immunological disorders

1. Immunological Disorders
Imran Waheed
Demonstrator
(INS-KMU)
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2. Objectives
• At the end of this session students will be able to:
• Review the following concepts of immune response
*Components of immune response
*Humoral versus cell mediated immunity
• Discuss the disorder of immune response including.
AIDS (Acquired Immunodeficiency syndrome)
• Discuss the epidemiology, pathogenesis & clinical
manifestation of HIV infection.
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3. Immune System
• Immune system is made of complex group of cells and
organs that are found throughout the body.
• The system includes primary organs such as the thymus
gland and bone marrow, and the secondary organs
such as the lymph nodes, spleen, liver and the tonsils.
• The lymphocytes, the major cells of the immune
system, arise and develops in the primary organs.
• The secondary organs are responsible for filtering
foreign substances and for providing the space for
antigen reactions.
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4. Conti…
• The cells of the immune system includes four types of
leucocytes:
• Polymorphonuclear leukocytes (PMNs)
• Monocytes
• Macrophages
• Lymphocytes
• Polymorphonuclear leukocytes (PMNs) also known as
granulocytes, and these cells are active in inflammatory
process.
• Some leucocytes react when infection threatens the body,
while others respond when there is an allergic reaction
preventing damage to cells and tissues.
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5. Conti…
• The monocytes and macrophages become phagocytic in
the presence of pathogens and foreign substances.
• The lymphocytes are the major players in the immune
response.
• Lymphocytesare formed in the bone marrow.Those
remaining and maturing in the bone marrow become B
lymphocytes.
• Others migrate and mature in the thymus and become T
lymphocytes.
• Once mature, both B and T lymphocytes enter the blood
and circulate and colonize the lymphatic organs-
predominantly the spleen and lympnodes.
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6. Conti…
• T lymphocytes are responsible for the cell mediated
response.
• These cells destroys microorganisms that invade the
body.
• These reactions do not requires antibodies produced by
the B cells because the T cells have been previously
sensitized by circulating antigens.
• There are several different types of T cells functioning to
stimulate B cells to produce antibodies, destroy foreign
cells in the body, stop the immune response, and
remember previous exposure to antigens.
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7. Conti…
• B lymphocytes are responsible for humoral
immunity.
• Humoral immunity is associated with circulating
antibodies, in contrast to cell mediated immunity.
• The B lymphocytes enlarge and divide to become
mature plasma cells.
• The plasma cells secrete antibodies into the
blood and lymph to protect the body against
infections and toxins produced by microorganism.
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8. Types of immune response
• There are two types of immune responses in the body:
specific and non-specific.
• Specific immune response is associatedwith antigens
and the antibody reaction.
• It is the body watch-guard systemfor foreign invaders.
The antibody response occurs after exposure to an
antigen.
• Antibodies may neutralize, kill or cause clumping of the
foreign microorganisms.
• The complement systemalso works with the antibodies
to destroy the invader.
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9. Conti…
• The complement system is a group of proteins that
are formed in the liver and circulate in the serum.
• They enhance the work of the antibodies in
destroying foreign cells.
• The non-specific immune response includes
inflammation, phagocytosis, physical barriers (the
skin and mucous membranes), and chemical barriers
(acids and other secretions).
• These immune response defenses are the body's first
line of protection against foreign invaders.
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10. Imran Waheed 10
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11. HIV
• HIV was first Identified in 1981 in USA among
homosexuals
• In 1983, French investigator named
Lymphadenopathy associated virus (LAV).
• In 1984 virus was isolated by Gallo and coworkers
from national institute of health in United States.
• They named Human T-cell Lymphotropic virus
III (HTLV-III).
• 1987- AZT is the first drug approved for treating AIDS
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12. Conti…
• Thailand was the first country in the SEAR to
report a case of AIDS, in 1984.
• In 1986, a new strain of HIV was isolated in West
African patient with AIDS which is called HIV-2.
• In May 1986, international committee on
taxonomy gave a new name called Human
immune deficiency virus.
• Since its identification, HIV/AIDS is devastating
disease of mankind
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13. Etiology
• Human Immuno Deficiency Virus
• Size: 1/10,000th of a millimeter in diameter.
• It is a protein capsule containing two short
strands of genetic material (RNA) and
enzymes.
• Two types: HIV-1 and HIV-2
• HIV-1 causes most HIV infections worldwide,
but HIV-2 causes a substantial proportion of
infections in parts of West Africa
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14. Human Immuno-deficiency
Virus (HIV)
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15. Structure of HIV
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• Enveloped RNA retrovirus
• Spherical 120 nm in diameter envelope proteins make the
spikes on the membrane.
• Enveloped truncated conical capsid
• Electron dense core
• Two copies of the single stranded (+) RNA
• Has enzymes: Reverse transcriptase, Integrase & Protease
• Has three structural proteins gag, pol and env (structural
genes)
• Has LTR (long terminal repeats) rev and neg regulatory
genes

16. Reservoir
• Once a person gets infected virus remains in his body
lifelong. And the person is a symptomless carrier for
years before the symptoms actually appear.
• The virus is found in great concentrations in blood, CSF
and semen.
• Lower concentrations have been found in tears, saliva,
breast milk, urine, cervical and vaginal secretions.
• Also isolated from brain tissue, lymph nodes, bone
marrow cells and skin.
• However only blood and semen are known to transmit
the virus.
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17. HIV in Body Fluids
Semen
11,000
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V
aginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids

18. HIV-InfectedT-Cell
HIV
Virus
T
-Cell
HIV Infected
T-Cell
New HIV
Virus
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19. HIV Life Cycle
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1. HIV binds to the T-cell
2. Viral RNA is released into the host cell
3. Reverse transcriptase converts viral RNA into
viral DNA.
4. Viral DNA enters the T-cells nucleus and inserts
itself into the T-cell’s DNA.
5. The T-cell begins to make copies of the HIV
components.
6. Protease helps create new virus particles.
7. The new HIV virion is released from the T-cell.

20. The HIV Life Cycle
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21. Pathogenesis of HIV Infection
7
HIV Virus
CD4 cells
Uncoating and
reverse transcription
Proviral DNA
Budding of virus particles
and cytopathic phase

22. High Risk Groups
• Age: Most cases are among sexually active
people aged between 20- 49 years.
• High risk groups: Male homosexuals, hetero
sexual partners, i.v. drug abusers, blood
transfusion recipients, hemophiliacs and
patients having STDs.
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23. HIV Transmission
• HIV enters the bloodstream through:
• Open Cuts Breaks in the skin
• Mucous membranes
• Direct injection
• HIV is not transmitted by casual nonsexual
contact as may occur at work, school, or
home.
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24. Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female orvice versa
Female-to-female
Blood Exposure: Injecting drug use/needlesharing
Occupationalexposure Transfusion
of blood products
Perinatal:
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Transmissionfrom mother tobaby
Breastfeeding

25. Routes of Transmission of HIV
OccupationalTransmission
Health care worker/ hospital staff
Laboratory workers
Other Routes
Organ transplantation Artificial
insemination Needle-prick
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26. AIDS
• Acquired immune deficiency syndrome or acquired
immunodeficiency syndrome (AIDS) is a disease of the
human immune system caused by the human
immunodeficiency virus (HIV).
• The infection causes progressive destruction of the
cell-mediated immune (CMI) system, primarily by
eliminating CD4+ T-helper lymphocytes.
• AIDS (acquired immune deficiency syndrome) is the
final stage of HIV disease, which causes severe damage
to the immune system.
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27. Earlier Four Stages Classification
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 Initial Infection
 Asymptomatic CarrierState
 AIDS-relatedComplex(ARC)
 AIDS

28. New Stages of HIV Infection
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• Stage I – Primary HIV Infection
• Stage II – HIV Asymptomatic
• Stage III – HIV Symptomatic
• Stage IV - AIDS

29. ST
AGE I : Primary HIV infection
⚫This stagelastsfor a fewweeks
⚫ Accompaniedby a short flu-likeillness
⚫ Diagnosis of HIV infection is frequentlymissed.
⚫During this stagethere is a largeamount of HIV in the
peripheral blood
⚫Immune system begins to respond to the virus by
producing HIV antibodies and cytotoxiclymphocytes.
This process is known asseroconversion.
⚫CD4(Clusterof differentiation4) cell + TLymphocyte
count will be normal i.e., 500 – 1500cells/cubicmm

30. STAGE II : HIV Asymptomatic
⚫This stagelastsfor an averageof tenyears
⚫ Freefrom major symptoms,although there may be
swollenglands
⚫People remain infectious and HIV antibodies are
detectablein the blood, so antibodytestswill showa
positiveresult.
⚫CD4 cells+ T lymphocytes– littleabove 500
cells/cubicmm

31. ST
AGE III : HIV Symptomatic
⚫ Immune systembecomes severelydamagedby HIV.
⚫The lymph nodes and tissuesbecomedamaged
⚫HIV mutatesand becomes morepathogenic- moreT
helper celldestruction
⚫The body fails tokeepup with replacing the T helper
cells that arelost
⚫ Immunesystemfailsand symptomsdevelop
⚫Initially many of the symptoms are mild, but as the
immunesystemdeterioratesthe symptomsworsen.
⚫Multi-systemdiseaseand infectionscan occurin
almost all bodysystems
⚫CD4 cells+ T lymphocytes– 200 – 499cells/cubicmm

32. ST
AGE IV : AIDS
⚫ Individual develops increasingly severeopportunistic
infections andcancers
⚫CD4 cells+ T lymphocytes - <200 cells/cubicmm

33. HIV Infection And AntibodyResponse
6 month ~ Years ~ Years ~ Years ~ Ye
Virus
Antibody
Infection
Occurs
AIDS Symptoms
Initial Stage---------------- --------Intermediate or Latent Stage-----------------Illness Stage
Flu-like Symptoms
Or
No Symptoms Symptom-free
----
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34. The Acute HIVSyndrome
Follows3-6 wks following primaryinfection
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35. Diagnosis
• ELISA (Enzyme Linked Immuno-Sorbent Assay):
• Done to detect HIV antibodies in patient’s serum
(antigens used are p24, p17, gp160, gp120, and
gp41).
• Anti-p24 is the first reliably detected antibody but
declines as viral titers rise in late infection
• Envelope antibodies rise more slowly but stay
high at the end
• Env antigens show major antigenic variation
• ELISA for p24 useful early
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36. Confirmation
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• Western blot for antibodiesspecific to HIV
• Immunoelectrofluorescence
• HIV DNA PCR (Polymerase Chain Reaction):
• Qualitative to detect HIV infection in
newborns of mothers are HIV+
• Quantitative HIV DNA PCR to determine viral
load to assess treatment

37. Complications
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• There are numbers of complications in HIV/AIDS. And these
complications include :-
• Recurrent infections
• Opportunistic infections
• Acute and chronic ENT infections (Hearing loss Tooth and
gum diseases)
• Tuberculosis
• Malabsorption and wasting, developmental delays
• Cardiomyopathy
• Nephropathy, Neuropathy
• Neutropenia, anemia, thrombocytopenia
• Psychological crisis

38. AIDS-related Herpes
Kaposi’s Sarcoma
Oral thrush
Wasting
syndrome
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39. Prevention
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• Numerous prevention interventions exist to combat
HIV, and new tools, such as vaccines, are currently
being researched.
• As AIDS is sexually transmitted disease so , can be
preventedby avoiding sexual abuse.
• Usage of condom while intercourse is recommended
when any of the life partner is affected.
• Special care must be taken while come across needles.
• Be careful in blood transfusion.
• A mother with AIDS should avoid to breastfeed her
baby.

40. Conti…
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• Effective prevention strategies include behavior
change programs, condoms, HIV testing, blood supply
safety, harm reduction efforts for injecting drug users,
and male circumcision.
• Additionally, recent research has shown that providing HIV
treatment to people with HIV significantly reduces the risk
of transmission to their negative partners and the use of
antiretroviral-based microbicide gel has been found to
reduce the risk of HIV infection in women.
• Pre-exposure antiretroviral prophylaxis (PrEP) has also been
shown to be an effective HIV prevention strategy in
individuals at high risk for HIV infection.

41. Treatment
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• HIV treatment includes the use of combination
antiretroviral therapy to attack the virus itself,
and medications to prevent and treat the many
opportunistic infections that can occur when the
immune system is compromised by HIV.
• Nucleotide reverse transcriptase inhibitor (NRTIs)
– block virus replication . E.g. : Zidovudine,
Abacavir
• Protease inhibitors .E.g. Amprenavir, Indinavir
• HAART ( Highly Active Antiretroviral Treatment)

42. Nursing diagnosis
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• Deficient fluid volume related to persistent diarrhea
associated with opportunistic infections
• Deficient knowledge (symptoms of disease
progression, risk factors, transmission of disease, home
care, and treatment options) related to lack of
exposure to information
• Grieving related to uncertain prognosis and change in
health status
• Imbalanced nutrition: Less than body requirements
related to:–anorexia–diarrhea–medication adverse
effects–nausea and vomiting

43. Conti…
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• Ineffective family coping related to parenteral
guilt and nature of disease.
• Fear related to frequent invasive procedures,
diagnosis, stigmatization.
• Risk of infection related to immunodeficiency,
neutropenia
• Impaired gas exchange related to:–respiratory
failure

44. Nursing interventions
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• Assess mucous membranes and document all oral
lesions. Note reports of pain, swelling, difficulty
with chewing and swallowing.
• Monitor daily weight when diarrhoea is present.
• Maintain intake output and assess skin and
mucus membrane for turgor and dryness.
• Encourage verbalization and interaction with
family.
• Discuss extent and rationale for isolation
precautions and maintenance of personal
hygiene.

45. Conti…
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• Limit food that induce nausea and vomiting or
are poorly tolerated by patient because of
mouth sores or dysphagia. Avoid serving very
hot liquids and foods.
• Administer medications as indicated

46. References
• 1. Rodger AJ et al (2019) Risk of HIV transmission
through condomless sex in serodifferent gay couples
with the HIV-positive partner taking suppressive
antiretroviral therapy (PARTNER): final results of a
multicenter, prospective, observational study. The
Lancet; 393: 10189, 2428-2438.
• 2. Sharp PM, Hahn BH (2011) Origins of HIV and the
AIDS pandemic. Cold Spring Harbor Perspectives in
Medicine; 1: 1, a006841.
• 3. WHO (2018) Number of Deaths Due to HIV/AIDS.
WHO.
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47. 11/20/2020
If you cannot do
great things, do
small things in a
great way. Napoleon Hill
THANK YOU !
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