S THT BI CA CC C CH KHNG

Trn Khim Hng

TNG QUAN:
1. Mc tiu ca cc p ng min dch:
2. p ng min dch thng qua:
- Min dch t nhin.
- Min dch c hiu:
+ Min dch dch th.
+ Min dch t bo.
3. Nu tht bi:
S TRN TRNH KHI H THNG MIN DCH CA CC TC NHN GY BNH

Hin
h 1. Hnh minh ha.

SUY GIM MIN DCH DI TRUYN SUY GIM MIN DCH MC PHI
I. S TRN TRNH KHI H THNG MiN DCH CA CC TC NHN GY
BNH:
1. Khng nguyn thay i:
a. Type huyt thanh (serotype):
VD: Streptococcus pneumoniae c khong 84 serotype.
b. t bin gen (mutation):
VD: Trong trng hp cm:
Bang 1. t b in trong trng hp cm.

Trt khng nguyn (Antigenic drift) Sang s khng nguyn (Antigenic shift)

+ Ti sp xp li ARN ca virus ly bnh v

+ t bin im gen cho KN hemagglutinin. virus c sn ca k ch.
+ Xy ra thng xuyn trong qu trnh sao H5 N1 (2003)H7 N 9
chp, xy ra chm v dn dn. + Xy ra t ngt, khng d bo trc c,
thng gy ra nhng i dch.
Hin
h 2. Trt khng nguyn to ra t b in nh, sang
s khng nguyn to ra chng mi.
Hinh 3. C ch t b in ca virus cm.
c. Ti sp xp ADN ca tc nhn gy bnh:
VD: African trypanosomes. VSG (variant Specific Glucoprotein) a dng hnh thnh trong qu
trnh c ng c th k ch.

Hinh 4. Vng i rui x x, k ch trung gian gy b nh ng thip.

 - There are at least 200 active VSG alleles and more than 1000
silent alleles and pseudogenes also encoding VSG variants. Thc
t ch cn mt allele l c 1 VSG tng ng.

Hin h 5. Trypanosoma
b rucei sp. (trng mi
khoan), k ch gy b nh
b un ng.

Hinh 6. iu ha b iu hin VSG.

2. Ng, yn lng:
- Herpes simplex virus:
+ HSV biu hin LAT (latency Associated
Transcript) c tc dng duy tr s sng ca
t bo m virus ang k sinh.
+ Mt loi protein c trong t bo thn kinh,
kt hp vi DNA ca HSV c tc dng iu
ha qu trnh tim tng ca virus.

Hin
h 7. HSV n np hch thn kinh sinh b a.

- Herpes zoster hay varicella zoster virus:

Hinh 8. Din tin b nh zona.

Hin
h 9. Biu hin b nh zona (1). Hinh 10. Biu hin b nh zona (2).
3. Tc nhn gy bnh tc ng ln cc t bo min dch, c th:
- HSV:
+ Ngn cn hot ng ca TAP bng ICP-47, mt cht c tit ra bi HSV
+ c ch qu trnh tng hp MHC-1
Hinh 11. C ch hot ng ca TAP (1).

Hinh 12. C ch hot ng ca TAP (2).

- Mycobacterium tuberculosis:

Hinh 13. Mycob acterium tub erculosis trong i thc b o.

- Listeria monocytogenes:
+ Haemolysin called listeriolysin O and two other enzymes: phospholipase A and phospholipase
B
Hin
h 14. Immune evasion strategy used b y Legionella
pneumophila to prevent b eing presented b y MHC
class II molecules. This schematic depicts L.
pneumophila evasion at the cellular level. The word
endosome and phagosome are synonymous.

Hin
h 15. Minh ha Listeria monocytogenes.
+ Listeriosis is characterized by its ability to
cause septicemia, meningitis, or spontaneous
abortion in infected individuals, especially
those who are immunocompromised (people
with cancer or AIDS).
- HIV:

Hin
h 16. HIV chn s chuyn phn t MHC loi I n b mt t b o.
4. Gy ng p lng ng:

- St xut huyt:
Hinh 17. Vn cha hiu sao hnh ny li c trong slide :v
II. Suy gim min dch:
1. Lm sao bit c bnh nhn b suy gim min dch bm sinh hay mc phi ch bng pp
vn chn?
2. Tng t, lm sao bit c bnh nhn b suy gim min dch t bo hay dch th?
Bang 2. Phn b it suy gim min dch b m sinh v suy gim min dch mc phi.
Bm sinh (< 10%) Mc phi (90%)
Lin quan cc yu t bn trong (intrinsic Lin quan mt bnh l c trc (Underlying
factors): disease):
- Thiu enzyme cn thit. - Bnh l lympho c tnh.
- Thiu t bo cn. - Nhim HIV.
- T bo khng thc hin c chc nng. - Suy dinh dng.
- Thuc c ch min dch.
Do khim khuyt gene. Mc phi.
Biu hin lm sng vo giai on sm. Biu hin tt c cc giai on.
III. Suy gim min dch bm sinh: + Nhim trng nng vi loi vi khun c v
1. Gim lng khng th trong mu: bao polysaccharide.
+ Hch ngoi bin t i.
+ T bo min dch gim.
+ VD: bnh XLA (X-linked
agammaglobulinemia) do khim khuyt gen
XLA trn NST X cn cho vic tng hp
Brutons protein kinase.

Hin
h 18. Mc khng th thay i theo tui.
- Cc con s bt thng:
+ Lng IgG<1000 l bt thng.
+ Lng IgM<100 l bt thng.
+ Lng IgA<10 l bt thng.
- Biu hin:
+ Vim ng h hp trn v di ti i ti
li.
Hin
h 19. Bnh XLA.
2. Gim lng b th: xut hin nhiu dng lm sng:
+ Thiu ht C3 hay qu trnh hot ha C3 dn n nhim vi khun sinh m.
+ Thiu ht phc hp C5-C9 tng kh nng nhim cc loi tc nhn sng ni bo,
+ VD: Neisseria spp Nht, t l nhim 1/2.000.000. Nhng nhm khim khuyt, t l 1/200
Gim kh nng loi tr phc hp MD Bnh t min?

Hinh 20. Phc hp min dch.

3. Suy gim chc nng thc bo: Sialyl-LewisX (Bch cu)-selectin (ni m):
+ Hu qu: khng vi liu php khng sinh, nhim trng dai dng mc d h thng min
dch t bo v dch th hon ton bnh thng.

Hinh 21. Neutrophils are directed to sites of infection through interactions b etween adhesion molecules.
+ Kh nng chng vi khun ca t bo thc bo suy gim nghim trng v???

Hinh 22. Thc b o vi sinh vt.

Hin
h 23. Thc b o vi khun.
4. Khim khuyt chc nng t bo T trong hi chng thiu ht min dch trm trng
(severve combined immunodeficiency): nh hng nhiu cp khc nhau:
+ Khim khuyt th th Interleukin: lin quan nhim sc th X:

Hin
h 25. Nhim sc th X.

Hinh 24. Th th Interleukin.

Hin
h 26. C ch hot ng th th ILR2.
+ Khim khuyt ADA (adenosine deaminase):

Hinh 27. Vai tr ca ADA.

Adenosine is a component of adenine nucleotides including ATP and RNA.

2-Deoxyadenosine is a component of DNA and primarily derives from its breakdown.
 2-Deoxyadenosine behaves as a cytotoxic metabolite and is generally considered the primary
cause of lymphotoxicity in ADA-severe combined immunodeficiency (SCID; Hirschhorn and
Candotti, 2006)
Elevated adenosine levels, as occurring in ADA deficiency contribute to apoptosis and block in
the differentiation of thymocytes, causing severe T lymphopenia in mice and humans (Apasov et
al., 2001; Gaspar et al., 2009; Poliani et al., 2009)
K c lympho B
+ Hi chng DiGeorge: do mt mt on nh NST 22, t bo tuyn c khng pht trin bnh
thng.
Cardiac abnormality (especially tetralogy of Fallot)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia/Hypoparathyroidism

Hin
h 29. H hm ch.

Hinh 28. c im khun mt c trng ca hi chng DiGeorge.

+ Hi chng lympho trn (BLS Bare Lymphocyte Syndrome)
Thiu phn t MHC II.
Thiu phn t MHC I.
Hin
h 30. Cc hi chng suy gim min dch b m sinh.

Hinh 31. Cc du hiu cnh b o b nh min dch b m sinh.

IV. Suy gim min dch mc phi:
- HIV/AIDS
Hinh 32. Cu to virus HIV.

Hinh 33. HIV entry into CD4+ cell via CCR5 co-receptor.
 Hin
h 34. Schematic representation of HIV-1 replication.
+ Chn on
+ iu tr
+ Phng nga