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BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
BL 4640 Clinical Immunology and Serology.doc
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BL 4640 Clinical Immunology and Serology.doc

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  • 1. BL4640 Clinical Immunology and Serology Syllabus Fall / Fourth Year 2 credits, (2-0-0) BL 4640 Clinical Immunology Serology Integrates basic and clinical immunological principles as well as outlines the diagnosis and evaluation of immune disorders and selected infectious diseases. Credits: 2.0 Lec-Rec-Lab (2-0-0) Semesters Offered: Fall Restrictions: Must be enrolled in one of the following Class(es): Junior Senior Prerequisites: BL 1710 and BL 2410 and BL 3640 or permission of instructor. Lecturer Alice Soldan, M.S., MT(ASCP), CLS(NCA) Director, Clinical Laboratory Science Program Office: Dow 735 Office Phone: 487-2547 Email address: afsold@mtu.edu Textbooks Title: Clinical Immunology and Serology, 2nd ed. The Immune System Author: C. D. Stevens P. Parham Publisher: F. A. Davis Company, 2003 Garland Publishing, 2000 Fundamental Concepts: Integration of Basic and Clinical Immunology Lecture Topics and Reading Assignments Lecture 1 The Scope of Clinical Immunology and Serology no reading assignment Safety and Specimen Preparation (review) Stevens: 114-123 Lecture 2 Immunity and Immunization Stevens: 2-4, 9-18 Parham: 1-9, 26-27, 233-235, 328-338 Lecture 3 Primary and Secondary Lymphoid Organs Stevens: 24-28 Parham: 10-18 Lecture 4 T Cells, B Cells, Third Population – Natural Killer Cells Stevens: 28-40 Parham: 182, 221-223 Lecture 5 Antigens and Haptens Stevens: 45-49 Parham: 19, G-2 Lecture 6 The Major Histocompatibility (Gene) Complex and Antigens Stevens: 49-55 Parham: 22-23, 61-81 Lecture 7 Antibodies (Immunoglobulins) Stevens: 59-73 Parham: 19-23, 31-40
  • 2. Lecture 8 Cellular Activities and Interactions Stevens: 77-88 Parham: 145-147 Lecture 9 Complement Stevens: 92-108 Parham: 183-197 Exam I Lecture 10 Immunological Precipitation Stevens: 128-134 Electrophoretic Precipitation Techniques Stevens: 134-137 Lecture 11 Immunological Agglutination Stevens: 142-151 Lecture 12 Labeled Immunoassays (radio-, enzyme, fluorescent) Stevens: 156-168 Lecture 13 Automated Procedures - Instrumentation no text assignment Lecture 14 Molecular Biology Techniques Stevens: 173-185 Diagnosis / Evaluation of Immune Disorders and Infectious Diseases Lecture 15 Hypersensitivity Stevens: 192-207 Lecture 16 Autoimmunity Stevens: 212-213, 227-228 Systemic Lupus Erythematosus Stevens: 214-218 Rheumatoid Arthritis Stevens: 218-220 Lecture 17 Hashimoto’s Thyroiditis Stevens: 221 Graves’ Disease Stevens: 222 Type I Diabetes Mellitus (Insulin-Dependent Diabetes) Stevens: 223-224 Lecture 18 Multiple Sclerosis Stevens: 224-225 Myasthenia Gravis Stevens: 225-226 Goodpasture’s Syndrome Stevens: 226
  • 3. Exam II Lecture 19 Immunoproliferative Disorders Stevens: 235-245 Lecture 20 Immunodeficiency Diseases Stevens: 212-219, 280-293 Lecture 21 Transplantation Immunology Stevens: 262-273 Lecture 22 Tumor Immunology Stevens: 278-287 Lecture 23 Spirochete Diseases Stevens: 294-307 Syphilis Lyme Disease Lecture 24 Streptococcal Infections/Serology Stevens: 313-318 Lecture 25 Serology of Non-HIV Viral Infections Stevens: 324-325, 337-339 Hepatitis Stevens: 325-330 Herpesvirus Group Stevens: 330-334 Herpes Simplex Virus Parham: 246 Epstein-Barr Virus Cytomegalovirus Varicella-Zoster Virus Childhood Viral Infections Stevens: 334-337 Rubella Rubeola Mumps Human T Cell Lymphotropic Virus Stevens: 336-337 Other Important Viruses Stevens: 338 Lecture 26 HIV Serology Stevens: 346-363 Lecture 27 Parasitic Immunology Stevens: 370-376 Toxoplasma gondii (toxoplasmosis) Giardia lamblia (backpacker's diarrhea) Entamoeba histolytica/dispar (amebic dysentery) Trichinella spiralis (trichinosis) Fungal Immunology Stevens: 376-381 Aspergillosis
  • 4. Candidiasis Coccidioidomycosis Cryptococcosis Grading Policy Grading Scale Participation & Presentations 100 points Exam I 100 points 90% - 100% A Exam II 100 points 86% - 89% AB Final Exam 100 points 80% - 85% B 76% - 79% BC TOTAL 400 points 70% - 75% C 66% - 69% CD 60% - 65% D 59% or less F MTU complies with all federal and state laws and regulations regarding discrimination, including The Americans with Disability Act of 1990 (ADA). If you have a disability and need a reasonable accommodation for equal access to education or services at MTU, please call Dr. Gloria Melton, Associate Dean of Students, (7-2212). For other concerns about discrimination, you may contact your advisor, department head, or the Affirmative Action Office (7-3310). BL4640 Clinical Immunology and Serology Lecture Objectives Fundamental Concepts: Integration of Basic and Clinical Immunology (first third of the course - Exam I information) After completing these lecture-discussion sessions, each student should be able to: Correlate the basic information learned in BL3640 General Immunology with how That information is used in the clinical laboratory. Diagnosis and Evaluation of Immune disorders and Infectious diseases (second third of the course - Exam II information) After completing these 'student taught' lecture-discussion sessions each student should be able to: 1. gather technical information from scientifically reputable sources. 2. cite their information sources. 3. present information in a concise, organized fashion using appropriate technical terminology.
  • 5. 4. field questions and lead a discussion dealing with advanced topics in immunology. The following are specific objectives for the last third of the course (final exam information). Transplantation and Tumor Immunology After completing the lecture-discussion session on transplantation and tumor immunology, each student should be able to: a. summarize the role played by the major histocompatibility complex in acceptance/rejection of transplanted tissue. b. define and state an example of each of the following. autograft syngraft allograft (homograft) xenograft (heterograft) c. describe each of the following forms of graft rejection. hyperacute accelerated acute chronic d. explain how and why the following tests are done prior to transplantation. ABO grouping on donor and recipient Lymphocytotoxicity Test (for HLA typing) Lymphocytotoxicity Test (selected donor-recipient) Mixed Lymphocyte Reaction Test e. recognize the following as types of tissues/organs that may be transplanted cornea heart-lung bone liver kidney pancreas heart bone marrow f. state the organ most commonly transplanted in the U.S. g. briefly describe graft-vs- host disease.
  • 6. h. compare and contrast the following terms. tumor specific antigen tumor-associated antigen i. name the malignancy associated with each of the following. carcinoembryonic antigen (CEA) alpha-fetoprotein (AFP) human chorionic gonadotropin (hCG) prostate-specific antigen (PSA) prostatic acid phosphatase (PAP) CA-125 CA-15-3 Immunodeficiency Diseases After completing the lecture-discussion session on primary and secondary immunodeficiency, each student should be able to: a. state the difference between specific and non-specific immunodeficiency diseases. primary and secondary immunodeficiency diseases. b. explain which types of deficiencies result in increased susceptibility to pyogenic infections. opportunistic infections. c. recognize the following as primary B-cell deficiencies and briefly describe each. transient hypogammaglobulinemia of infancy IgA deficiency X-linked agammaglobulinemia common variable immunodeficiency isolated IgG subclass deficiency immunodeficiency with hyper IgM d. recognize the following as primary T-cell deficiencies and briefly describe each. DiGeorge anomaly PNP deficiency severe combined immunodeficiency (SCID)
  • 7. Wiskott-Aldrich syndrome ataxia telangiectasia reticular dysgenesis e. recognize that genetic deficiencies of almost all human complement components have been documented. f. recognize the following as primary defects influencing phagocyte function and briefly describe each one. chronic granulomatous disease leucocyte adhesion molecule deficiency g. recognize the following as factors which can cause secondary (acquired) immunodeficiency. drugs steroids antineoplastic agents immunosuppressives used to facilitate organ transplantation malnutrition protein-energy malnutrition (PEM) individual nutrients such as: zinc vitamin A iron vitamin B6 selenium folate copper human immunodeficiency virus (HIV) h. list the screening, and confirmatory tests performed in the clinical laboratory when trying to detect and diagnose immunodeficiency diseases of the following classes. all immunodeficiencies (screening test only) humoral immunity deficiency cell-mediated immunity deficiency phagocyte defect complement system defect Immunoproliferative Diseases After completing the lecture-discussion session on immunoproliferative disorders, each student should be able to: a. define immunoproliferative.
  • 8. b. state the fundamental difference between leukemias and lymphomas. c. explain the concept termed 'monoclonality of malignancy'. d. define the following terms: dyscrasia monoclonal gammopathy para-protein cryoglobulin e. briefly describe each of the following plasma cell malignancies. multiple myeloma Waldenstrom's macroglobulinemia f. explain how each of the following laboratory procedures is used in the detection and diagnosis of monoclonal gammopathies. serum immunoglobulin levels serum protein electrophoresis immunoelectrophoresis immunofixation electrophoresis Non-HIV Viral Infections After completing the lecture-discussion session on non-HIV viral infections, each student should be able to: re: Hepatitis a. define hepatitis. b. recognize that hepatitis may be caused by: autoimmune processes. exposure to chemicals. exposure to radiation. viral infections. c. list the five hepatitis viruses. d. describe each of the five hepatitis viruses with attention to the following characteristics. (See Stevens text, Table 17-1, p. 265.) type (DNA or RNA) route of transmission
  • 9. form of disease (acute, chronic, or both) disease complications e. associate the antibody and/or antigen marker(s) listed with the diagnosis and monitoring of each of the following kinds of hepatitis. hepatitis A - poor sanitation and/or contaminated food and water IgM anti-HAV - acute infection IgG anti HAV - convalescence hepatitis B - blood and/or body fluids (three marker systems) HBsAg (surface antigen) - seen first, current or recent infection anti-HBs - end of 'core window', late convalescence, Hep B vaccine HBcAg (core antigen) IgM anti-HBc - 'core window' IgG anti-HBc - convalescence, past infection HBeAg (capsid antigen) - acute and chronic infection anti-HBe -conclusion of infection hepatitis C - blood and/or body fluid similar to HBV, but more commonly leads to chronic hepatitis, cirrhosis, and hepatocellular carcinoma marker system under study currently no characteristic antigens anti-HCV - most common diagnostic test (high risk populations) RIBA (low risk populations) - uses recombinant HCV proteins /blot HCV RNA - major confirmatory test for disease persistence hepatitis D - found only in conjunction with hepatitis B infection HDAg - very early infection (measurement of questionable value) IgM anti-HDAg - acute infection total (IgM and IgG) anti-HDAg - acute infection, chronic infection hepatitis E - poor sanitation and/or contaminated food and water marker system under study currently no characteristic antigens f. name the laboratory technique most commonly used to detect/measure hepatitis markers.
  • 10. g. recognize that hepatitis D is associated with a biphasic (i.e. HBV, then HDV) alanine aminotransferase (ALT) pattern. re: Herpesvirus Group a. recognize that the following viruses are categorized as herpesviruses. Epstein-Barr virus (EBV) cytomegalovirus (CMV) herpes simplex viruses (HSV-1, HSV-2) varicells-zoster virus (VSV) b. recognize that the viruses listed in a. above are DNA viruses re: EBV a. list four diseases caused by the EBV. b. define the following terms. heterophil(e) antibodies Forssman antibodies IM heterophil(e)antibodies (= Paul-Bunnell, or non-Forssman antibodies) c. name the EBV antigens associated with each of the following phases of the viral replication cycle. early acute late latent d. explain the conditions under which EBV-specific antibody testing is performed. e. name the EBV-specific antibody most useful in early diagnosis of IM. re: CMV a. explain how CMV is transmitted. b. describe CMV infections as seen in: healthy adults newborns immunosuppressed patients c. recognize the following as laboratory methods used to diagnose CMV. latex agglutination screening tests (most practical for routine use) other serological tests ELISA, RIA, IHA monoclonal IFA for CMV antigens viral culture (fibroblast cells) microscopy (urine, blood, biopsy)
  • 11. cytomegalic cell with 'owl's eye' due to central intranuclear inclusion PCR and DNA probes re: HSV-1 and HSV-2 a. describe the typical infections caused by HSV-1 and HSV-2. b. explain how the following laboratory methods are used in the diagnosis of HSV infections. Tzanck smear direct immunofluorescent or immunoperoxidase staining of cells from lesion viral culture plus labeled HSV antibodies viral culture plus ELISA PCR and DNA probes re: VZV a. state the common name for each of the following infections. varicella zoster b. describe the symptoms associated with the primary and latent stages of VZV infections. c. name the other viral disease that has symptoms which are often confused with those of VZV. d. recognize that laboratory methods used in the diagnosis of VZV infections are comparable to those used for HSV infections, and serological methods are generally preferred over culture methods. re: Rubella Virus a. list two 'common name' synonyms for rubella infection. b. recognize that the rubella virus is an RNA virus. c. describe rubella infection as it typically appears in: a fetus. a child or young adult. d. state two reasons for performing rubella testing. e. name the analyte most commonly measured to detect acute rubella infection.
  • 12. f. recognize that serological test procedures are generally preferred over viral culture methods for detection of rubella infection. g. list five criteria used to determine which of the many available serological procedures for detecting rubella infection is appropriate for a particular laboratory. h. recognize that the rubella test procedure currently used most often is the ELISA. Spirochete Diseases After completing the lecture-discussion session on spirochete diseases, each student should be able to: a. give a general description of spirochetes with respect to the following. morphology Gram reaction oxygen requirement motility b. list three characteristics that spirochete diseases have in common. c. state the two most important human spirochete diseases. d. explain why serological testing is generally used to diagnose spirochete diseases. re: Syphilis a. recognize that syphilis is a sexually transmitted disease (STD), and is usually transmitted by direct contact. b. name, to subspecies, the organism that causes syphilis. c. describe each of the following conditions. primary (initial) syphilis secondary syphilis latent syphilis tertiary syphilis congenital syphilis d. define reagin and cardiolipin. e. name and briefly describe the tests in each of the following categories of lab procedures used to diagnose syphilis. See Stevens, Table 15-1, p. 234.
  • 13. direct microscopy serological tests nontreponemal treponemal re: Lyme disease a. explain the connection between Lyme, Connecticut and Lyme disease. b. recognize that Lyme disease is the most common vector-borne disease in the U.S. c. name the Lyme disease: causative agent (genus and specific epithet). vector (genus and specific epithet, common name). reservoir host (genus, common name). d. describe each of the following stages of Lyme disease. erythema chronicum migrans initial spread to various organ systems chronic disseminated disease spontaneous remission e. recognize that although it is possible to culture the causative agent of Lyme disease, until recently it has been very hard to isolate from patient specimens. New growth media are now available for culture of skin samples. f. state the source of the antigen and/or antibody used in each of the following tests used to diagnose Lyme disease. IFA ELISA Western Blot DNA probe g. define seronegative and seroconversion. Streptococcal Infections After completing the lecture-discussion session on streptococcal infections, each student should be able to: a. give a general description of streptococci.
  • 14. b. compare and contrast streptococcal serotypes and Lancefield groups. c. explain, using the following terms, why infection with one strain of Streptococcus pyogenes doesn't confer immunity to other strains. M protein phagocytes C3 serotype d. name the two most common sites of strep infections and the major disease/s associated with each one. e. recognize that strep infection may result in the following. tonsillitis otitis media scarlet fever erysipelas cellulitis puerperal sepsis abscess septic arthritis bacterial endocarditis meningitis f. define nephritogenic streptococcal strain. g. name and describe two nonsuppurative complications that may follow a strep infection. h. state the two methods commonly used to rapidly diagnose acute strep pharyngitis, and explain the value of each. i. explain why serological procedures, rather than culture procedures, are used to diagnose rheumatic fever and poststreptococcal glomerulonephritis. j. list the five antibodies measured in diagnostic tests for strep infections. Febrile Diseases After completing the lecture-discussion session on febrile diseases, each student should be able to: a. recognize the following as organisms that cause febrile diseases in humans. Brucella abortus Francisella tularensis Salmonella spp. b. name the febrile disease that may be diagnosed by testing patient serum
  • 15. with each of the following antigens in a Widal Test. See Stevens, Table 9-3, p. 139. Brucella abortus Salmonella H Salmonella O Salmonella H (paratyphi A) Salmonella H (paratyphi B) c. define the following. Rickettsia rickettsia rickettsiae d. name the test procedure used to test patient serum for antibodies to rickettsial diseases. e. list the three bacterial antigens that are used to diagnose rickettsial febrile diseases due to cross-reactivity with rickettsial antibodies. See Stevens, Table 9-2, p. 138. f. name the disease caused by each of the following rickettsial organisms. See Stevens, Table 9-2, p. 138. R. prowazekii R. typhi R. rickettsii R. tsutsugamushi Coxiella burnetii g. explain the significance of performing febrile agglutinin tests on paired sera. Fungal Infections After completing the lecture-discussion session on fungal infections, each student should be able to: a. recognize that fungal diseases are rapidly rising worldwide due to the following. use of broad-spectrum antibiotics use of immunosuppressant drugs the AIDS epidemic b. name the two basic morphological forms of fungi. c. define the following terms.
  • 16. hyphae mycelium septa aseptate conidia monomorphic thermal dimorphism mycoses d. recognize that diagnosis of fungal diseases may include the following procedures. ID of fungal organisms in patient specimens (w/o culturing) fungal culture antigen detection via serology antibody detection via serology e. name the causative agent for each of the following. aspergillosis (Genus only.) candidiasis coccidioidomycosis cryptococcosis f. recognize that there commercial serodiagnostic tests are currently available for each of the diseases listed in e. above, as well as some other fungal conditions (i.e., blastomycosis, histoplasmosis, sporotrichosis, paracoccidioidomycosis). g. name the organism that is the single most common cause of serious fungal infections. h. describe the India Ink preparation used to diagnose cryptococcal meningitis. Parasitic Infections After completing the lecture-discussion session on parasitic infections, each student should be able to: a. explain why most parasitic infections are diagnosed by morphologic (macroscopic or microscopic) identification, rather than serological procedures, including the following issues. See Stevens, p. 315. cost effectiveness technologist time proficiency testing FDA regulation life cycles
  • 17. antigen switching antibody class cross-reactions b. name the two parasitic infections most commonly diagnosed by serological procedures. c. list two reasons why serological procedures are performed to aid in the diagnosis of toxoplasmosis, cysticercosis, echinococcosis, and trichinosis. d. state the similarity in serologic test procedures available for the following parasites. Entamoeba histolytica (not in our text) Cryptosporidium parvum Giardia lamblia Pneumocystis carinii Trichomonas vaginalis e. explain the purpose of a ToRCH panel. f. list the organisms included in a ToRCH panel.

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