve-muscle junction results in
  severe weakness, difficulty talking and
  swallowing, drooping eyelids and diplopia.

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Autoimmune Diseases (contd.)

• Vasculitis
• Inflammation in the walls of blood vessels that
  may lead to necrosis, thrombus formation, and
  local infarct
• Can be classified as small vessel or systemic
  affecting medium and large arteries