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Transcript of Immunological disease
Dr. Deepak K. Gupta
Immuno deficiency disorders a brief knowledge of various types of immuno deficiency
disorders A sound knowledge of immunodeficiency disorders
relevant to dentistry.
Hypersensitivity reactions Hypersensitivity reactions Autoimmune disorders
Basic knowledge of various types sound knowledge of autoimmune disorders of oral cavity
and related structure
Immunology of Transplantation and Malignancy Immunehaematology
Immunodeficiency disordersImmunodeficiency disorders
A state in which the immune system's ability to fight infectious disease is compromised or entirely absent.
It may be 2 types It may be 2 types Primary: Usually congenital, resulting from genetic
defects in some components of the immune system.
Secondary (Acquired): as a result of otherdiseases or conditions such as HIV infection,malnutrition, immunosuppression
Primary Immunodeficiency Disease Myeloid lineage
Severe combined immunodeficiency (SCID)
B cellsAgammaglobulinemia Agammaglobulinemia
Specific Ig Deficiencies
T cells DiGeorge Syndrome
Wiskott Aldrich Syndrome
Complement system deficiency
Disorder of Phagocytosis : chronic granulomatous disease
Recurrent respiratory infections.
Persistent bacterial infections sinusitis, otitis and bronchitis.
Increased susceptibility to opportunistic infections (OIs) and recurrent fungal yeast infections.and recurrent fungal yeast infections.
Skin and mucous membrane infections.
Resistant thrush, oral ulcers and conjunctivitis.
Diarrhoea and malabsorption.
Failure to thrive and delayed or incomplete recovery from illness.
Aetiology Aetiology associated with
Genetic defects of missing enzymes.
Specific development impairment (pre-B-cell failure). cell failure).
Infections, malnutrition and drugs
Severe combined immunodeficiency (SCID)
Various genetic defects
No TCR or defective TCR
Defective cell signaling
Defective IL 2 Defective IL 2
Death at early age
T helper cell as target
Acquired Immunodeficiency Syndrome/AIDSSyndrome/AIDS
Caused by Human
Human immune Human immune
system are unable to
The person becomes
A weak immune system can no longer effectively
defend the body resulting to
The body becomes vulnerable to a variety of infections &
Infections that take advantage of a weakened immune
system are opportunistic infections.
Eventually the immune system is so weak that the body is
overwhelmed by infections and/or cancers, and the person
Acquired Immunodeficiency Syndrome (AIDS)
A syndrome is a group of symptoms & signs associated with the same underlying condition.
Classified in 2-type Classified in 2-type
HIV-1: predominantly found in East, Central, South Africa and other parts of the world
HIV-2 reported mainly in W. Africa.
HIV infection global pandemic Worldwide 40.3 million infected people,
Among adults 15 - 49 yrs. , 1.1%
4.1 million death 4.5 million new cases/ year 4.5 million new cases/ year 14,000 new infections/ day
2.40 million Indians are living with HIV 83% are the in age group 15-49 years 39% (930,000) are among women Andhra Pradesh, Maharashtra, Karnataka , Tamil Nadu account
(UNAIDS 2006 )
1979 Increased Kaposi sarcoma and Pneumocystis carinii infections in homosexuals noted in Africa.
1981 First case in California. 1981 First case in California.
> 30 million in world 1999 increasing
It is RNA virus, in the group of lenti virus.
Subfamily of retrovirus.
It contains two copies of single stranded Ribonucleic Acid (RNA).
Viral RNA is surrounded by a capsid made from viral Viral RNA is surrounded by a capsid made from viral proteins
This is enclosed in a viral envelope formed from the cellular membrane of the host cell.
Primary targets CD4+T lymphocytes
Over time, CD4 cell counts decline and results in a poorly functioning immune system
Penetration of virus in tohost plasma membrane results into virion
Reverse transcriptase and integrase molecules get attached to viral RNA. attached to viral RNA.
These helps in the synthesizes of DNA copies of RNA. Integrase catalyses
their insertion into the host DNA chromosome in the nucleus.
TransmissionIt can be transmitted through the following body fluids: Blood Semen Vaginal fluid Breast milkHIV cant be transmitted through the following :HIV cant be transmitted through the following : Saliva Tears Urine Mosquitoes Toilet Seats Kissing Hugging
Concentration in Human Body FluidsConcentration in Human Body Fluids
CDC classifies HIV infection into 3 categories, as follows : Category A: Asymptomatic HIV infection without a
history of symptoms or AIDS-defining conditions
Category B: HIV infection with symptoms that are Category B: HIV infection with symptoms that are directly attributable to HIV infection (or a defect in T-cellmediated immunity) or that are complicated by HIV infection
Category C: HIV infection with AIDS-defining opportunistic infections
These 3 categories are further subdivided on the basis of the CD4+ T-cell count, as follows:
1. > 500/L: Categories A1, B1, C1
2. 200-400/L: Categories A2, B2, C22. 200-400/L: Categories A2, B2, C2
3. < 200/L: Categories A3, B3, C3
SIGNS AND SYMPTOMS
The patient with HIV may present with signs and symptoms of any of the stages of HIV infection.
No physical findings are specific to HIV infection; The physical findings are those of the presenting infection
or illness. Manifestations include the following: Manifestations include the following:
Acute seroconversion manifests as a flulike illness, consisting of fever, malaise, and a generalized rash
The asymptomatic phase is generally benign Generalized lymphadenopathy is common and may be a
presenting symptom Recurrent, severe, and occasionally life-threatening infections or
SIGNS AND SYMPTOMS
HIV infection can cause some sequelae,
Including AIDS-associated dementia/encephalopathy
HIV wasting syndrome HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause)
SIGNS AND SYMPTOMS
HIV Screening & Diagnosis
Antibody detection: Blood donors screening, ELISA, Western-Blot (Confirmatory)
Antigen detection Blood donors screening, diagnostic Blood donors screening, diagnostic ELISA
Nucleic Acid Testing (DNA, RNA): Blood donors screening (on pools), diagnostic, follow up Lymphocyte culture
Tests for defects in immunity CD4+ T cell counts
Oral Manifestation of HIV
Oral conditions associated with HIV infection are divided into five major groups:
-Microbiological infections (fungal, bacterial, viral)
-Lesions of uncertain aetiology-Lesions of uncertain aetiology
-Oral conditions associated with HIV treatment.
Other co-infections and conditions associated with HIV infection, which are significant to dentists are:
-Persistent generalised lymphadenopathy
-Gastro-oesophageal reflux disease (GORD).
Highly active antiretroviral therapy (HAART) is the principal method for preventing immune deterioration.
Classes of antiretroviral agents include the following: Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors (PIs) Protease inhibitors (PIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
CCR5 co-receptor antagonists (entry inhibitors)
HIV integrase strand transfer inhibitors
An exaggerated or inappropriate state of An exaggerated or inappropriate state of normal immune response with onset of
adverse effects on the body
The lesions of hypersensitivity are a form of antigen - antibody reaction.
Subdivided into four types; Type I hypersensitivity
Type II hypersensitivity
Type III hypersensitivity
Type IV hypersensitivity
First three are variations on antibody-mediated (Immediate type) injury, whereas the fourth is cell mediated (delayed type)
TYPE I HYPERSENSITIVITY
A state of rapidly developing or anaphylactic type of immune response to an antigen (i.e. allergen) to antigen (i.e. allergen) to which the individual is previously sensitised.