IMMUNO &

INFLAMMATORY
DISEASES

Jasmin S. Betinol
Nurse Clinical Instructor
• Immune system
• Includes the cells and tissues that
carry out immune responses
• Immunocompetencies
• Ability of the cells to carry out
immune responses
• Immunity (specific resistance)
• Ability of the body to defend itself
against specific invading agents
such as bacteria, toxins, viruses
and foreign tissues
 3 body defenses

• First line defense – skin and

mucous membrane
• Second line defense – non-
specific immune response
(involves inflammation)
• Third line defense – specific
immune response (involves
lymphocytes)
 ANATOMY AND
PHYSIOLOGY OF IMMUNE
SYSTEM
• IMMUNE SYSTEM
• is a collection of cells and chons
that works to protect the body
from harmful infectious
microorganisms

• LYMPHATIC SYSTEM
• the body system responsible for
immunity
 COMPONENTS OF
LYMPHATIC SYSTEM

• Lymph
• Lymphatic vessels
• Lymphatic tissues
• Red bone marrow

• Consist of a fluid called lymph flowing with

in lymphatic vessels, several structures &
organs that contain lymphatic tissues, and
red marrow, which houses stem cells that
develop into lymphocytes.
 FUNCTIONS OF THE
LYMPHATIC SYSTEM

• draining interstitial fluid

• transporting dietary fluids
• facilitating immune response
ORGANS OF THE IMMUNE
SYSTEM/ LYMPHATIC
ORGANS OR TISSUES
A. PRIMARY LYMPHATIC ORGANS

• Provide a microenvironment that are

essential for lymphopoeisis (it is the initial
production of lymphocytes)

1. Bone Marrow – constitutes one of the

largest organ in the body
• a marrow mass was originally described
as being RED or YELLOW
• RBM – consist of a mass supporting
cells surrounding aggregates
of hemotopoetic cells
- this is where hematopoesis
occur
• YBM – contains large number of
adipose cells
- not active in hematopoesis. -
- However, during severe blood loss
or in the development of
hypoxia, the YBM can be
converted to RBM.
2. THYMUS
- is a lymphoepithelial organ in the
mediastinum, the thoracic cavity
between the lungs and above the
heart.
2. THYMUS

• the thymus reaches peak development

during childhood, however, after puberty,
it begins to atrophy but remnants
(residue) persist into old age.
• it is the primary site at which T-
lymphocyte differentiate and become
functionally competent.
 SECONDARY LYMPHATIC
ORGANS/ TISSUES

• Is the site where most immune

response occur.

1. LYMPH NODES
• are bean shaped organs located
along lymphatic vessels.
• can only be palpated when it is
swollen due to inflammation
• Supernatural nodes
• are those lying close to the body
surface
• Cervical nodes
• are those that lie alongside the
neck, axillary nodes in the armpit
and inguinal nodes in the creases
between the upper thigh and the
trunk.
• Resident macrophages with in
the node monitor the lymph fluid
for foreign particle & remove
them by phagocytosis
2. LYMPH NODULES
• are oval-shaped concentration
of lymphatic tissue.

Among these are:

A. TONSILS
• Fxn : to detect and respond to
pathogens in the respiratory
and alimentary secretion.
 Five tonsils:

• single pharyngeal tonsil

• embedded in the posterior wall of
the nasopharynx.
• Two palatine tonsils
• lie in the posterior region of the
oral cavity, one on either side.
• Paired lingual tonsils
• located at the base of the tongue.
5 TONSILS
The ORGANS LYMPH
of Immune NODES
System

TONSILS
THYMUS

BONE
MARROW

SPLEEN
B. AGGRAGATED LYMPHATIC
FOLLICLES (PEYER’S PATCHES)

• Found in the ileum of the small

intestine
• Fxn: to detect substances that
diffuse across the intestinal
epithelium.
3. SPLEEN
• is the largest single mass of
lymphatic tissue in the body.
• - it is located in the left
hypochondriac region
between the stomach &
diaphragm.
3. SPLEEN
• Fxn: include the blood –
clearing process via fixed
macrophages in sinusoids as
well as serving as a major site
of humoral-immune response
to blood-borne antigen.
 Humoral Immunity

• B - Lymphocytes
• Antibody Mediated Immunity
 Types of Antibodies

1. IgG - heavy chain gamma

• Monomer - has 2 heavy chains and
2 light chains,
• fix complement or allow it to cross
the placenta.
• Has 2 antigen binding sites.
• IgG, is the most abundant
immunoglobulin located in serum and
tissues (works best in tissues).

• and is responsible for immunity in the

newborn (can cross placenta)
2. IgA - heavy chain alpha

• Secretory component allows IgA

to cross membranes to get into
secretions of the respiratory tract,
GI tract, GU tract, etc.
2. IgA - heavy chain alpha

• Located in serum and secretions

(works best in secretions -tears,
saliva, mucous, breast milk)
• Antiviral and antibacterial.
• Helps to protect against
respiratory infections and keep
organisms from entering the body.
 3. IgM - Heavy chain mu

• IgM is good at agglutinating and

precipitating antigens.
• IgM is found only in serum.
• Main function is to protect against
bacteriemia (bacteria in the blood
stream).
 3. IgM - Heavy chain mu

• Second in abundance,(after IgG).

• First to appear in fetal life.
• First antibody to develop in response
to an infection, so it is important in a
primary infection.
 4. IgE- Heavy chain epsilon

• Found on cell membranes of Basophils

and mast cells, where it acts as an
antigen receptor.
• When binds with an antigen, causes
degranulation of basophils and mast
cells.
 4. IgE- Heavy chain epsilon

• Responsible for Immediate (Type I)

hypersensitivity.
• IgE levels rise during an allergic
reaction.
• IgE can also fight parasitic infections.
5. IgD- heavy chain delta

• Found on cell walls of immature

B cells.
• Acts as a B cell receptor, may
be related to B- cell growth.
 Explanation
1. T & B cell both arise from the
subject of hematopoetic stem
cells in the BONE MARROW, or
fetal liver
2. B cells complete their
development into mature
immunocomponent cells in the
bone marrow – A process that
continues through out life
3. T cells, though originated in the
bone marrow, that develop from the
immature precursor
4. Pre-T cells leave the marrow and
travel through the blood stream to
the thymus , where they proliferate
and differentiate into mature T-
lymphocyte,
5. Most T cell arise before puberty,
some continue to mature throughout
life
6. Before T cells leave the thymus
Or B cells leave the RBM, they
require several distinctive surface
proteins.
7. This is your ANTIGEN
RECEPTOR- molecules capable of
recognizing specific antigens
• Helper T cell
• CD4 and T cells that aid both cell-
mediated and antibody-mediated
immune response

• Cytotoxic Killer cells

• Cause lysis and death of foreign
antigens on the surface of body
cells infected by virus, some tumor
cells and cells of a tissue
transplant
• Suppressor T cells – suppresses
the immune response of B cells
and T cells to an antigen
• Memory cells – have the ability to
recognize similar antigens who had
a previous entry to the system
ORGANIZATIONS INVOLVED IN Ix
PREVENTION

1.  Centers for Dse Control & Prevention

Goal: dse reduction; voluntarily guidelines
1. Guidelines for preventing the
transmission of tuberculosis and health
care facilities
2. Recommendations for prevention of
HIV transmission in health care settings
3. STD Tx guidelines
4. Standards for pediatric immunization
process
PRIMARY (CONGENITAL)

• Primary immunodeficiency can

be inborn as the result of a
genetic defect or can result from
developmental abnormalities
PRIMARY (CONGENITAL)

• The genetic or developmental

abnormalities that cause primary
immunodeficiencies affect B-cells,
T-cells or both.
• Some primary
immunodeficiencies affect
natural killer cells (NK),
phagocytes
• Agammaglobulinemia, a disease in
which few or no antibodies are
produced, occurs in one in about
50,000 people

• severe combined immunodeficiency

(SCID), where neither T or B
lymphocytes are functional, occurs in
only about one of 500,000 live births.
• Selective IgA deficiency, in which very little
or no IgA is produced,
• It is the most common primary
immunodeficiency known.
• It has been reported in different studies
to occur as often as one per 333 to 700
people.
• Although people with this
disorder may appear healthy,
many have repeated bacterial
infections of the respiratory,
gastrointestinal, and
genitourinary tracts, where
secretory IgA is normally
protective.
• In children with DiGeorge syndrome, the
thymus fails to develop in the embryo.
• As a result, T cells do not differentiate and
are absent.
• Affected individuals have other
developmental defects as well, such as heart
and blood vessels abnormalities, and a
characteristic appearance with low-set
deformed ears, small mouth, and wide-set
eyes.
• As expected from a lack of T cells,
affected people are very
susceptible to infections by
eukaryotic pathogens, such as
Pneumocystis carini and other
fungi, as well as viruses and
obligate intracellular bacteria.
• Severe combined
immunodeficiency (SCID)
results from neither T nor B
lymphocytes are produced
from bone marrow stem cells.
Other individuals with SCID lack
adenosine deaminase, an enzyme
important in proliferation of B
and T cells.
A number of these people have
responded well to repeated
replacement of the adenosine
deaminase enzyme.
 Interventions
• Avoid Infections,
• May need long term antibiotics,
• May need reverse isolation.
• Severely suppressed needs life
bubbles or islands.
• Replacement therapy for persons
with primary immunodeficiencies.
 Interventions

• Persons with B-cell defects can

be given gamma globulin or
Fresh frozen plasma.
• Tx for T cell defects is
experimental transplant of T
cells from other persons. Bone
Marrow Transplants are
experimental treatment for
Primary Immunodeficiencies
 SECONDARY
(ACQUIRED)
• Secondary immudeficiency can be
acquired as the result of infection
or other stresses in the immune
system such as malnutrition.
• People with either type of
immunodeficiency are subject to
repeated infections
 ACQUIRED IMMUNODEFICIENCY
SYNDROME

• Causative agent
• Human immunodeficiency
virus, type 1 (HIV-1), a single
stranded RNA virus of the
retrovirus family.
 ACQUIRED IMMUNODEFICIENCY
SYNDROME

• Incubation period
• Usually 6 days to 6 weeks for
acute symptoms;
immunodeficiency symptoms
within 10 years in half the
infection (10% within 5 years
and 90% within 17 years).
 Modes of transmission

1. Semen or vaginal fluid

1. During unprotected sexual intercourse
or oral sex
2. Direct blood to blood contact
1. Such as occurs among intravenous
drug users who share hypodermic
needles
3. Blood transfusion containing the
virus
 High risk populations
1. males, homosexual, bisexuals
2. Sexual partners of persons with the
infection
3. Infants if HIV–infected mothers
4. Intravenous drug users
5. Hemophiliacs and multiple transfusion
1. Characterized by prolonged bleeding,
particularly after accidental, surgical or
dental trauma
 Signs and symptoms
Immediate following infection with
HIV, most people experience a brief
flu like illness
1. Fever
2. Fatigue
3. Rash
4. Headache
5. Joint pain sore, throat, & swollen
lymph nodes
 After a period of 2-10 years, the
virus destroy enough of the helper T
cells, that most infected people begin
to experience symptoms of
immunodeficiency.
1. Enlarged lymph nodes
2. Persistent fatigue
3. Involuntary weight loss
4. Night sweats
5. Skin rashes
6. Various lesions of the mouth & gums
7. Visual disturbances
As the immune system slowly
collapse, an infected HIV-
infected person becomes
susceptible to a host of --
OPPORTUNISTIC INFECTIONS
1. Pneumocystic carinii pnuemonia (PCP)
1. It is ubiquitous (exist in all places,
everywhere) organism that is airborne
and can be found in the lungs of
humans and animals
2. s/s: coughing – non-productive which
progresses to productive cough
fever – dyspnea on exertion and
eventually dyspnea at rest
2. Cytomegalovirus infection (CMV)
> transmitted through direct
contact with infected secretions,
including saliva, cervical fluid, urine,
semen, breast milk, feces & blood
Tx: ANTIVIRALS
3. MYCOBACTERIUM
TUBERCULOSIS
4. HEPA B
5. HERPES SIMPLEX ZOSTER
> spread by direct contact
with infected secretions (oral &
genital)
 Diagnostic test
1. ELISA TEST
(enzyme–linked immunosorbent
Assay)
used to detect Ab
Usually after 3 to 4 weeks, plasma
cell begin to secrete Abs to
components of HIV protein coat.
These are ab are then detectable in
blood plasma
When a person is being tested of
HIV positive, this usually means
that he or she has Ab to HIV in
 However, if the Ab test is
negative, a laboratory test should
be done again to detect HIV’s
RNA or P24 coat protein in the
blood plasma, and her\his can
confirm the presence if HIV.
2. WESTERN BLOT – this is for
confirmation of reactive serologic
screening tests for HIV ABs
PREVENTION OF AIDS IS THE
BEST CURE

• Avoid high-risk behavior such

as injection drug abuse, sexual
promiscuity, and sexual
contact with anyone you
believe has indulged in such
activities.
PREVENTION OF AIDS IS THE
BEST CURE

• Make certain you know a

partner's sexual history.
• Remember that someone can
appear perfectly healthy, yet
still be
harboring HIV.
• All people who are at risk (i.e.
have multiple sexual contacts or
a partner with multiple
contacts) must practice "safer
sex."
• This means no sexual contact
should be unprotected.
• Latex condoms and spermicidal
jellies that can kill the virus
should always be used.
• Sexual practices such as
unprotected anal intercourse
should be avoided.
• If you suspect you're at risk,
get tested for HIV
periodically.
• Remember that it may take
up to six months--or even a
year--for the virus to show
up.
• Do not donate blood if unsure
of your status.
• Although the blood supply is
generally safe in the U.S., you
may want to consider banking
your own blood prior to elective
surgery.
 Medical management

1. Reverse transcriptase inhibitors

- It interferes with the action of the
reverse transcriptase enzyme that
the virus uses to convert its RNa
into a DNA copy
Eg. Azidovudine, didanosine,
dideoxycytidine
 Medical management

2. Protease inhibitors
- This drugs interfere with the
action of protease, a viral enzyme
that cuts proteins into pieces that
are assembled into the coat or
newly produces HIV particles.
Eg. Nelfinavir. Ritonavir, saguiavir
Nursing management

HIV is very fragile virus, it

cannot survive for long outside
the human body
The virus is not transmitted by
insect bites
It is important to understand
that one cannot become infected
by casual physical contact such
as hugging or sharing household
items
Nursing management

The virus can be eliminated

from personal care items and
medical equipment by exposing
them to heat (135F for 10 min)
or by cleaning them with
common disinfectants such as
hydrogen peroxide, rubbing
alcohol, Lysol, standard
dishwashing, and clothes washing
1. Reduce risk of infection:
Observe sign of opportunistic infections,
weight loss, skin lesions, sore throat
Monitor vs
Note secretions & excretions: change in
color, consistency, or odor indicating
infection
Diet: monitor fluid and electrolytes,
encourage dietary intake (high calorie,
high nutrient)
Protective isolation
medications
 2. Prevent the spread of
the disease
Observe universal precaution
wash hands before and after all patients
or specimen contact
Handle blood or body fluids of all patients
as potentially infected
Wear gloves for potential contact with
blood and body fluids
Wear protective eyewear and mask if
splatter with blood and body fluids is
possible
wear gowns when splash with blood
and body fluids is anticipated
Place used needles and syringes in
impermeable container in the
patients room. Do not recap or
manipulate needles. Replace
container when full
Handle all linen soiled with blood or
body secretions as potentially
infectious
3. Provide physiological
and psychological
support
Frequent oral care
Cooling bath
Encourage verbalization of fears
Determine status of support
network, average contact with
support group
Observe for severe emotional
symptoms (surgical tendencies)
 Health teachings

About risk – reducing behaviors, use of

condoms, limit sexual partners, avoid
exposure to blood or semen during
intercourse
Family counseling
Information of disease, progression and
life span
Expected side effect with drug therapy,
and importance of compliance.
T H E

E N D