Download Autoimmune Diseases (cont`d.)

 Unit 2
Seminar
 Dr. J. V. Stoia
Slide 0
Question #1
 You are asked to place an HIV
positive patient in an exam room
and obtain vital signs. The patient
brings into the exam room a
requested urine specimen. What
infection control precautions
should you be using in this
situation?
Slide 1
Question #1
 Because the patient may be
immunodeficient, you should first make
sure to wash your hands properly and
thoroughly before approaching and
touching the patient.
Slide 2
Question #1
 Gloves or other personal protective
equipment are not necessary for normal
contact with the patient (i.e., obtaining
radial pulse or blood pressure).
However, when coming in potential
contact with body fluids (i.e., urine
specimen, saliva with oral temperature
probe) you should wear gloves.
Slide 3
Question #1
 Remember that equipment used to
obtain the vital signs (i.e.,
stethoscope, thermometer) will need
to be properly disinfected before
being reused on another patient. If
they are available, use disposable
probes and other equipment.
Slide 4
Question #1
 . Finally, rewash your hands after
contact with the patient is complete.
Slide 5
Question #2
 Many elderly patients with rheumatoid
arthritis are treated with non-steroidal
anti-inflammatory drugs (NSAIDs) at the
outpatient facility you are assigned to
work. Some express concerns about
various signs and symptoms they are
experiencing. What are the side effects
of NSAIDs they should be concerned
about and report to the physician or
nurse?
Slide 6
Question #2
 Potentially dangerous side effects of
NSAID therapy include GI ulceration and
bleeding, and blood dyscrasias (i.e.,
abnormalities) that may affect bleeding
and clotting factors.
Slide 7
Question #2
 . Other common side effects are rash,
tinnitus, and hypersensitivity to sunlight.
Slide 8
Question #2
 Side effects as well as drug
toxicities are more common in the
elderly population not only for
NSAIDs but other classes of drugs,
too. This is due to impaired or
decreased liver and/or renal
metabolism as part of the normal
aging process.
Slide 9
Question #2
 Encourage each patient to discuss
problems such as GI upset, GI
bleeding, dark or tarry stools,
increased bruising, rash, or
tinnitus with the doctor or nurse
for further assessment.
Slide 10
Major functions of the immune
system
 Protect the body against foreign
organisms
 Maintain homeostasis by eliminating
damaged cells (phagocytosis)
 Recognize and guard against abnormal
cells (inflammatory response)
Slide 11
Inappropriate responses of the
immune system
 Hyperactive (allergic) – excessive
response
 Immunodeficient (e.g., AIDS) –
inadequate response
 Autoimmune (e.g., SLE) – misdirected
response
 Transplant rejection – attack to beneficial
foreign tissues
Slide 12
Acquired Immunity
Slide 13
Trivia Question
 Where does the term “vaccination”
come from?
Slide 14
Cellular Elements of Immunity:
 Cellular elements of natural immunity:
 Natural killer cells (NK)
 Polymorphonuclear neutrophils (PMN)
 Macrophages
 Cellular elements of acquired immunity:
 T lymphocyte cells
 B lymphocyte cells
 Phagocytes
Slide 15
T lymphocyte cells include
 Cytotoxic T cells: destroy virus-infected
cells, tumor cells, or allograft cells
 Helper T cells: stimulate B cells and
activate cytotoxic T cells
 Suppressor T cells: moderate the
immune response by inhibiting B and T
cells
 Memory T cells: are reactivated only by
re-exposure to previous antigen
Slide 16
B lymphocyte cells include
 Memory B cells: reactivated only by
re-exposure to previous antigen
 Plasma cells: secrete antibodies that
attach to antigens
Slide 17
Orderly Function of the Immune
System (cont’d.)
 Immunoglobulins
 IgG (75-85%)
 IgA (5-15%)
 IgM (5-10%)
 IgD (0.2%)
 IgE (0.5%)
Slide 18
Immunodeficiency Diseases
 Increased susceptibility to bacterial
infections resulting from a B cell
deficiency.
 Increased susceptibility to viral,
fungal, and protozoan infections,
usually from T cell deficiency.
Slide 19
Acquired Immunodeficiency
Syndrome (AIDS)
 Caused by human immunodeficiency
virus (HIV)
 Diagnosed by presence of HIV
antibodies in the blood (common test:
ELISA; confirmation: Western blot)
 HIV attacks helper T lymphocytes
 Reduces cell-mediated immunity
 Attacks nervous system directly
Slide 20
Acquired Immunodeficiency
Syndrome (AIDS)
 HIV transmission is through direct contact
with blood or semen of infected person
 sexual contact
 blood transfusions and other blood products
 contaminated shared needles (IV drug use, etc.)
 accidental needle sticks
 to fetus via placenta or during birth process from
infected mother
Slide 21
Acquired Immunodeficiency
Syndrome (AIDS)
 AIDS treatment
 currently no cure
 Goal is to maintain the best possible
immune status by using immunizations
and anti-infective therapy
Slide 22
Immunodeficiency Diseases (cont’d.)
Universal Precautions
 Thorough and frequent hand washing.
 Personal protective equipment worn as required by
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specific task (e.g. gloves, gown, goggles, mask).
Proper disposal of all sharps in designated
biohazard containers.
No needle recap prior to disposal.
Caution in handling of laboratory specimens.
Proper containment and disinfection of blood and
body fluid spills.
Use clean mouthpieces and resuscitation bags.
Slide 23
Immunodeficiency Diseases (cont’d.)
 Common Variable Immunodeficiency
 acquired B cell deficiency
 Selective Immunoglobulin A
Deficiency
 inadequate production of IgA
 Severe Combined Immunodeficiency
 ineffective development and function of
both T cells and B cells
Slide 24
Autoimmune Diseases
 What is autoimmune disease?
 What are some examples?
Slide 25
Autoimmune Diseases
 Lymphocytes and antibodies are
sensitized to develop against the
body’s own organs or tissues.
 May be triggered by disease, injury,
metabolic changes, or mutation in
immunologically competent cells.
 May be caused by certain drugs or
chemicals, trauma, or viral infection.
Slide 26
Autoimmune Diseases (cont’d.)
Pernicious anemia
 Impaired absorption of B12 due to
decreased gastric production of
hydrochloric acid.
 Treatment consists of monthly
intramuscular injections of vitamin
B12 during the person’s entire
lifetime.
Slide 27
Autoimmune Diseases (cont’d.)
Pernicious Anemia
 Symptoms: weakness and tingling and
numbness in extremities, altered vision,
lightheadedness, tinnitus, palpitations,
weight loss, digestive disturbances, sore
tongue.
 Signs: decreased red blood cell, white
blood cell, and platelet counts; increased
red blood cell mean volume; decreased
hemoglobin levels; jaundice; optic nerve
atrophy; decreased amount of gastric acid.
Slide 28
Autoimmune Diseases (cont’d.)
Collagen Diseases
 Systemic lupus erythematosus
 Scleroderma
 Sjogren syndrome
 Rheumatoid arthritis
 Juvenile rheumatoid arthritis
 Ankylosing spondylitis
 Polymyositis
Slide 29
Autoimmune Diseases (cont’d.)
Systemic Lupus Erythematosus (SLE)
 Inflammation of skin, joints, nervous
system, kidneys, lungs, and other
organs.
 Butterfly rash across face may be
present.
 Other rashes may appear on other
exposed skin areas.
Slide 30
Autoimmune Diseases (cont’d.)
Systemic Lupus Erythematosus (SLE)
 Butterfly face rash
 Pleuritis or pericarditis
 Alopecia
 Protein or casts in the
 Photosensitivity
 Raynaud’s
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phenomenon
Thrombocytopenia
Discoid skin lesion
Nasopharyngeal
ulceration
Polyarthritis
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urine
Hemolytic anemia
False-positive serology
Abnormal blood
antibodies
LE cells (leukocytes)
present in lab testing
Slide 31
Autoimmune Diseases (cont’d.)
 Rheumatoid arthritis (RA)
 Chronic, inflammation and edema of the synovial
membranes surrounding joints.
 Destruction of cartilage and adjacent bone.
 May produce weight loss, fever, and malaise.
 Joint pain and stiffness, especially in morning.
 Bilateral joint tenderness, edema, erythema,
warmth.
Slide 32
Autoimmune Diseases (cont’d.)
Rheumatoid arthritis treatment aimed at:
 Reducing inflammation and pain
 Preserving joint function
 Preventing joint deformities
Slide 33
Autoimmune Diseases (cont’d.)
Ankylosing spondylitis
 Inflammation and ossification of the
joints leading to decreased range of
motion and spinal bone fusion.
 Sacroiliac spine area is usually affected
first and results in recurring low back
pain and morning stiffness.
 History may include inflammatory bowel
disease, heel pain, and family incidence
of arthritic conditions
Slide 34
Autoimmune Diseases (cont’d.)
 Multiple sclerosis (MS)
 Inflammatory disease of the central
nervous system.
 Demyelination of nerves occurs in the
brain and spinal cord.
 Signs and symptoms are primarily
neurologic and related to areas of myelin
destruction.
Slide 35
Autoimmune Diseases (cont’d.)
Myasthenia gravis (MG)
 Chronic progressive neuromuscular
disorder.
 Autoantibodies produced to
acetylcholine receptor in muscle cells.
 Ineffective nerve-muscle junction results
in severe weakness, difficulty talking and
swallowing, drooping eyelids and
diplopia.
Slide 36
Autoimmune Diseases (cont’d.)
 Vasculitis
 Inflammation in the walls of blood
vessels that may lead to necrosis,
thrombus formation, and local infarct
 Can be classified as small vessel or
systemic; affecting medium and large
arteries
Slide 37