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Immunology case 9 PLAY Click on this icon to come back to this page How to Play? Each section starts with question to test your knowledge. Click on the answer you think is correct. DON’T worry there will be information following to supplement your knowledge VIRUSES VACCINES ADULT AND CHILD IMMUNISATION CHILDHOOD MILESTONES IMMUNOLOGY Next VIRUSES and MenINGITIS Thissection will cover how certain viruses present, meningitis and some memory aides to remember them all. BEGIN QuestIon no.1 A 21 year old man presents with painful ulcers around his mouth. He remembers seeing similar around his girlfriends mouth. What is your diagnosis? A. HSV 1 - Genital cold B. HSV 2 - Oral cold C. HPV 11 - Genital cold sores sores sores D. HSV 1 - Oral cold E. HPV 6 - Oral cold sores soresCorrect: HSV 1 - Oral cold sores well done Click for the explanationIncorrect HINT: ‘1 mouth and 2 balls’ Try again Click for the explanation VIRUSES Herpes simplex virus (HSV) Human papilloma virus Varicella Zooster • HSV 1 = Oral herpes • HPV 6 & 11 = Genital warts • Primary infection = • HSV 2 = Gential herpes • HPV 16 & 18 = Cervical chickenpox cancer • Reinfection = shingles Remember: ‘1 mouth, 2 balls’ Remember: 16 & 18 are Remains LATENT in NERVES Remains LATENT in NERVES bigger numbers so more Management = Aciclovir severe Widespread blistering rash that starts on the head/trunk • Age 25-64 = Cervical screening • Age 12/13 (year 8) = Vaccination for BOTH females and males Next MMR Measles Mumps Rubella (German Measles) • Koplik spots and measles • Puffy cheeks and parotid • Whole body red rash rash gland swelling • Spread via droplets • Spread via droplets • Spread via droplets If mother contracts rubella in the first 3 months of pregnancy -> Congenital rubella = ‘oh HEC’ • Hearing abnormalities (sensorineural deafness) • Eye abnormalities • Congenital heart disease NextLatency • Epstein Barr lays latent in B cells • CytoMegalovirus lays latent in the bone Marrow and Monocytes • HSV-1 and HSV-2 lay latent in nerVes Next COMMON CAUSES OF MENINGITIS IN AGE GROUPS Is aBACTERIAL INFECTION Classically presents with neck stiffness, fever and photophobia Memory aides: Group B is for NewBorns The last of a group is always the first of the next group Babies/children and older adults are the same Next VaccINA TIONS Thissection will cover the childhood vaccination schedule andways to remember; it will also cover vaimmunocompromised give for the BEGIN QuestIon no.2 A mother comes in with her child to your GP for routine vaccinations. You administer the following vaccines: 6 in 1 vaccine and Men B vaccine How old should her child be? A. 3 years and 4 months B. 1 year C. 16 weeks D. 12 weeks E. 8 weeksCorrect: 12 weeks well done Click for the explanation Incorrect HINTS: At this age it would be the 2nd time they’ve had their Men B dose Try again Click for the explanation VACCINATION SCHEDULE Write them out over and over again to make them stick **There is also a comprehensive list at Next the end for completionVACCINATION SCHEDULE NextAge Groups Next QuestIon no.3 Elara has been brought to the doctor's office in order to receive his 6-in-1 (diphtheria,tetanus, pertussis, polio, Hib and hepatitis B), PCV and rotavirus vaccinations by his mother, as they are now due. You are a second year medical student shadowing the paediatrician administering the vaccinations, when they ask you which age group Hakainde would most likely fall into. What do you tell them? A. Elara is a toddler B. Elara is an infant C. Elara is a neonate D. Elara is a pre-school E. Elara is an aged child adolescentCorrect: Elara IS AN INF ANT Click for the explanation Incorrect HINTS: These vaccinations are given at 12 weeks Try again Click for the explanation AGE GROUPS Early childhood: Prenatal: • Toddler, 1-3 years • Embryonic, conception to 8/40 • Preschool, 3-4 years • Foetal stage 8/40 or 8/42 Middle childhood Neonatal: birth to the end of 1 month School age: 4-12 years Infancy: 1 month to the end of 1 year Late childhood Adolescence: 13-18 years Next QuestIon no.4 Mr Arlo has just had a splenectomy He wishes to know which vaccinations he can and can’t have for future travel Which is he NOTallowed? A. Influenza B. Measles C. Pertussis D. Hepatitis A E. PneumococcalCorrect: Measles well done Click for explanation Incorrect HINTS: Those that have just had a splenectomy can’t have live attenuated vaccinations Try again Click for explanationLIVE-A TTENUA TED VACCINES MR. TOY Rationale: • Measles, mumps The spleen helps to filter blood, removing pathogens, especially encapsulated bacteria (e.g., Streptococcus • Rubella pneumoniae, Haemophilus influenzae, and Neisseria meningitidis). Encapsulated bacteria are particularly dangerous because they evade the immune system, but the • TB spleen helps clear them, by producing various WBCs • Oral polio Live attenuated vaccines contain living organisms and therefore would overwhelm those with a • Yellow fever weakened immune system i.e. those without a spleen PT knowledge: Patients post-splenectomy should receive an annual influenza vaccination and a pneumococcal vaccine every 5 years NextForcompletion NextDEVELOPMENT AL MILESTONES Thissection will ONLY cover the red flags for the developmental milestones BEGIN Red flag ages Motorred flagages (mentioned inThelecture) • 3 months - head control • 6 months - rolling prone to supine (front to back) and reaching • 9 months - sitting independently • 15 months (1 year 3 months) - cruising • 18 months - walking • 30 months - running • 36 months - jumping Next WELL DONE YOU’VE COMPLETED THIS SECTION Press the houseiconto go backto themenupage Or press theword ‘next’to gotothe next section Immunology This section covers Innate,Adaptive, Cell mediated and Humoral immune response BEGINInnate Immune response BEGIN QuestIon no.1 An 18 yr old presents to the GP with cough, rhinitis, fever and myalgia. The GP realises she has the flu and advices home rest. Which statement is true? A. Surface TLRs in dendritic cells B. Endosomal TLRs in dendritic C. Receptors are activated in detect and bind to PAMP of a viral cells detct and bind to pamp NK cells to bind to PAMP of a pathogen on viral pathogen viral pathogen D. CD4 T cell detect antigens E. CD8 T cell detect antigens on the viral pathogen to on the viral pathogen to produce cytokines introduce apoptosisCorrect: b well done Click for explanation Virus Detection Virus invades tissue and replicates Preformed solubleeffector molecules: • defensins • lactoferrin • lysosymes • complement system Resident effectorcells: • macrophages • mast cells • conventional dendritic cells • NK cells• Pattern associated molecular patterns (PAMP’s) on virus bind to receptors on cell surface • Enter host cell via endocytosis • Viral genome (mainly RNA) is released into the cell which is what is detected as a foreign entity PRR’s (PatternRecognition Receptors) detect PAMP’s There are 2 types of PRR’s TLR’S(Toll-like receptors) RLR’s (Rig like receptors) • Found in macrophages and dendritic • Intracellular receptors found in cells cytoplasm of the infected cell • Involved in detecting the viral pathogen • Detect the viral RNA within the host cell TLR’S Memory AID Nintendo 3ds Iphone 7s, 8s Year 9 use ‘CGP’ books to learn about ‘DNA’ Surface TLRs Endosomal TLRs TLR 1,2,3,4,5,6,11 TLR 3,7,8,9 Detects bacteria or yeast by bindingDetects viral pathogen by binding to to various antigen peptides virus nucleic acids (PAMP’s) Detects viral glycopeptides Dendritic cells Plasmacytoid dendritic cells (pDC) Conventional dendritic cells (cDC) • found in blood plasma • Resident effector cells • TLR7 TLR9 signalling pathway • MHC I and II • Interferon factories (IFN-1 alpha and beta) • Bridge between innate and adaptive immunity Activation of TLRs Viral detection triggered TLRs Sentinel cells produce cytokinesPlasmacytoid dendritic cells Antiviral state PRRs activated Interferon response factor enters the nucleus intereferons are transcribed Interferons acts autocrine, paracrine, endocrine fashion to stimulate IFN-R JAK/Stat (transcription factors) pathway Inteferon stimulated genes are switched on Antiviral State Viral entry changes cell metabolism viral replicationConventional Dendritic cells Now a PRR on a cDC has been activated Now cDC upregulates CCR7 receptors on its cell surface It now becomes an antigen presenting cellCCR7 & CCL21 Question no.2 dendritic cells bridge the innate and adaptive immune system together. They are found in all tissues and are very important APC’s. There are 3 cell surface proteins you must know about Which of these is not found on dendritic cells? A. B7 B. CD28 C.CCR7 D. TLR E. MHCCorrect: B well done Click for explanation Innate and Adaptive Immunity Bridge MHC II+ CD4+ 1 x 8 = 8 Two signals needed: b7 + CD28 MHC II + TCR MHC I+ CD8+ 2 x 4 = 8ADAPTIVE Immune response BEGINCell medIated Immune response BEGIN Question no.3 Which subtype of helper T cell is the most specialised to deal with aCOVID-19 infection without antibody involvement A. Th1 B. Th2 C. Th17 D. Treg E. TfhCorrect: A well done Click for explanationHelper T cell differentiationHumoral Immune response BEGIN Question no.4 Upon repeated b cell exposure to a specific antigen, higher affinity antibody against a specific antigen begin to develop a more refined adaptive immune respons. This explains why we need multiple doses of vaccines for them to be the most effective. Which mechanism is involved in producing these antibodies A. Class switching B. Somatic C. Darwinian selction hypermutation D. Deamination E. VDJ recombinationCorrect: B well done Click for explanation• Changes the variable region of the antibody • Introduces point mutation to the gene • Generating a diverse pool of b CELLS WITH VARYING ANTIGEN BINDING AFFINITIES. B cells with higher affinity for the antigen are selected to process antigens effectively • This allows b CELLS TO PROLIFERATE AND PRODUCE ANTIBODIES WITH HIGH AFFINITY THANKYOU FOR PLAYING YOU’VE COMPLETED THIS RESOURCE Information collated fromlectures given aspart of the C21 Cardiff Medical School Curriculumreferences