\u20acDiscriminate between self and foreign
\u20acExclude, eliminate or kill foreign invasion
\u20acDevelop memory and amplified recall response
\u20acDeficits result in

Our immune systems need to be able to discriminate between self and foreign in a way that allows it to exclude, eliminate or kill the foreign invader. Any deficits in these functions will result in either an increased frequency or severity of infections, that essentially produce disease in otherwise healthy individuals. If the organism is able to get past the native immune, and the native immune first exists in the absence of previous exposure to the organism. Infection can occur, but the disease will not occur because the immune system suppresses the growth prior to that. Disease occurs if the tempo of replication is faster, but yet allows the immune system to catch up, and then severe fatal infection occurs in a situation where the organism is able to replicate more rapidly than the immune response. And of course this can happen in one of two ways; either the organism is very rapidly growing, or the immune system is slow in responding, and of course if you have an inadequate immune system.

\u20acBarriers - skin and mucus membranes, normal flora, spleen
\u20acOpsonins - complement, collectins, CRP
\u20acPhagocytes - neutrophils, monocytes, macrophages and NK cells

And our phagocytes, which of course we routinely end up knocking these out in cancer chemotherapy and other sorts of interventions that are being performed in trying to help patients. So the phagocytic cells included of course are neutrophils and monocytes in the blood, active follicles in the tissues. These cells of course regularly protect us initially from viruses, primarily in the absence of prior increase in the antigens specific immunity.

What are the components of antigens specific immunity? While these are becoming the illustrated test to find HIV, The C4 T-cells are particularly important because they are sort of the regulators of everything else. They set the tempo for the whole immune response, that of rest of the antigens specific system. They do it by secreting proteins called cytokines. In addition to secreting cytokines, they have proteins that are expressed on the membrane when they are activated by a form of antigen, and these proteins help enhance the recognition phase of the immune response, by including antigen presenting subfunction, and also act on B cells. And finally there are B cells and antibodies of course that protect us from bacterial pathogens, especially capsular pathogens, but in addition, play an important role in protecting us against a wide variety of things, such as viral infections and so forth.

The patient presents to you with a clinical problem, usually infection, sometimes odd immunity, sometimes malignancy, and you must try to figure out what is going on. So, your looking at infections that are associ- ated with or patients that present with recurring or persistent sign of pulmonary or ear infections, I usually like to break them down into two groups. If they occur without GI infections, the most common deficits are deficits in innate respiratory mucosal defenses. Allergies were secondarily affects of the defenses, or deficits in humoral immunity, that is antibody production in particular. If there are also GI type of infections, than antibody deficiencies becomes even the more vital. So what are the components of the innate defenses that are intrinsic to our respiratory tract. We do not get many humans that have this deficiency. And then finally, macrophages in the lung, and those play a primary role in clearing microbes in the first patch effect, and also in secreting cytokines that were recruited for other intentions. Well the most common one I will refer to is unfavorable anatomy. Occurring in the first year or two of life. In other situations, secondary to infection, or other anatomical abnormalities such as we seen in individuals with cleft palate and lip, you may have difficulty with normal cleft, because of unfavorable anatomy. And then of course there are secondary or primary cellular dysfunction. Secondary being overwhelmingly the more common, and usually being secondary to prior infections. So the ciliated cells don\u2019t function normally. That is commonly associated with cystic fibrosis. So that is a rare immune deficiency localized in the respiratory tree, that is usually on the bottom of our evaluation list.

So how does one go about evaluating these children who have recurrent infections in the sinus and ears. After you take the history, evaluate the patient, and do a radiograph of the sinuses and of the chest, looking for abnormalities. Screening allergy evaluation generally to those, the second part of that is a good history and family history. Swab tests of course is straightforward, easy, and a part of the evaluation. Ancillary evaluation may occur except in those cases where we have exhausted other possibilities, and this means obtaining ciliated cells from the nose, or the bronchial tree. The problem here is you have to get it from a noninflamed area, because