IMMUNE SYSTEM

IMMUNE SYSTEM DISORDERS

Functions of immune system  

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  • Provide protection against invasion of microorganism.
  • Protect the body form internal threats.
  • Maintain the internal environment by removing dead or damaged cells.

 Immune response  

  • In our boy T lymphocyte and B lymphocyte are responsible for maintaining immunity power.
  • Bothe T and B Lymphocytes are necessary for a normal immune response.
  • T lymphocytes are responsible for rejection of transplanted tissue.
  • B Lymphocytes are responsible for the production of antibody against organism.
  • Both are the part of produced by Thymus gland
  • B Lymphocytes are produced by Lymph node.
  • Both are producing cellular and humoral immunity.

Humoral response   

  • It is an immediate response.
  • It provides protection against acute, developing bacterial and viral infection.

 Cellular response  

  • It is a delayed response, also called delayed hypersensitivity.
  • It is active against slowly developing bacterial infection, allergic reaction and rejection of foreign cells.

IMMUNITY

  1. Natural immunity also called innate immunity, present at birth
  2. Acquired immunity
  • Active Acquired immunity Immunization produce
  • Passive acquired immunity It receives passively from the mother’s antibodies.

Laboratory Studies 

  1. Antinuclear antibody (ANA) test   
  • Test used in differential diagnosis of autoimmune diseases and to detect antinucleoprotein factor associated with certain autoimmune diseases.
  • Positive at a titer of 1: 20 or 1: 40 depending on the laboratory.
  1. Anti-ds DNA antibody test  
  • A blood test done to identify or differentiate DNA antibodies found in SLE (Systemic Lupus erythematous) or other autoimmune disorder.
  • Value
    • Negative Less than 70 units.
    • Borderline 70 to 200 units.
    • Positive more than 200 units.  

Diseases Condition  

  1. HYPERSENSITIVITY AND ALLERGY




  • Allergy is an abnormal, individual response to certain substances that normally do not trigger such as exaggerated reaction.
  • Reaction can occurs within seconds.
  • Skin testing may be done to determine the allergen.

Signs and symptoms

  • History of exposure to allergens.
  • Itching, tearing, and burning of eyes.
  • Itching and burning of the skin.
  • Nose twitching,
  • Nasal stuffiness.

Management   

  • Identification of the specific allergen.
  • Administration of anti-histamines,
  • Corticosteroids and anti-inflammatory agent.
  • Administration of wet compress, and soothing bath for local reaction.
  • Desensitization programs.

 

  1. ANAPHYLAXIS    

  • A serious and dramatic allergic reaction, with the release of histamine from damaged cells.
  • Can cause shock and death if not treated.

Signs and symptoms

  • Identification of allergies,
  • Difficulty in breathing,
  • Difficulty in swallowing,
  • Complaints of a swollen tongue,
  • Facial edema and swelling of the lips,
  • Skin redness,
  • Presence of rash,
  • Signs of shocks.

Management  

  • Establish a patent airway.
  • Administration of epinephrine; diphenhydramine hydrochloride (Benadryl) or corticosteroids.
  • Provide measures to control shock.
  • Wear a Medic –Alert bracelet.

 

  1. LATEX ALLERGY   

  • A hypersensitivity to latex

Common routes of exposure 

  • Ex Wearing natural latex gloves.  
  • Percutaneous and Parenteral. Ex IV Lines, catheters and haemodialysis equipment.
  • Ex Use of Latex condoms, catheters, airway and nipples.
  • Aerosol Ex Powder from latex gloves.

Risk Individuals

  • Health care workers,
  • Individual who are working in Latex manufacturing company,
  • Individuals who wear gloves frequently like food handlers, hairdressers, and Auto Mechanics.
  • Individual who are allergic to kiwis, bananas, pineapples, tropical fruits, Avocados, or Potatoes

Signs and symptoms

  • Anaphylactic hypersensitivity
    • Rapid onset,
    • Urticaria,
    • Wheezing,
    • Dyspnea,
    • Laryngeal edema,
    • Tachycardia,
    • Hypotension, and Cardiac arrest.
  • Delayed type hypersensitivity  
    • Contact dermatitis,
    • Pruritus,
    • Edema,
    • Erythema,
    • vesicles, and Papules,
    • Crusting and thickening of the skin.

Management  

  • Assess whether the patient is allergic to latex or not.
  • Identify the risk factor.
  • Avoid the latex product, if there is risk.
  • Obtain an emergency medical kit that contains antihistamines and epinephrine.
  • Wear a medic-alert bracelet.

 

  1. SLE (SYSTEMIC LUPUS ERYTHEMATOSUS )

  • It is a chronic, progressive, systemic inflammatory disease that can cause major organ and systems to fail.
  • It affects connective tissue and fibrin deposit in the blood vessels, collagen fibers, and organs.
  • There is no cure for the diseases.

Cause  

  • Autoimmune disorder.

Precipitating Factor   

  • Medication,
  • stress,
  • genetic factors,
  • Sunlight or ultra violet light,

Signs and symptoms

  • Dry scaly raised rash on the face or upper body.
  • Weakness, malaise and fatigue.
  • Anorexia, weight loss.
  • Photo sensitivity.
  • Joint Pain.
  • Erythema of the palms.
  • Butterfly Erythema of the face.
  • Positive ANA and Anti-ds DNA test.
  • Elevated ESR.

Management  

  • Monitor skin integrity and give skin care.
  • Provide frequent oral care.
  • Apply creams and ointments for rash.
  • Identify factor contributing fatigue,
  • Administer iron, folic acid and vitamins.
  • Provide high protein diet, iron, and vitamin diets.
  • Balanced rest and activity.
  • Administer topical or systemic corticosteroids, salicylates, and NS AIDS for pain and inflammation.
  • Administer hydroxychloroquine as prescribed to decrease inflammatory response.
  • Monitor for bruising, bleeding and injury.
  • Avoid exposure to sunlight.
  • Prepare the patient for plasma pheresis to remove antibodies and immune complexes.
  • Monitor for organ involvement such as pleuritis, nephritis, pericarditis, neuritis, anemia, and peritonitis.
  • Provide supportive therapy.
  • Provide emotional support.

 

  1. POLYARTERITIS NODOSA 




  • A collagen disease that causes inflammation of the arteries and thickening and impairment of circulation.
  • If affect middle-aged men and involves every body system.
  • Prognosis is poor

Signs and symptoms

  • Malaise and weakness.
  • Low grade fever.
  • Severe abdominal pain.
  • Bloody diarrhea.
  • Weight loose.
  • Elevated ESR.  

Management     

  • Treatment is similar to SLE.
  • Provide supportive care.
  • Provide well balanced diet.
  • Administer corticosteroids, analgesics and NSAIDS to control pain and inflammation.
  • Provide emotional support.
  • Encourage verbalization of feeling.

 

  1. PEMPHIGUS  

  • It is an autoimmune disorder characterized by formation of lesions in the oral mucosa and then progress to generalized distribution.
  • It occurs between middle and old age.
  • Case is Fatal.

Signs and symptoms

  • Lesions appear as fragile flaccid bullae.
  • Partial thickness wound that bleed, weeps and form crusts when bullae are disrupted.
  • Chewing and swallowing difficulty.
  • Malaise and pain.
  • Nikolsky sign (separation of the epidermis caused by rubbing the skin)
  • Foul- smelling discharge from skin.

Management   

  • Provide supportive management.
  • Provide oral hygiene.
  • Increased fluid intake.
  • Soothe oral lesion.
  • Assist with oatmeal or potassium permanganate baths to relief of symptoms.
  • Administer topical or systemic antibiotics as prescribed for secondary infections.
  • Administer corticosteroids.

 

  1. SCLERODERMA   

  • A chronic connective tissue disease similar to SLE characterized by inflammation, fibrosis and sclerosis.
  • Affect the connective tissue throughout the body.
  • It will be cause hardening and thickening of the skin, fibrosis, degenerative inflammatory changes with vascular insufficiency, resulting in joint insufficiency, resulting in joint changes, dysfunction of internal organ, such as GI tract, Heart, Lung and Kidney.

Signs and symptoms

  • Painless pitting edema on hand and fingers feet legs and face.
  • Edema gradually replace by thickening and tightening of skin.
  • Wrinkle free skin.
  • Skin is dry due to suppression of sweat secretions.
  • Face appears mask like.
  • Mouth becomes rigid.
  • Extremities become stiff.
  • Hands are clow like.
  • Finger semi flex and immobile.
  • Heart
    • Heart becomes fibrotic.
    • Cardiac dysrhythmias.
    • Conduction disturbed.
    • Angina and CHF.
  • GI track   

Esophagus become harden and GERD

  • Lung
    • Pulmonary fibrosis.
    • Pulmonary hypertension.
  • Renal
    • Renal failure.

Management 

  • Avoid exposure to cold.
  • Maintain constant room temperature.
  • Administer vasodilator drugs.
  • Small frequent soft nonirritant food.
  • Sit upright for one to two hour after eating.
  • Eliminate food stimulate gastric secretions such as spicy food, caffeine, and alcohol.
  • Administration of corticosteroids.
  • Lubricate the skin with creams.
  • Avoid soap and drying agent.
  • Administer antacid before and after meal and at bed time.

 

  1. AIDS  

  • An infectious disease characterized by severe deficits in cellular functions.

Cause  

  • Human immune deficiency virus (HIV)

Incubation periods   

  • Some up to 10 years or more.   

High Risk group    

  • Male homo sexual or bisexuals.
  • Intravenous drug abusers.
  • Persons receiving blood transfusions.
  • Frequent exposure to blood and body fluids.
  • Hetero sexual.
  • Unsafe sexual practice.
  • Trans placental.
  • Breast feeds.
  • Baby bone in infected mothers.

Signs and symptoms

  • Malaise, Weight loose, Fatigue.
  • Lymphadenopathy of at least 3 months.
  • Night sweats.
  • Presence of opportunistic infection.
  • Pneumocystic carinii pneumonia.
  • Kaposi’s sarcoma (Purplish red lesions on internal organs and skin).
  • Candidiasis, Fungal infections, cytomegalovirus (CMV)

Diagnosis   

  • ELISA
  • Western blot test (Confirmation test )  

Management   

  • Provide respiratory support.
  • Administration of respiratory treatment.
  • Administration of oxygen.
  • Maintain fluid and electrolyte balance.
  • Monitor signs of infection.
  • Prevent spread of infections.
  • Initiate standard precautions.
  • Provide comfort as necessary.
  • Provide meticulous skin care.
  • Provide adequate nutrition support.

 Medication   

  • Administration of Zidovudine orally or IV.
  • Administer antifungal and anti-viral as prescribed by doctor.

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