Immuno Step Q’s

1. (M1.IM.53) A 3-year-old female is found to have unusual
susceptibility to infections by catalase-producing organisms. This
patient likely has a problem with the function of which of the
following cell types?
Patients with chronic granulomatous disease, in which neutrophils
are dysfunctional, have increased susceptibility to infection by
catalase-producing organisms.
Chronic granulomatous disease (CGD) is characterized by a deficiency
of neutrophil NADPH oxidase. Normally, NADPH oxidase generates
reactive oxygen species in the neutrophil which are converted into the
antibacterial hydrogen peroxide. Individuals whose neutrophils cannot
produce their own hydrogen peroxide are thus highly susceptible to
bacteria that break down hydrogen peroxide (catalase-positive
organisms). Examples of catalase positive organisms include S. aureus,
E. coli, Pseudomonas, and Aspergillus. (PLACESS)

2. A 28-year-old female suffering from a urinary tract infection is
given trimethoprim-sulfamethoxazole (TMP-SMX) by her
physician. As a result of the medication, she begins to
experience itchiness and joint pain. Laboratory and histologic
analysis reveals vasculitis and antibody complexes deposited
near the basement membrane of the glomerulus. What other
serological finding is expected with this presentation?
The patient presents with serum sickness as a result of an immune
reaction to the TMP-SMX she was prescribed for her urinary tract
infection. Serum sickness is the result of immune complex deposition
in various tissues of the body which activate/consume C3 and result in
decreased serum levels of C3.
Serum sickness is a Type III hypersensitivity reaction. When certain
medications are given, the immune system can become sensitized to
antigens present within the medications and produce antibodies. These
antibodies combine with the antigens from the medication to form
immune complexes, which can be deposited in the vasculature,
kidneys, skin, and joints and lead to vasculitis, nephritis, pruritis, and
arthritis, respectively. Additionally, these IgG antibodies activate

The development of carditis in the context of acute rheumatic fever and rheumatic heart disease is a result of molecular mimicry. In contrast to acute rheumatic fever (ARF). Twenty years later. The most common valvular abnormality of RHD is mitral stenosis. The bacteria are gram-positive and bacitracin inhibits their growth. erythema marginatum. A throat swab and culture reveal the growth seen in Figure A. The child is given treatment and sent home. and nodule formations beneath the skin. CD27 = plasma cell marker --> preformed antibodies (in hyperacute REJECTION” 3. The patient's current symptomatology most likely occurred secondary to which of the following? The patient suffered from Streptococcus pyogenes pharyngitis that ultimately resulted in rheumatic heart disease. . chorea. The clinical hallmarks of acute rheumatic fever include fever. This molecular mimicry leads to immune activation and inflammation of the heart (myocarditis). swelling of joints. the patient presents to the emergency department with dyspnea on exertion and CXR showed an enlarged cardiac silhouette and pulmonary edema. The myocarditis associated with these diseases occurs due to antibodies specific for the bacterium cross-reacting with self-antigens of the heart tissue. Other examples of a type III hypersensitivity reaction are systemic lupus erythematosus and the arthus reaction.complement resulting in a low C3 level in serum. Rheumatic heart disease (RHD) occurs as a complication of prior group A streptococcal pharyngitis. RHD is a chronic valvular abnormality that develops secondary to repeated inflammation and resolution. A 10-year-old male is taken to his physician by his parents due to a sore throat. myocarditis.