pathology,immunopathology,aids

1. JALA-LABAD STATE MEDICAL UNIVERSITY
PROJECT =PATHOLOGY,IMMUNO PATHOLOGY ,AIDS
DR SUJEET KUMAR JHA

2. PATHOLOGY
• Pathology (from the Greek roots of pathos (πάθος),
meaning "experience" or "suffering" whence the English
word "path" is derived by transliteration, and -logia (-
λογία), "study of") is a significant component of the causal
study of pathogens and a major field in modern medicine
and diagnosis. Hence, 'the study of paths', by which
disease comes.

3. A pathologist examines a tissue section for evidence
of cancerous cells while a surgeon observes

4. PRINCIPAL PATHOLOGY= Disease Infection Neoplasia
Cause Pathogenesis Hemodynamics Ischemia Inflammation
Cell damage Wound healing,
Cellular adaptation Atrophy Hypertrophy Hyperplasia
Dysplasia Metaplasia Squamous Glandular
• Cell death Necrosis Coagulative necrosis Liquefactive
necrosis Gangrenous necrosis Caseous necrosis Fat
necrosis Fibrinoid necrosis Programmed cell death
Apoptosis Pyknosis Karyorrhexis Karyolysis
• Accumulations pigment Hemosiderin
Lipochrome/Lipofuscin Melanin Steatosis

5. • Anatomical pathology =Surgical pathology Cytopathology
Autopsy Molecular pathology Forensic pathology Oral and
maxillofacial pathology
• Gross examination Histopathology Immunohistochemistry
Electron microscopy Immunofluorescence Fluorescence
in situ hybridization
• Clinical pathology
• Clinical chemistry Hematopathology Transfusion medicine
Medical microbiology Diagnostic immunology
Immunopathology

6. IMMUNO-PATHOLOGY
• Immunopathology is a branch of medicine that deals with
immune responses associated with disease. It includes
the study of the pathology of an organism, organ system,
or disease with respect to the immune system, immunity,
and immune responses.
• In biology, it refers to damage caused to an organism by
its own immune response, as a result of an infection. It
could be due to mismatch between pathogen and host
species, and often occurs when an animal pathogen
infects a human (e.g. avian flu leads to a cytokine storm
which contributes to the increased mortality rate)

7. IMMUN DISORDER
• An immune disorder is a dysfunction of the immune
system. These disorders can be characterized in several
different ways:
• By the component(s) of the immune system affected
• By whether the immune system is overactive or
underactive
• By whether the condition is congenital or acquired

8. • According to the International Union of Immunological
Societies, more than 150 primary immunodeficiency
diseases (PIDs) have been characterized.[1] However,
the number of acquired immunodeficiencies exceeds the
number of PIDs.
• It has been suggested that most people have at least one
primary immunodeficiency. Due to redundancies in the
immune system, though, many of these are never
detected

9. AUTO-IMMUN DISEASES
• An autoimmune disease is a condition arising from an
abnormal immune response to a normal body part.There
are at least 80 types of autoimmune diseases. Nearly any
body part can be involved. Common symptoms include
low grade fever and feeling tired.Often symptoms come
and go.
• Main article: autoimmune disorders
• Scleroderma
• Certain types of hemolytic anemia
• Rheumatoid arthritis
• Type one diabetes

10. IMMUNO-DEFICIENCY
• Immunodeficiency (or immune deficiency) is a state in
which the immune system's ability to fight infectious
disease and cancer is compromised or entirely absent.
Most cases of immunodeficiency are acquired
("secondary") due to extrinsic factors that affect the
patient's immune system. Examples of these extrinsic
factors include HIV infection,

11. BY AFFECTED COMPONENT
• Humoral immune deficiency (including B cell deficiency or
dysfunction), with signs or symptoms depending on the
cause, but generally include signs of
hypogammaglobulinemia (decrease of one or more types
of antibodies) with presentations including repeated mild
respiratory infections, and/or agammaglobulinemia (lack
of all or most antibody production) which results in
frequent severe infections and is often fatal.
• T cell deficiency, often causes secondary disorders such
as acquired immune deficiency syndrome (AIDS).

12. • Granulocyte deficiency, including decreased numbers of
granulocytes (called as granulocytopenia or, if absent,
agranulocytosis) such as of neutrophil granulocytes
(termed neutropenia). Granulocyte deficiencies also
include decreased function of individual granulocytes,
such as in chronic granulomatous disease.
• Asplenia, where there is no function of the spleen
• Complement deficiency is where the function of the
complement system is deficient

13. PRIMARY-IMMUNO DEFICIENCY
• A number of rare diseases feature a heightened
susceptibility to infections from childhood onward. Primary
Immunodeficiency is also known as congenital
immunodeficiencies. Many of these disorders are
hereditary and are autosomal recessive or X-linked. There
are over 80 recognised primary immunodeficiency
syndromes; they are generally grouped by the part of the
immune system that is malfunctioning, such as
lymphocytes or granulocytes.

14. • The treatment of primary immunodeficiencies depends on
the nature of the defect, and may involve antibody
infusions, long-term antibiotics and (in some cases) stem
cell transplantation.The characteristics of lacking and/or
impaired antibody functions can be related to illnesses
such as X-Linked Agammaglobulinemia and Common
Variable Immune Deficiency

15. SECONDARY-IMMUNO-DEFICIENCY
• Secondary immunodeficiencies, also known as acquired
immunodeficiencies, can result from various
immunosuppressive agents, for example, malnutrition,
aging, particular medications (e.g., chemotherapy,
disease-modifying antirheumatic drugs,
immunosuppressive drugs after organ transplants,
glucocorticoids) and environmental toxins like mercury
and other heavy metals, pesticides and petrochemicals
like styrene, dichlorobenzene, xylene, and ethylphenol.

16. • Many specific diseases directly or indirectly cause
immunosuppression. This includes many types of cancer,
particularly those of the bone marrow and blood cells
(leukemia, lymphoma, multiple myeloma), and certain
chronic infections. Immunodeficiency is also the hallmark
of acquired immunodeficiency syndrome (AIDS),[7]
caused by the human immunodeficiency virus (HIV). HIV
directly infects a small number of T helper cells, and also
impairs other immune system responses indirectly.

17. • Various hormonal and metabolic disorders can also result
in immune deficiency including anemia, hypothyroidism,
diabetes and hypoglycemia.
• Smoking, alcoholism and drug abuse also depress
immune response.

18. ACQUIRED IMMUNO DEFFICENCY DISEASE(
AIDS)

19. • Human immunodeficiency virus infection and acquired
immune deficiency syndrome (HIV/AIDS) is a spectrum of
conditions caused by infection with the human
immunodeficiency virus (HIV).Following initial infection, a
person may not notice any symptoms or may experience
a brief period of influenza-like illness.Typically, this is
followed by a prolonged period with no symptoms.As the
infection progresses, it interferes more with the immune
system, increasing the risk of common infections like
tuberculosis, as well as other opportunistic infections, and
tumors that rarely affect

20. • people who have working immune systems. These late
symptoms of infection are referred to as acquired
immunodeficiency syndrome (AIDS).This stage is often
also associated with weight loss.
• SIGN & SYMPTOM = There are three main stage of HIV
-INFECTION (1) ACUTE LATENCY (2) CLINICAL
LATENCY AND (3) AIDS

21. ACUTE LATENCY
• The initial period following the contraction of HIV is called
acute HIV, primary HIV or acute retroviral syndrome.
Many individuals develop an influenza-like illness or a
mononucleosis-like illness 2–4 weeks post exposure while
others have no significant symptoms.Symptoms occur in
40–90% of cases and most commonly include fever, large
tender lymph nodes, throat inflammation, a rash,
headache, and/or sores of the mouth and genitals.The
rash, which occurs in 20–50% of cases, presents itself on
the trunk

22. • and is maculopapular, classically. Some people also
develop opportunistic infections at this
stage.Gastrointestinal symptoms, such as vomiting or
diarrhea may occur. Neurological symptoms of peripheral
neuropathy or Guillain–Barré syndrome also occurs. The
duration of the symptoms varies, but is usually one or two
weeks.

23. ACUTE HIV INFECTION

24. • The initial symptoms are followed by a stage called
clinical latency, asymptomatic HIV, or chronic HIV.Without
treatment, this second stage of the natural history of HIV
infection can last from about three yearsto over 20
years(on average, about eight years).While typically there
are few or no symptoms at first, near the end of this stage
many people experience fever, weight loss,
gastrointestinal problems and muscle pains.Between 50
and 70% of people also develop persistent generalized
lymphadenopathy, characterized by unexplained, non-
painful enlargement of more than one group of lymph
nodes (other than in the groin) for over three to six
months.

25. • Acquired immunodeficiency syndrome (AIDS) is defined
in terms of either a CD4+ T cell count below 200 cells per
µL or the occurrence of specific diseases in association
with an HIV infection. In the absence of specific treatment,
around half of people infected with HIV develop AIDS
within ten years.The most common initial conditions that
alert to the presence of AIDS are pneumocystis
pneumonia (40%), cachexia in the form of HIV wasting
syndrome (20%), and esophageal candidiasis.Other
common signs include recurring respiratory tract
infections.

26. • Opportunistic infections may be caused by bacteria,
viruses, fungi, and parasites that are normally controlled
by the immune system.Which infections occur depends
partly on what organisms are common in the person's
environment.These infections may affect nearly every
organ system.
• People with AIDS have an increased risk of developing
various viral-induced cancers, including Kaposi's
sarcoma, Burkitt's lymphoma, primary central nervous
system lymphoma, and cervical cancer.

27. • Kaposi's sarcoma is the most common cancer occurring
in 10 to 20% of people with HIV. The second most
common cancer is lymphoma, which is the cause of death
of nearly 16% of people with AIDS and is the initial sign of
AIDS in 3 to 4%.Both these cancers are associated with
human herpesvirus 8. Cervical cancer occurs more
frequently in those with AIDS because of its association
with human papillomavirus (HPV).Conjunctival cancer (of
the layer that lines the inner part of eyelids and the white
part of the eye) is also more common in those with HIV.

28. • Additionally, people with AIDS frequently have systemic
symptoms such as prolonged fevers, sweats (particularly
at night), swollen lymph nodes, chills, weakness, and
unintended weight loss.Diarrhea is another common
symptom, present in about 90% of people with AIDS.
They can also be affected by diverse psychiatric and
neurological symptoms independent of opportunistic
infections and cancers.

30. TRANSMISSION
• HIV is transmitted by three main routes:(1) sexual contact,
(2)significant exposure to infected body fluids or tissues,
and(3) from mother to child during pregnancy, delivery, or
breastfeeding (known as vertical transmission). There is
no risk of acquiring HIV if exposed to feces, nasal
secretions, saliva, sputum, sweat, tears, urine, or vomit
unless these are contaminated with blood.It is possible to
be co-infected by more than one strain of HIV—a
condition known as HIV superinfection

31. DIAGNOSIS
• HIV/AIDS is diagnosed via laboratory testing and then
staged based on the presence of certain signs or
symptoms. HIV screening is recommended by the United
States Preventive Services Task Force for all people 15
years to 65 years of age including all pregnant
women.Additionally, testing is recommended for those at
high risk, which includes anyone diagnosed with a
sexually transmitted illness. In many areas of the world, a
third of HIV carriers only discover they are infected at an
advanced stage of the disease when AIDS or severe
immunodeficiency has become apparent

32. A generalized graph of the relationship between HIV copies (viral load) and CD4+ T cell counts over the
average course of untreated HIV infection.
CD4+ T Lymphocyte count (cells/mm³)
HIV RNA copies per mL of plasma

33. TREATMENT
• There is currently no cure or effective HIV vaccine.
Treatment consists of highly active antiretroviral therapy
(HAART) which slows progression of the disease. As of
2010 more than 6.6 million people were taking them in
low and middle income countries.Treatment also includes
preventive and active treatment of opportunistic
infections.

34. • Current HAART options are combinations (or "cocktails")
consisting of at least three medications belonging to at
least two types, or "classes," of antiretroviral agents.
Initially treatment is typically a non-nucleoside reverse
transcriptase inhibitor (NNRTI) plus two nucleoside
analog reverse transcriptase inhibitors (NRTIs). Typical
NRTIs include: zidovudine (AZT) or tenofovir (TDF) and
lamivudine (3TC) or emtricitabine (FTC).Combinations of
agents which include protease inhibitors (PI) are used if
the above regimen loses effectiveness.

35. Stribild – a common once-daily ART regime consisting of elvitegravir, emtricitabine, tenofovir
and the booster

36. DIET
• The World Health Organization (WHO) has issued
recommendations regarding nutrient requirements in HIV/AIDS.A
generally healthy diet is promoted. Dietary intake of micronutrients
at RDA levels by HIV-infected adults is recommended by the
WHO; higher intake of vitamin A, zinc, and iron can produce
adverse effects in HIV positive adults, and is not recommended
unless there is documented deficiency. Dietary supplementation
for people who are infected with HIV and who have inadequate
nutrition or dietary deficiencies may strengthen their immune
systems or help them recover from infections, however evidence
indicating an overall benefit in morbidity or reduction in mortality is
not consistent.

37. PROGNOSIS
• HIV/AIDS has become a chronic rather than an acutely
fatal disease in many areas of the world.Prognosis varies
between people, and both the CD4 count and viral load
are useful for predicted outcomes. Without treatment,
average survival time after infection with HIV is estimated
to be 9 to 11 years, depending on the HIV subtype.After
the diagnosis of AIDS, if treatment is not available,
survival ranges between 6 and 19 months.HAART and
appropriate prevention of opportunistic infections reduces
the death rate by 80%, and raises the life expectancy for
a newly diagnosed young adult to 20–50 years.

38. • This is between two thirdsand nearly that of the general population. If
treatment is started late in the infection, prognosis is not as good: for
example, if treatment is begun following the diagnosis of AIDS, life
expectancy is ~10–40 years.Half of infants born with HIV die before two
years of age without treatment.opportunistic infections and cancer, both of
which are frequently the result of the progressive failure of the immune
system.Risk of cancer appears to increase once the CD4 count is below
500/μL. The rate of clinical disease progression varies widely between
individuals and has been shown to be affected by a number of factors such
as a person's susceptibility and immune functiontheir access to health care,
the presence of co-infections and the particular strain (or strains) of the virus
involved.Tuberculosis co-infection is one of the leading causes of sickness
and death in those with HIV/AIDS being present in a third of all HIV-infected
people and causing 25% of HIV-related deaths.HIV is also one of the most
important risk factors for tuberculosis.Hepatitis C is another very common co-
infection where each disease increases the progression of the other.[197]
The two most common cancers associated with HIV/AIDS are Kaposi's
sarcoma and AIDS-related non-Hodgkin's lymphoma