National License: Infectious disease

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NL: Immunity.. Encoded by Nics152 and Tan72 MED34Edited by 32 MED34

Overview

2 1. Non-specific Immunity (Innate) Ag immune specific Immunity Physical barrier skin, mucous membrane, reflex (coughing), mucocilliary syste

Chemical barrier lysozyme, complement, properdin, interferon

Cellular barrier phagocyte (neutrophil, macrophage)

2.Specific Immunity (Acquired) 2 Humeral immunity response (HIR) immune response antibody B-cell lymphocyte plasma cell (lymphocyte 2 type B-cell T-cell B-cell 25% T-cell 75% B-cell bursa bone marrow) B-cell differentiate germinal center lymphoid tissue Antibody extracellular infection pyogenic bacteria

Cell-mediated immune response (CMIR) immune response cell cell T-cell lymphocyte differentiate paracortical area lymphoid tissue cytotoxic activity cell Ag cytokine intracellular infection Salmonella, TB, Fungus (Histoplasmosis, Cryptosporidium, Cryptococcus neoforman) defect CMIR HIV CMIR T-cell Delay-type hypersensivity Tuberculin skin test

Antigen Immune response cross reaction antigenicity (specific reactivity) ( antibody specific T cell) immunogenicity Hapten incomplete antigen hapten carrier immunogenicity penicillin hapten (carrier) antibody penicillin

Genetic influences on the immune response

Ag genetic Human leukocyte antigen (HLA) system major histocompatibility complex (MHC) Immune response autoimmune disease

MHC gene 6 2 class MHC class I (A B C) present CD8+ T-cell (CD8+ cytotoxic T-cell Ab ) MHC class II (DR DP DQ) present CD4+ T-cell (CD4+ T-cell B-cell lymphocyte plasma cell autoimmune Ab detect Rheumatoid factor, ALA) DR DP DQ mutation autoimmune disease SLE, Rheumatoid arthritis, idiopathic thrombocytopenic purpura, Sjgren's syndrome HLA HLA match immune reaction graft rejectionImmunoglobulin

Immunoglobulin polypeptide 2 disulfide bond Heavy chain identify immunoglobulin Light chain kappa and lambda 5 classes H-chain IgG, IgA, IgM, IgD IgE

Immunoglobulin 2 Fab Ag antigen binding site Fc complement activation, opsonization, chemotaxis

IgG serum neutralize toxin fix complement opsonin class secondary immune response IgM class primary immune response reaction activate complement acute hepatitis dengue fever IgM class ( IgM ) lipopolysaccharide gram negative bacteria (pentamer) agglutination necrosis gangrene IgM macroglobulinemia Macroglobulinemia of Waldenstrom IgD IgA (secretion) fix complement IgE plasma cell anaphylaxis type I hypersensitivity parasitic infection mast cell basophil degranulation allergic mediator histamine IgE chemotactic factor eosinophil parasite

Immune reaction

Ag CMIR / HIR HIR antibody (Ab) specific Ag Ag neutralization complement phagocyte Ab Ag immune complex reaction autoimmune disease immune complex complement system pathway

Classical pathway Ag-Ab complex C1 C4 complement pathway C4 Alternative pathway C3b microbial surface structure common pathway cell lysis C3b opsonin phagocytosis C4 classical pathway C3 Alternative pathway C5 common pathway MAC (Membrane attack complex) C5-C9 protein cell membrane cell lysis final common pathway Neisseria sp. complement C3a C5a anaphylatoxin hypersensitivity type I anaphylaxis C5a chemotactic factor Mononuclear phagocyte system

Monocyte migraite macrophage tissue function phagocytosis complement system interferon, proteolytic enzymes, pyrogen growth factors Rheumatoid arthritis AutoAb macrophage TNF- synovial membrane Macrophage Antigen-presenting cell Immunopathology

3 (hypersensitivity) (immune deficiency)

Hypersensitivity reaction Ag 4 typesType I Anaphylactic (immediate) hypersensitivity anaphylaxis, atopy, allergy, asthma antigen allergen IgE mast cell histamine vasodilate bronchoconstriction drug of choice epinephrine bronchodilation tachycardia acute myocardial infarction

Type II Antibody-mediated cytotoxic hypersensitivity Ab Ag cell Ag RBC autoimmune hemolytic anemia (AIHA) 2-4 wks Ag thyriod Graves disease NMJ MG transfusion reaction

Hemolytic Disease of the Newborn (HDN) Rh- D Ag Rh+ D Ag Rh positive Fetomaternal hemorrhage Anti-D 2 Rh positive Anti-D () IgG 2 sensitized RE system hemolysis jaundice hemolysis compensate severe anemia heart failure (generalized edema) hydrops fetalis hemolysis indirect bilirubin brain brain KernicterusType III Immune complex hypersensitivity Ag Ab immune complex complement activation SLE, Serum sickness, Goodpastures syndrome Type IV Cell-mediated (delayed-type) hypersensitivity T-cell reaction Tubercle follicle, rejection of graft, several autoimmune disease (RA, DM and IBD), Contact dermatitis ()

Immune deficiency immune drop 2 Primary deficiency development HIR deficiency pyogenic bacteria terminal complement deficiency Neisseria sp. Secondary deficiency CMIR (immunodeficiency state) HIV infection

immune chronic disease DM phagocytic activity Staph Mucor Chronic renal failure immune Burkholderia pseudomallei (DM, Chronic renal failure, Thalassemia ) Cirrhosis Gram negative bacilli Thalassemia capsule Hematologic malignancy lymphoma leukemia

Autoimmune disease immune response normal tissue Autoimmune disease 2 1. 2. antigen antigen antigen immune Antigen inflammation antigen antibody antigen normal cell cross reaction rheumatic heart disease postreptococcal GN3. immune T-cell activity imprint T-cell actived B-cell Plasma cell autoAb ( cytotoxic Ag-Ab complex) normal cell cell death CD4 activated cell cytotoxic T-cell CD4 cytokine hypersensitivity reaction Autoimmune disease 2 1. organ specific autoantibody target Ab thyroid gland peroxidase enzyme Hashimoto thyroiditis Ab TSH receptor action TSH Graves disease

Ab parietal cell intrinsic factor pernicious anemia

Ab RBC membrane AIHA

Ab -cell pancreas DM type 1 ( emergency condition) Ab adrenal gland Addisons disease

Ab nicotinic receptor Myastenia gravis2. non- organ specific systemic SLE (Systemic lupus erythematosus)Criteria 11 ( 4 11 ) DOPAMIN RASH

DDiscoid rashO Oral ulcers

PPhotosensitivity expose AAntinuclear antibody Antinuclear antibody MMalar rash

IImmunologic disorderAnti-DNA, LE cell, Anti-Sm VDRL NNeurologic disorder Seizures, Psychosis

RRenal disorder

lupus nephritis

AArthritis

symmetrical polyarthritis RA

SSerositis

serous , HHematologic disorder, , , AIHA

Dermatomyositis autoAb muscle organ Rheumatoid arthritis extra-articular involvement Rheumatoid nodule interstitial pneumonitis Systemic sclerosis Ab vessel fibroblast proliferation