Decreased Immune Response: Susceptibility to Infection<br />C Washington RN, MSNEd<br />
Infection<br />Host organism’s <br />response to a <br />pathogen or disease causing substance<br />
Infection<br />Tissue destroying microorganisms enter & multiply in the body<br />
Invasion of the body by pathogenic organisms that multiply and produce injurious effects<br />
Four types of microorganisms can enter the body & cause infection<br />
Harmless Organisms<br />Resident flora <br />	-E Coli (intestine)<br />	-Staph aureus (skin)<br />Colonization<br />	-micr...
Harmful Actions of Microorganisms<br /># of organism present<br />Ability of organism to cause disease<br />Person’s immun...
Climate for Infection<br />Poor nutrition<br />Stress<br />Humidity<br />Poor sanitation<br />Crowded living conditions<br...
Opportunistic infections<br />Risk for Infection<br />Inhalation<br />
Risk for Infection<br />Direct contact<br />
Ingestion<br />Insect or animal bite<br />
Controlling Microorganism <br />Medical Asepsis <br /><ul><li>Clean technique
Limit #, growth, & transmission of microorganisms
Handwashing
Barrier techniques
Environmental cleaning </li></ul>Surgical Asepsis <br />Sterile technique<br />Completely free of microorganisms<br />
The Spread of Infection<br /><ul><li>An elderly pt, admitted with a GI disorder, is on bedrest and requires assistance wit...
Frequent uncontrolled diarrhea stools; the nurse provided excellent care to maintain cleanliness & comfort.
After one episode of cleaning the pt & changing the bed linen, the nurse went over to a second pt to adjust foleycath tubi...
The nurse’s hands were not washed before assisting the second patient.</li></li></ul><li>Breaking the Chain<br />A patient...
Nosocomial Infections<br />Drug Resistant Organisms<br />Vancomycin-resistant enterococcus (VRE)<br />
Methicillin-resistant Staph aureus (MRSA)<br />
Clostridium difficile (C Diff) <br />
Nosocomial Infections<br />Pneumonia<br />	-Pseudomonas<br />	-Improper suctioning<br />	 technique<br />
Nosocomial Infections<br />Bloodstream<br />	-Staph aureus<br />	-Improper IV site care<br />
Nosocomial Infections<br />Surgical Site<br />	-Enterococcus<br />	-Improper dsg <br />    change<br />
Nosocomial Infections<br />Urinary Tract<br />	-E Coli<br />	-Poor cath care<br />
Preventing Nosocomial Infections<br />
Transmission Based Precautions<br />Droplet precautions (pneumonia, meningitis)<br />	-Private room/mask &lt;3 ft from pt<...
Transmission Based Precautions<br />Airborne precautions (measles, TB)<br />	-Private neg airflow room 6 air exchanges/hr<...
Transmission Based Precautions<br />Contact precautions<br />	-Direct (kissing, bathing, toughing)<br />	-Indirect (instru...
Transmission Based Precautions<br />Protective Precautions<br />
What might you NOTICE (subjective & objective) if the patient has inadequate protection as a result of infection or infect...
What should you ASSESS for a patient with inadequate protection as a result of infection or infectious disease?<br />
How should you INTERVENE for a patient with inadequate protection as a result of infection or infectious disease?<br />
What should you EVALUATE when a patient is being treated for an infection or infectious disease<br />
2 days post-op below-the-knee amputation<br />Reports feeling hot and sweaty<br />VS 100-98-30 156/88<br />What is your be...
Adm from nursing home<br />H/O Stroke<br />MRSA urine<br />Incontinent of urine & stool<br />No private room available<br ...
Immune Response<br /> <br />recognize foreign substances<br /> neutralize, eliminate, or metabolize them with or without i...
Functions of the Immune System<br /><ul><li>Defense: protection against antigens
Homeostasis: removal of worn out or damaged components (e.g., dead cells)
Surveillance:  ability to perceive or destroy mutated cells or nonself cells. </li></li></ul><li>Alterations in Immune Fun...
Hypofunction:  Immunosuppression with increased susceptibility to infection (neutropenia, AIDS, immunosuppression
Hyperfunction:  Inappropriate and abnormal response to external antigens; an allergy</li></li></ul><li>Alterations in Immu...
Hypofunction:  No known effect
Hyperfunction:  Abnormal response where antibodies react against normal tissues and cells; an autoimmune disease</li></li>...
Hypofunction:  Inability of the immune system to perceive and respond to mutated cells, suspected mechanism in cancer
Hyperfunction:  No known effect</li></li></ul><li>Immune Response: Inflammation <br />Reaction of the tissues of the body ...
Inflammatory Response:  Cause<br />Physical irritants (e.g., trauma or a foreign body) <br />Chemical irritants (e.g., str...
Inflammatory Response: Local<br />Pain<br />Swelling<br />Heat<br />Redness<br />impaired function of part <br /> *five ca...
Inflammatory Response: Systemic<br />appear with moderate to severe response<br />Fever<br />Leukocytosis<br />Chills<br /...
Types of Immunity<br />
Test Yourself<br />A baby is born temporarily immune to the<br />diseases to which the mother is immune. <br />The nurse u...
Test Yourself<br />A mother brings her children into the clinic & they are diagnosed with chicken pox<br />The mother had ...
Factors Influencing Immunity<br />Age<br />Sex<br />Nutritional Status<br />Stress<br />Treatment Modalities<br />
Nursing History<br />Present illness<br /><ul><li>Associated symptoms
Location
Radiation
Intensity
Duration
Frequency
Precipitating & alleviating factors</li></ul>Chief complaint<br />Lack of energy<br />Light-headedness<br />Frequent infec...
Nursing History<br />Medical history<br /><ul><li>Changes in overall health
Allergies
Childhood diseases
Recurrent infections
Innumizations
Rashes
Visual disturbances</li></ul>Present illness<br />Prescription drugs<br />Over the counter drugs<br />Herbal remedies<br /...
Nursing History<br />Medical history<br />Fever<br />Changes in elimination<br />h/o immune disorders<br />Menstural patte...
Nursing History<br />Social history<br /><ul><li>Work
Exercise
Diet
Recreational drugs & alcohol
Hobbies
Stress
Support systems
Coping mechanisms</li></li></ul><li>Physiologic Responses Immunologic Dysfunction<br />Urticaria<br />Hives (wheals)<br />
Physiologic Responses Immunologic Dysfunction<br />Angioedema<br />   Generalized swelling<br />
Physiologic Responses Immunologic Dysfunction<br />Conjunctivitis<br />Inflammation of membranes of eyelids<br />
Physiologic Responses Immunologic Dysfunction<br />Bronchoconstriction<br />Swelling of airway	<br />
Physiologic Responses to Immunologic Dysfunction<br />Pruritis<br />Associated with erythema & urticaria<br />Hypotension<...
Physiologic Responses Immunologic Dysfunction<br />Leukocytopenia<br />Abnormal decrease in WBCs<br />
Physiologic Responses Immunologic Dysfunction<br />
Hypersensitive Immune Responses<br />Allergies<br />Anaphylaxis<br />Transfusion reactions<br />Transplant rejection<br />...
Allergies<br />Allergic disorders are the result of a hypersensitivity (excessive reaction to a stimulus) of the immune sy...
Allergies<br />A pt has allergic rhinitis.  <br />If the pt does not remain compliant with the treatment regime, the patie...
Anaphylaxis<br />A systemic reaction to allergens and the most serious type of allergic reaction.<br />Foods, drugs, hormo...
Anaphylaxis<br />
Anaphylactic Reaction<br />A patient is being given PCN via IVPB.<br />Develops an anaphylactic reaction<br />What would y...
Transfusion Reactions<br /><ul><li>Any client receiving blood products that are homologous or from a donor may develop a t...
Five types: febrile nonhemolytic; allergic urticarial; delayed hemolytic; acute hemolytic; and anaphylactic.</li></li></ul...
Transplant Rejection<br />Even with the use of immunosuppressive medications, 10% to 15% of transplanted organs fail.<br />
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Decreased Immune Response Infection Immunity

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Decreased Immune Response Infection Immunity

  1. 1. Decreased Immune Response: Susceptibility to Infection<br />C Washington RN, MSNEd<br />
  2. 2. Infection<br />Host organism’s <br />response to a <br />pathogen or disease causing substance<br />
  3. 3. Infection<br />Tissue destroying microorganisms enter & multiply in the body<br />
  4. 4. Invasion of the body by pathogenic organisms that multiply and produce injurious effects<br />
  5. 5. Four types of microorganisms can enter the body & cause infection<br />
  6. 6. Harmless Organisms<br />Resident flora <br /> -E Coli (intestine)<br /> -Staph aureus (skin)<br />Colonization<br /> -microorganisms<br /> become resident<br /> flora<br />Intestinal flora help synthesize vitamin K<br />
  7. 7. Harmful Actions of Microorganisms<br /># of organism present<br />Ability of organism to cause disease<br />Person’s immune system<br />Length of contact between person & organism<br />
  8. 8. Climate for Infection<br />Poor nutrition<br />Stress<br />Humidity<br />Poor sanitation<br />Crowded living conditions<br />Pollution<br />Dust<br />Medications<br />
  9. 9. Opportunistic infections<br />Risk for Infection<br />Inhalation<br />
  10. 10. Risk for Infection<br />Direct contact<br />
  11. 11. Ingestion<br />Insect or animal bite<br />
  12. 12. Controlling Microorganism <br />Medical Asepsis <br /><ul><li>Clean technique
  13. 13. Limit #, growth, & transmission of microorganisms
  14. 14. Handwashing
  15. 15. Barrier techniques
  16. 16. Environmental cleaning </li></ul>Surgical Asepsis <br />Sterile technique<br />Completely free of microorganisms<br />
  17. 17.
  18. 18. The Spread of Infection<br /><ul><li>An elderly pt, admitted with a GI disorder, is on bedrest and requires assistance with ADLs.
  19. 19. Frequent uncontrolled diarrhea stools; the nurse provided excellent care to maintain cleanliness & comfort.
  20. 20. After one episode of cleaning the pt & changing the bed linen, the nurse went over to a second pt to adjust foleycath tubing.
  21. 21. The nurse’s hands were not washed before assisting the second patient.</li></li></ul><li>Breaking the Chain<br />A patient assigned for morning care has an open wound on her left lower leg. <br />The wound is draining & when last cultured, the organism MRSA was identified. <br />What steps would you take to break the chain of infection while changing the patients bed.<br />
  22. 22. Nosocomial Infections<br />Drug Resistant Organisms<br />Vancomycin-resistant enterococcus (VRE)<br />
  23. 23. Methicillin-resistant Staph aureus (MRSA)<br />
  24. 24. Clostridium difficile (C Diff) <br />
  25. 25. Nosocomial Infections<br />Pneumonia<br /> -Pseudomonas<br /> -Improper suctioning<br /> technique<br />
  26. 26. Nosocomial Infections<br />Bloodstream<br /> -Staph aureus<br /> -Improper IV site care<br />
  27. 27. Nosocomial Infections<br />Surgical Site<br /> -Enterococcus<br /> -Improper dsg <br /> change<br />
  28. 28. Nosocomial Infections<br />Urinary Tract<br /> -E Coli<br /> -Poor cath care<br />
  29. 29. Preventing Nosocomial Infections<br />
  30. 30. Transmission Based Precautions<br />Droplet precautions (pneumonia, meningitis)<br /> -Private room/mask &lt;3 ft from pt<br />
  31. 31. Transmission Based Precautions<br />Airborne precautions (measles, TB)<br /> -Private neg airflow room 6 air exchanges/hr<br />
  32. 32. Transmission Based Precautions<br />Contact precautions<br /> -Direct (kissing, bathing, toughing)<br /> -Indirect (instruments, needles, dressing)<br />
  33. 33. Transmission Based Precautions<br />Protective Precautions<br />
  34. 34. What might you NOTICE (subjective & objective) if the patient has inadequate protection as a result of infection or infectious disease?<br />
  35. 35. What should you ASSESS for a patient with inadequate protection as a result of infection or infectious disease?<br />
  36. 36. How should you INTERVENE for a patient with inadequate protection as a result of infection or infectious disease?<br />
  37. 37. What should you EVALUATE when a patient is being treated for an infection or infectious disease<br />
  38. 38. 2 days post-op below-the-knee amputation<br />Reports feeling hot and sweaty<br />VS 100-98-30 156/88<br />What is your best action at this time<br />
  39. 39. Adm from nursing home<br />H/O Stroke<br />MRSA urine<br />Incontinent of urine & stool<br />No private room available<br />Semi private bed with older pt with fractured leg<br />
  40. 40. Immune Response<br /> <br />recognize foreign substances<br /> neutralize, eliminate, or metabolize them with or without injury to the body&apos;s own tissues.<br />
  41. 41. Functions of the Immune System<br /><ul><li>Defense: protection against antigens
  42. 42. Homeostasis: removal of worn out or damaged components (e.g., dead cells)
  43. 43. Surveillance: ability to perceive or destroy mutated cells or nonself cells. </li></li></ul><li>Alterations in Immune Functioning<br /><ul><li>Immune Function: Defense
  44. 44. Hypofunction: Immunosuppression with increased susceptibility to infection (neutropenia, AIDS, immunosuppression
  45. 45. Hyperfunction: Inappropriate and abnormal response to external antigens; an allergy</li></li></ul><li>Alterations in Immune Functioning<br /><ul><li>Immune function: Homeostasis
  46. 46. Hypofunction: No known effect
  47. 47. Hyperfunction: Abnormal response where antibodies react against normal tissues and cells; an autoimmune disease</li></li></ul><li>Alterations in Immune Functioning<br /><ul><li>Immune function: Surveillance
  48. 48. Hypofunction: Inability of the immune system to perceive and respond to mutated cells, suspected mechanism in cancer
  49. 49. Hyperfunction: No known effect</li></li></ul><li>Immune Response: Inflammation <br />Reaction of the tissues of the body to injury in order to destroy or dilute an injurious agent<br />prevent the spread of injury <br />promote repair of damaged tissue<br />
  50. 50. Inflammatory Response: Cause<br />Physical irritants (e.g., trauma or a foreign body) <br />Chemical irritants (e.g., strong acids or alkalis) <br />Microorganisms (e.g., bacteria and viruses) <br />
  51. 51.
  52. 52. Inflammatory Response: Local<br />Pain<br />Swelling<br />Heat<br />Redness<br />impaired function of part <br /> *five cardinal signs of inflammation<br />
  53. 53. Inflammatory Response: Systemic<br />appear with moderate to severe response<br />Fever<br />Leukocytosis<br />Chills<br />sweating <br />Anorexia<br />weight loss<br />general malaise<br />
  54. 54. Types of Immunity<br />
  55. 55. Test Yourself<br />A baby is born temporarily immune to the<br />diseases to which the mother is immune. <br />The nurse understands that this is an example of which type of immunity?<br />
  56. 56. Test Yourself<br />A mother brings her children into the clinic & they are diagnosed with chicken pox<br />The mother had chicken pox as a child and is not concerned with contracting the disease when caring for her children<br />What type of immunity does this mother have?<br />
  57. 57.
  58. 58. Factors Influencing Immunity<br />Age<br />Sex<br />Nutritional Status<br />Stress<br />Treatment Modalities<br />
  59. 59. Nursing History<br />Present illness<br /><ul><li>Associated symptoms
  60. 60. Location
  61. 61. Radiation
  62. 62. Intensity
  63. 63. Duration
  64. 64. Frequency
  65. 65. Precipitating & alleviating factors</li></ul>Chief complaint<br />Lack of energy<br />Light-headedness<br />Frequent infections<br />Bruising<br />Slow wound healing<br />
  66. 66. Nursing History<br />Medical history<br /><ul><li>Changes in overall health
  67. 67. Allergies
  68. 68. Childhood diseases
  69. 69. Recurrent infections
  70. 70. Innumizations
  71. 71. Rashes
  72. 72. Visual disturbances</li></ul>Present illness<br />Prescription drugs<br />Over the counter drugs<br />Herbal remedies<br />Vitamins & nutritional supplements<br />Alternative therapies<br />
  73. 73. Nursing History<br />Medical history<br />Fever<br />Changes in elimination<br />h/o immune disorders<br />Menstural patterns<br />Family history<br />Recurrent infections<br />Allergies<br />Cancer<br />
  74. 74. Nursing History<br />Social history<br /><ul><li>Work
  75. 75. Exercise
  76. 76. Diet
  77. 77. Recreational drugs & alcohol
  78. 78. Hobbies
  79. 79. Stress
  80. 80. Support systems
  81. 81. Coping mechanisms</li></li></ul><li>Physiologic Responses Immunologic Dysfunction<br />Urticaria<br />Hives (wheals)<br />
  82. 82. Physiologic Responses Immunologic Dysfunction<br />Angioedema<br /> Generalized swelling<br />
  83. 83. Physiologic Responses Immunologic Dysfunction<br />Conjunctivitis<br />Inflammation of membranes of eyelids<br />
  84. 84. Physiologic Responses Immunologic Dysfunction<br />Bronchoconstriction<br />Swelling of airway <br />
  85. 85. Physiologic Responses to Immunologic Dysfunction<br />Pruritis<br />Associated with erythema & urticaria<br />Hypotension<br />
  86. 86. Physiologic Responses Immunologic Dysfunction<br />Leukocytopenia<br />Abnormal decrease in WBCs<br />
  87. 87. Physiologic Responses Immunologic Dysfunction<br />
  88. 88. Hypersensitive Immune Responses<br />Allergies<br />Anaphylaxis<br />Transfusion reactions<br />Transplant rejection<br />Latex allergy<br />
  89. 89. Allergies<br />Allergic disorders are the result of a hypersensitivity (excessive reaction to a stimulus) of the immune system to allergens (a type of antigen commonly found in the environment).<br />
  90. 90.
  91. 91. Allergies<br />A pt has allergic rhinitis. <br />If the pt does not remain compliant with the treatment regime, the patient is at risk for developing an infection <br />Such as Sinusitis<br />
  92. 92. Anaphylaxis<br />A systemic reaction to allergens and the most serious type of allergic reaction.<br />Foods, drugs, hormones, insect bites, blood, and vaccines are all associated with anaphylactic reactions.<br />
  93. 93. Anaphylaxis<br />
  94. 94. Anaphylactic Reaction<br />A patient is being given PCN via IVPB.<br />Develops an anaphylactic reaction<br />What would you do first?<br />What symptom may the pt be experiencing?<br />What is the medication of choice for anaphylaxis?<br />
  95. 95. Transfusion Reactions<br /><ul><li>Any client receiving blood products that are homologous or from a donor may develop a transfusion reaction.
  96. 96. Five types: febrile nonhemolytic; allergic urticarial; delayed hemolytic; acute hemolytic; and anaphylactic.</li></li></ul><li>
  97. 97. Transplant Rejection<br />Even with the use of immunosuppressive medications, 10% to 15% of transplanted organs fail.<br />
  98. 98. Latex Allergy<br /><ul><li>Since 1987, when universal precautions (now called Standard Precautions) were mandated, exposure to latex by health care workers has dramatically increased.
  99. 99. By June, 1996, 28 latex-related deaths had been reported to the FDA.</li></li></ul><li>Latex in our lives<br />A combination of exposures to proteins found in latex products and certain foods may be the cause of a rise in latex allergies <br />
  100. 100. Latex in our lives<br />Assess for allergies to avocados, bananas, kiwi or chestnuts for cross sensitivity to latex<br />
  101. 101. Latex Allergies: Signs & Symptoms<br />Contact dermitis<br />Facial swelling<br />Itching<br />Hives<br />Rhinitis<br />eye symptoms<br /><ul><li>Bronchospasms
  102. 102. generalized edema
  103. 103. difficulty breathing
  104. 104. cardiac arrest</li></ul>Latex cart at bedside<br />
  105. 105. Latex Allergy Precautions<br /><ul><li>Mrs. Smith tells you she has allergic reactions when she eats bananas, seafood, eggs
  106. 106. Based on this information what would you ask Mrs. Smith
  107. 107. What actions would you take?</li></li></ul><li>Nursing Diagnosis<br />Ineffective airway<br />Clearance (obstructed airway)<br />Facial edema<br />Bronchospasms<br />Laryngeal edema<br />Decreased cardiac output<br />(Histamine release)<br /><ul><li>Peripheral vasodilation
  108. 108. Increased capillary permeability</li></li></ul><li>Nursing Diagnosis<br />Risk for Injury<br />Hypersensitivity responses high<br />Blood transfusions<br />
  109. 109. Components of Immune Response<br />Located throughout the body <br />Organs include thymus, bone marrow, lymph nodes, spleen, tonsils, appendix, Peyer&apos;s patches of small intestine. <br />
  110. 110. Components of Immune Response<br />Main cell types are WBCs (especially lymphocytes, plasma cells, and macrophages)<br />all originate from the same stem cell in bone marrow, then differentiate into separate types <br />
  111. 111. Components of Immune Response<br />Granulocytes <br />Eosinophils: increase with allergies and parasites <br />Basophils: contain histamine and increase with allergy and anaphylaxis<br />Neutrophils: involved in phagocytosis <br />
  112. 112. Components of Immune Response<br />Monocytes (macrophages) (e.g., histiocytes, Kupffer cells): involved in phagocytosis<br />Lymphocytes (T cells and B cells): involved in cellular and humoral immunity <br />
  113. 113. Immune System Response<br />Infection<br />WBCs released from bone marrow into blood<br />Bone marrow increases production of additional leukocytes<br />
  114. 114. White Blood Cell Count & Differential<br />
  115. 115. Leukocytes (WBC) <br /><ul><li>4,500 to 10,000 cell per cubic millimeter
  116. 116. Transports themselves to site of inflammatory or immune response
  117. 117. Detect, attack, & destroy anything foriegn
  118. 118. Locates damaged tissue & infection by responding to chemicals released by other leukocytes & damaged tissue</li></li></ul><li>WBC <br />Leukocytosis<br />Leukopenia<br /><ul><li>WBC greater than 10,000/mm3
  119. 119. Infection or inflammation
  120. 120. Leukemia
  121. 121. trauma or stress
  122. 122. tissue necrosis
  123. 123. bone marrow depression
  124. 124. overwhelming infection
  125. 125. viral infection
  126. 126. Immunosuppression
  127. 127. autoimmune disease
  128. 128. dietary deficiency </li></li></ul><li>Differential WBC<br />Granulocytes<br /><ul><li>Play key role in protecting body from harmful microorganisms during acute inflammation & infection</li></ul> -neutrophils<br /> -eosinophils<br /> -basophils<br />
  129. 129.
  130. 130. Neutrophils (55% to 70%)<br />Neutrophilia<br />Acute infection<br />Stress response<br />Myelocytic leukemia<br />Inflammatory disorders<br />Metabolic disorders<br />Neutropenia<br /><ul><li>Bone marrow depression
  131. 131. Overwhelming bacterial infection
  132. 132. Viral infection
  133. 133. Addison’s disease</li></li></ul><li>Eosinophils (1% to 4%)<br />Eosinophilia<br />Eosinopenia<br />Parasitic infections<br />Hypersensitivity reactions<br />Autoimmune disorders<br />Cushing’s syndrome<br />Autoimmune disorders<br />Stress<br />Certain drugs<br />
  134. 134. Basophils (0.5% to 1%)<br />Basophilia<br />Basopenia<br /><ul><li>Hypersensitivity responses
  135. 135. Chronic myelogenous leukemia
  136. 136. Chickenpox/smallpox
  137. 137. Splenectomy
  138. 138. hypothyroidism</li></ul>Acute stress<br />Hypersensitivity reactions, hyperthyroidism<br />
  139. 139. Monocytes (monos)<br />Monocytosis<br />Monocytopenia<br /><ul><li>Chronic inflammatory disorders
  140. 140. Tuberculosis
  141. 141. Viral infections
  142. 142. Leukemia
  143. 143. Hodgkin’s disease
  144. 144. Multiple myeloma</li></ul>Bone marrow depression<br />Corticosteroid therapy<br />
  145. 145. Lymphocytes (lymphs)<br />Lymphocytosis<br />Lymphocytopenia<br />Chronic bacterial infection<br />Viral infections<br />Lymphocytic leukemia<br /><ul><li>Bone marrow depression
  146. 146. Immunodeficiency
  147. 147. Leukemia
  148. 148. Cushing’s disease
  149. 149. Hodgkin’s disease
  150. 150. Renal failure</li></li></ul><li>Autoimmune Diseases<br />Systemic lupus erythematosus<br />Rheumatoid arthritis<br />Myasthenia gravis<br />Multiple Sclerosis<br />AIDS<br />
  151. 151. Systemic Lupus Erythematosus (SLE)<br />A chronic, progressive, incurable autoimmune disease affecting multiple body organs.<br />T cells attack the skin, kidneys, and other organs <br />Characterized by periods of remission and exacerbation.<br />
  152. 152. Rheumatoid Arthritis<br />A chronic, systemic autoimmune disease characterized by joint stiffness<br />T cells attack the linings of joints <br />
  153. 153. Myasthenia Gravis<br />
  154. 154.
  155. 155. Acquired Immune Deficiency Syndrome<br />

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