Immuno cardio condensed

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dtminhthu
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33651
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Immuno cardio condensed
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2010-09-11 11:18:01
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immuno cardio
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immuno cardio
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  1. direct Abs or cell mediated vasculitis
    Giant cell and kawasaki
  2. Immune complex mediated vasculitis is an example of type ___ hypersensitivity
    III
  3. Type III hypersensitivity rxn
    rxn is initiated when Ag combines w/ Ab w/in circulation --> immune complexes --> deposited in vascular endothelium or in capillary beds, such as those in skin, kidneys or lungs.
  4. C3a from complement activation via immune complexes induces
    degranulation of mast cells
  5. corticosteroids
    inhibit cytokine gene transcription --> decr maturation of monocytes and macs, decr T cell activation, decr NK cell fxn, decr expression of adhesion molecules by endothelial cells
  6. Cyclosporin
    blocks IL12, inhibits calcineurin
  7. Cyclophosphamide.
    • inhibits DNA synthesis, reduces Ag specific Ab production, & lowering of T cell numbers. Particularly useful in aggressive autoimmune
    • diseases such as Wegener’s granulomatosis and SLE vasculitis
  8. Endocarditis microbes that enter/spread via oral cavity
    Strep mutans (viridans strep), HAECK group (heamophilus, actinobacilus, cardiobacterium, eukenella, kingella)
  9. endocarditis agents that enter/spread via airway
    Strep, staph epidermis
  10. endocarditis agents that enter/spread via GI tract
    Strep, staph epidermidis, neisseria
  11. viral myocarditis
  12. IVIG in suppression autoimmune vasculitis
    • effective for kawasaki. FcRn normally recycles IgG, providing increased half life for IgG. High dose IVIG may bind up all FcRn, blocking
    • recycling of endogenous Ab (which includes the autoreactive stuff) thus lowering titers of autoreactive antibody
  13. Henoch-Schonlein Purpura:
    most common type of childhood vasculitis. Systemic disorder caused by vascular localization of immune complexes containing mostly IgA, which activates alternative complemt pathway. Thus, find more deposits of C3, than C1q and C4
  14. vasculitis involving small arteries, as well as glomerulonephritis and arthritis. also a tendency to cause ischaemic damage by plugging of small blood vessels with large #’s of inflammatory cells. Fibrinoid necrosis.
    SLE
  15. immunoglobulins which form precipitates, gels or even crystals at low temperatures. generated secondary to neoplasms of lymphoid system or during periods of prolonged immune stimulation
    Cryoglobulins
  16. characterized by presence of monoclonal Ig, usually IgM, no recognizable Ab activity. underlying malignancy (lymphoma or myeloma)

    Monoclonal=recognize same Ag, same Ag receptor. All Ab come from same clonal B cell
    Type 1 cryoglobulin
  17. mixed type in which monoclonal protein (usually IgM) attacks Fc portion of IgG (Rf activity). precipitation occurs when complexes of IgM-anti-IgG Ab are formed. Strongly assoc w/ chronic hep C, or less often w/ B cell malignancy or SLE
    Type II cryoglobulin
  18. mixed type, but contain poly- or oligoclonal IgM directed against Fc portion of IgG. Strong assoc w/ Hep C, others assoc w/ RA, SLE, PAN or other chronic infection
    Type III cryoglobulin
  19. major cause of sudden unexpected death in adults <40yr
    myocarditis
  20. Laboratory tests may show leukocytosis, an elevated sedimentation rate, eosinophilia, or an elevation in the cardiac fraction of creatine kinase. Cardiac troponin (troponin I or T) may be elevated
    myocarditis
  21. Viral causes of myocarditis
    Cox B, ECHO, influenza, HIV, and opportunistic infections
  22. parasitic causes of myocarditis
    trypanosome, toxo, and trichinella
  23. ANCAs are type ____ hypersensitivity
    II
  24. Diagnosing ANCAs
    ELISA and western blot. detect anti IgG agent.
  25. Churg strauss syndrome
    allergic/asthmatic granulomatosis. small vessel necrotizing vasculitis classically assoc w/ asthma, allergic rhinitis, lung infiltrates, peripheral hypereosinophilia, and extravascular necrotizing granulomas. high levels of IL-5 and the presence of IgE immune complexes
  26. most common world wide cause of myocarditis
    Chagas dz. Trypanosome. South and Central americas. Trasmitted by reduviids (kissing bugs).
  27. inflammation caused by an immune response to an infective agent, or to viral or bacterial superantigens. IVIG has been shown to prevent coronary aneurysm formation, lessen fever and reduce myocardial inflammation
    kawasaki
  28. vasculitis often assoc w/ granuloma formation. Presence of activated CD4 T cells in lesion, HLA class II predisposition to dz
    Giant cell/temporal arteritis.
  29. Macs produce what to promote leukocyte recruitment in atherosclerosis?
    IL-1, TNFa & chemokine, MCP-1
  30. atherosclerotic lesion contains cytokines, such as ___ and ___ that promote Th1 differentiation
    IL 12 and IL18
  31. ___ and ____ produced by activated Th1 CD4 T cells further stimulate macrophage activation and release of NO, proteases and other pro-inflammatory cytokines (IL1)
    IFNg and TNFa
  32. Picorna virus --> enterovirus. all SS RNA, linear non enveloped, + sense
    poliovirus, echovirus, coxsackie, rhinovirus, and Hep A
  33. parvovirus B19 also causes
    myocarditis. infection of endothelial cells
  34. TGF beta
    produced by endothelial cells, smooth muscle cells, and Th2/reg T cells to inhibit Th1 cell differentiation/proliferation, reduce TNFa and IFNg --> decr inflammation
  35. risk of cardiovascular dz
    Increased levels of CRP and IL-6. high mac colony stimulating factor or low TGFb-1 (poor outcome of CAD)
  36. activated macrophages and T cells produce
    IL1, TNFa, IFNg
  37. myocarditis can lead to ...
    dilated heart. IV septum shifts to the right.
  38. diagnosis method for endocarditis
    3-4 blood cultures in a 24 to 48-hour time period (each from a separate venipuncture). With at least 1-3 hours between draws
  39. Strep A characteristics
    Catalase -, coagulase -, Bacitracin sensitive, Hyaluronic capsule, M-protein, Lipoteichoic acid. Extracellular dextran, FimA mediated adherence. Enzymes (Hemolysins, Streptokinase)
  40. Causes of endocarditis
    rheumatic heart (community acquired), mitral valve prolapse (congenital), prosthetic heart valves, IV drug use (most severe, progresses rapidly, tricuspid valve)
  41. Prothetic heart valve microbes in endocarditis
    • S. epidermidis- Acute. Catalase +, coagulase -
    • S. aureus- Acute
    • Gram negative bacilli- Acute
    • C. albicans- Acute
    • Streptococci- subacute
  42. IV drug microbial causes of endocarditis
    • Staphylococcus aureus: Catalase positive, Coagulase positive. utilizes fibrinogen-binding protein to bind strongly to fibrinonectin, coagulase allows formation of fibrin clots
    • Streptococci: Extracellular dextran, FimA mediated adherence
    • Enterococcus faecalis: Gram positive cocci (clusters). Catalase negative. Alpha, beta, or gamma hemolytic. grows in 6.5% NaCl. Bind
    • fibrinogen. Cell wall lipoteichoic acid
    • pseudomonas
    • Candida albicans
  43. statins
    may interfere with transcriptional induction of MHC class II molecules, NF-kappa B function (responsible for induction of inflammatory cytokines), CRP levels, ICAM-1 levels
  44. libman sacks
    valvular endocarditis caused by lupus. immune complexes and antiphospholipid antibodies may cause endothelial damage and promote atherosclerosis
  45. antibodies directed against M proteins of certain strains of streptococci cross-react w/ glycoprotein antigens in heart, joints and other tissues
    Strep A rheumatic fever
  46. Tissue bound antibody elicits inflammatory neutrophil and macrophage response. (Type II hyp.)
    CD4+ T cells specific for streptococcal peptides react w/ self proteins in heart, and produce cytokines that activate macrophages. (Type IV hypersensitivity rxn). Responsible for formation of granulomas (Aschoff nodules)
    chance resemblance of pathogen and host antigens that leads to targeting of host tissues is called molecula mimicry.
    acute Rheumatic fever myocarditis
  47. It is proposed that CD4+ T cells responding to an as yet unidentified Ag accumulate in tissues and release cytokines that activate inflamm cells and fibroblasts.
    Evidence for inappropriate activation of humoral immunity & presence of various autoantibodies provides diagnostic and prognostic information
    Pericarditis with effusion and myocardial fibrosis, along with thickening of intramyocardial arterioles, occurs in 1/3 of pts.
    Scleroderma (systemic dz)

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