Immunological disease

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  • Immunological DiseaseDisease

    Dr. Deepak K. Gupta

  • Syllabus

    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

  • Introduction

    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

    Congenital agranulocytosis

    Leukocyte-adhesion deficiency

    Lymphoid 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

  • Symptoms

    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

    Recurrent infections

    Death at early age

  • Secondary Immunodeficiency

    Drug related

    Disease related




    T helper cell as target

  • Acquired Immunodeficiency Syndrome/AIDSSyndrome/AIDS

  • Introduction

    Caused by Human


    Virus (HIV)

    Human immune Human immune

    system are unable to

    overcome the


    The person becomes


  • Introduction

    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

    for 55%

    (UNAIDS 2006 )

  • History

    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


  • HIV Pathophysiology

    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





    Vaginal secretion



    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


    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

    opportunistic malignancies


    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)


  • 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)

    -Oral neoplasias

    -Neurological conditions

    -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)

    Fusion inhibitors

    CCR5 co-receptor antagonists (entry inhibitors)

    HIV integrase strand transfer inhibitors

  • Hypersensitivity reactions

    An exaggerated or inappropriate state of An exaggerated or inappropriate state of normal immune response with onset of

    adverse effects on the body

  • Hypersensitivity reactions

    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)


    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.