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Lymph Node Organization Cortex Follicle: B Cells (Inactive & Germinal), Paracortex: T Cells, Medullary Sinus: Macrophages, Medullary Cords: Plasma Cells.
Lateral dorsal foot lymph drainage Popliteal nodes.
Lymph drainage of anal canal above & below pectinate line Internal Illiac, Superficial inguinal
Upper limb & lateral breast lymph drainage Axillary Nodes
Spleen Sinusoid Organization Arteriole -> White Pulp PeriArterial Lymphatic Sheath (T Cells) -> White Pulp: (B cells) -> Marginal zone (macrophages) -> Red pulp (RBCs, T Cells)
Innate Immunity Neutrophils, Macs & Dendritics, Complement.
Adaptive Immunity T Cells & B Cells
Th1 Cells Induced by IL-12. Make IL-2, IFN-gamma, activate macrophages & CD8s.
Th2 Cell Induced by IL-4. Make Il-4,5, B Cell IgE>IgG. Inhibited by IFN-gamma
IgG Opsonize bacteria. Induce Cytotoxic MAC attack (Type 2 Hypersensitivity) & Immune Complex (Type 3 hypersensitivity).
IgE Induce Type 1 Allergic Hypersensitivity
IL-2 Th Cells-> Cytotoxic & Th cell growth
B Cell Receptor CD 19, 20, 21 & 40; B7
Macrophage Receptors B7, CD40, CD 14, Fc & C3b receptors
NK Cells CD16, CD 56
T Cell Receptors CD3, 4, 8, 28, CD40L
APC Receptor B7, CD14
Terminal Deoxynucleotidyl Transferase Utilized to produce antibody diversity.
IL-1 Macrophages -> Inflammation & chemokine production
IL-3 Activated T Cells -> Bone marrow stem cells (like GM-CSF)
IL-4 Th2 Cells ->B Cell growth, IgG & IgE
IL-5 Th2 Cells -> B Cell differentiation, IgA, Eosinophil activation
IL-6 Th2 Cells & Macrophages -> Acute Phase Reactants, Ig production
IL-8 Macrophages -> Neutrophil chemotaxis
IL-10 Tr Cells -> Inhibit Th1 cells
IL-12 (+ deficiency) B Cells & Macrophages -> Th1 & NK cell stimulation. LOF-> mycobacterial infx.
IFN-Alpha, Beta, Gamma General: NK Activation. Alpha & Beta: Inhibits viral protein synthesis. Gamma: Th1 cells -> Macrophage stimulation, inhibits TH2 cells, amps up MHC I, II expression
TNF Macrophages -> Septic shock & vascular leak, leukocyte recruitment
Macrophage Cytokines: IL-1, IL-8, IL-12, TNF
Th2 Cytokines IL-4, IL-5, IL-6
Antiviral Complement C1,2,3 & 4
Anaphylactic/Inflammatory Complement C3a, 5a
Neutrophil Chemotaxis Complement C5a
C1 Esterase Deficiency Angioedema  Kalikrein –(C1)-> Bradykinin
C3 Deficiency Recurrent pyogenic respiratory infections (H. Flu, Pneumococcus)
C6-C8 Deficiency Neisseria bacteremia- no MAC 
DAF deficiency Paroxysmal nocturnal hemoglobinuria (Lack of RBC MAC inhibition)
Passive Immunity Ig administered to patients w/ Botulinum, Tetanus, Rabies, HBV (recall report w/ Robbie). Active immunity is IS production of antibodies
Antigenic Variation Pathogens Salmonella (2 flagellae), Borellia (cause the relapsing fever), N Gonorrhoea (pillus protein). FLU!, Trypanosomes (Chagas, Sleeping sickness)
Type 1 Hypersensitivity Mech Anaphylaxis. Preformed IgE antibody -> Mast or Basophil granule release (histamine).
Type 2 Hypersensitivity Mech Cytotoxic: IgM/G binding->Complement MAC attack or phagocytosis of cell
Type 3 Hypersensitivity Mech Immune-Complex: 1) Antibody-antigen-Complement -> Neutrophil recruitment & Inflammation 2)Serum Sickness: antibody to drug. Reaction 5+ days after administration. 3)Arthus Reaction: SubQ antigen injection->edema, necrosis, complement.
Type 4 Hypersensitivity Mech T-Cell mediated -> macrophage recruitment. Delayed. Mechanism of TB test, transplant rejection, touching (contact dermatitis).
Type 1 Hypersensitivity Examples Anaphylaxis, allergic rhinitis (hay fever)
Type 2 Hypersensitivity Examples Hemolytic anemia, Erythroblastosis Fetalis, Idiopathic Thrombocytopenic purpura, Rheumatic Fever, Bullous pemphigoid, Graves, Myasthenia, SLE
Type 3 Hypersensitivity Examples SLE, RA, Polyarteritis Nodosum, Post-Strep Glomerulonephritis, Serum Sickness, Arthus Rx, Hypersensitivity Pneumonitis
Type 4 Hypersensitivity Examples DM1, MS, Guillain-Barre Synd, Hashimoto’s, Graft v. Host, PPD, Contact dermatitis.
Burton’s Agammaglobulinemia XR. Tyrosine kinase defect -> low B cell activation. Low B #s, in Boys 6 mos+, Bacterial infx.
DiGeorge Syndrome No 3rd & 4thPharyngeal pouch development -> no Thymus, parathyroids. Tetany, no Ts (Viral & Fungal infx), TwentyTwo “q”11 syndrome: persistent Truncus, TofF
Severe Combined Immunodeficiency LOF MHC II, IL-2, Adenosine Deaminase -> no B or T differentiation. More susceptible to all infx.
Hyper IgM Syndrome T Cell CD40 LOF-> no Ig class switching from IgM-> Pyogenic infx
Wiskott-Aldrich Syndrome X-Linked. W-A -> low IgM, high IgA. WIPE: Wiskott-> pyogenic Infx, thrombocytopenic Purpura, Eczema.
Job’s Syndrome INF-gamma LOF-> no neutrophil chemotaxis. FATED: coarse Facies, Abscesses, primary Teeth, IgE, Derm (eczema).
Leukocyte Adhesion Deficiency Synd Type 1 Integrin defect on phagocytes -> no diapedesis -> bacterial infx, no pus, slow umbilicus separation.
Chediak-Higashi Disease AR. Microtubule & phagocytic lysosomal defect -> Pyogenic Staph & strep infx, partial albinism, peripheral neuropathy
Chronic Granulomatous Disease NADPH Oxidase def-> no antibacterial/antifungal ROS in phagosomes -> S. Aureus, E. Coli, Aspergillus infx. Dx: (-) Nitroblue tetrazolium dye reduction test
Chronic Mucocutaneous Candidiasis T cell dysfunction -> persistent C. Albicans infx (LIKE IN AIDS)
Selective Ig Deficiency Isotype switching defect . Lack of IgA-> Sinus, lung infx, milk allergies, diarrhea.
Common Variable Immunodeficiency No B Cell maturation -> no plasma cells, low Ig. CAN BE ACQUIRED.
ANA, Anti-dsDNA, Anti-Smith, Anti-Histone SLE (Sensitive, Specific, Specific, Drug-induced)
Anti-IgG Rheumatoid Arthritis, (Rheumatoid factor)
Anticentromere, Anti-Scl-70 Scleroderma (Crest, Diffuse)
Antimitochondrial Ab Primary Biliary Cirrhosis
Anti-BM Goodpastures
Anti-epithelial cell Pemphigus Vulgaris
Antimicrosome + other Hashimotos (+ antithyroglobulin)
Anti-Jo-1 Poly/Dermato-myositis
Anti-Rho, La Sjogren’s Syndrome (SS-A, -B)
Anti-U1 Ribonucleoprotein Mixed CT Disease
Anti-Smooth Muscle Autoimmune Hepatitis
Anti-Glutamate Decarboxylase DM1
c-ANCA Wegener’s
p-ANCA Churg-Straus, Polyarteritis Nodosa
HLA-B27 PAIR: Psoriasis, Ankylosing spondylitis, IBD, Reiters
HLA-B8 Graves, Celiac
HLA-DR2 MS, hay fever, SLE, Goodpasture’s
HLA-DR5 Pernicious Anemia, Hashimotos
HLA-DR7 Nephrotic syndrome
Created by: Kyle Tiemeier



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