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Chapter 14 Immunology Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Immunity Is the body’s ability to resist disease Serves three functions Defense Homeostasis Surveillance Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Types of Immunity Innate Present at birth First-line defense against pathogens Acquired Developed immunity Active Passive Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Vaccines Active immunity occurs either naturally or through vaccine administration. Live or attenuated Killed or inactivated toxins Human immune globulin Animal serum or antitoxins Under-served children may not receive vaccines. 5Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.
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Normal Immune Response Antigens Substances the body recognizes as foreign that elicit an immune response Most are composed of protein. Antibodies Immune globulins produced by lymphocytes in response to antigens Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Organs of Immunity Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Lymphoid Organs Central (primary) lymphoid organs Thymus gland Thymus gland shrinks with age. Involved in the differentiation and maturation of T lymphocytes Bone marrow Produces red blood cells, white blood cells, and platelets Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Lymphoid Organs Peripheral lymphoid organs Lymph nodes Tonsils Spleen Lymphoid tissues associated with the gut, genitals, bronchi, and skin Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune System Cells of Immune Response Mononuclear phagocytes Include monocytes in the blood and macrophages found throughout the body Capture, process, and present antigens to lymphocytes to initiate an immune response Capture antigens by phagocytosis Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune System Cells of Immune Response Lymphocytes Produced in the bone marrow Eventually migrate to peripheral organs Differentiate into B and T lymphocytes T Cytotoxic cells T Helper cells Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Types of Lymphocytes Copyright © 2014 by Mosby, an imprint of Elsevier Inc. T cells70%–80% B cells10%–20% Natural killer (NK) cells<10%
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Normal Immune Response Cytokine types Interleukins Interferons Tumor necrosis factor Colony-stimulating factors Erythropoietin Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Cytokines Tumor necrosis factor (TNF) Activates macrophages and granulocytes Promotes the immune and inflammatory responses Kills tumor cells Responsible for extensive weight loss Associated with chronic inflammation and cancer Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Comparison of Humoral and Cell-Mediated Immunity HumoralCellular Cells involved B lymphocytes T lymphocytes T lymphocytes Macrophages Macrophages ProductsAntibodies Sensitized T cells Sensitized T cells Cytokines Cytokines Memory cells Present Present Present 15
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Normal Immune Response Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Comparison of Humoral and Cell-Mediated Immunity HumoralCellular Protection BacteriaBacteria Viruses (extracellular)Viruses (extracellular) Respiratory pathogensRespiratory pathogens Gastrointestinal pathogensGastrointestinal pathogens FungusFungus Viruses (intracellular)Viruses (intracellular) Chronic infectious agentsChronic infectious agents Tumor cellsTumor cells 16
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Normal Immune Response Humoral Immunity Antibody-mediated immunity Antibodies produced by plasma cells (differentiated B lymphocytes) Primary immune response is evident 4 to 8 days after initial exposure to antigen. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Humoral Immunity Five classes of immune globulins Each has specific characteristics IgG lgA lgM lgD lgE Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Humoral Immunity When an individual is exposed to an antigen for a second time, the response is faster (1 to 3 days) and lasts longer. Main product of secondary response is IgG rather than IgM. Memory cells account for more rapid production of IgG. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Primary and Secondary Immune Response Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Cell-Mediated Immunity Immune responses initiated through specific antigen recognition by T cells Several cell types involved in cell- mediated immunity T lymphocytes Macrophages NK cells Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Normal Immune Response Cell-Mediated Immunity Important roles Immunity against pathogens that survive inside cells (viruses, some bacteria) Fungal infections Rejection of transplanted tissues Contact hypersensitivity reactions Tumor immunity Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Effects of Aging on the Immune System Immunosenescence ↑ Incidences of tumors Greater susceptibility to infection ↑ Autoantibodies ↓ Cell-mediated immunity Thymic involution Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infections Localized – limited to a small area Disseminated- spreads beyond site of infection Systemis- spread throughout the body (sepsis) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infections Bacterial E Coli, normal in intestine only Virus Influenza Fungal Similar to plants, think mushrooms Candida Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infections Emerging infections- infectious diseases that have recently increased or threatens to increase in near future. HIV Ebola Lyme Herpes types 6 & 8 Hanta Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infections Reemerging infections- infections once thought gone but now reemerging Diptheria Pertussis (whooping cough) TB Plague Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Antibiotic Resistant Organisms Methicillin Resistant Staphylococcus Aureus (MRSA) Vancomycin Resistant Enterococcus (VRE, more virulent than MRSA) Streptococcus Pneumonia Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Antibiotic Resistant Organisms HCP have contributed to this Antbx for viral infections Prescribing pts antbx for unnecessary reasons Inadequate drug regimens ( 7 vs 10-14 days) Using broad spectrum antbx instead of 1 st line antbx Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Antibiotic Resistant Organisms Pts contribute to this by: Skipping doses Not taking antbx for full duration of therapy Saving unused antbx for “later, just in case” Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infection Prevention OSHA – Occupational Safety & Health Administration is a federal agency that protects workers from injury or illness in places of employment Employee MUST be provided with appropriate PPE and safety equipment Ebola THR 2014 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Infection Prevention HAI- Healthcare Associated Infections (Nosocomial infections) Risks to pts- Actions to reduce these risks? PPE and HANDWASHING, foam, sanitizer Most susceptible are hospitalized pts and immunosupressed Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Precautions Standard or universal – for all pts Isolation: Airborne- infection suspended in air Droplet- through air or respiratory system Contact- through direct and indirect contact Boxes, carts and signs on door for how to dress before entering pt room Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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