Inflammation & Immunity Final Final Final (7)

8/8/2019 Inflammation & Immunity Final Final Final (7)

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Group 2


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Immunologyy Is the study of the immune system and immune

responses

y Immune responses involve complex interactionsamong many different types of body cells and cellularsecretions.


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Immune System

y The third line of defense against pathogens; a specifichost defense mechanism

y It involve the production of antibodies that recognize,bind to and inactivate or destroyspecific pathogens ortheir toxins


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Immunity

y Is the condition of being immune or resistant to aparticular infectious disease.

y Is a biological term that describes a state of havingsufficient biological defenses toavoid infection, disease, or other unwanted biologicalinvasion.


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Types of Immunity


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Types of Immunity

Natural (Innate) Immunity

y Nonspecific immunity present at birth

y Provides a nonspecific response to any foreign invader,regardless of the invaders composition

y The basis of natural defense mechanism is the abilityto distinguish between foe or self or nonself

y Natural mechanisms include physical and chemicalbarriers, the action of WBCs and inflammationresponse.


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Acquired (Adaptive) Immunity

y Immunity develop after birth

y Immunologic responses acquired during life but notpresent at birth

y Usually develops as a result of prior exposure toantigen through immunization (vaccination) or bycontracting a disease, both of which generate aprotective immune response.


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Types of acquired immunityActiveAcquired Immunity

yNatural Acquired Immunity- Immunity that is acquired

in response to the entry of a live pathogen into thebody.

yActual Acquired Immunity- It is the immunity that isacquired in response to vaccine


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PassiveAcquired Immunity

y Natural Passive Acquired Immunity- Temporaryimmunity transmitted from another source that has

developed immunity through previous

disea

se orimmunization.

y Artificial passive Acquired Immunity- Immunitythat is acquired when a person receives antibodies

contained in antisera or gamma globulin


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Types of Hypersensitivity

ReactionsHypersensitivity

y Refers to the excessive, undesirable (damaging,discomfort-producing and sometimes fatal) reactionsproduced by the immune system.

y Reaction require pre-sensitized (immune) state of thehost

y Reactions can be divided into four (4) types:Type I,

Type II, Type III and Type IV, based on themechanisms involved and time taken for the reaction.

y Frequently, particular clinical condition (disease) mayinvolve more than one type of reaction


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Type I Hypersensitivity

y Also known as immediate or anaphylactichypersensitivity

y Reaction may involve skin (uticaria and eczema), eyes

(conjunctivitis), nasopharynx (rhinorrhea, rhinitis),bronchopulmonary tissues (asthma) andgastrointestinal tract (gastroenteritis).

y The reaction may cause a range ofsymptoms from

minor inconvenience to death.y The reaction usually takes 15-30 minutes from the time

of exposure to the antigen, although sometimes it maybe a delayed onset (10-12 hours)


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y Immediate sensitivity is mediated byIg E

y Cellular component in this hypersensitivity is the mastcell or basophils.

y Reaction is amplified and or modified by platelets,neutrophils and eosinophils.

y Abiopsy of the reaction site demonstrates mainly mastcells and eosinophils.


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Type II Hypersensitivity

y Also known as Cytotoxic Hypersensitivity and mayaffectvariety of organs and tissues.

yThe antigens are normally endogenous, althoughexogenous chemical (haptens) which can attach to thecell membranes can also lead to type IIhypersensitivity.

yDrug-induced hemolytic anemia, glaucoma andthrombocytopenia are such examples.


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y The reaction time is minutes to hours.

y Type II hypersensitivity is primarily mediated byantibodies of the Ig M or Ig G classes and complementPhagocytes and K cells may also play a role.

y Lesions contains antibody, complement and

neutrophils.

y Diagnostics test include detection of circulatingantibodies against the tissues involved and the presenceof antibody and complement in the lesion (biopsy) by

immunofluorescence.

y Treatment involves anti-inflammatory andimmunosuppressive agents.


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Type III Hypersensitivityy Also known asImmune Complex Hypersensitivity

y The reaction may take up to 3 10 hours after

exposure to the antigeny They are most of the IgG class, although IgM may also

involved

y Example given systemic Lupus Erythematous, SLE


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Type IV Hypersensitivityy Also known as cell mediated or delayed type

hypersensitivity

yThe classical example is tubercullin ( Montoux )reaction 48 hours after the injection of antigen ( PPDor old tubercullin )

y Involved in the pathogenesis of many autoimmune

and infectious diseases ( tuberculosis, leprosy,blastomycosis, histoplasmosis and toxoplasmosis ) andgranulomasdue to infection and foreign antigens


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Comparison of Different Types of

Hypersensitivity

Characteristics Type-I

(Anaphylactic)

Type II (Cytotoxic) Type III

( Immune Complex)

Type-IV

(delayed type )

Antibody IgE IgG, IgM IgG, IgM T cells

Antigen Exogenous Cell surface Soluble Tissues & organs

Response time 15 -30 minutes Minutes hours 3-8 hours 48 72 hours

Appearance Weal & flare Lysis and necrosis Erythema and edema,

necrosis

Erythema and

induration

Histology Basophils and

eosinophils

Antibody and

complement

Complement and

neutrophils

Monocytes and

lymphocytes

Transferred with Antibody Antibody Antibody T cells

Examples Allergic, asthma, hay

fever

Erythroblastosis

Fetalis,

Goodpastures

Nephritis

SLE, farmers lung

disease

Tubercullin test,

poison Ivy and

granuloma


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Terminologies

Immunocompetent

y If the persons immune system is functioning properly,that person issaid to be an immunocompetent person.


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TerminologiesImmunodefficiency

y Occurs as a result of deficiencies in antibody

production, complement activity and phagocyticfunction.

y Hereditary disease (agammaglobulinemia,hypogammaglobulinemia, chronic granulomatosus

disease and Chediak-Higasi syndrome)


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TerminologiesImmunosupression

y Immunosuppression may result from certain diseasessuchas AIDS or lymphoma or from certain drugssuch assome

of those used to treat cancer.y It may also be deliberately induced with drugs, as in

preparation for bone marrow orother organ transplantation to prevent the rejection ofthe transplant.

Immunosuppressive drugs :

y glucocorticoids, cytostatics, antibodies, drugs acting onimmunophilins


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TerminologiesAutoimmune Diseasesy Results when a persons immune system no longer

recognizes certain body tissues asself, and attempts to

destroy those tissues as if they were oneself or foreign.y Examples include:y rheumatoid arthritis,y multiple sclerosis,y myasthenia gravis,y systemic lupus erythematosusy Crohn's diseasey pemphigusy ulcerative colitis


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TerminologiesVaccine

y Is defined as material that can artificially induce

immunity to an infectious disease, usually afterinjection or, in some cases ingestion of the material(i.e., oral polio vaccine).

y Vaccines are made from living or dead (inactivated)

pathogens or from certain toxins they produce.


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TerminologiesAntigens

y Substances capable ofstimulating response from theimmune system.

Antibodies or Immunoglobulin

y Proteins created in response to specific antigen.

y

Immunoglobulin plays an essential role in the body'simmune system.

y They attach to foreign substances, such as bacteria,and assist in destroying them.


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CLASSES OF IMMUNOGLOBULINS

Immunoglobulin A (Ig A) The most predominant class, found in saliva,

seminal fluid, colostrums, breast milk and

mucous secretion of the nose, lungs and

gastro intestinal tract.

Immunoglobulin D (Ig D) Found in large quantities on the surface of B

cells

Immunoglobulin E (Ig E) Ig E is produced in response to allergens.

Found on the surfaces of basophils and mass

cells. Plays a major role in allergic responses.


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CLASSES OF IMMUNOGLOBULINS

Immunoglobulin G (Ig G) The only class of immunoglobulin

that can cross the placenta.

Maternal Ig G that crosses the

placenta help protect the newborn

during its first months of life.

Immunoglobulin M (Ig M) Most abundant circulatory

antibodies.

First Ab formed in the primary

response to antigens. It provides

protection in the earliest stage of

infection


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xpan e r gram r

Immunizati n (EPI)

Objective:

y To reduce the infant mortality and morbidity ratethrough decreasing the prevalence of 6 vaccines

preventable diseases.Preventable Diseases

y Tuberculosisy Diphtheriay

Pertussisy Tetanusy Polioy Measles


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Vaccine Min Age at

1st

ose

No. of

oses

ose Minimum

Interval

Route Site Reason

Bacillus

Calmette-

Guerin

Birth or

anytime

after birth

1 0.05 ml --- Intradermal Rt.

eltoid

region of the

arm

BCG given the

earliest possible age,

protects the

possibility of TB

meningitis and other

TB infections in

which infants are

prone.

PT 6 weeks 3 0.5 ml 4 weeks Intramuscular Upper outer

portion of the

thigh

An early start with

PT reduces the

chance of severe

pertussis.


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Oral Polio

Vaccine

6 weeks 3 2-3 drops 4 weeks Oral Mouth The extent of

protection against

polio is increased the

earlier the OPV is

given.

Hep B Vaccine At birth 3 0.5ml 6 wks

interval from

1stdose to

2nd

dose, 8wks interval

from 2nd

dose to 3rd

dose

Intramuscular Upper outer

portion of the

thigh

The early start of

Hepatitis B vaccine

reduces the chance

of being infected andbecoming a carrier.

Prevents liver

cirrhosis and liver

cancer which are

likely to develop if

infected with Hep Bearly in life.

MeaslesVaccine 9 months 1 0.5 ml --- Subcutaneous Upper outer

portion of the

arms

At least 85% of

measles can be

prevented by

immunization at this

age.


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Tetanus Toxoid Immunization Scheduled for

Women

When given to women of childbearing age, vaccinesthat contain tetanus toxoid, may not only protect

women against tetanu

s, but al

so prevent neonataltetanus in newborn infant.


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Vaccines Minimum Age/Interval Percent

Protected

uration of Protection

TT1 As early as possible

during pregnancy

--- ---

TT2 At least 4 weeks later 80% Infants born to the mother will be protected

from neonatal tetanus, give 5 years

protection for the mother

TT3 At least 6 months later 95% Infants born to the mother will be protected

from neonatal tetanus, give 5 years

protection for the mother

TT4 At least 1 year later 99% Infants born to the mother will be protected

from neonatal tetanus, give 10 yearsprotection for the mother

TT5 At least 1 year later 99% Gives life time for the mother.

All infants born to the mother will be

protected.


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Universal recautions of Immunization

yHand washing after any direct contact with patients

yPreventing two-handed recapping of needles

y Safe collection and disposal of needles (hypodermic andsuture) and sharps (scalpel blades, lancets, razors, scissors),with required puncture- and liquid- proof safety boxes ineach patient care area

yWearing gloves for contact with body fluids, non-intact skin

and mucous membranes


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Universal recautions of Immunization

yWearing a mask, eye protection and a gown (and sometimes aplastic apron) if blood or other body fluids might splash

y Covering all cuts and abrasions with a waterproof dressing

yPromptly and carefullycleaning up spills of blood and otherbody fluids

y

Using a safe system for health care waste management anddisposal


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Group 2


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Inflammation

y Adefensive reaction intended to neutralize, control oreliminate the offending agent and to prepare the sitefor repair.

y Redness, swelling, pain, and/or a feeling of heat in anarea of the body are protective reactions to injury,disease, or irritation of the tissues.


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Types of Inflammationy Acute Inflammation

y Chronic Inflammation

y Subacute Inflammationy CellularHealing

Regeneration

Replacement


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Types of InflammationAcute Inflammation

y Is characterized by the local vascular and exudative

changes

and usually la

sts

less

than 2 weeks.

y Immediate and serves as a protective function

y After the causative again is removed, the inflammationsubsides and healing takes place with the return of

normal or nearly normal structure and function.


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Chronic Inflammation

y Develops if the injurious agent persists and the acuteresponse is perpetuated

y Symptoms are present for many months or yearsy May begin insidiously and never have an acute phase

y As the inflammation becomes chronic, changes occur atthe site of injury and the nature of exudates becomes

proliferative.


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Chronic Inflammation (cont.)

y Acycle of cellular infiltration, necrosis and fibrosis

begins with repair and breakdown occurringsimultaneously.

y Considerablyscarring may occur, resulting inpermanent tissue damage


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y Subacute inflammation falls between acute andchronic inflammation

y

It includes elements of the active exudative phase ofthe acute response as well as the elements of repair, asin the chronic phase.

Subacute Inflammation


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CellularHealing (cont.)

y It may occur by regeneration, in which gradual repairof the defects occur by proliferation of cells of thesame types as those destroyed or by replacement, in

which cells of another type, usually connective tissue,

fill in the tissue defect and result in scar formation.


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Regeneration

y The ability of the cells to regenerate depends onwhether they are labile, permanent or stable

y Labile cells multiple constantly to replace cell worn

out by normal physiologic proce

sses;


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Replacement

y The condition of the host, the environment and thenature and severity of the injury affect the process ofthe inflammation, repair and replacement.

y Depending on the extent of damage, repair and

replacement may occur by first, second or thirdintention healing.


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CLASSIFICATION OF HEALING

First Intention Healing Second Intention Healing Third Intention Healing

Wound edges are

approximated

Little scar formation

occurs and the wound

healing occurs without

granulation.

Occurs in clean cut wound

The edges are not

approximated and the

wound fills with

granulation tissue.

Occurs when the wound

is extensive and there is a

great amount of tissue

loss.

The process of repair

takes longer and may

result in scar formation,

with loss of specialized

function.

Ex. People who have

recovered from MI.

Wound edges are

approximated and healing

is delayed

Occurs when there is a

delayed surgical closure of

infective wound


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Stages of Inflammation


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Incubation

y The time between the exposure to an infectiousdisease and its development.

y This period may last from a few minutes to a few days,weeks, months or even years.

y During thisstage morbid matter, poisons,microorganisms and other excitants of inflammationgather and concentrate in certain parts and organs ofthe body.


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Aggravation

y The battle between the phagocytes and Nature'santitoxins on the one hand, and the poisons andmicroorganismsof disease on the other hand,

gradually progress

es, accompanied by a corre

spondingincrease of fever and inflammation, until it reaches its

climax, marked by the greatest intensity of feverishsymptoms.


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Destruction

y This battle between the forces of disease and thehealing forces is accompanied by the disintegration oftissues due to the accumulation of exudates, to pus

formation, the development of abscesses, boils,fistulas, open sores, etc., and to other morbid changes.

y Thisstage ends in crisis, which may be either fatal orbeneficial.


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Abatement

y The absorption and elimination of exudates, pus, etc.,take place during the period of abatement.

y It is accompanied by a gradual lowering of

temperature, pulse rate and the other symptoms offever and inflammation.


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Resolution orReconstruction

y The work of rebuilding the injured parts and organsbegins. More or less destruction has taken place in thecells and tissues, the blood vessels and organs of theareas involved.

y These must now be reconstructed, and this last stageof the inflammatory process is, therefore, in a way themost important.


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Universal precautions of inflammation

The first step in getting pain under control is to change yourdiet.

y Sugar and simple carbohydrates are known to fire upinflammation.

y Eliminate as many of these as possible.

The second step is to get an adequate amount ofsleep.

y Afull night sleep is not a luxury, it is a necessity.y Our bodies repair during sleep, and sleep deprivation has

been shown to markedly increase inflammation.y One studyshowed a fifty to sixty percent increase in pro-

inflammatorysubstances during times of inadequate sleep.


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The third step is to exercise.

y Exercise suppresses inflammation.

y Gentle walking and stretching is beneficial even to thosewith chronic conditions who otherwise have trouble beingactive.

The forth step is to control your blood sugar levels.

y Insulin is a factor in chronic inflammation.y Choose foods that are low on the glycemic index. (This is a

measurement of how quickly a food causes blood sugarspikes.)

The fifth step is to keep your weight at a healthy level.

y Excess body fat produces pro-inflammatorysubstances, aswell as putting stress on your joints.


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The last step is to consider taking supplements that areknown to reduce inflammation.

y Fatty acids from fish oil interrupt the production ofpro-inflammatorysubstances in the body.

y Other supplements to research are DHEA, vitamin Eand turmeric.All of these have anti-inflammatoryproperties.

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Inflammation & Immunity Final Final Final (7)