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IMMUNITY
Concepts
(Immunity, antigens, antibodies, antigen
antibody reactions, vaccines)
Dr. Ashish V. Jawarkar
M.D.
INFECTION
Relationship between host and
infectious agent
 Saprophytes – live on dead tissue – do not
cause diseases
 Parasites – multiply in hosts
 Pathogens – cause diseases
 Commensals – donot cause diseases
normally – only during immunosuppression
Infection
 Lodging of parasite in tissues of host
 This is not necessarily disease
Disease
 Any deviation from good health
Infectious disease
 Any deviation from good health due to
infectious agent
Infection
 Primary infection – in healthy host
 Re-infection – repeat infection by the
same agent
 Secondary infection – second infection by
a new agent
Infection
 Acute – rapid progress
 typhoid
 Chronic – slow onset and progress
 tuberculosis
Infection
 Localised – restricted to specific area
 Systemic
Infection
 Clinical – with symptoms
 Subclinical – no obvious symptoms
Infection
 Oppurtunistic – when host resistance is
lowered
 Nosocomial – acquired from hospital, not
present on admission
 Laboratory acquired – from laboratory
Sources of infection
 Humans – carriers
 Animals – zoonoses
 Insects
 Soil and water
 Food
Methods of transmission
 Contact – direct, indirect, sexual
 Inhalation
 Ingestion
 Inoculation
 Insects
 Congenital – vertical
 Iatrogenic
Pathogenicity
 Capacity of micro organisms to cause
diseases
Virulence
 Degree of pathogenicity
Factors predisposing to
pathogenicity
 Adhesion – attachment due to receptors
and ligands
Factors predisposing to
pathogenicity
 Invasiveness
 Highly invasive – septicemia following wound
infection by streptococci
 Less invasive – staphylococcal abscess
Factors predisposing to
pathogenicity
 Toxins
 Exo toxins – released outside
 Endotoxins – LPS (part of cell wall)
Factors predisposing to
pathogenicity
 Communicability
 Ability to spread from one host to other
 Ensures survival
Types of infectious diseases
 Endemic – constantly present in a
particular area
 Eg typhoid
 Epidemic – one that spreads rapidly
involving many persons at the same time
 influenza
 Pandemic – spreads through many areas
of the world at the same time
IMMUNITY
Immunity
 Resistance exhibited by host towards
micro organisms
Types of immunity
 Innate
 Immunity that a person possesses due to
genetic make up
 Acquired
 Active
• Acquired after an exposure to infection (natural) /
artificially induced (vaccine)
 Passive
• Injection of antibodies
Innate immunity Epithelial surfaces
 Skin
 Mucosa
 Saliva
 Urine
 Antibacterial systems in blood and tissues
 Complement system
 Interferons
 Microbial antagonism
 Flora
 Cells
 macrophages
 Neutrophils
 NK cells
 Inflammation
 Fever
 Acute phase proteins
 CRP
Acquired (Active)
 Due to stimulation by an antigen (like
microorganism)
 Long lasting
 Associated with memory
Active immunity
 Natural active
 Clinical or subclinical infection
 Eg chicken pox
 Artificial active
 vaccines
Passive immunity
 Natural passive
 Placenta
 Breast milk
 Artificial passive
 Rh iso immunisation
HERD IMMUNITY
 Overall level of immunity in a community
 Useful in case of epidemics
OVERVIEW OF STRUCTURE AND
FUNCTION OF IMMUNE SYSTEM
Lymphocytes
 B lymphocytes – produce antibodies –
Humoral immunity
 T lymphocytes – cell mediated immunity
T cell maturation
(central lymphoid organs)
Central lymphoid organs
 Bone marrow
 Thymus
B cell maturation
(Peripheral lymphoid organs)
Peripheral lymphoid organs
 Lymph nodes
 Spleen
 Mucosa associated lymphoid tissue
(MALT)
 Tonsils
 Peyer’s patches
Other cells of the immune system
 ANTIGEN PRESENTING CELLS (APCs)
Phagocytes (macrophages)
Dendritic cells
eg Langerhan’s cell
MAJOR HISTOCOMPATIBILITY
COMPLEX (MHC)
 Differentiates between self and foreign
ANTIGENS AND ANTIBODIES
ANTIGEN
 Any substance which, when introduced
into the body stimulates production of
antibody
ANTIBODY
 Substance that is produced by the body
against the antigen is an antibody
 It is a protein
 Almost 25% of our body proteins are
Immunoglobulins
Types of antigens
 Xenoantigens – from different species
 Alloantigens – from same species
 Autoantigen – lens protein, testis
 Heterophile antigen – closely related
antigens from different species
Antigens – on the basis of ability to
cause disease
 Immunogen – develop undesired response
– transplants
 Tolerogens – induce immunological
tolerance due to memory
 Allergens – over reactions
 Vaccines – protective response
Biological classes of antigens
 T cell dependent
 T cell independent
Antibodies - types
 Ig G
 Ig A
 Ig M
 Ig D
 Ig E
Structure
IgG
 Can be transported across placenta,
provides immunity to new born
 Neutralize viruses
 Encourage phagocytosis
IgA
 Main immunoglobulin in mother’s milk,
saliva and tears
 Called secretory Ig
 Local immunity
IgM
 Earliest Ig to be synthesized by fetus
 Not transported across placenta
 Presence useful in diagnosis of congenital
infections such as syphilis, rubella, HIV
and toxoplasmosis
 Responsible for protection from blood
invasion by microorganisms
IgD
 Occur on the surface of B lymphocytes
(with IgM) and act as receptors for
antigens
IgE
 On mast cells and basophils
 Responsible for anaphylaxis
(hypersensitivity)
In short
 IgG - protects body fluids
 IgA – protects body surfaces
 IgM – protects the blood stream
 IgD – receptor on surface of B
lymphocytes
 IgE – mediates anaphylaxis
Antigen – Antibody reactions
 Antigen and antibody can react and cause
 Precipitation
 Agglutination
 Lysis
 Killing of live antigens (micro organisms)
Precipitation
Agglutination
Lysis
Killing of microorganisms
General features of antigen –
antibody reaction
 Reaction is specific
 Combination occurs at surface – so
surface antigens are relevant
 Combination is firm but reversible
 Antigen and antibody can combine in
variable proportions
Combinations occur at surface
Combination is reversible
 Affinity – intensity of attraction
 Avidity – strength of bond
 Combine in variable proportions
Applications
 Precipitation reactions
 Agglutination reactions
 Complement fixation tests
 Neutralization tests
 Labelled immunoassays
 Immunofluorescence
 Radio immunoassay
 Enzyme linked immunosorbent assay (ELISA)
Precipitation reactions
 Precipitation – when a soluble antigen
combines with its antibody – antigen
antibody complex forms an insoluble ppt in
the medium
Prozone
 Ring test – to group streptococci
 Slide test – VDRL for syphilis
 Tube test – Widal test
Agglutination reactions
 For blood grouping
Labelled immunoassays
Radio immuno assay
ELISA
 HIV
HYPERSENSITIVITY
REACTIONS
(ALLERGY)
.
Definition
• Hypersensitivity – exaggerated immune
response
• Allergen – substance which causes
hypersensitivity
• Hypersensitivity reaction occurs after
second exposure to antigen
• First exposure causes sensitisation
Types
• Based on time between second exposure
and clinical reaction –
– Immediate hypersensitivity
– Delayed hypersensitivity
Types
• Type I – anaphylactic
• Type II – cytotoxic
• Type III – immune complex
• Type IV – delayed type
Type I hypersensitivity (Allergy)
• a/k/a anaphylaxis (ana – without, phylaxis
– protection)
degranulation
• Releases histamine, serotonin, cytokines
and prostaglandins
• These cause
– Smooth muscle contraction (larynx, lungs)
– Leaky blood vessels (rhinorrhoea, oral
secretions)
– Intestinal fluid secretion (diarrhoea and
vomitting)
• Systemic anaphylaxis is fatal within
minutes
• Unless given adrenaline immediately
allergens
• Nuts
• Seafood
• Eggs
• Insect venom
• Drugs
Atopy
• Anaphylaxis in a localised area
• Eg asthma, hay fever
• Allergens here include
– Dust
– Pollen
– Eggs
– milk
TYPE II HS
• Mediated by IgG or IgM (with complement)
antibodies
• Examples are autoimmune hemolytic
anemias and hemolytic disease of
newborn
Type III HS
• Complexes of antigen and antibody get
deposited in various sites of the body like
– Kidneys
– Joints
– Skin
– Eye
• Examples
– Vasculitis
– Arthus reaction
– Serum sickness
Type IV HS
• Take 2-3 days to occur
• Delayed HS
• Mediated by T cells – antibodies not
involved
• Examples
– Tuberculin reaction
– Contact dermatitis
Tuberculin reaction
(Montaux test)
• To know whether the person is infected by
TB
• Injection of PPD into skin
• Look for raised area (induration) after 48
hours
Contact dermatitis
• Skin reaction caused by application of
various chemicals such as nickel,
chromium, drugs such as penicillin and
toiletries.
Contact dermatitis
Granulomatous reactions
• Occur due to intracellular pathogens such
as Mycobacteria, fungi and Leishmania
• Phagocytes are unable to remove and
digest them and become giant cells with
multiple nuclei
Summary
VACCINES AND
IMMUNISATION
Immunising agents
• Vaccines (active – slower, long lasting)
• Immunoglobulins (passive – faster, short
lasting)
Vaccine
• Substance designed to induce production
of antibodies against a specific disease
causing organism
Types
• Live – live but attenuated organisms
– Eg BCG, oral typhoid vaccine, oral polio
vaccine
• Killed – typhoid, cholera, injectable polio
vaccine
• Toxoids - DPT
Immunoglobulins (Passive)
• Administering directly antibodies
• Newborns receive passive immunisation
from colostrum
• Eg – Hep B antibodies given after
accidental exposure
• Protect immunodeficient individuals
Vaccines available
Herd immunity
Contact immunity
• Children immunised with live OPV shed
virus in feces
• An unimmunised family member /
community member who is exposed to this
shed virus develops immunity as well
National immunisation schedule
(Indian academiy of Paediatrics)
Optional immunisation
• Chicken pox
• Influenzae
• HPV
• Yellow fever
• Japanese encephalitis
• Pneumococcal vaccine
Immunity - concepts - antigen, antibody, ag-ab reactions, vaccines

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