Immune Deficiency Disorders - NCM 112 - 2024-2025

LESSON 3: IMMUNE DEFICIENCY DISORDERS NCM 112 IMMUNOLOGY | FIRST SEMESTER | ACADEMIC YEAR 2024-2025 | PROF. MARLO N.BOBIER, RM, RN, MAN...

LESSON 3: IMMUNE DEFICIENCY DISORDERS NCM 112 IMMUNOLOGY | FIRST SEMESTER | ACADEMIC YEAR 2024-2025 | PROF. MARLO N.BOBIER, RM, RN, MAN Sharing of infected injection drug use equipment IMMUNODEFICIENCIES Sexual relations with infected individuals Deficiencies in the proper expression of the Infant born to mothers with HIV infection and/or immune response system who are breast fed by HIV infected mothers It is classified into two types: People who received organ transplants, HIV-infected blood, or blood products ○ Primary Immunodeficiencies ○ Secondary Immunodeficiencies HIV LIFE CYCLE PRIMARY IMMUNODEFICIENCIES Deficiencies resulting from the improper development of the immunosuppressive cells and tissues Mainly genetic disorders seen in children ○ Example: T-Cell Deficiency: Di-Goerge’s Syndrome ( Thymic Hypoplasia) ○ Absence of thymus in the neonate SECONDARY IMMUNODEFICIENCIES Any condition that can interfere with the normal growth or expression of the immune response system ○ Ex: HIV/AIDS HUMAN IMMUNODEFICIENCY VIRUS (HIV) Weakening of the body’s immune system from opportunistic infections due to an infection that attacks the body’s immune system, specifically the Stages of the HIV lifecycle CD4 cells. 1. HIV attaches to the surface of a CD4 cell. 2. HIV proteins and enzymes are released into HIV TRANSMISSION the cell. BODY FLUIDS 3. Reverse transcription produces a double ○ Blood strand HIV. ○ Seminal Fluid 4. Integrase enables HIV to link into the cell's ○ Vaginal Secretions DNA. ○ Amniotic Fluid 5. Protease cuts and reassembles new HIV. ○ Breastmilk 6. Each cell produces hundreds of new virions. HIGH RISKS FOR HIV HIV LIFE CYCLE NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 1  Attachment ○ Glycoproteins (GP120 and GP41) of HIV bind with the host’s uninfected CD4+ receptor and chemokine coreceptors (CCR5) resulting in fusion of HIV with CD4+ T Cell membrane Uncoating ○ HIV’s viral core = two single strands of viral RNA + three viral enzymes: reverse transcriptase, integrase, and protease are emptied into the CD4+ T Cell membrane DNA Synthesis ○ Through reverse transcriptase, HIV changes its genetic material from RNA to DNA resulting in double stranded DNA that carries STAGES OF HIV DISEASE instruction for viral replication Integration Acute HIV CD4+ T cells = 2500/μL ○ Through action of integrase, the new viral Infection or Window period - an DNA enters the nucleus of the CD4+ T cell is Primary infected person initially blended with the DNA of the CD4+ T cell Infection tests negative an HIV resulting in permanent, lifelong infection antibody blood test Transcription Widespread dissemination ○ CD4+ T cell is activated and the and high levels of viral double-stranded DNA forms singe-stranded replication Symptoms (but not limited messenger RNA (mRNA) and builds new to): fever, viruses lymphadenopathy, Translation pharyngitis, skin rash ○ New chains of new proteins and enzymes myalgias, and arthralgias (polyproteins) created by mRNA contain the components needed in the construction of Symptomatic CD4+ T cells = 2200-499/μL new viruses HIV Infection HIV infection or a defect in cellular immunity Cleavage Symptoms (but not limited ○ The polyprotein chain is cut by the HIV to): Candidiasis, Idiopathic enzyme resulting into individual proteins that thrombocytopenic purpura, make up the new virus Peripheral neuropathy, fever Budding (38.5C) or diarrhea ○ The viral RNA and new proteins migrate to exceeding 1 month in duration the membrane of the infected CD4+ T cell, exit from the cell and restart the process. AIDS (Acquired CD4+ T cells = 2200/μL Immunodeficie Symptoms (but not limited PATHOPHYSIOLOGY ncy Syndrome) to): Wasting syndrome, Kaposi's sarcoma, Pneumocystis jiroveci pneumonia, Taxoplasmosis of brain, Mycobacterium tuberculosis NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 2  leukoencep CLINICAL MANIFESTATIONS OF HIV halopathy Integument Rashes, skin Herpes SYSTEM MANIFESTAT ASSOCIATED ary discoloration zoster and IONS DISEASES s herpes simplex Respiratory Shortness of Pneumocyst Molluscum breath, is contagiosu dyspnea, Pneumonia m cough, chest (most Seborrheic pain, and common dermatitis fever infection) Eczema or Mycobacteri Psoriasis um avium Complex Gynecologic Persistent, Ulcerative Tuberculosis recurrent sexually vaginal transmitted Gastrointest Loss of Oral candidiasis diseases inal appetite, candidiasis (STDs are nausea, Wasting more severe vomiting, syndrome in women oral and with HIV) esophageal candidiasis, and chronic DIAGNOSTIC TESTS diarrhea causing profound 1. CIA/ELISA weight loss Antibodies are detected, resulting in positive results, and marking the end of the window Oncologic Flat or Kaposi’s period raised, sarcoma brownish (most pink to deep common purple skin HIV-related discoloration malignancy) s, B-Cell lymphedema Lymphomas , pain Cervical carcinoma Neurologic Motor Peripheral dysfunction neuropathy and HIV behavioral encephalop change athy 2. WESTERN BLOT Cryptococcu s Also detects antibodies to HIV; used to confirm neoformans EIA Progressive multifocal NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 3  4. OraQuick In-home HIV Self Test Works by looking body’s responses (antibodies) to fighting the HIV Virus + result is preliminary and ff up confirmatory test is needed 3. VIRAL LOAD Measures HIV RNA in the plasma TREATMENT HAART (Highly Active Antiretroviral Therapy) 4. CD4/CD8 For reduction in replication of HIV and reductions in morbidity and mortality also a rise in CD4+ T These are markers found on lymphocytes. HIV kills Cell count CD4+ cells, which results in a significantly Reduce the viral load impaired immune system NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 4  HIV PREVENTION (ABCDEP) NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 5  IMPLEMENTATION AMONG HEALTH CAREGIVERS The syndrome is manifested clinically by opportunistic infections and unusual neoplasms Boiling equipment (20 minutes) Dishwashing (hot water, air drying) The disease has long incubation period, sometimes up to 10 years or more Laundry (use bleach) Do not share razors, toothbrush. These are contaminated with body secretions TRANSMISSION OF THE DISEASE Sexual exposure to genital secretions of an IMPLEMENTATION AMONG CLIENTS infected person Client education and counseling. Parenteral exposure to infected blood and tissue ○ Disease transmission: blood and body fluids Perinatal exposure of an infant to infected maternal secretions through birth or ○ Advice client to practice safe sex as follows: 🠂 Abstinence breastfeeding 🠂 Mutual, monogamous sexual relationship 🠂 Avoid multiple partners 🠂 Use of soluble lubricants and condoms Prevention of Infections Promote ○ Self-care ○ Safety HIGH RISK GROUPS FOR AIDS Provide psychosocial care. Male homosexuals or bisexuals ○ Pharmacotherapy: AZT (Retrovir/Zidovudine) Intravenous drug abusers 🠂 Slows progress of opportunistic Persons receiving blood transfusions infections and dementia ○ E.g. hemophiliacs, those with Thalassemia, ○ Side effects hemodialysis, and surgical clients 🠂 Malaise Frequent exposure to blood and body fluids 🠂 Nausea Heterosexual contact with high-risk individuals 🠂 Headache Babies born to infected mothers 🠂 Fever 🠂 Insomnia CLINICAL MANIFESTATIONS OF AIDS 🠂 Myalgia Malaise, weight loss ○ Toxic effects Lymphadenopathy for at least 3 months 🠂 Bone Marrow Suppression (serum level determination should be done at regular basis); weekly CBC should be monitored Precaution ○ Avoid pregnancy ○ Do not donate blood, sperm, organs ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) A disorder caused by the human ○ immunodeficiency virus (HIV) Leukopenia It is characterized by generalized dysfunction of Diarrhea the immune system Fatigue Night Sweats NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 6  Presence of opportunistic infections Pneumocystis jirovecii pneumonia ○ Kaposi’s sarcoma ○ DIAGNOSTIC TESTS 1. Enzyme-linked immunosorbent assay (ELISA) → It determines the response of antibodies to the HIV virus 2. Western Blot → It confirms the presence of HIV antibodies 3. p24 antigen ○ → Two or more positive results are diagnostic Fungal infections for HIV infection Candidiasis 4. CD4+ ○ → It is used to assess immune system status, Cytomegalovirus risk for disease progression → Adults normally have 800 to 1,200 CD4+ T cells per microliter of blood. The normal lifespan of CD4+ T cells is about 100 days, but HIV-infected CD4+ T cells will die after an average of 2 days → A decline in CD4+ T cells count leads to impaired immune function NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 7  MEDICATION FOR HIV AND AIDS NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS Ziagen (Abacavir), Videx (Didanosine), Epivir (Lamivudine), Ritrovir, AZT (Zidovudine) ○ Can cause nausea, vomiting, diarrhea Didanosine, Stavudine, Zalcitabine (HIVID) ○ Can cause neuropathy, hepatoxicity, and pancreatitis ANTIVIRAL MEDICATIONS DIAGNOSTIC CRITERIA FOR AIDS Cytovene (Ganciclovir) AIDS is diagnosed when an individual with HIV ○ Used to treat cytomegalovirus retinitis. It infection develops at least one of these conditions: causes bone marrow depression. CD4+ T cells count drops below 200 Zovirax (Acyclovir) cells/microliter ○ Used to treat herpes simplex, herpes zoster Development of one of the following or varicella zoster. opportunistic infections: fungal, viral, ○ It is nephrotoxic protozoal or bacterial Foscavir (Metronidazole) Development of one of the following ○ Used to treat cytomegalovirus retinitis. opportunistic cancers: ○ It is nephrotoxic. ○ Invasive Cervical Cancer ○ Kaposi’s sarcoma (KS) ANTI-INFECTIVE MEDICATIONS ○ Burkitt’s lymphoma Pentam 300 (Pentamidine) ○ Immunoblastic lymphoma ○ Used to treat pneumocystis carinii ○ Primary lymphoma of the brain pneumonia. Wasting syndrome occurs. ○ It is nephrotoxic, hepatotoxic, and ○ Wasting is defined as a loss of 10% or immunosuppressive. more ideal body mass ○ It may cause hypotension and hypoglycemia AIDS dementia complex (ADC) can also be Flagyl (Metronidazole) developed ○ Used to treat cryptosporidiosis and giardiasis ○ Avoid alcohol during treatment to prevent INTERPROFESSIONAL COLLABORATIVE disulfiram-like manifestations MANAGEMENT FOR PATIENTS WITH AIDS Implement standard precautions ANTIFUNGAL MEDICATIONS Promote respiratory function Nizoral (Ketoconazole) Provide adequate nutritional support ○ Used to trat candidiasis, coccidiodomycosis Maintain fluid and electrolyte balance or histoplasmosis Promote comfort ○ It is hepatotoxic and may cause Monitor for signs of infection photosensitivity ○ Avoid alcohol during treatment to prevent Best practice: Proper handwashing when caring for liver damage clients with HIV infection and AIDS Diflucan (Fluconazole) NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 8  ○ Used to treat candidiasis ○ It is hepatotoxic Fungizone (Amphotericin B) ○ Used to treat candidiasis and other fungal infections ○ It is nephrotoxic, can cause thrombophlebitis and bone marrow depression PROTEASE INHIBITORS Agenerase (Amprenavir) ○ It is nephrotoxic Crixivan (Indinavir) ○ It causes hyperbilirubinemia, nephritis, and kidney stones Kaletra (Lopinavir and Ritonavir) ○ It is hepatotoxic Viracept (Nelfinavir) ○ It can cause nausea, flatulence, and diarrhea Norvir (Ritonavir) ○ It is hepatotoxic and increases triglyceride levels NCM 112: MEDICAL SURGERY LESSON 3 | TRANSCRIBED BY: TOSHILA MAE C. CARGULLO | BSN-3A 9