NCM notes: Immune system


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NCM notes: Immune system

  1. 1. IMMUNE SYSTEM TONSILS, ADENOIDS- either side of behind the nose on the posterior on the soft palate and wall of theM. Dablo- Dec. 16, 2011 nasopharynx and oropharynx - Filter bacteria from tissue fluidImmune system- to protect every tissue and organ in - Exposure infected and locally inflamedthe body against any pathogen - Mgt: erythromycin (ruins stomach lining), cephalelxin - Defense against infection - Protection against some tumor SPLEEN- hematopoietic and immune functionsPrimary Organs- thymus, bone marrow (WBC - Emerging reservoir of blood and blood filterproduction) - Macrophages remove bacteria and old, dead, or damaged blood cells from circulation - Bone marrow: RBC, WBC, Platelets o WBC: Lymphocytes LYMPH NODES- lymphatic system- Vessels that drain  Monocytes- ingests foreign tissue fluid === lymph materials, wastes - Converge and drain into large structures (lymph  Eosinophils- found usually at nodes) the skin, allergic reactions, - Contain B & T lymphocytes- eliminate bacteria parasites and other foreign materials  Basophils- primarily for allergic reaction  Neutrophils- bacterial infection HOST DEFENSESSecondary organs- spleen, lymph nodes, tonsils 1. Innate- physical/chemical barriers - SPLEEN: backs up bone marrow in the - Complement complex production of WBC - Cells such as phagocytes, natural killer lymphocytesLymphoid tissues- also found on the surface of the 2. Acquiredmucous membranes of the intestines, on alveolarmembranes of the lungs, and in the lining of the ___ of A. Active immunitythe liver B. Passive immunityTHYMUS GLAND- below the thyroid gland and extends 1. Natural passive- when antibodies are passedinto the thorax behind the top of the sternum from the mother to thet fetus via the placenta or to the infant through the colostrum and - Produces lymphocytes during fetal breast milk development 2. Artificial – involves injecting a person with o Embryonic origin of other lymphoid antibodies that were produced in another structures- spleen and lymph person or animal - After birth: programs T lymphocytes to become regulation or effector cells - During adolescence: becomes smaller but retain 2 types of immunity: activity 1. Humoral- B lymphocytes - Antibody mediated response - Production of immunoglobulin
  2. 2. - Activation of complement cascade Specific and Non-specific immunity 2. Cell-mediated immunity- T-lymphocytes 1. Recognize (mature in mast cells) 2. Respond 3. Distinguish autoimmune disordersT-cells Inflammation- mechanism that allows cells to beHelper T-cells- also called T4+ or CD4+ cells reapaired when subjected to stress or damage - Recognize antigen (protein that stimulates - Response to injury: vascular and celllular immune reaction) - Vascular phase - Stimulate B-cells to produce antibodies  o Vasonconstricton vasodilation  inc chemical substances that destroy foreign agents capilllary pressure  plasma and blood cells to tissuesSuppressor T-cells- referreed to as T8 or CD8 cells Inflammatory mediators regulation - Limit or turn off the immune response in the absence of continued antigenic stimulation 1. Histamine- temporary constriction of large - Ratio of helper T-cells: suppressor T cells- 2:1 vessels, increasing vascular permeability 2. Leukotrienes- contraction of smooth muscle,Natural Killer cells- also known as CD16+ cells greater permeability of vessels, inc motility of - Can exert killing effects without being first neutrohils and eosinphils sensitized 3. Prostglandins- inc smooth muscl contraction, - Conduct “seek and destroy” missions in the vascuular permeability, may modulate body to eliminate non-self cells inflammation by suppressing the release of - Specifically determined with HIV histamine 4. Platelet activating factor- inc vascularB-cells permeability, helps to facilitate the movement of white cells out of the vessels to damaged - Mature in the bone marrow tissue, activates platelets - Humoral - Blood PathophysiologyCytokines Causative agent: retrovirusTUMOR NECROSIS FACTOR (TNF)- first discovery: - Infects & depletes CD4+ T-helper lymphocytesshrinking tumors AND infects monocytes & macrophages  integrates into the lymphocytic genome--. - Small doses cellular repair Prodn of new HIV virions cell death for T4 - Large doses destroy health tissues cellular and humoral immunity declines Physiologic aspects of cellular defense mechanism opportunistic infxns3 main lines of defense HIV cannot be transmitted through: sweat, salive, tears, urine, mosquito bites, sharing food/drinks, kissing, 1. Anatomic barriers hugging 2. Inflammatory and non-specific immune responses - High risk groups: homosexual or bisexual, IV 3. Specific immune responses drug users, BT (before 1985), heterosexual
  3. 3. contact with infected partner, babies from HIV - Tests conducted are confidential + mother Complications:Natural history - Resistant HIV, repeated opportunistic - Normal CD4 count: 800-1000/mm infections, wasting, med-related conditions, - 2-4wwks post exposure- 50-90% with flu-like sx renal failure [Primary HIV infxn (acute)] AIDS Research: - 4-6wks- seroconversion  HIV + - No cure yet due to the mutating nature of theCxMx- peresistent cough, PCP, MTB, CMV virus - GI: diarrhea, wt. Loss, anorexia, enteric - Much work being done on vaccines pathogens (salmonella, shigella) - Combination therapies- drug to boost the - CNS: AIDS dementia/HIV encephalopathy, immune system neuorpathies - HAART- highly active anti retroviral therapy- - Ocular- retinopathy, blindness suppress the virus and prolong life but very - Oral- lesions- C. Albicans, vesicles, hairy expensive leukoplakia, oral warts –HPV, peridontitis, - Vaginal microbicides apthous ulcers - Malignancies: Kaposi’s sarcoma can signal the Med mgt: final stage of HIV infxn - HAART- suppresses viral actionDx: - Antiretroviral drugs: NRTI, NNRTI, PI, Entry inhibitors - History - Blood test (>12wks) Goals of tx: o ELISA - Improve quality of life o Western blot- more specific - Prolong life o Rapid HIV test - Dec viral load o Orasure - Inc CD4 count o Celypte HIV-1 urine EIA o Lymphocyte panel Preventive: o CBC - Infections o Presence of indicator dse o PCP- started with CD4 <200  Dactrim o Neuropsychological testing o M. Avium complex- CD4 <50  o Viral load Azithromycin, clarithromycinHIV antibody test - Vaccinations o TB- PPD - Looks for antibodies in the blood, not the HIV o PCP- pneumovax virus o Influenza- flu vaccine - Must be accompanied by pre- and post- test counseling Standards of care - Window period- the period during which - Universal precaution antibodies cannot be detected despite the - Protect confidentiality possible presence of HIV, can be up to six - Medication compliance months but a person with HIV is infectious from - Nonjudgmental attitude early stage
  4. 4. - Reverse isolation- Nutrition- Enteric precaution- Suicide precaution- Safer sex- Encourage to disclose diagnosis- Refer complementary medicines to AP