Presentation is about some of the infectious and immunological disorders

1. PRESENTED TO,
Mrs. URMILA MISHRA
PRESENTED BY,
Mr. SAGAR KAMBLE

2.  Immunity is the balanced state of having adequate
biological defenses to fight infection, disease, or other
unwanted biological invasion, while having
adequatetolerance to avoid allergy, and autoimmune
diseases.
 Immunology is a branch of biomedical science that
covers the study of all aspects of the immune
system in all organisms.
Infection
Invasion and multiplication of microorganisms in body
tissues, as in an infectious disease.

4. Lymphocytes of the Immune System
B Lymphocytes:
Immunocompetency occurs in bone marrow
Produce Antibodies
Conduct Humoral Immunity
T Lymphocytes:
Immunocompetency occurs in thymus
Non antibody producing cells
Conduct Cellular Immunity

5.  Antibody Mediated
Immunity
 Helper T cells recognize non
self antigens and stimulate B
cells to produce antibodies
 B cells release antibodies
which bind to non self antigens
present on infected cells
 B cells complete their
maturation upon binding to non
self antigens and destroying
infected cells
 Cell Mediated
Immunity
 Macrophages
phagocytize pathogens
 Upon phagocytosis
macrophages present
non self antigens on
their membranes
 Helper T cells recognize
non self antigens and
recruit cytotoxic T cells
 Cytotoxic T cells destroy
infected cell

6. “Human Immunodeficiency Virus”
A unique type of virus (a retrovirus)
Invades the helper T cells (CD4 cells) in the
body of the host (defense mechanism of a
person)
Threatening a global epidemic.
Preventable, managable but not curable.

7. Former names of the virus include:
• Human T cell lymphotrophic virus (HTLV-III)
• Lymphadenopathy associated virus (LAV)
• AIDS associated retrovirus (ARV)

8.  “Acquired Immunodeficiency Syndrome”
 HIV is the virus that causes AIDS
 Disease limits the body’s ability to fight
infection due to markedly reduced helper T
cells.
Patients have a very weak immune system
(defense mechanism)
Patients predisposed to multiple
opportunistic infections leading to death.

9.  Acquired immunodeficiency syndrome (AIDS)
is a term which applies to the most advanced
stages of HIV infection. It is defined by the
occurrence of any of more than 20
opportunistic infections or HIV-related cancers.
 Persons with positive HIV serology who have
ever had a CD4 lymphocyte count below 200
cells/mcL or a CD4 lymphocyte percentage
below 14% are considered to have AIDS.

11. Blood products
Semen
Vaginal fluids

12.  Sharing Needles
• Without sterilization Increases the chances of
contracting HIV
Unsterilized blades

13. Unprotected Intercourse
 Oral
 Anal

14. Before Birth
During Birth

16. Short, flu-like
illness - occurs
one to six weeks
after infection
 Mild symptoms
 Infected person
can infect other
people

17. Lasts for an average of ten years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to
low levels
HIV antibodies are detectable in the
blood

18. The immune system deteriorates
Opportunistic infections and cancers
start to appear.

19. The immune
system weakens
too much as CD4
cells decrease in
number.

20. CD4<500
Bacterial infections
Tuberculosis (TB)
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposi’s sarcoma

21. CD4<200
Pneumocystic carinii
Toxoplasmosis
Cryptococcosis
Coccidiodomycosis
Cryptosporiosis
Non hodgkin’s
lymphoma

22. CD4 <50
Disseminated mycobacterium avium
complex (MAC) infection
Histoplasmosis
CMV retinitis
CNS lymphoma
Progressive multifocal
leukoencephalopathy
HIV dementia

23.  TB is the most common opportunistic infection in HIV and
the first cause of mortality in HIV infected patients (10-
30%)
 10 million patients co-infected in the world.
 Immunosuppression induced by HIV modifies the
clinical presentation of TB :
1. Subnormal clinical and roentgen presentation
2. High rate of MDR/XDR
3. High rate of treatment failure and relapse (5% vs < 1% in HIV)

26. HIV enzyme-linked immunosorbent
assay (ELISA)
Screening test for HIV
Sensitivity > 99.9%
Western blot Confirmatory test
Speicificity > 99.9% (when combined with
ELIZA)
HIV rapid antibody test Screening test for HIV
Simple to perform
Absolute CD4 lymphocyte count Predictor of HIV progression
Risk of opportunistic infections and AIDS when
<200
HIV viral load tests Best test for diagnosis of acute HIV infection
Correlates with disease progression and
response to HAART

27. Urine Western Blot
• As sensitive as testing blood
• Safe way to screen for HIV
• Can cause false positives in
certain people at high risk for
HIV

28. Orasure
• The only FDA approved
HIV antibody.
• As accurate as blood
testing
• Draws blood-derived fluids
from the gum tissue.
• NOT A SALIVA TEST!

31. Class of Antiretroviral Drug Drug Names
Nucleoside or nucleotide reverse
transcriptase inhibitors (NRTIs)
Abacavir, emtricitabine (FTC), zidovudine (AZT), didanosine
(DDI), zalcitabine (DDC), lamivudine (3TC), tenofovir
(disoproxil fumarate), and stavudine (D4T)
Nonnucleoside reverse transcriptase
inhibitors (NNRTIs)
Efavirenz (EFV), etravirine, nevirapine, and
delavirdine
In clinical trials: Rilpivirine, GSK2248761 (Viiv) and RDEA806
(Ardea)
Protease inhibitors (PIs) Amprenavir, atazanavir, darunavir, fosamprenavir,
indinavir, lopinavir/ritonavir, nelfinavir (NFV),
ritonavir, saquinavir, and tipranavir
Pharmacokinetic Enhancers Ritonavir
In clinical trials: Cobicistat
Fusion entry inhibitors Enfuvirtide
CCR5 entry inhibitors Maraviroc
In clinical trials: Vicriviroc , Monoclonal Abs: ibilazumab,
PRO140
Integrase inhibitors Raltegravir
In clinical trials: Elvitegravir, S/GSK1349572
Maturation Inhibitors (new class) In clinical trials: Bevirimat and Vivecon (MPC-9055)
*HAART, highly active antiretroviral therapy. Note: This list is likely to be incomplete because new antiretroviral drugs are rapidly being

32. Abstinence
Monogamous Relationship
Protected Sex
Sterile needles
New shaving/cutting blades

34. Autoimmune disease
A disease in which the body produces
antibodies that attack its own tissues,
leading to the deterioration and in
some cases to the destruction of such
tissue.
The cause of autoimmune disease is unknown. There
are many theories about what triggers autoimmune
diseases, including:
Bacteria or virus
Drugs
Chemical irritants
Environmental irritants

37. Treatment
The goals of treatment are to:
•Reduce symptoms
•Control the autoimmune process
•Maintain the body's ability to fight disease
Some patients may need supplements to replace a hormone or vitamin that
the body is lacking. Examples include thyroid supplements, vitamins such as
B12, or insulin injections.
If the autoimmune disorder affects the blood, you may need blood
transfusions.
People with autoimmune disorders that affect the bones, joints, or muscles
may need help with movement or other functions.
Immunosuppressive medicines. Such medicines may include corticosteroids
(such as prednisone) and nonsteroid drugs such as azathioprine,
cyclophosphamide, mycophenolate, sirolimus, or tacrolimus

38. CHRONIC FATIGUE SYNDROME
A medical condition of unknown cause, with fever, aching,
and prolonged tiredness and depression, typically
occurring after a viral infection.

39. MAJOR CRITERION
Severe chronic fatigue for ≥ 6 months
 Not due to ongoing exertion or other medical
conditions
 Not substantially relieved by rest
 Significant interference with daily activities

40. MINOR CRITERION
 Concurrent presence of 4 or more of 8
symptoms:
 Post-exertion malaise lasting > 24 hours
 Unrefreshing sleep
 Impairment of memory or concentration
 Muscle pain
 Pain in multiple joints without swelling or redness
 Headaches of a new type, pattern, or severity
 Tender lymph nodes in the neck or armpit
 Frequent or recurring sore throat that

41.  For ≥ 6 months  tired most of the time, trouble
concentrating and carrying out daily activities
 Other symptoms include
• mild fever
• lymphadenopathy
• headache
• myalgia
• arthralgia
• depression, and memory loss
• Not caused by ongoing exertion, not relieved by rest

42. Viral infection
• Ebstein-Barr virus initially proposed
Hypothalamic pituitary adrenal Axis
dysfunction
• Mild hypocortisolism observed in cases of CFS

43. 3. Immunologic basis
• High pro inflammatory cytokines, high IL-1 levels
in CFS
NK cell dysfunction- either decrease in number or
impaired function
• increased levels of T regulatory cells
(CD25+/FOXP3+) CD4 T cells
• Lower activation of CD8 T cells
• Allergies (atopy) and CFS

44. 3. Immunological basis (contd)
• Serotonin and CFS – anti 5-HT autoimmune
activity could play a role in the pathophysiology of
CFS and the onset of physio-somatic symptoms

45. 4. Genetics
• Concordance 55% in monozygotic and 20% in
dizygotic twins
• Sequence variation in genes coding for HTR2A
serotonergic receptor potentially enhancing its activity
may be involved in pathophysiology of CFS
• Differences observed in gene expression in exercise
responsive genes in terms of gene ontology in attempt
to explain fatigue which worsens post exercise in CFS

46. 5. Neuroimaging
 Functional
• Reduced basal ganglia function in terms of decreased
activity of right caudate and right globus pallidus on
fMRI
 Structural
• Reduced grey and white matter volume in the occipital
lobe and reduced grey matter in the right angular
gyrus and right parahippocampal gyrus on VBM in
CFS patients

47. • Increased prevalence of maladaptive personality
features and personality disorders
• Prevalence of paranoid, schizoid, avoidant, obsessive-
compulsive and depressive personality disorders
significantly higher in CFS compared to normals
• Neuroticism frequently associated with CFS; patients
with CFS were found to be less extraverted

48.  Impaired information processing speed (reaction
time)
(Cockshell et al, 2013)
 Impaired working memory and poor learning of
information
(Mitchiels 2001)
 Impaired working memory and alterations in
motor speed
(Majer et al.,`2008)

49. NICE Guidelines (2007)
 General strategies
• Symptom management
• Function and quality of life management (sleep,
rest period, relaxation, pacing, diet)
• Equipment to maintain independence
• Education and employment
 Complementary and supplementary care
 Referral to specialist

50.  Depression/Anxiety - SSRIs/SNRIsi,e
selective serotonin reuptake inhibitors-
fluoxitine, dapoxitine
 Pain symptoms - TCAs/Duloxetine
 Sleep Disturbance - BZDs/Non-BZD
Hypnotic

51. Pharmacological interventions for symptom
control
 If chronic pain is a predominant feature - referral
to a pain management clinic
 Prescribing of low-dose tricyclic antidepressants,
specifically amitriptyline, for poor sleep or pain
 Melatonin may be considered for children and
young people with CFS/ME who have sleep
difficulties
(NICE, 2007)

52. Drugs with some evidence for CFS
• vitamin B1
• vitamin C
• co-enzyme Q10
• magnesium
• NADH (nicotinamide adenine dinucleotide) or
multivitamins and minerals
(NICE, 2007)

53. Drugs with no evidence in CFS
• monoamine oxidase inhibitors
• glucocorticoids (such as hydrocortisone)
• mineralocorticoids (such as fludrocortisone)
• dexamphetamine
• methylphenidate
• thyroxine
• antiviral agents
(NICE Guidelines, 2007)

54. • Immunological and Anti-Viral Agent
• Supported by 2 RCTs, awaiting FDA approval
• Acts by stimulating the innate immune system
• Binds to Toll-like Receptor-3 (TLR-3) and
increases production of interferons
• Activates intra-cellular RNAse enzyme – Causes
destruction of viral RNA
(Chambers et al, 2006)

55.  Graded Exercise Therapy is based on the
model of deconditioning and exercise
intolerance and usually involves
• a home exercise program that continues for 3–5
months.
• Walking or cycling is systematically increased, with set
target heart rates
 The primary component of CBT and GET is a
reduction in fatigue is the change in the
patient's perception of fatigue and focus on
symptoms

56. LYME’S DISEASE
A form of arthritis caused by bacteria that are
transmitted by ticks.
Causative Organism
Borrelia burgdorferi
Loosely coiled spirochete
8-20 micrometers

57.  Ixodes scapularis ticks are much smaller than common
dog and cattle ticks
 Below adult female, adult male, nymph, and larva on a
centimeter scale.
 Humans acquire disease from bite of nymphal or adult tick.

58. Single dose doxycycline shortly after tick
bite.
Lyme disease give doxycycline followed by
amoxacillin
Neuroborreliosis requires IV antibiotic
therapy.

59. o The brain and spinal cord are covered by connective
tissue layers collectively called the meninges which
form the blood-brain barrier.
1-the pia mater (closest to the CNS)
2-the arachnoid mater
3-the dura mater (farthest from the CNS).
The meninges contain cerebrospinal fluid (CSF).
Meningitis is an inflammation of the meninges, which, if
severe, may become encephalitis, an inflammation
of the brain.

60. -Bacterial Infections
-Viral Infections
-Fungal Infections
(Cryptococcus neoformans
Coccidiodes immitus)
-Inflammatory diseases
(SLE)
Cancer
-Trauma to head or spine.

62. One of the physically
demonstrable symptoms
of meningitis is Kernig's
sign. Severe stiffness of
the hamstrings causes
an inability to straighten
the leg when the hip is
flexed to 90 degrees.
DIAGNOSIS

63. Another physically
demonstrable symptoms
of meningitis is
Brudzinski's sign.
Severe neck stiffness
causes a patient's hips
and knees to flex when
the neck is flexed.

64. Blood cultures
Examined under a microscope for bacteria
Imaging
X-rays and computerized tomography (CT) scans of
the head, chest or sinuses may reveal swelling or
inflammation
Spinal tap (lumbar puncture)
The definitive diagnosis of meningitis requires an
analysis of your cerebrospinal fluid (CSF), which is
collected during a procedure known as a spinal tap.
In people with meningitis, the CSF fluid often shows
a low sugar (glucose) level along with an increased
white blood cell count and increased protein

65. TREATMENT
Bacterial meningitis
•Intravenous antibiotics- Gentamycin, Ceftriaxone
•Cortisone medications, to ensure recovery and reduce the risk of
complications, such as brain swelling and seizures.
•The Broad spectrum antibiotic or combination of antibiotics depends
on the type of bacteria causing the infection.
Viral meningitis
•Bed rest
•Plenty of fluids
•Over-the-counter pain medications to help reduce fever and relieve
body aches
•If the cause of your meningitis is a herpes virus, an antiviral
medication
Other types of meningitis
•Fungal meningitis is treated with antifungal medications- Micanozole,
Flucanazole, Itraconazole
•Noninfectious meningitis due to allergic reaction or autoimmune
disease may be treated with cortisone medications
•Cancer-related meningitis requires therapy for the individual cancer.

66.  The common cold is a viral infection of the
upper respiratory tract
 Usually last approximately 7 days
 Associated with a number of viruses
• Ex. Rhinoviruses, parainfluenza viruses
 Season of the year, age, and prior
exposure are important factors in the type
of virus causing the infection and the type
of symptoms that may occur

67. Adults have 2-4 colds per year
Children may have up to 10 colds per year

68. Very contagious
Spread from person to person
Usually from nasal secretions and from
fingers of the affected person
Most contagious in the first 3 days after
symptoms begin
Viruses can last up to 5 hours on the skin
and hard surfaces

69. Begins with a feeling of dryness and
stuffiness in the nasopharynx (nose)
Nasal secretions (usually clear and watery)
Watery eyes
Red and swollen nasal mucous
membranes
Headache
Generalized tiredness
Chills (in severe cases)

70. Fever (in severe cases)
Exhaustion (in severe cases)
If the pharynx and larynx (throat) becomes
involved:
• Sore throat
• Hoarseness

71. Antihistamines
Decongestants
Pain Relievers
Cough suppressants
Nasal Strips
Antibiotics are ineffective!!!

72. GOOD HANDWASHING!
Cough and sneeze into arm or tissue, not
into your hand
Aerosol sprays (ex. Lysol)
Antibacterial sanitizers (ex. Purell)

73. Influenza (the flu) is a contagious respiratory illness caused by
influenza viruses. It can cause mild to severe illness, and at times
can lead to death. The best way to prevent seasonal flu is by getting
a seasonal flu vaccination each year.
•In virus classification influenza viruses are RNA viruses that make
up three of the five genera of the family Orthomyxoviridae.
Influenzavirus A
Influenzavirus B
Influenzavirus C
Influenza (the flu)

74. Influenza A virus
•The type A viruses are the most virulent human pathogens among the three
influenza types and cause the most severe disease. Type A flu or influenza A
viruses are capable of infecting people as well as animals.
•Wild aquatic birds are the natural hosts for a large variety of influenza A.
•The influenza A virus can be subdivided into different serotypes based on the
antibody response to these viruses. The serotypes that have been confirmed in
humans, ordered by the number of known human pandemic deaths, are:
•H1N1, which caused Spanish flu in 1918, and the 2009 flu pandemic
•H2N2, which caused Asian Flu in 1957
•H3N2, which caused Hong Kong Flu in 1968
•H5N1, a current pandemic threat
•H7N7, which has unusual zoonotic potential
•H1N2, endemic in humans and pigs
•H9N2
•H7N2
•H7N3
•H10N7

75. Influenza B virus
Influenza B almost exclusively infects humans and is less common than
influenza A. This type of influenza mutates at a rate 2–3 times lower than
type A. This reduced rate of antigenic change, combined with its limited
host range ensures that pandemics of influenza B do not occur.
Influenza virus C
Influenza C virus, which infects humans, dogs and pigs, sometimes
causing both severe illness and local epidemics. However, influenza C is
less common than the other types and usually only causes mild disease
in children.

78. Low pathogenicity (LPAI) - usually only causing mild
respiratory disease in domestic poultry .
High pathogenicity (HPAI) - the more virulent type formerly
known as fowl plague which often results in up to a 100%
flock mortality.

85. The single best way to prevent seasonal flu is to get a seasonal flu
vaccination each year. There are two types of flu vaccines:
•The "flu shot" : an inactivated vaccine (containing killed virus) that is given
with a needle. The seasonal flu shot is approved for use in people 6 months of
age and older, including healthy people and people with chronic medical
conditions.
•The nasal-spray flu vaccine : a vaccine made with live, weakened flu viruses
that do not cause the flu (sometimes called LAIV for "Live Attenuated
Influenza Vaccine"). LAIV is approved for use in healthy* people 2-49 years of
age who are not pregnant.
About two weeks after vaccination, antibodies develop that protect against
influenza virus infection. Flu vaccines will not protect against flu-like illnesses
caused by non-influenza viruses.
A seasonal flu vaccine will not protect you against the new 2009 H1N1 flu. A
vaccine against the new H1N1 flu is being produced.
Preventing Seasonal Flu: Get Vaccinated

86. •Vaccinations have been produced to help
fight the spread of influenza A, but because
there are so many strains of the virus,
vaccinations are not always effective or
reliable.

87. ????

88. Treatment
•Treatment with oseltamivir (trade name Tamiflu®) or zanamivir (trade name
Relenza®) is recommended for all people with suspected or confirmed
influenza who require hospitalization.

89.  Human Papillomavirus (HPV) is a virus that
can cause various disease states including
“genital” or “venereal” warts
 Papillomaviruses are a complex group of DNA
tumor viruses. They can cause benign
growths (papillomas), cancers, or more
commonly, transient infections
 HPV infection is causally associated with
cervical cancer ; other genital cancers
including anal, penile, vulvar, and vaginal
cancers may have HPV as co-factor

90. Young age (less than 25 years)
Multiple sex partners
Early age at first intercourse (16 years
or younger)
Male partner has (or has had) multiple
sex partners

91. Direct skin-to-skin contact
• Usually, but not always sexual contact
Infected birth canal
Fomites (very rare)

92.  The symptoms may include single or multiple
fleshy growths around the penis, scrotum,
groin, vulva, vagina, anus, and/or urethra
 They may also include: itching, bleeding, or
burning, and pain
 The symptoms may recur from time to time

93. Source: Cincinnati STD/HIV Prevention
Training Center
Source: CDC/ NCHSTP/ Division of STD Prevention,
STD Clinical Slides

94. Source: Cincinnati STD/HIV Prevention Training Center

95. •Risk for penile cancer
•May influence the risk of HPV
acquisition, transmission and
cervical cancer

96. Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

97. History
Visual exam
Pap smears
DNA testing

98. Primary goal for treatment of visible warts
is the removal of symptomatic warts
Therapy may reduce but probably does not
eradicate infectivity
Difficult to determine if treatment reduces
transmission
•No laboratory marker of infectivity
•Variable results utilizing viral DNA

99. Abstinence
Monogamy
Condoms
Removal of warts
Vaccine (Females aged 9-26)
50% to 70% of sex partners of people
with genital warts already have or do
develop warts.

101.  Approved in June 2006
• Produced by Merck and Co.
 First vaccine to prevent cervical cancer
 Recombinant vaccine
 Approved for use in females aged 9-26
• Ideally, before becoming sexually active
 Protects against infection with
Types 6, 11, 16, 18
• Women aren’t protected if they have already been
infected with the HPV type(s) that are covered by the
vaccine prior to vaccination

102. Medicines that can be applied
include podofilox (Condylox) and
trichloroacetic acid (TCA), which kill the
wart tissue, or Aldara, a cream that
stimulates your immune system to fight the
virus.

103.  Miscellaneous Pneumotrophic Viruses
• Rhinovirus
• Adenovirus
• Respiratory Syncytial Virus

104.  Miscellaneous Dermotrophic Viruses
• Measles (Rubeola)
• Rubella
• Mumps
• Fifth disease
• Papilloma (HPV)

105.  Miscellaneous Viscerotrophic Viruses
• Enterovirus (Coxsackie & Echo Viruses)
• Rotavirus
• Norwalk Virus

106.  Miscellaneous Neurotrophic Viruses
• Poliomyelitis
• Rabies
• Arbovirus
• Arenavirus (lymphocytic choriomeningitis)

107.  Prion Diseases
• Bovine Spongiform Encephalopathy
• Scrapie
• Creutzfelt-Jakob Syndrome
• Kuru