IMMUNOLOGY RECALLS

1. ASO titer and Anti-DNAse be are used for 8. Stages of syphilis TREPONEMES -> REITER
detecting strep infection 1. Primary: hard chancre STRAIN
(soft chancre: H. ducreyi)  NICHOL STRAIN -> fixed to slides
2. Major sites of infection with Group A strep are 2. Secondary: condylomata lata
the upper respi tract and skin with pharyngitis 3. Latent: absence of clinical symptoms
and impetigo being the most common 4. Tertiary: gummas, neurosyphilis

3. Streptococcal Antigens/extracellular products 9. Test for Syphilis

1. SLO – Oxygen labile, stab on BAP, ASO A. Nontreponemal
2. SLS - No antibodies detected - detects an using cardiolipin (readin or
3. HS – Antihyaluronidase, ASH test reaginic antibody)
4. SK – Anti-Streptokinase, ASK test - flocculation is the result of the reaction
5. DNAse – Anti-DNAse, Anti-DNAse Test bet. regain and cardiolipin
6. NADase – Anti-NADase, Anti-NADase test - VDRL, RPR, TRUST, USR, RST
10. Components of the Immune System
4. ASO Titer A. Nonspecific defense mechanisms
- ASO is oxygen labile hemolysin that can a. First line of defense
lyse RBC by binding to chole in the RBC  Skin
membrane  Mucus memb
- Titer bigns to increase ~7days after  Skin secretions
infection, peaks after 4-6 weeks b. Second line of defense
- Based on neutralization of hemolytic  Phagocytic WBC
activity of SO  Antimicrobial prot
- NORMAL : 166 Todd units  Inflammatory response
- MOD ELEV: <240 Todd units for adults B. Specific defense mechanisms
<320 Todd units for children a. Third line of defense
B. Treponemal  Cellular: Lymphocytes
5. Anti-DNAse B -detects ab-directed against T. pallidum  Humoral: Antibodies
- Appears earlier than ASO in strep against specific trep ag
pharyngitis - usually becomes positive before nontrep
- Based on neutralization tests
- Measured by effect on DNA-methyl green - once an individual becomes reactive,
conjugate, positive result indicates colorless, individual remains so for life
since the conjugate will be hydrolyzed by - fewer false +, cross reactivity seen with
the DNA other nontrep diseases
a. TPI Test
6. Streptozyme  If >50% immobilized: POSITIVE
- Detects many streptococcal anitgens: SL,  If <20% immobilized:
SK, HS, DNAse, NADase NEGATIVE
 20-50%: DOUBTFUL
7. Syphilis b. FTA-ABE ’
- caused by T. pallidum  Heat inactivated, prepared with a 11. Papain cleaves at the hinge, separating fragments
- Wasserman test is the first diagnostic blood test sorbent consisting of into 3
NONPATHOGENIC
IMMUNOLOGY RECALLS
12. Pepsin cuts below the disulfide bond leaving one
unit of 2 partial heavy chains and 2 light chains
all attached with a disulfide bond
13. Urea and mercaptoethanol digestion removes
ALL disulfide bonds leaving free units of light
and heavy chains
14. IgG agglutinates rbcs after anti-human globulin is
added to the tube
15. IN VIVO – Direct Coombs test
16. RHEUMATOID ARTHRITIS
- Affects synovial membrane of multiple joints
- Characterized by the presence of an autoab
called RF which is most often of IgM class and
is directed against the Fc portion of IgG
- Found in px with other connective tissue disease
such as SLE, Sjogren’s syndrome, scleroderma
and mixed CT disease
- Found in 5% of healthy individuals and 10-25%
of those >65 years of age -> not a definitive
parameter to diagnose arthritis
- Thrives in cold temperature because IgM
- CCP is the most highly specific indicator for
rheumatoid arthritis
17. RF test
- Agglutination using charcoal of latext
particles
- Tests detect the IgM isotype (75%) only, not
IgG and IgA isotypes
- Sheep agglutination
- RF latext agglutination
 POS: titer of 80 or greater
 W. POS: titer of 20-40
 NEG: no agg of 1:20
18. Anti-CCP
- 20-30% of RF negative patients are positive
for anti-CCP -> higher speci
- Presence of anti-CCP precedes onset of RA
by several years, making it a better marker
for early disease
- Assoc. with increased likelihood to develop
clin sig disease activity with worse
prognosis
- Anti-CCP and RF = specificity of 98-100 ->
more accurate diagnosis of RA
19. 2 types of light chains: Kappa and lambda
20. Albumin is the highest concentration in serum
21. Igg is the highest concentration
immunoglobulins
22. Late steps of complement activation
formation of the MAC results in cell lysis
23. Chediak Higashi
- Both morphologically and functionally
abnormal leukocytes
- WBCs unable to degranulate and kill
invading bacteria
- Abnormal fusion of primary and secondary
neutrophilic granules
- Large gray-green POD positive granules in
the cytoplasm of wbc
24. CGD
- Morphologically normal but functionally
abnormal bc of enzyme deficiency that
result results in an inability to degranulate,
causing inhibited bactericidal function
25. Antithyroid peroxidase is usually found in a
patient with Hashimoto’s thyroiditis
in HASHIMOTO’S THYROIDITIS
- Lymphocytic infiltration
- Destruction of the thyroid glands
- Anti-thyroid peroxidase ab or Anti-
microsomal antibodies
- Anti-thyroglobulin antibodies
26. Features of SLE
- Positive ANA
and - Circulating immune complexes
- Elevated ESR
- Decreased serum complement
SLE
-characterized by presence of ANA
- immune response directed against a broad range
of target antigens, as the typical px has an
average of 3 circulating autoantibodies
- immunoregulation is also compromised as T reg
cells seem to be more sensitive to apoptosis
IMMUNOLOGY RECALLS
27. Double- stranded DNA ab are the most specific
for SLE and their presence is considered
diagnostic for SLE
28. Anti-Sm antibody is also diagnostic for SLE bc it
is not found in other autoimmune disease,
however it is only found in 7-25% patients with
this disease
29. APC include macrophages, dendritic cells, B
cells and tissue cells.
30. INFECTIOUS MONONUCLEOSIS
- DNA virus
- Herpes virus associated with Burkitt’s
lymphoma and nasopharyngeal carcinoma
- 80-90% of healthy adults have EBV antibodies,
the virus is ubiquitous
- Acute, self-limiting, infectious
- 2-8 weeks as average incubation period
- Affected cells: B Cells having CD21
- Type II Downey cells present on hematologic
examination (an enlarged lymphocyte with
atypical nuclei)
31. HEPATITIS
32. Epstein Barr infected B lymphocytes express
variety of new antigens encoded by the virus
a. EBV infection results in expression of VCA,
EA, and EBNA
b. The correct sequence of the immunologic EBV
response in IM is: VCA, EBNA, VCA-IgM,
and EA (a misnomer lol)
33. HYPERSENSITIVITY REACTIONS
a.
Type I: Immediate
b.
 Occurring in previously sensiti-
zed individual triggered by
binding of ag to IgE ab on the
surface of Mast Cells
 Reactions = allergy
 Antigens = allergens
 May occurs as a systemic disorder
or as local reaction
 TWO PHASE REACTION
1. Immediate response is rapid,
5-30 min after exposure to ag
2. Late phase response, 2-8 hrs
later, occurs in 50% of patients,
infiltration of mono, eo, baso,
PMNs
Type II: Cytotoxic Hypersensitivity
 Characterized by interaction of
IgG or IGM ab to cell bound
antigen
 Binding results to complement
activation and cytolysis
 Rbc, wbc, plts can be lysed
 Initiated by the interaction
between antibody except IgE and
antigen
 Ab coated cells are lysed by
effector cells such as NK cells and
macrophages
 NK cells synthesize a number of
cytokines involved in the
modulation of IR
IMMUNOLOGY RECALLS
 NK destroy target cells through an
EC non-phagocyte mechanism
reffered to as a cytotoxic reaction
c. Type III:
d. Type IV:
34. CYTOKINES
- IL-2 and IL-3: T cell growth factor and
Multicolony Stimulating Factor; originates
from activated T-cells. IL-22 originates in
activated T cells as well
- IL-2 is adaptice immunity, activates all
clones of T cytotoxic, increases function of
T and NK cells
- IL-3 promotes expansion of early blood cells
differentiating into all known mature cell
types.
- IL-8 originates from macrophages and
certain types of epithelial cells
- IL-18 originates from macrophages and IL-
19 originates from monocytes
- IL-1 originates from monocytes, activated
macrophages, fribroblasts, and dendritic
cells
35. Normal ratio of B cells producing kappa chains
versus those producing lambda chains is
approximately 2:1. Anything outside the ratio is
an indication of monoclonal gammopathy such as
MM
36. MOLECULAR TESTING
a. Transcription-Mediated Amplification is an
isothermal assay targeting DNA or RNA but
makes RNA as its amplified product
b. RT-PCR or Nucleic Acid sequencing is the
procedure that can be modified to include
conversion of RNA to DNA using reverse
transcriptase in the initial steps
c. Nucleic Acid Sequence-Based Amplification is
similar to TMA but only RNA is targeted for
amplification. Applications include detection
and quantitation of HIV and CMV
37. Heating serum at 56 degrees is used to inactivate
complement in several immunological assays.
During heating both heat-labile and heat-stable
anticomplementary activity develop.
38. B cell disorders rank as the most common
primary immunodeficiency category (53%)
because the primary function of B cells is to
produce antibody, the major clinical
manifestation of B cell deficiency is an increased
susceptibility to severe bacterial infections.
39. Primary immunodeficiencies (PIDs) are rare
genetic disorders of the innate and adaptive
immune system. More than 120 different gene
mutations that cause impairment in the
differentiation and function of immune cells have
been identified, with different degrees of severity.
PID disorders are predominantly seen (75%) in
children younger than 5 years. This include
Selective, Combined, and Partial Combined
immune deficiency disorders. A deficiency in this
grouping is the partial combined immune
deficiency disorder, WAS
40. OTHER TERMINOLOGIES
 Granulomatous – aggregation of many
activated macrophage and histiocytes in the
area, particularly with the formation of
multinucleated giant cells
 Purulent or Suppurative – sequence of an
inflammatory reaction that begins with the
local accumulation of segmented neu
 Opportunistic – evolution of an infectious
dse in an immunocompromised or
debilitated host by a bacterial species that
does not commonly cause infection in
healthy host
 Chronic infection – if the infective agent is
not removed by the neutrophils,
mononuclear inflammatory cells, initially
lymphocytes followed by monocytes and
macrophages invade the area
41. Macrophage and Monocytes are phagocytic cells,
activated during infection thru the release of
macrophage-activating cytokines (IFN-Y. G-CSF
from T cells). When exposed to an endotoxin, it
releases TN
42. PMNs are the principal leukocyte associated with
phagocytosis and localized inflammatory
response. It can prolong inflammation by release
of soluble substances such as cytokines and
chemokines
43. Eosinophils are considered a homeostatic
regulator of inflammation, meaning that the
eosinophil attempts to suppress an inflammatory
reaction to prevent excessive spread of
inflammation
44. A nonreactive result must be obtained for both
HIV-1 and HIV-2, as well as the p24 antigen, in
order to consider a patient negative for HIV. This
CDC algorithm allows for earlier detection of
infections and overcomes the limitations
associated with the use of the western blot test.
45. As part of initial screening, an HIV-1/2
antigen/antibody combination immunoassay
should be performed.
46. An HIV-1/2 antibody differentiation
immunoassay should be used to differentiate a
positive screening test.
47. HIV-1 NAT testing should only be used to
resolve any discrepant results between initial
IMMUNOLOGY RECALLS
reactive testing and nonreactive follow-up
testing.

48. The purified protein derivative skin test is also

known as a targeted tuberculin testing. This form
of skin testing for Mycobacterium tuberculosis. It
is performed by injecting 0.1 ml of tuberculin
purified protein derivative (PPD) into the inner
surface of the forearm. The result is read 48-72
hours after the intradermal injection to look for
the presence of a lesion greater than or equal to
10 mm in diameter

49. The rapid plasma reagin test (RPR) is not a skin

test. It is a serologic test for venereal disease
(syphillis).

50. QuantiFERON® assay is not a skin test. It is an

interferon-gamma release assay (IGRA)
performed in the laboratory.

51. SPOT TB® assay is not a skin test. It is an

interferon-gamma release assay (IGRA)
performed in the laboratory.

52. Nephelometry directly measures the amount of

light scattered by particles in solution,
turbidimetry measures decrease in incident-light
intensity