Arcadia Clin Dx exam II immunology/Virology
Terms
undefined, object
copy deck
- define immunology
-
1. study of systems reponsible for recognition and disposal of foreign, non-self entities
2. a desirable - natural and acquired resistance to infectious disx -
acquired immunity
2 types -
cell mediated
humoral - cell mediated immunity
-
Tcell lymphocytes + phagocytic cells
- Tcells recognize Ag from APC macrophages
ex: cytokines, interluekins - humoral immunity - Active
-
formed by the host in response to exposure
1. natural - Ab formed due to infxn
2. artificial - vaccine - expansion of Bmemory cells - humoral immunity - passive
-
1. natural - transfer in-vivo or in colostrum (mom's milk)
2. artificial - serum or plasm infusion w/ incr. [c] of PRE_FORMED Ab
ex: Rhogam or needle stick -
IgG
how much in serum? what are characteristics -
70-75% in serum
diffuses to EXTRAVASCULAR spaces- neutralizes toxins or binds to orgs
- can X placenta
adult level by 16
subclasses differ
*can activate complement cascade - can IgM cross placent or bind to microorganisms?
- nope
- how do the subclasses of IgG differ?
- in heavy chain, bio activities
- IgM
-
10% in serum
pentamer - largest Ig
INTRAVSCULAR AREAS
see EARLY immune response
ACUTE disease
adult level b/t 8-15 y/o - IgA
-
15-20% serum
MAIN Ig in secretions
-tears, saliva, colostrum, milk
Secretory IgA protected from GI proteolytic enz
adult level by age 16 - IgD
-
<1% in serum
- a cell membrane Ig
-see on surface of Bcells in association w/ IgM - IgE
-
trace in serum
elev in hypersens rxn = allergies, parasitic infx
-binds strongly to mast cell and basophil receptor
along w/ Ag meadiates release of histamine and heparin - Type I hypersensitivivty rxn
-
immediate
IgE mediated
RAST allergy panel - msrs total Ag specific IgE - Type II
-
Tcytotoxic mediated
free Ab rxn w/ Ag on cell surface
ex: ABO transfusion rxn - DAT
-
direct antiglobulin tests
- detects presence of Ab coating RBC post rxn
use LAVENDAR top - Indirect Coomb's Test
-
used in X-matching blood
tests for Ab in transfused blood
use RED top - type III
-
immune complex
uses up complement- decr in C3,4,CH50 - Type IV
-
-delayed hypersens. rxn
-symptoms 24-48 hrs post exposure
-ex: contact derm, PPD (screen for TB) - DFA
-
direct immunofluorescence
-looking for Ag (known Ab vs Ag)
-Ab is tagged with FITC
ex: testing for chlamydia or Legionella - FITC
- fuorescein isothiocyanate
- IFA
-
indirect immunofluoresence
looking for Ab
ex: ANA, FTA-ABS - Radioimmunoassay
-
radioisotopes used to msr [c]
-very sensitive
-detects trace amts of analyte
ex: T4, T3, TSH, B-HCG - Latex agglutination
-
latex particles are coated w/ specific Ag for the Ab to be detected
ex: monospot, strep screen - Flocculation
-
clumping of particles to form visible masses similar to agglutination
ex: RPR - ANA
-
antinuclear Ab
-screening test for
1. collagen
2. rheumatic
3. CT disx
4. Primarily for SLE
[-] is normal result
less than screen dilution value 1:20 - using ANA to test for SLE
-
ANA - negative result excludes SLE
order with reflex to titer
90% lupus pts are +
a NEG ANA is MORE important than + = means can r/o - ANA - fine speckled
- mixed CT disx, Sjogren's , scleroderma
- ANA discrete speckled
- CREST, Raynaud's,
- ANA nucleolar
- assoc with Scleroderma and polymyositis
- what is significant about Hydralazine and procainamide and ANA test?
-
both can cause lupus-like syndrome and show positive for lupus
-stop drug, rxn reversible - what tests are used for Lupus?
-
ANA
Anti-ds DNA - Anti-ds DNA
-
can be used to test
1. Lupus nephritis
2. active lupus (40-60%)
3. incr w/. recurrance of SLE
4. decr w/ successful Tx SLE - ENA
-
extractable nuclear Ag's
assoc. w. Rheumatic disx
ordered when have a + speckled ANA - what tests are used to detect Sjogren's?
- anti-SSA (anti RO), anti-SSB (anti-LA)
- anti-RNP, antiy-Sm, Anti-Sc170 - describe
-
anti -RNP = ribonucleoprotein
anti-Sm = anti-Smith
anit-Sc170,associated with scleroderma - ANCA
-
antineutrophilic cytoplasmic Ab
-WEGENER'S granulomatosus-vasculitis
-polyarteritis nodosa
-churg strauss syndrome
*can be perinuclear or cytoplasmic - explain Thyroid Ab's
-
autoantibodies - against the thyroid
10% pop has low titer and no symptoms of disease - what is high titer of TSH seen in?
-
Hashimoto disease
Grave's disx
Thyroid cancer - hypothyroidism
- not enough T3, so body incr the TSH level
- what is the most specific test for thyroid?
-
TSH,k T3 and T4 fluxuate daily
normal range = 0.5-5.0 -
ASMA
what is it
what is it associated with? -
anti-smooth muscle antibody
-liver and bile duct autoimmune disx
-foundin in chronic active hepatitis, biliary cirrhosis
**may see in 20% of intrinsic asthma pts - tests used for liver or hepatic disease dx
-
LFT's
ASMA-anti-smooth muscle Ab
AMA-anti-mitochondrial Ab
AST, ALT, SGOT/SCPT
AFP-alpha fetal protein
CEA-carcinoembryonic Ag
CA19-9 for pancreatic and hepatobiliary cancers - AMA
-
anit-mitochondrial Ab
-liver and bile duct autom-immune disx
-Ab directed against the LIPOPROTEIN in the inner mitochondrial membrane - what is used to differentiate pernicious anemia form megaloblastic anemia?
- APCA - anti-parietal cell Ab
- let's say you get a + speckled ANA, what is the next most logical test?
- ENA
- what diseases can be tested using APCA?
-
the anti-parietal cell Ab test is used for:
-chronic gastric disx
- pernicious anemia
-gastric ulcer and cancer
-Diabetes Mellitus - what is the prevelance of false + for APCA?
- 10-20% in elderly, and 2% in normal children
- what is RF and how does it relate to disease?
-
Rheumatoid factor
22S IgM (nl IgM is 19s)
correlation b/t presence of nodules and severity of disx
-RF is NOT specific for rheumatoid arthritis
-RF neg result does not r/0 RA - what is 22S IgM?
- rheumatoid factor and associated with rheumatoid arthritis
- what diseases can produce a + result with RF?
-
SLE, TB, syphillis carcoidosis, viral infx, sjogren's
[+] result is >30IU
false [+] seen in elderly, and liepmic specimens -
ASO
dx for?
see in? -
anti-stetolysin O
-prior,not acute infx
-glomerulonephritis, pyoderma, rheumatic fever
age dependent
<100 for age <5
<200 for ages >6 -
RPR
what does it detect?
how is it reported?
range of results? -
rapid plasmin reagin
-secondary and latent syphillis
- false + in pregnancy,
once tx is successful, RPR will beomce non-reactive for syphillis - FTA-ABS
- fluorescent treponemal antibody absorption
- what does FTA-ABS confirm?
-
dx of syphilis
d-etects Ab to spirochette, treponema pallidum
nl = non-reactive
[+] graded 1+ wk, 4+ strong - what factors interfere with FTA-ABS results?
-
pts with SLE
-hypergammaglobulinemia
pregnant pts
*may yield low false reactive results - bcuz PRO sticks to substrates
**repeated or sent to lab for confirm - VDRL
- veneral disease research lab
-
what is VDRL used to detect?
characteristics of too -
detects reagin Ab in CSF to dx tertiary (neurosyphilis) syphillis
teritary dev in 3-10 years in plastic
false [+] from contamination
teriary syphillis
[+] reported as reactive and a titer is given
nl is nonreactive,
RBC contamination can give false +
any + is reported to the county and state authorities - borrelia-burgdorfer
- lyme disease by spriochette
- testing for Lyme disease
-
ELISA - reported
as [-],equivocal, or [+]
confirmed with Western blot
if serology is [-] and you have a high suspicion, retest in 4-6 wks - to test for Syphillis use these
-
FTA-ABS
Rheumatoid factgor RF
RPR
VDRL - how is the Lyme disx antibody titer run on
- CSF,
- what factors interfere with Lyme antibody titer
- Rheumatoid factor,other spirochete infx,
- tumor markers - problem with
- not tumor specific, may be detected in non-neoplastic coditions
- CEA
- carcinoembryonic antigen
- when is CEA seen?
-
colorectoal, stomachc, pancreatic, breast, lung, stomach and helpatobiliary cancers
INCREASED in SMOKERS and ulcerative colitis in diverticulitis
*not all colorectal ca produce CEA - AFP
- alpha fetal protein, a protein normally produced by the fetal liver and yolk sac
- what is AFP and what is it used for>
-
mainline use is testing for neural tube defects using mothers serum
2. other is testicular and hepatic cancers
a. found in >90% hepatomas - what is the correlation AFP and tumor growth?
-
incr AFP relates directly to incr tumor growth
AFP is NOT specific for hepatomas however - what is normal range for AFP?
- <40IU (ng/dl)
- when testing a pregnant pt, what timeframe is safe to do the AFP test?
- b/t 16-18 weeks gestation when levels peak.
- B-HCG
- the beta version of human chorionic gonadotropin
- when is it seen?
-
1. trophoblastic tumors
2. hydatidiform moles
3. breast and testicular cancer -
PSA
used for?
range? -
prostatic specific antigen
-BPH-benign prostatic hypertrophy
-normal is <4.0 ng.dl
if value >4 but< 10, order free PSA - what tests allow you to detect up to 90% of prostate cancers?
-
PSA and DRE - digital rectal exam
**levels can be elevated post procedure
ex: TURP - PAP
- prostatic acid phosphatase - less specific than PSA
- CA-125
-
increased in up to 80% pts with ovarian cancer
used ONLY as a SCREEN for pts at high risk with strong family history
non specific-may be incr with endometriosis - breast cancer staging tests
- CA 15-3 and CA 27.29
- pancreatic and hepatobiliary cancer screens
- CA19-9
- used to test for Wegener's granulomatosus vasculitis
- ANCA - antineurtrophilic cytoplasmic Ab tests
-
EBV
etiology
incubation
s/s
labs -
epstein-barr virus
HHV 4 - the kissing disease
found in saliva
s/s= pharyngitis, malaise, fever, (distate of cigs)
physE: enlarged erythematous tonsils w/ exudate, palatine petechia, cervical adenopathy , spenomegally - used to test for Hashimoto's and Graves disease
- Thyroid Ab test
- in what disease do smokers suddenly get a distate for cigarettes>
- Epstein-Barr Virus
- used to test for Chrug-Strauss
- ANCA
- incubation and phases of EBV
-
incubation = 4-8 wks
acute phase = 1-3 wks
recovery 6-8 wks - what labs are run to test for EBV?
-
AST/ALT - incr
blood- see WBC elevation-lymphocytosis (in reversed diff)
ATYPICAL lymphs
50% reduction of platelets
MONO spot - shows current infx - Treatment for EBV?
-
supportive, avoid strenuous exercise to prevent splenic rupture,
Ampicillin ( but can cx rash) - forms of EBV?
-
Africa - Burkitt's Lymphoma
China_nasopharyngeal carcinoma - status post infection>
-
lifelong carriers,
LATENT EBV carriers can reactivate and have CHRONIC FATIGUE SYNDROME - the vaccine is Recombivax the virus is?
- Hep B, and vaccine is given in two doses 6 mo apart
- these are both wataerborne viruses that hapve fecal/oral transmission
- Giardia L. and Hepatitis E
- this virus presentation does not cross the midline
- varicella zoster
- this is an RNA virus and can replicate only when _______ strain of __________ is present
- B hepatitis
- false + for these viruses/diseases may show up when donating blood
- autoimmune diseases, anyone with incr gammaglobulin, Ab's to viral Hep C
- what tests are used to confirm or r/o fasle + obtained from blood donation?
- PCR and RIBA-2
- symptoms include malaise, pharyngitis, fever and distaste for cigarettes in regular smokers
- EBV
- damage to respiratory ET from this virus predisposes pt to secondary bacterial infxn
- influenza RNA virus
- these viral strains can cx cirrhosis and hepatocellular carcinoma
- hepatitis B and C
- anti-HBc is detected in serum when s/s of _____ begin
- hepatitis B
- this form of hepatitis does not have a vaccine
- hepatitis c
- kissing disease
- EBV mono
- treatments include Rimantadine, Relenza or Tamiflu, but avoid use of ASA
- influenza virus
- dermatomal distribution is seen w/ this virus
- varicella Zoster
- this is associated with Burkitts lymphoma
- EBV - African strain
- this is a ds-DNA virus
- CMV
- this is an RNA virus that can be confused at first with a cold
- influenza virus
- labs show up with ATYPICAL lymphocytes
- EBV - see reversed diff
- transmission forms include respiratory droplets
- influenza A
- what viral family is CMV associated with?
- human herpes virus
- s/s include splenomegaly, enlarged erythematous tonsils with exudates, cervical adenopathy and palantine petechia
- EBV in active stage
- labs present with NL to decr WBCs, proteinuria; s/s of abrupts onset fever >102F, myalgia and HA
- influenza RNA virus
- EIA test can be used to detect Ab against __________virus components
- EBV
- symptoms are expansion glutitis, foot paresthesia, decreased peripheral circulation, incr adipose to posterior regions, inflammation of periorbital space, altered mental status including hallucinations of life beyond current status
-
prolonged studyosis due to PA school :-)
just checking to see if you are still awake! hang in there, keep going, rah rah rah! - this virus has recently been correlated with chronic fatigue syndrome
- EBV
- post recovery of this primary infxn confirs pt as life-long carrier that risk reactivation
- EBV
- presentation of anti-VCA, but NOT anti_____ equates recent______infection
- EBNA, EBV
- past infectin of EBV shows persence of both anti_____and anti______
- VCA, EBNA
- symptoms include esophagitis, colitits, retinitis, and seen in IMC pts
- CMV, seen in HIV pts
- definitive Ab test if german measles is suspected in a newborn
- IgM
- some s/s are non-productive cough, sore throa, coryza, abrupt onset fever >102F, myalgia
- influenza RNA virus
- this virus is the mc cx of blindness in HIV pts
- CMV
- amantadine is an effective tx against type A but not type B of this virus
- viral influenza
- microscopic view of this virus presents with large intranuclear inclusions with clear halos
- CMV - you are seeing "owls eyes" inclusion bodies in tissue
- Rimantadine is preferred over Amantadine inthese pts with viral influenza
- Renal pts
- side effects of Ganciclovir tx
- toxicity to bone marrow
- side effect of Foscarnet tx
- Kidney/ hepatotoxicity
- this virus is associated with nasopharyngeal carcinoma
- EBV in China
- treatment for CMV
- ganciclovir and foscarnet
- incubation and immunity time line for Hepatitis A vaccine
-
incubation >3wks, immunity is conferred 4 weeks post dose
will confer lifelong immunity - see lab values of CD4<100 in HIV pts and suspect this virus
- CMV
- what seroligcal test is good for detecting EBV antibodies
- EIA
- what congenital problems can arise if pregnant pt contracts german measles in 1st trimester?
- heart vavle malformations / miscarriage
- why is testing for IgM preferred over testing for IgG in newborn suspected of having german measles?
- IgM will show active infection whereas IgG would show ONLY the maternal transfer of Ab
- vaccine Havrix
- for hepatitis A
- Flumist
- live attenuated vaccined against influenza A and B given ages 5-49
- Relenza is a powder form tx for this virus
- influenza
- varicella zoster
-
chicken pox
appears as dewdrops on petals
red, erythematous base - this does not cross the midline, but will have dermatomal distribution
- shingles of repeat varicella virus
- T/F a positive test result of HIV means you have the virus and will get AIDS
- FALSE, all it means is that yo are carrying the virus and that you can infect others - you may not develop AIDS, nor are you immune to it
- the biggest cause of cervical dysplasia and cancer
- Human papilloma virus
- presents as slapped cheek, fever, doilie rash, arthralgia
- Parvovirus-fifths disease
- EBV and antibody titers
-
after recovery from virus anti-VCA and anti-EBNA are ALWAYS present but in lower levels, also sometimes anti-EA may be present
EBNA is persistent for the rest of the pts life - if recent infx what Ab do you see? if past infectin what do you see?
-
recent=anti-VCA but NOT anti-EBNA
past=anti-VCA AND anti-EBNA - what tests do you order to determine 5ths disease?
- parvovirus Ab IgG, IgM, with a postive reslut post 3 days viremia
- treatment for parvovirus?
- supportive to symptoms
- T/F a negative HIV test result means you do not have the virus
- FALSE, it could be too early to test for it, there is a window period and you may have to come back and get rechecked
- treatments include Valtrex, Famvir and help prevent complication of postherpatic neuralgia
- shingles-varicella zoster
- what is the window peiod from infection with virus to sero-conversion to HIV?
- 3-6 months , most pts,
- three methods for testing HIV
-
ELISA
Western Blot
IFA - what is the preferred protocal for testing HIV?
-
use ELISA first, and if positive, go to Western blot or IFA.
*IFA can give results faster than western blot - hepatitis A
-
fecal/oral route or shellfish
vaccine = Havrix - hepatitis B + C
-
both implicated in cirrhosis and hepatocellular cancer
NO vaccine for hep C - Hep B,C,D
- chronic disease
- Hepatitis D
-
Delta RNA virus - replicated only if Hep B present
NO vaccine - Hepatitis E
-
-waterborne, fecal/oral route, under-developed countries
-NO vaccine - Twinrix vaccine
- combo vaccine used for hepatitis A and B - but do NOT give pt who has recv'd seperate vaccines for hep A or B previously
- Recombivax vaccine
- used for hepatitis B two doses, give 6mo apart
- defiinition of Hepatitis
-
inflammatory process in the liver
chronic = > 6 months symptoms - what strain of hepatitis is MC source of post-transfusion infxn?
- Hepatitis C - 70% pts
- what forms (not strains) of hepatitis are there?
-
1. viral
2. drug induced
3. autoimmune
4. ETOH related (see AST>ALT) - acute phase of this virus shows + for IgM and IgG anti-VCA
- EBV
- EA-D is commonly found in
- nasopharyngeal cancer
- Chronic EBV is denoted by serological lab results of ____titer
- anti-EA, titer>80 post 2 yeras of infx
- green fluorescent protein is seen on micrscopic eval
- EBV viral cells
- Xantham virus
- Rubelle - German Measles
- when do you see HBs antigen?
- first during incubation period of Hep B and then it disappears = core window
- what about the "core window"? what is going on?
- when IgM anti-HBc is at its peak as well as ALT is high
- explain what is going in during the infective phase of Hepatitis B?
-
hepatitis surface Ag first appears, then a response by the body to make Hep B surface Ab,
if you NEVER make the Ab, you are a CARRIER,
most people will make the anitbody and it confirs the immunity to hep B - you are a carrier for Hep B when....?
- when anti-HBs do not develop and HBs Ag persists = carrier
- what is present during recovery phase of Hep B?
- increase anti-HBs Ab which will last for life - confers life-long immunity
- how do you know if a pt is a carrier?
- order a quantitative Hep B serologic test
- present around 1.5 months post Hep B infection?
-
begining of IgM anti-
HBc, it peaks at about 3 months post infx - when do you see a spike in ALT presence in Hep B?
- start of 2-3 months post infx
- when do you see a peak in IgM anti-HBc?
- onset around 1.5 months post infx, peak around 3-3.5 months
- when do you see a peak in anti-HBe?
- starts around 3-4 mo post infx and peaks around 5-6 months post infx
- when does anti HBs show up?
- around 5-5.5 mo post infection and it peaks around 1 year
- when is the core window for Hep B?
- b/t 2-4 months post infection
- when is anti-HBc detected?
- in serum when symptoms FIRST begin
- where is HBV core antigen found?
- ONLY IN THE LIVER cells
- what is the first Ig developed?
- anti-HBc IgM develops first then followed by IgG which is present for LIFE
- what do you order to check immunity status to Hep B vaccine?
- quantitative HBs antibody screen
- what does HBe antigen indicate?
- active viral replication and infectivity- and pt is contagious
- what does persistent presence of HBe Antigen predict?
- development of CHRONIC HEPATITIS B - high levels of anti-HBe indicate a good prognosis
- what do you use to tst for anti-HBcIgG?
- nothing, there is NO test for that,
- what is the antigen mc seen in the core window>
- anti-HBcIgM
- CMV
-
ds-DNA virus in herpes family
in HIV pts can cx esophagitis, colitis, retinitis, and is the MC cx of blindness in HIV pts with CD4<100
"owls eyes" enlargement of cells w/ lg intranuclear inclusions and clear halos
TX= ganciclovir
caution - toxic to bone marro
Tx= Foscarnet - toxic to kidneys - what are the cautions with gangiclovir and foscarnet as tx for CMV?
- toxic to bone marrow and kidneys respectively
- avoid ASA treatment with which diseases?
- viral influenza,
- preferred treatment for viral Flu?
- amantadine for type A but not B
- other treatments for viral influenza?
-
Rimantadine for pts with renal failure
Tamiflu for uncomplicated acute illness (s/s <2days)
Relenza-dry powder strains A/B w/ s/s <2days - what are the vaccines available for influenza?
-
yearly vaccine
partial immunity
-avoid if allergic to eggs
Flumist- ingtranasally
-live attenuated, confers partial, short term immunity
-for A/B, age 5-49 and healthy - shingles
-
does not cross the midline
-a reactivation of varicella zoster
- dermatomal distribution
treat with VALTREX, FAMVIR - appears as a dewdrop on a petal ( as I see it, looks like a freakin leaf)
- chicken pox
- treatment of shingles
-
treat with Valtrex, Famvir
good for prevention of complication of herpetic neuralgia - ELISA is an intial test used for what diseases/illness? what are two confirmatory tests used?
-
HIV
Lyme disease
Giardia( dx with O and P)
confirmatory
1. Western Blot
2. IFA (immunofluoresce Assay - is faster than western blot and used for HIV testing) - GIEMSA stain is used to dx what?
- malaria
- MC cause of cervical dysplasia and cancer?
- HPV - human papilloma virus
- slapped cheek presentation and doile rash?
- parvovirus -fifths disease
- parvovirus
-
-slapped cheek and doile rash
-arthralgia
-Order parvovirus antibody IgG and IgM, Ig M may be positive 3 days post viremia
tx= supportive - German measles (Rubella ab)
-
viral Xantems
nl value IgG
congenital infx most severe if contrx during 1st trimester
-can cx heart valve defect, malformations, miscarriage
order IgM antibody if suspect in newborn