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CLASP - SEPSIS > Host-Microbe Interaction > Flashcards

Host-Microbe Interaction Flashcards

1
Q

Initial immune protection is provided by what?

A

Physical barriers

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2
Q

What are the two main components of the immune system?

A

Innate (phagocytes / NK cells)

Acquired/adaptive (B cells / T cells)

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3
Q

Bacteria are controlled by what immune cells?

A

Phagocytes
B lymphocytes and antibodies
Complement

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4
Q

Fungi are controlled by what types of immune cells?

A

Phagocytes
T-lymphocytes
Eosinophils

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5
Q

Viruses are controlled by what types of immune cells?

A

T and B lymphocytes

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6
Q

Protozoa are controlled by what groups of immune cells?

A

T lymphocytes

Eosinophils

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7
Q

Worms are controlled by what 2 types of immune cell?

A

Mast cell

Eosinophils

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8
Q

What properties does the skin have which make it suitable as a physical barrier to infection?

A

Keratinocytes secrete antimicrobial peptides (defensins)

Sweat glands secrete microbe-inhibiting substances (e.g. fatty acids)

Antigen-presenting cells in skin

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9
Q

The mucous membranes of the Respiratory/GI/GU tracts contain which properties that make them suitable physical barriers to infection?

A

Antimicrobials e.g. lysozyme
IgA
Gastric acid

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10
Q

What disease processes can cause the skin to be an impaired physical barrier to infection?

A
  • Eczema, psoriasis, erythroderma
  • Tinea pedis / cracking of skin
  • Ulcers / pressure sores
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11
Q

What lung diseases can impact the efficiency of the respiratory tract mucous as a physical barrier to infection?

A
  • Cystic fibrosis / Bronchiectasis (impaired mucus clearance)
  • COPD
  • Poor swallow (neurological illness, e.g. stroke)
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12
Q

What diseases can affect the ability of the GI tract mucosa to be a suitable physical barrier to infection?

A
  • Mucositis secondary to chemotherapy
  • IBD
  • Bowel cancer
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13
Q

What WBCs are the main types of phagocyte?

A

Neutrophils and macrophages

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14
Q

In what conditions would a patient be deficient in phagocytes?

A
  • Haematological malignancy (e.g. acute leukaemia)

- Cytotoxic chemotherapy

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15
Q

Describe the difference between CD4 and CD8 T cells

A

CD4 activate phagocytes to kill pathogen

CD8 Directly kill pathogen

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16
Q

What diseases cause a deficiency in T cells?

A 
HIV infection (acquired deficiency in CD4)
Lymphoma
Primary immunodeficiency syndromes (e.g. SCID)
17
Q

What antibody is produced first from B cells, and what antibody is produced most abundantly?

A 
IgM = first (but has weak affinity)
IgG = most abundant (strong affinity)
18
Q

Deficiencies of B cells occur in what diseases?

A
  • Myeloma (plasma cell cancer)
  • Primary immunodeficiency syndromes
  • Certain immune suppressants (e.g. rituximab)
19
Q

There is a high risk of strep. pneumoniae infection in patients with HIV, regardless of their CD4 count. TRUE/FALSE?

A

TRUE

20
Q

In HIV, a CD4 count of <350 predisposes to what infections?

A

Mycobacterium tuberculosis TB

Candidiasis

21
Q

In HIV, a CD4 count of <200 predisposes to what infections?

A

Pneumocystis jirovecii

Toxoplasma gondii

22
Q

In HIV, a CD4 count of <100 predisposes to what infections?

A

Cryptococcus neoformans

Cytomegalovirus (CMV)

23
Q

What can lead to hyposplenism?

A

Splenectomy
=> (trauma, ITP, lymphoma)

”Functional” hyposplenism
=> (sickle cell, cirrhosis, coeliac disease)

24
Q

Patients with hyposplenism are particularly at risk of infection from what types of organisms?

A

ENCAPSULATED ORGANISMS

  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae type B (HiB)
  • Neisseria meningitidis (meningococcus)
25
Q

How can risk of encapsulated organism infection in hyposplenism be reduced?

A

Vaccinations (particularly before splenectomy if this is the case)

26
Q

Elderly patients are more prone to infections. TRUE/FALSE?

A

TRUE

  • Less able to distinguish self from non-self (autoimmune disorders common)
  • Immune system reacts slower and produces less immune cells
27
Q

What is the main aim of immunosuppressive drugs?

A

Reduce damage due to the immune response

28
Q

In what ways do immunocompromised patients not respond to infection in the same way as normal patients?

A
  • Fever may be absent
  • Lack of inflammatory response (CRP / neutrophilia)
  • Non-specifically unwell (illness not localised)
29
Q

There is often a lower threshold for treatment in patients who are known to be immunocompromised. TRUE/FALSE?

A

TRUE

30
Q

Steroids are particularly associated with what type of infections?

A

fungal infections (Candida, Aspergillus)

31
Q

Anti-TNF therapies (infliximab/etanercept) are particularly associated with what types of infection?

A

Mycobacterium tuberculosis (TB)

Fungal infections (Aspergillus)

32
Q

What infections are associated with purine analogue drugs?

A

Viral infections (Herpes Simplex and Varicella Zoster)

Pneumocystis jirovecii

33
Q

In what patients is the risk of infection so high that we would prescribe prophylactic antibiotics?

A

Co-trimoxazole in patients with HIV

Antifungal (e.g. itraconazole) in bone marrow transplant recipient

34
Q

What groups of patients are all eligible for their flu vaccine?

A 
PREGNANT WOMEN
Chronic heart/lung/kidney/liver disease
Immunocompromise
Diabetes
Aged >65 years
35
Q

What groups of patients qualify for a pneumococcal vaccine

A 
HYPOSPLENISM
Chronic heart/lung/kidney/liver disease
Immunocompromise (including HIV infection)
Diabetes
Aged >65 years
36
Q

The Haemophilus influenzae type B (HiB) / DTP/ MMR vaccine is now given to ALL children. TRUE/FALSE?

A

TRUE

37
Q

What causes the “cytokine storm” of unregulated inflammation in SEPSIS which eventually causes organ dysfunction?

A

IL-1
TNFa
IL-17

38
Q

Why does Lactate rise during SEPSIS?

A

Tissue hypoxia
=>Cells must respirate Anaerobically
=> lactic acid production

39
Q

Lactate production in sepsis creates a metabolic acidosis with what complication?

A

Acidosis worsens cardiovascular stability

CLASP - SEPSIS (9 decks)

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