Primary Immunodeficiencies Overview Quiz
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Questions and Answers

What is a common symptom of primary immunodeficiencies typically seen in infants?

  • Recurrent infections (correct)
  • Persistent cough
  • High fever
  • Skin rashes

Which of the following best describes the classification of primary immunodeficiencies affecting T lymphocytes?

  • Cell Mediated Immunity (CMI) defects (correct)
  • B lymphocyte defects
  • Phagocyte dysfunction
  • Combined B and T cell defects

Which of the following is NOT a hallmark of primary immune deficiencies?

  • High body temperature (correct)
  • Frequent medical intervention
  • Symptoms starting in childhood
  • Developmental delay

What is the risk associated with stem cell transplantation in the treatment of immunodeficiencies?

<p>Rejection of transplant (D)</p> Signup and view all the answers

What type of infections are commonly seen in patients with Chronic Granulomatous Disease?

<p>Fungal infections (D)</p> Signup and view all the answers

Which of the following is a primary consideration when deciding on immunodeficiency treatments?

<p>Risk: Benefit ratio (C)</p> Signup and view all the answers

How does severe primary immunodeficiency typically affect a child's growth?

<p>Failure to thrive (D)</p> Signup and view all the answers

Which of the following is not a type of primary immunodeficiency as classified by WHO?

<p>Autoimmune disorders (B)</p> Signup and view all the answers

What is a common symptom presented by patients with complement deficiencies?

<p>Developmental delay (D)</p> Signup and view all the answers

Which of the following is associated with X-linked agammaglobulinaemia (XLA)?

<p>Bruton’s Tyrosine Kinase deficiency (A)</p> Signup and view all the answers

What are typical clinical features of Di George Syndrome?

<p>Facial abnormalities and cardiac defects (A)</p> Signup and view all the answers

In patients with severe combined immunodeficiencies (SCID), what is a common outcome if left untreated?

<p>Mortality within the first year of life (D)</p> Signup and view all the answers

What laboratory finding is expected in Di George Syndrome?

<p>Minimal or no thymus on ultrasound (D)</p> Signup and view all the answers

What is an appropriate treatment for managing infections in patients with complement deficiencies?

<p>Prophylactic antibiotic cover (A)</p> Signup and view all the answers

In XLA, what happens to the immune system?

<p>Decreased levels of circulating B cells (A)</p> Signup and view all the answers

What does the 'CATCH 22' mnemonic refer to in Di George Syndrome?

<p>Cardiac abnormalities, antibody deficiencies, T cell deficit, hypocalcemia, 22q11 deletion (A)</p> Signup and view all the answers

What is the primary difference between HIV-1 and HIV-2?

<p>HIV-1 is the global common infection, while HIV-2 is mainly found in W Africa. (D)</p> Signup and view all the answers

Which cells are primarily targeted by HIV for infection?

<p>T cells, macrophages, and dendritic cells. (C)</p> Signup and view all the answers

What is the estimated number of people infected with HIV worldwide by the end of 2023?

<p>39.9 million. (A)</p> Signup and view all the answers

What is the primary mode of HIV transmission globally?

<p>Sexual intercourse. (D)</p> Signup and view all the answers

During which phase of HIV infection does seroconversion typically occur?

<p>Acute phase. (C)</p> Signup and view all the answers

Which of the following proteins is involved in binding HIV to host cells?

<p>Gp41. (C)</p> Signup and view all the answers

What type of virus is HIV classified as?

<p>Single-stranded diploid RNA retrovirus. (D)</p> Signup and view all the answers

What is the main purpose of antiretroviral therapy for individuals with HIV?

<p>To reduce viral load and improve quality of life. (D)</p> Signup and view all the answers

What is the mean duration of the asymptomatic phase of HIV infection?

<p>10 years (D)</p> Signup and view all the answers

Which of the following symptoms is NOT characteristic of the symptomatic phase of HIV?

<p>Weight gain (D)</p> Signup and view all the answers

During which phase of HIV infection does a significant loss of memory CD4+ cells occur?

<p>Acute infection phase (D)</p> Signup and view all the answers

What is a common mechanism by which HIV initially attaches to cells?

<p>Attachment to dendritic cells (A)</p> Signup and view all the answers

What happens to the viral phenotype in approximately 50% of late-stage HIV infection cases?

<p>It switches from R5 to X4 (D)</p> Signup and view all the answers

Why is constant monitoring necessary for drug treatments of HIV?

<p>To prevent viral mutations (A)</p> Signup and view all the answers

What immune response is primarily attempted during the chronic phase of HIV infection?

<p>Recovery of CD4+ T cells (B)</p> Signup and view all the answers

What is a common result of mutations in HIV’s immunogenic epitopes?

<p>Formation of escape mutants (A)</p> Signup and view all the answers

What role does glycosylation play in the context of HIV?

<p>It occludes epitopes on gp120 and gp41. (A)</p> Signup and view all the answers

How do CCR5-Δ32 mutations affect susceptibility to HIV?

<p>Homozygotes are resistant to HIV infection. (A)</p> Signup and view all the answers

What is the effect of mutations in viral protease and Tat on HIV fitness?

<p>They can lead to loss of viral fitness. (C)</p> Signup and view all the answers

Which HLA-B alleles are associated with delayed progression to AIDS?

<p>HLA-B<em>57 and HLA-B</em>27 (C)</p> Signup and view all the answers

What key treatment strategy is referred to as HAART?

<p>A highly active antiretroviral therapy. (D)</p> Signup and view all the answers

What was one unique outcome for Timothy Ray Brown following his stem cell transplant?

<p>He was cured of HIV. (D)</p> Signup and view all the answers

What impact do escape mutants have during HIV infection?

<p>They can avoid presentation by MHC class I. (B)</p> Signup and view all the answers

What happens to HIV replication in resting T cells?

<p>It does not replicate. (A)</p> Signup and view all the answers

Flashcards

Primary Immunodeficiency

A group of disorders where the immune system is weakened due to genetic defects, present from birth, often manifesting in early childhood with frequent infections.

Phagocyte Dysfunction

A classification of primary immunodeficiency that involves problems with phagocytes, the cells that engulf and destroy pathogens.

Chronic Granulomatous Disease (CGD)

A rare genetic disorder characterized by impaired phagocytes, leading to recurrent infections, especially with fungal organisms like Aspergillus.

Complement Abnormalities and Deficiencies

A classification of primary immunodeficiency that involves issues with the complement system, a group of proteins essential for immune responses.

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B Lymphocyte (Humoral) Defects and Deficiencies

A classification of primary immunodeficiency that involves defects in B lymphocytes, the cells responsible for producing antibodies.

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T Lymphocyte Cell Mediated Immunity (CMI) Defects and Deficiencies

A classification of primary immunodeficiency that involves problems with T lymphocytes, the cells responsible for cell-mediated immunity.

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Combined B and T Cell Defects and Deficiencies

A classification of primary immunodeficiency where both B and T cell functions are impaired.

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Stem Cell Transplantation

A treatment option for primary immunodeficiency, involving the replacement of defective cells with healthy stem cells.

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Primary Immunodeficiency Diseases

A group of genetic disorders that affect the body's ability to fight infections. They are classified based on the specific component of the immune system affected.

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Complement Deficiencies

Patients with this condition present with recurrent infections, failure to thrive, developmental delay, and may have severe bacterial infections. The onset of symptoms starts early in life.

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X-linked Agammaglobulinaemia (XLA)

A genetic disorder that affects the development of B cells, resulting in a deficiency of antibodies. It is an X-linked recessive disorder, meaning that males are more likely to be affected.

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DiGeorge Syndrome

A rare genetic disorder that affects the development of the thymus, leading to a deficiency of T cells. This results in a weakened immune system and an increased risk of infections.

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Severe Combined Immunodeficiency (SCID)

A group of severe disorders that affect both T and B cells, resulting in a severely weakened immune system. These patients are highly susceptible to infections and often require bone marrow transplantation for treatment.

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Prophylactic Antibiotic Cover

A treatment approach that involves the use of antibiotics to prevent infections in individuals with primary immunodeficiency.

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Properdin Deficiency

A rare inherited condition that affects the complement system. It is associated with certain bacterial infections, particularly Neisseria meningitidis.

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ADA SCID

A specific type of SCID caused by a deficiency in the enzyme adenosine deaminase (ADA). This deficiency affects the development and function of T cells and B cells.

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Secondary Immunodeficiency

A type of immunodeficiency that develops after birth due to various factors, such as infections, medications, or malnutrition.

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Immunomodulatory Drugs

A group of drugs used to modify the immune system's response, either to suppress it (e.g., in autoimmune diseases) or to enhance it (e.g., in organ transplantation).

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HIV Progression to AIDS

The process by which HIV infection progresses over time, eventually leading to AIDS. It involves stages of viral replication, immune system decline, and opportunistic infections.

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HIV (Human Immunodeficiency Virus)

A type of virus that primarily targets the immune system's CD4+ T cells, which are crucial for fighting infections. This weakens the immune system and makes the body vulnerable to opportunistic infections.

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HIV-2

A type of HIV that is found predominantly in West Africa.

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HIV Entry into Cells

The process by which HIV enters a cell by binding to its CD4 receptor and a co-receptor (CCR5 or CXCR4), leading to the fusion of the viral envelope with the cell membrane and the entry of the viral genome.

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Reverse Transcriptase (RT) in HIV

The enzyme encoded by the HIV virus that transcribes its RNA genome into DNA. This is a critical step in the viral replication cycle.

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Integrase in HIV

The enzyme encoded by the HIV virus that integrates the newly synthesized DNA into the host cell's genome, allowing the viral genes to be expressed and produce new viral particles.

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HIV gp120 Variable Loop Mutations

HIV mutations in variable loops of gp120 protein can escape antibody recognition without compromising viral fitness.

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HIV Epitope Obstruction

HIV can evade immune responses by blocking antibody access to epitopes by using different strategies like glycosylation, extending variable loops, oligomerization, and steric hindrance.

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Nef Downregulation of MHC Class I

HIV Nef protein downregulates MHC class I expression on infected cells, making them invisible to cytotoxic T lymphocytes (CTLs).

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HIV Internal Protein Mutations

HIV mutations in internal proteins like Tat and protease can lead to resistance to CTL response and may potentially reduce viral fitness.

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HIV Latency in Resting T Cells

HIV can establish a latent state in resting T cells, where it does not replicate, allowing it to evade immune clearance.

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CCR5-Δ32 Mutations

Mutations in the CCR5 gene can confer resistance or delay the progression of HIV infection. A truncated CCR5 receptor prevents the virus from entering the cell.

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The Berlin Patient

The Berlin patient received a bone marrow transplant from a donor with a mutated CCR5 gene, which resulted in the removal of HIV from his body.

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HAART for HIV Treatment

HAART (highly active antiretroviral therapy) is a combination of antiviral drugs that can effectively control HIV infection, delaying or preventing progression to AIDS.

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Asymptomatic phase of HIV

The period during which HIV infection is present but no symptoms are experienced. It can last for years and is characterized by a low level of virus in the body.

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Symptomatic phase of HIV

The period during which HIV infection causes noticeable symptoms, such as fever, weight loss, and skin infections. Immune function is weakened during this stage.

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AIDS (Acquired Immunodeficiency Syndrome)

The final stage of HIV infection, where the immune system is severely compromised. This is characterized by opportunistic infections, cancers, and a high risk of death.

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Early Immune Cell Loss in HIV

A large, rapid loss of immune cells (specifically CD4+ T cells) in the gut-associated lymphoid tissue (MALT) during the initial phase of HIV infection.

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R5 Virus

A specific type of HIV that primarily targets cells expressing the CCR5 receptor, found on the surface of some immune cells (like T cells and macrophages). This is the most common type of HIV.

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X4 Virus

A specific type of HIV that targets cells expressing both CCR5 and CXCR4 receptors. This type of HIV is often associated with faster progression to AIDS.

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Highly Active Antiretroviral Therapy (HAART)

A complex combination of antiretroviral drugs used to suppress HIV replication and manage HIV infection. It can improve quality of life and slow the progression to AIDS.

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HIV's Ability to Evade Immune Response

The ability of HIV to escape immune surveillance and continue to replicate in the body, despite immune responses. This is due to the high mutation rate of HIV.

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Study Notes

Immunodeficiency Overview

  • Immunodeficiency encompasses conditions where the immune system is weakened, making individuals susceptible to infections.
  • Two main types exist: primary (inherited) and secondary (acquired).
  • Primary immunodeficiencies manifest at birth or early childhood, usually stemming from genetic defects impacting immune cell development or function.
  • Secondary immunodeficiencies arise later in life, often due to underlying diseases like HIV/AIDS, malnutrition, or certain medications.

Learning Objectives

  • The videos cover examples of primary and secondary immunodeficiencies, their underlying causes, and manifestations.
  • Basic detection, monitoring, and treatment strategies/plans for these conditions are also addressed.
  • By the video's end, students should be able to detail the causes of both primary and secondary immunodeficiencies and how these lead to immune dysfunction.
  • Laboratory investigation methods used in diagnosing and monitoring the conditions are also to be understood.

Primary Immunodeficiency

  • Classification is based on the specific immune components affected: phagocytes, complement, B lymphocytes (humoral immunity), T lymphocytes (cell-mediated immunity), and combined B and T cell defects.
  • Primary immunodeficiencies are often characterized by frequent and prolonged infections, presenting in early childhood usually within 1-2 months of birth.
  • They are also associated with developmental delay (DD) or failure to thrive (FTT) and require medical interventions.

Primary Immunodeficiencies - Specific Conditions

  • Phagocyte dysfunction (Chronic Granulomatous Disease):
  • Early-onset recurrent infections, particularly fungal.
  • Normal antibody and complement responses, but impaired phagocyte function.
  • Dysfunction in genes for oxidative burst.
  • Complement abnormalities (Complement Deficiencies):
  • Characterized by recurrent infections.
  • Often results in increased susceptibility to severe bacterial infections and developmental delay.
  • B lymphocyte defects (XLA):
  • X-linked agammaglobulinemia; deficiency of Bruton's tyrosine kinase.
  • Characterized by a decrease in B cells and gamma globulin.
  • Patients prone to recurrent bacterial infections and often diagnosed in childhood.
  • T lymphocyte cell-mediated immunity (CMI) defects (DiGeorge Syndrome):
  • Recurrent serious viral, bacterial, and fungal infections, including failure to thrive and developmental delay.
  • Associated with impaired T cell function and anatomical abnormalities, including cardiac issues.
  • Often diagnosed by the absence or underdevelopment of the thymus.
  • Combined B and T cell deficiencies (SCID):
  • Severe combined immunodeficiency; marked immune deficiency impacting both B and T cells.
  • Characterized by severe recurrent infections and failure to thrive.
  • This often necessitates a stem-cell transplant for a cure.

Treatments

  • Stem cell transplantation: Replaces faulty immune cells with healthy ones.
  • Risk and benefit ratio—critical to understanding the choice of therapy.

Secondary Immunodeficiency

  • Causes of secondary immunodeficiency: Immunosuppressive drugs, malnutrition, HIV, and various health conditions.
  • HIV (Human Immunodeficiency Virus):
  • Characterized by gradual destruction of CD4+ T cells.
  • Leads to progression from acute (initial) infection, through an asymptomatic phase, and eventually to AIDS (Acquired Immunodeficiency Syndrome).

HIV Infection Timeline

  • Includes stages of acute infection (flu-like), asymptomatic, symptomatic (non-specific symptoms), and finally progressing to AIDS.
  • CD4+ T-cell count decrease correlates with the progression of disease.
  • The initial infection usually establishes in genital/anal mucosa and moves to lymphoid tissues and cells for viral replication.

HIV Genes & Replication

  • HIV's genetic material, RNA is converted into DNA by reverse transcriptase.
  • The newly created DNA integrates into the host cell's DNA, creating a provirus leading to continuous HIV replication.
  • HIV primarily targets Helper T cells (CD4+ T-cells) and, macrophages, and dendritic cells.
  • Viral proteins such as gp120, gp41 and others allow entry, fusion in the host cell and replication.

HIV Treatment (HAART)

  • HAART (Highly Active Antiretroviral Therapy) aims to reduce viral load and protect CD4 counts, often with mixed success due to drug resistant mutants.
  • Antivirals can target specific stages of HIV replication such as entry, replication and budding.

Summary

  • The presentation covers primary immunodeficiencies (inherited).
  • Also includes details regarding secondary immunodeficiencies like HIV and the pathogenesis and treatment (HAART).
  • Various factors that can affect the immune response to infections and the progression to immunodeficiency disorders like HIV are discussed.

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Test your knowledge on primary immunodeficiencies, including their symptoms, classifications, and treatment options. This quiz covers essential concepts relevant to immunodeficiency disorders as they occur in infants and children. Brush up on key details to better understand immunology in clinical practice.

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