Immune system: ch. 4

Immunology

study of the physiologic mechanisms that allow the body to recognize materials as foreign and to neutralize or eliminate them (protects the organism from infection and disease

Types of immunity

Innate and acquired

Innate immunity

Acts as the body's 1st line of defense to prevent the entry of pathogens (immune system does not distinguish different types of invaders)

Acquired immunity

Characterized by specificity and memory

Factors affecting immunity

1. Age

2. Nutrition

3. Environmental pollution

4. Trauma

5. Medication

6. Splenectomy

7. Stress

8. Exposure to toxic chemicals

9. Current illness

10. Sleep disturbance

Exercise immunology

Exercise is a mean of preventing illness and attain healthy lifestyle

Consequences of immunodeficiency

increased risk for developing infection

Immunodeficiency risk factors

1. Poor physiologic and psychological health

2. Old age

3. Coexistence of other diseases

4. Invasive procedures

5. Treatments

when treating pt in PT

1. Use infection control strategies

2. Pulmonary complications are common

3. Individuals are often debilitated and easily fatigued

HIV

Human immunodeficiency virus

Human immunodeficiency virus (HIV)

Infection of immune system

HIV if untreated

Results in progressive and ultimately profound immune suppression

HIV is susceptible to...

Opportunistic infections

HIV definition

Includes entire spectrum of illness

3 phases of HIV

1. Asymptomatic HIV

2. Symptomatic HIV

3. Acquired Immunodeficiency syndrome (AIDS)

First case of aids in U.S.

1981

New infections of HIV in U.S.

40,000 per year

Death from aids...

declined to 63%

Age range for HIV

20 to 49 y/o

Etiology

"Causes"

Etiology of HIV

Primary cause is the type 1 retrovirus

HIV transmission

Exchange of body fluids and is associated with high-risk behaviors

Pathogenesis of HIV

Virus begins in blood > tissues to infect T4 cells in lymph tissues > Blood to infect remaining lymphocytes

HIV infects...

1. T4 (helper) lymphocytes

2. Macrophages

3. B cells

Clinical manifestations of HIV

Asymptomatic and symptomatic

Asymptomatic

Infected person is clinically healthy and capable of normal daily activities

symptomatic

1. Generalized adenopathy

2. Diarrhea, weight loss

3. Night sweats, fever

4. Fatigue that limits physical and recreational activities

HIV advanced

AIDS

AIDS

1. CNS, PNS, ANS

2. HAD

3. Dermatologic conditions

Dermatologic conditions w/ AIDS

1. Infections

2. Dry flaking skin

3. Telangiectasia

4. Kaposi sarcoma

Diagnosis of HIV

1. HIV-1 antibody enzyme test

2. Western blot test (more expensive)

HIV treatment

No cure or vaccine

HIV treatment goals

Stop HIV from replicating, Increase the number of T4 (helper) lymphocytes, Delay HIV progression

Drug resistance in HIV

One of the most significant threats to effective therapy

HIV treatment interventions

1. NSAIDs

2. Pain meds

3. Surgical procedures

4. Non-pharmacological intervention

HIV prognosis for therapies

1. Extending the lives of AIDS clients

2. Avoid hospitalization

3. Extending survival

4. Return to work

PTA role with HIV pt

1. Discreet and non-judgemental environment with the assurance of confidentiality

2. Psycologic support

3. Transmission risk is low

4. Do not need to isolate pt

5. Prepared for possible seizures

6. Exercise has clinically significant effects on the immune system responsiveness

Chronic fatigue syndrome (CFS) and immune dysfunction syndrome

CFS duration

greater or equal to 6 months

CFS prevalence

among adults

Etiology of CFS

1. Viral infections

2. Immune dysfunction

3. Dysfunction of the CNS

4. Exercise capacity

5. Sleep patterns

6. Genetics

Clinical manifestations of CFS

Sore throat, fever, muscle pain, and muscle weakness, Neurally mediated Hypotension (NMH), Periods of exacerbation and remission, Post-exterional malaise

CFS cure

No current cure

CFS treatment

1. Symptom relief and improved function

2. Combination and drug and non-drug therapy is recommended

3. Lifestyle changes

Role of PTA in treating CFS pt

1. Supervises exercise

2. Recommendation of support groups

3. Must observe for altered breathing patterns and components of poor posture

4. Stretching, strengthening and cardio training are essential

5. Monitor vital signs

Hypersensitivity disorder

1. Increased immune response to the presence of an antigen that results in tissue destruction

2. An exaggerated or inappropriate immune response may lead to various hypersensitivity disorders

How many types of hypersensitivities

4 types

Allergens

Special class of antigens that cause an allergic response

Types of allergens

1. Inhaled

2. Eaten

3. Injected

4. Contact w/ skin

Type I hypersensitivity

1. immediate hypersensitivity

2. Hay fever

3. Anaphylaxis

Type I hypersensitivity reactions

1. Immunoglobulin E (IgE)

2. IgE meets pathogen > histamine released

Histamine release results in...

1. Systemic vasodilation

2. Bronchospasm

3. Increased mucus secretion

4. Edema

Type I signs and symptoms

Wheezing, Hypotension, Swelling, Urticaria, Rhinitis, Rhinorrehea, Anaphylaxis

Type II hypersensitivity

Body's own tissue is recognized as foreign

Type II self-antigen disorders

1. Blood transfusion reactions

2. Hemolytic disease of the newborn

3. Auto-immune hemolytic anemia

Type III hyper sensitivity

Overproduction of immunoglobulin antibody,Vasculitis

Vasculitis

systemic lupus erythematosus

Type IV hypersensitivity

Delayed hypersensitivity

Delayed hypersensitivity

Reaction occurs after sensitization to an allergy

Delayed hypersensitivity examples

1. Latex sensitivity

2. Posion ivy

3. Response to TB skin test

Autoimmune disease

Immune system to direct immune responses against normal (self) tissue and become self destructive

Number of identified Autoimmune disease

56 diseases affecting everything from skin and joints to vital organs

Etiologic and risk factors of autoimmune disease

1. Multifactoral

2. No single genes has been identified as being responsible for autoimmune disease

Pathogenesis of autoimmune disease

normal cells turn self-destructive, resulting in tissue damage

Clinical manifestations of autoimmune disease

1. Synovitis

2. Vasculitis

3. Myositis

4. Skin rash

5. Nephritis

6. Fatigue

7. Malaise

8. Myalgia

9. Arthralgia

Autoimmune medical management

Diagnosis and treatment

autoimmune disease diagnosis

Lab tests

Autoimmune disease treatment

1. Varies with specific disease

2. Corticosteroids

Lupus erythematosis

chronic inflammatory autoimmune disorder

2 forms of Lupus erythematosis

1. Discoid Lupus erythematosis (DLE)

2. Systemic Lupus erythematosis (SLE)

SLE incidence

1. Primarily a disease of young women

2. Genetic and environmental factors play a role

Etiologic and risk factors of SLE

Cause remains unknown but evidence points to...

1. Immunologic, environmental, hormonal, and genetic factors

2. Family links

SLE pathogenesis

The body produces antibodies (ANAs) against its own cells

SLE can produce antibodies against...

1. RBCs

2. Neutrophils

3. Platelets

4. Lymphocytes

Clinical manifestation of SLE

1. Musculoskeletal systems

2. Cutaneous and membranous lesions

3. Cardiopulmonary systems

4. CNS

5. Renal system

6. Other systems

Musculoskeletal clinical manifestation of SLE

1. Arthralgia's and arthritis

2. Tenosynovitis and tendon rupture may occur

Cutaneous clinical manifestation of SLE

1. Skin rash

2. Vasculitis

3. Diffuse or patchy alopecia

4. Painless ulcers the mucus membrane are common

Cardiopulmonary clinical manifestation of SLE

Inflammation of the variety of layers of the heart, dyspnea, tachycardia, and pneumonitis

CNS clinical manifestation of SLE (4)

1. Headaches, irritability, and depression

2. Emotional instability, seizures, CVA

3. Verbal memory, attention, language skills

4.Progressive cognitive impairment

Renal systems clinical manifestation of SLE (3)

1. Hematuria

2. Proteinuria

3. Kidney failure

Other systems clinical manifestation of SLE (4)

1. Anemia from deceased erythrocytes

2. Amenorrhea in women

3. Occasional enlargement of nodes

4. GI involvement

PTA role in treating SLE (4)

1. PT and OT are important components of overall treatment plan

2. Adequate rest

3. Educate

4. Instruct pts on pacing activities and conserve energy

Fibromyalgia syndrome (FMS)

Chronic muscle pain syndrome

Key symptom of FMS

Widespread tender points

Incidence of FMS

More than 6 million Americans

Incidence of FMS women vs. men

women more affected (90% of women)

FMS age

20 to 55 years

FMS risk factors (7)

1. Prolonged anxiety

2. Emotional stress

3. Trauma

4. Rapid steroid withdrawal

5. Hypothyroidism

6. Infection

7. May develop w/ no obvious precipitating events/ illness

Etiologic factors of FMS (7)

1. Diet

2. Viral origin

3. Sleep disorder

4. Occupational

5. Seasonal/ environmental influences

6. Psychologic distress

7. Hereditary

FMS clinical manifestations (5)

1. Muscle pain

2. Diffuse pain or tender points

3. Sleep disturbance

4. Exacerbated stress

5. Circulation is decreased during exercise

FMS tender points (9)

1. Low cervical

2. 2nd rib

3. Lat epicondyle of humerus

4. Knee

5. Occiput

6. Trapezius

7. Supraspinatus

8. Gluteal

9. Greater troch

PTA role in treating FMS (4)

1. Lessening pain/ fatigue and eliminating sleep disturbance

2. Strategies for work modifications

3. Modalities

4. Exercise

FMS exercises (4)

1. Aerobic

2. Gentle stretch

3. Resistance exercise

4. Aquatic therapy