The immune response differs from inflammation in that it has the capacity to
remember and respond more quickly to a foreign substance that enters the second (and subsequent) times
Antigens are ______ and are mainly ______
- the foreign substances that the immune system defends against.
- proteins and are often bacteria and their toxins (for example LPS).
What are the cells involved in the immune response
- –B lymphocytes (plasma cells)
- –T lymphocytes
- –Natural killer cells (NK cells)
______ are the primary WBC involved in the immune response and are derived from the _______. The three main types are
- stem cell in the bone marrow.
- T-cells and B-cells and the natural killer (NK) cell
After developing in the bone marrow, B lymphocytes mature and live in the
What are the two types of B lymphocytes and what are they responsible for
One is the plasma cell, which is responsible for producing the specific antibody needed to fight the specific antigen
The other type of lymphocyte is the B memory cell, which is able to retain the memory of previously encountered antigens. All newly formed B memory cells are able to remember this specific antigen and produce antibodies to it rapidly. This is known as clonal selection.
________ + Antigen= Antibody
Plasma cells produce proteins called _______, also known as ________.
- immunoglobulins (Ig)
What are the 5 different types of antibodies produced and what are the specific antigens
- IgG (blood serum, passes through placental barrier to help with passive immunity for the newborn)
- IgM (activates B lymphocytes, complement)
- IgE (hypersensitivity and allergic reactions)
- IgA (blood and saliva, mucosa)
- IgD (Activates B lymphocytes)
T lymphocytes develop in the bone marrow and then travel to the _______, where they mature.
What are the different T-cells and their function
- T memory cells
- T-helper cells also known as, T4 or CD4 cells
- T-suppressor (T8) cells act to turn off or suppress immune cells
- T-cytotoxic cells are able to recognize and destroy virus or tumor cells. They are also responsible for rejection of grafts by directly attacking and killing the foreign cells
What are the roles of T4 Lymphocytes
- –Activate macrophages and NK cells
- –Produce cytokines (lymphokines) that enable B-lymphocytes to rapidly proliferate, differentiate into effector cells, and produce different classes of antibodies
- –Produce cytokines (lymphokines) that enable T-lymphocytes to rapidly proliferate and differentiate into effector cells
Macrophages are known as ________ cells
Major divisions of the immune response include the
Humoral response and the Cell-mediated response
Humoral response involves the production of _______ mediated by ________
Cell-mediated response involves the production of ________ in response to an antigen, mediated by _______
- cytotoxic T-lymphocytes and macrophages
- T lymphocytes
Passive immunity is the process of ________. This type of immunity can occur _________ or _________
- using antibodies produced by another person to protect you against an infectious disease.
- naturally or acquired
Natural passive immunity occurs when
antibodies from the mother are passed to the infant through the placenta and breast milk
Acquired passive immunity can be acquired through
an injection of antibodies against a microorganism that the individual has never been exposed to.These antibodies are collected from someone else who has already had the disease and has naturally produced antibodies.
In active natural immunity the body develops immunity by
natural exposure to an antigen and responds by making its own antibodies and producing memory cells
What is active acquired immunity
A better way of getting active immunity is by being given it artificially with a vaccine. A person swallows or is injected with altered pathogenic microorganisms (antigens) or products from the bacteria or virus.
In TYPE I HYPERSENSITIVITY or _______ plasma cells produce _____ as a response to the antigen which causes mast cells to release their ________. This release causes ______. Some examples include ________
- histamine granules
- increased dilation and permeability of the blood vessels and causes constriction of the smooth muscle in the bronchioles in the lungs
- asthma, hay fever or latex allergy which can result in urticaria, angioedema, conjunctivitis, rhinitis, bronchospasms and anaphylaxis
TYPE II HYPERSENSITIVITY or _______ type involves an ________ and usually involves IG_. Examples include ______
- antigen-antibody reaction against our cells or extracellular membranes
- IgG or IgM
- Graves disease, pemphigus, pemphigoid, rheumatic fever, some drug reactions
TYPE III HYPERSENSITIVITY involves ________ and usually involves antibodies ______. Examples are
- tissue injury mediated by immune complex formation.
- IgG, IgM or IgA
- systemic lupus erythematosus and rheumatoid arthritis.
TYPE IV HYPERSENSITIVITY , also called ________, is the only one that does not involve _______ but is a _______. Some examples are
- delayed hypersensitivity
- cell-mediated immune response
- PPD test, Poison Ivy and in transplant rejection
IMMUNODEFICIENCY is a type of immunopathologic condition that involves a deficiency of
white blood cells and their products.
What is the most common oral ulcers
What are the three forms of Aphthous ulcers and who are they more common in
What are the possible causes of Aphthous ulcers
- –Trauma is the most often reported precipitating factor, like after dental treatment.
- –Emotional stress has also been implicated
- –Eating citrus fruits.
- - Also seem to occur in association with certain other systemic diseases such as Crohn’s disease and ulcerative colitis
What are the characteristics of a Minor aphthous ulcer
- –The most common type.
- –Appear as discrete, round to oval ulcers up to 1cm in diameter with a yellowish white fibrin surface surrounded by a halo of redness.
- –NOT preceeded by a blister
- - occur on the movable oral mucosa (nonkeratinized tissue) and sometimes extend onto the gingiva and more frequently occur in the anterior of the mouth
Minor aphthous ulcers have a prodromal period of _____ and lasts
What are some of the characteristics of Major Aphthous Ulcers
- –Larger than 1 cm in diameter and deeper and last longer than the minor variety.
- - They are more common in the posterior of the mouth
- - several weeks to heal
- - Nonkeratinized mucosa
- - Usually appear on unattached mucosa
What are some of the characteristics of Herpetiform Aphthous Ulcers
- –Very tiny, 1 to 2 mm and resemble ulcers caused by the herpes simplex virus.
- –Painful and usually occur in groups
- – They usually occur on unattached mucosa
What is the treatment for Aphthous Ulcers
TREATMENT consists of application of topical steroids (Kenalog in Orabase), which is best done during the prodromal stage
topical steroids are contraindicated with
herpetic viral ulcers
Describe Urticaria and what is it caused by
- Urticaria, also called hives, appears as multiple areas of well-demarcated swelling of the skin usually accompanied by itching (pruritis).
- caused by localized areas of vascular permeability in the superficial connective tissue beneath the epithelium
Describe Angioedema and what is it caused by
- appears as a diffuse swelling of tissue
- The vascular permeability is from deeper blood vessels
- Causes may include stress, infection, trauma, allergins
Contact mucositis and dermatitis are lesions that result from ________. The development of these conditions involves cell-mediated immunity and is an example of type ___ hypersensitivity
- direct contact of an allergen with the skin or mucosa
In contact mucositis, the mucosa becomes ________, often accompanied by pruritis and burning. The appearance is _____.
- erythematous and edematous
- smooth, shiny and firm
In contact dermatitis, the initial lesion is _________. This later becomes ______
- erythematous, with swelling and vesicles
- scaly and white (not constantly moist as in the mouth)
What are the common causes of Contact Mucositis and Dermatitis
Topical antibiotics, antihistamines and the preservatives in local anesthetics and topical medications
What are Fixed Drug Eruptions and what type of hypersensitivity reaction are they
- lesions that appear in the same site every time a drug is used
- type III
Is Erythema Multiforme acute or chronic, who does it commonly occur in and describe it
- an acute, self-limiting disease that affects the skin and mucous membranes
- Occurs in adults and more commonly men.
- The characteristic lesion is a target or bull’s eye lesion consisting of concentric rings of erythema alternating with normal skin color
The oral lesions of Erythema Multiforme are usually _____, frequently on the _________
- lateral borders of the tongue
The most common and most severe form of erythema multiforme is called _________
Lichen planus have a characteristic pattern of
interconnecting lines called Wickham’s striae
Reticular lichen planus is the one with the .
lacey white lines
In lichen planus micro-scopically there is a degeneration of the ________ of the epithelium with many T-lymphocytes in the connective tissue. There is a suggestion that people with lichen planus may be more susceptible to ________.
- basal cell layer
- squamous cell carcinoma
Reiter’s Syndrome is a triad of _________. It is much more common in _______. It is believed to be due to an ________, as it frequently follows a course of _______.
- arthritis, urethritis and conjunctivitis
- men than women
- abnormal immune response to a microbial antigen
- chlamydia or Salmonella infection
In Reiter’s Syndrome _______ lesions are common.
Skin and mucous membrane
Histiocytosis X is a traditional name for 3 diseases all of which are characterized by _______ called ______, which are actually _______, in multiple areas of the body. The disease is most common in _______.
- proliferation of antigen-processing cells
- Langerhan’s cell
- infants and children
________ is an acute fulminating (rapid and severe) form of Histiocytosis X that affects young children. It has a rapidly fatal course.
Hand-Schuller-Christian disease occurs in ________. In about 25% of the cases there are ________.
- young children
- well-defined radiolucent areas in the skull or jaws, exopthalamos(buldging eyes) and diabetes(classic triad).
Eosinophilic granuloma are
bone lesions that resemble periodontal disease or periapical disease appearing as well-circumscribed radiolucencies
SJOGREN’S SYNDROME is an autoimmune disease that affects the ________ glands resulting in ________, which consists of __________.
- salivary and lacrimal
- sicca syndrome
- xerostomia and xerophthalmia
Primary Sjogren’s occurs ______
without another autoimmune disease
Secondary Sjogren’s are those
accompanied by another autoimmune disease
About 20% of people with Sjogren’s syndrome also have _______, which is a disorder affecting the ________.
- Raynaud’s phenomenon
- the fingers and toes with cold or stress appearing to be the triggers
Diagnosis of Sjogren’s is made when 2 of 3 components are present: _______ plus either ________ or ________
- sicca syndrome (xerostomia, xerophthalmia)
- keratoconjunctivitis and rheumatoid arthritis or other autoimmune disease
With Lupus women are affected _______ than men and occurs _______ in black than in white females
- 8 times more frequently
- 3 times more
In SYSTEMIC LUPUS ERYTHEMATOSUS there are actually antibodies to the person’s own DNA and are part of the diagnoses of SLE. These circulating antibodies are called ________
ANA or Antinuclear antibodies
What are the clinical features of SLE
- Skin lesions are the most typical with an erythematous rash occurring in areas of the body exposed to sunlight.
- The classic “butterfly” rash occurs over the bridge of the nose.
PEMPHIGUS VULGARIS is a severe, progressive autoimmune disease that affects the ________. It is characterized by _______. This is called _______. The autoimmune antibody attacks a protein in the desmosome which ________.
- skin and mucous membranes
- intraepithelial blisters that cause separation between epithelial cells
- allows the epithelial cells to separate
In PEMPHIGUS VULGARIS gentle finger pressure can separate the epithelium from itself leaving a bulla. This is called ________.
In PEMPHIGUS VULGARIS microscopically the detached epithelial cells take on a _________ and help with the diagnosis. They are called ________.
- rounded appearance
- Tzanck cells
The treatment for PEMPHIGUS VULGARIS involves
high dose corticosteroids and other immunosuppressive drugs
In Benign Mucous Membrane Pemphigoid or cicatricial pemphigoid the lesions occur due to ________.
cleavage of the epithelium from the underlying connective tissue
The most common site for lesions in Benign Mucous Membrane Pemphigoid or cicatricial pemphigoid is the
gingiva and range from erythema to wide ulcerations of the gingiva and mucosa
Benign Mucous Membrane Pemphigoid or cicatricial pemphigoid
The gingival lesions of Benign Mucous Membrane Pemphigoid or cicatricial pemphigoid have been called
desquamative gingivitis, but this is more a descriptive term than a diagnosis
The Diagnosis of Benign Mucous Membrane Pemphigoid is made by biopsy and histologic exam which shows a ________ There is no ________ as in pemphigus vulgaris
- separation of the epithelium at the basement membrane or by immunofluorescence.
- degeneration of the epithelium
BEHCET'S SYNDROME is a chronic, recurrent autoimmune disease consisting of _________.
oral ulcers, genital ulcers and ocular inflammation
Diagnosis of BEHCET'S SYNDROME requires ________.Treatment is ________.
- at least two of the manifestations oral ulcers, genital ulcers, or ocular inflammation
- topical or systemic corticosteroids