WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

CLINICAL IMMUNOLOGY

AN INTRODUCTION TO

North Coast Medical Training College

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Classification of the immune response

Body Immune System

Innate

Epithelium WBC Ab

Acquired

Active Passive

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Hypersensitivity/allergy dses

1. ANAPHYLAXIS2. URTICARIA3. HAY FEVER4. ASTHMA

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

anaphylaxis

• triggered by sensitivit to substances like penicillin,peanuts or latex rubber

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Hay fever

• Atopic/immediate hypersensitivity to to foreign poteins eg pollen mites animal dander=

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

asthma

• INHERITED IgEOutcome• Responsive imm.rxn to allergen• Outcome=inflamation of the airways• Obstraction of the airways=bronchioles• Secretion of mucous• Bronchoconstriction• Dyspenea• Wheezing

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

AUTOIMMUNE DISEASES• When the immune response fail

to recognize its own tissues1. alopecia areata2. autoimmune hemolytic

anemia3. autoimmune hepatitis4. dermatomyositis5. diabetes (type 1)6. some forms of juvenile

idiopathic arthritis7. glomerulonephritis8. Graves’ disease9. Guillain-Barré syndrome10. idiopathic thrombocytopenic

purpura

11. myasthenia gravis12. some forms of myocarditis13. multiple sclerosis14. pemphigus/pemphigoid15. pernicious anemia16. polyarteritis nodosa17 polymyositis18. primary biliary cirrhosis19. psoriasis20. rheumatoid arthritis21. scleroderma/systemic sclerosis22. Sjögren’s syndrome23. systemic lupus erythematosus24. some forms of thyroiditis25. some forms of uveitis26. vitiligo27. granulomatosis with polyangiitis

(Wegener’s)

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Rheumatoid athritis

• Ab to synovial membranes• principally attacks flexible

(synovial) joints• inflammatory r around the joints • swelling of synovial cells, • excess synovial fluid, • development of fibrous tissue in

the synovium.• destruction of articular cartilage

and ankylosis (fusion) of the joints. • RA can also produce diffuse.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Hashimoto’s dse• Ab to thyroglobulin

=hypothyroidism causing inflammation and, in most cases, eventual destruction of the gland.

• Outcome• fatigue, weight gain, pale or puffy

face, feeling cold, joint and muscle pain, constipation, dry and thinning hair, heavy menstrual flow or irregular periods, depression, a slowed heart rate, and problems getting pregnant and maintaining pregnancy.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Grave’s dse

• Ab to thyroid cells=hyperthyroidsm/goiter

• Outcome• such as increased

heartbeat, • muscle weakness, • disturbed sleep, • irritability. • causing bulging eyes

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Autoimmune haemolytic anaemia• Ab to rbcs• Outcome• Abnormal and accelerated destruction

of red cells and, in some anemias, their precursors

• Increased breakdown of hemoglobin, which may result in: increased bilirubin level (mainly indirect-reacting) with jaundice

• increased fecal and urinary urobilinogen• Hemoglobinemia, methemalbuminemia,

hemoglobinuria and hemosiderinuria

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

myasthenia

• Women• 20-40yrs• Ab bind and block

acetyl choline receptors of neuromuscular junction

• =extensive muscle weakness

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Diabetes type 1

• A condition in which the immune system destroys insulin-producing cells of the pancreas, making it impossible for the body to use glucose for energy.

• Type 1 diabetes usually occurs in children and young adults.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

vitiligo

• A disorder in which the immune system destroys pigment-making cells called melanocytes. This results in white patches of skin on different parts of the body.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Immunodeficiency

• Immunodeficiency (or immune deficiency) is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent

• Prone to infectious diseasesCAN BE • PRIMARY/inborn /congenital• Hereditary and X-LINKED

– Lymphocyte deficiency– Granulocytes deficiency

•

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

SECONDARY/acquired1. malnutrition.2. aging .3. diseases directly or indirectly cause

immunosuppression many types of cancer, particularly those of the bone marrow and blood cells

4. leukemia,5. lymphoma,6. multiple myeloma7. acquired immunodeficiency

syndrome .8. HIV directly infects a small number

of T helper cells, and also impairs other immune system responses indirectly.

• particular medications. chemotherapy,

• disease-modifying antirheumatic drugs,

• immunosuppressive drugs after organ transplants, glucocorticoids. For medications, the term immunosuppressant generally refers to both beneficial and potential adverse effects of decreasing the function of the immune system, while the term immunodeficiency generally refers solely to the adverse effect of increased risk for infection

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

IMMUNIZATION

ACTIVE

ATTENUATED/ WEAKENED

INACTIVE/KILLED

GENETICALLY

ENGINEERED

TOXOID

PASSIVE

GAMMA GLOBULIN

BOOSTERS

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Active immunization

• 1.    Active Immunization (= Immunization or Vaccination)

• a.     Active Immunization Defined - a person's own immune system is stimulated

• b.    Vaccine Defined - an agent containing antigen capable of inducing active immunity without causing disease;

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

passive

• a.     Defined - Ab's from an immune person or animal are transferred to a patient; like an Ab transfusion!

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

reflection

• Why do you think innate immunity is not sufficient enough to fight infectious diseases?• The reason above gives us the role of

adaptive immunity.• What would be the effect of defective

adaptive immunity?=suscptibility to dses.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

How is immunity induced to an individual?

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

1. By infection 2. Vaccination (active immunity)3. Transfer of ab or lymphocytes

from an actively immunized individual (passive immunity) eg?

ANSWER

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

cont

4.New borns accquire ab frm their mothers through the placenta and milk.

-shortlived before the child is active immunized.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Immunocompromised states

primary •inborn•congenital

secondary

•acquired•AIDS•CHEMOTHERAPY•IRRADITIATION

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

ASSIGNMENT FOR THE GROUPS• GROUP 1:GET IMAGES

OF IMMUNOCOMPROMISED PATIENTS

• GROUP2:GET INFORMATION ON IMMUNOCOMPROMISED CHILDREN

• GROUP3:GET INFORMATION ON IMMUNOCOMPROMISED FEMALE PATIENTS

• GROUP 4:GET INFORMATION ON IMMUNOCOMPROMISED MALE PATIENTS

ALL THE ABOVE INFORMATION SHOULD BE IN POWERPOINT AND SHALL BE PRESENTED AFTER TWO DAYS

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Compliment system

The outcome

Compliment system

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

INITIATION Compliment system1.Classical pathway =triggered by the

Ab-Ag complex

2.Alternative pathway =triggered by the microbe ie cell wall endotoxins&OTHER COMPONENTS

3.Lectin mannose pathway=TRIGERED BY MANNOSE RESIDUE ON THE MICROBES

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

OUTCOME OF THE COMPLIMENT SYSTEM

INFLAMATION

PHAGOCYTOSIS

LYSIS OF THE MICROBE

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Outcome of tissue injury

TISSUE INJURY

INFLAMATION

COMPLIMENT ACTIVATION

HYPERSENSITIVITY

INDUCED MAST CELL

prostaglandinHISTAMINE

ANAPHYLAXISVASCULAR PERMEABILITY

Vascular effect

opsinization

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Opsonization

•What do you think would be the role of opsonin?• you can imagine the stick

thing for grabbing.• Sticky thinks are easy to

grab.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

COMPLIMENT SYSTEM

• What is the immunological relevance of the compliment system

• Enhances effectiveness of innate and adaptive

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

Outcome f the compliment system

1. MAC=Lesion on the surface of the Ag2. Inflamation= histamine3. Vasodilation=vasodilators4. chemotaxis chemicals=attract neutrophils

and macrophages into the region=site of infection

5. Opsonization =cell membranes of Ag bcomes sticky easier to be done wat?

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

INTERFERON

• What are they?• When are they released

INDIVIDUAL ASSIGNMENT

DEADLINE:AFTER TWO DAYS

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

opsonin

• Substance that bind to particulate antigen and induce their phagocytosis by macrophages and neutrophils

Substances1) Opsonising antibodies2) Compliment proteins

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

• STORY TIME• Once upon a time, there was no malaria in

Manda Island• Every inhabitant lived and slept comfortably

with little or minimal covering• The main inhabitant were fishermen• Then one day Abdul,a villager of Manda island

decided to visit the mainland.• That day it the waves were so strong and he

couldn’t return back.

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

• So he slept on his boat till morning• On waking up his whole body was itching and

some flying insect were biting him• When the sea had calmed he went back to his

home• After some days he fell sick• Luckly for him he recovered• After some weeks more bizarr insect kept biting

the community

WALTER WAKHUNU WASWA,BSC.MLS,MSC.MED.EDU.

• People died of this mysterious disease especially the children and pregnant women and the elderly

• After three years the no of peaple dying of the mysterious disease rapidly dwindle

• Why?