Immune System part 2

POD winter '26

What 3 things lower in the immune system with aging?

number of cells, efficiency of cells, memory of infection

the presence of concurrent illnesses will ____ immune system function

alter

define iatrogenic

medically-induced source

what medical tool for complex fractures is very highly associated with infection?

external fixation devices

what non-medically related factor increases pathogen exposure?

sexual practices

true or false: exercise cannot affect the immune system

false

What intensity of exercise for what duration enhances the immune system (include %VO2max)

moderate (40-70% VO2max) for 10-60 minutes

What intensity of exercise should be used in a HIIT training protocol to enhance immune function?

alternating 80-100% VO2max with 30-40% VO2max for 1-4 minutes and 1-3 minutes respectively

What intensity of exercise will suppress immune function?

long duration high intensity (>/= 70% VO2max for over 60 minutes)

How long can high intensity exercise suppress the immune system for after the workout is completed?

up to 72 hours

Exercise (increases/decreases) number and (phagocytic/apoptotic) activity of neutrophils.

increases, phagocytic

The release of what chemical during moderate intensity exercise stimulates release of neutrophils?

cortisol

how long does it take for neutrophils to return to baseline after prolonged strenuous exercise?

>24 hours

moderate intensity exercise leads to (increased/decreased) number of circulating macrophages

increased

how does exercise influence macrophages to trigger less localized tissue inflammation?

affecting the genetic expression of macrophages to release more anti-inflammatory cytokines

in what type, duration, and intensity of exercise do the number and activity of NK cells increase?

any

where do you see a larger NK response to exercise, in trained or untrained individuals?

untrained

when is hte maximal reduction of NK cells after long duration high intensity exercise?

2-4 hours post-exercise

pre-exercise NK cell values are (higher/lower) than post-long duration high intensity exercise

higher

what immune cell can be permanently suppressed by repeated long-duration-high-intensity exercise?

NK cells

What does moderate intensity exercise do to B and T cells? (3)

increases number of both, increases B cell antibody production, increases cytotoxicity of T cells

what does long-duration-high-intensity exercise do to B and T cells?

decreases numbers, suppresses immunoglobulin production, shifts production of T cells to regulatory

what does the shift of T cell production toward regulatory T cells mean for the immune system?

downregulation

what does long-duration-high-intensity exercise do regarding the inflammatory response?

triggers the acute phase response

Regular exercise can activate cytokines such as IL-6, which can protect against what?

chronic systemic low-grade inflammation

In illness where symptoms are “above the neck,” when can you proceed with regular planned exercise?

when symptoms are alleviated after 10 minutes at half intensity

In illness where symptoms are “above the neck,” when should you cease the planned exercise?

when symptoms worsen or the head is pounding after 10 minutes at half intensity

In illness where symptoms are “below the neck,” when can you proceed with regular planned exercise?

never! do not initiate

when should you initiate exercise with a fever?

never

what are the exceptions for exercising with a fever or “below the neck” symptoms?

to maintain ROM, circulate fluid, and avoid pressure wounds

define immunosenescence

general decline in normal functioning of the immune system

true or false": regular exercise cannot delay the onset of immunosenescence

false

true or false: geriatric patients often can tolerate high intensity exercise to a greater degree than younger patients without the same immune impairments

true (don’t underdose geriatrics)

define primary immune deficiencies

typically genetic, concerning deficiencies in innate or adaptive immunity

what would a deficiency in the C1 regulatory inhibitor complement proteins cause?

hereditary angioedema

what would a deficiency in the C3 complement proteins cause?

increased vulnerability to pyogenic bacteria

define pyogenic

pus-forming

what would a deficiency in the C1q, C2, C4 complement proteins cause?

increased risk of immune mediated diseases due to impaired clearance of cells

what would a deficiency in the C5-C8 complement proteins cause?

increased infection by meningococci bacteria

what do phagocyte deficiencies cause?

recurrent infections with encapsulated bacteria

what are phagocyte deficiencies linked with?

antibody and complement deficiencies

what are secondary immune deficiencies?

deficiencies that occur as a result of another condition

What does HIV selectively attack and incapacitate?

CD4+ helper T cells

What does HIV do to the immune system by taking out its specific target?

reduces promotion of immunity, ability to downregulate adaptive immune response, weaken B cell antibody production, and more (general chaos and bad things)

approximately how many people (%) are unaware of their HIV status?

25% of the world

as of 2015, what is the most common way for females to contract HIV?

heterosexual sex

what are the 3 routes of transmission of HIV?

contaminated blood, sexual activity, maternal to child

define fomite

inanimate objects people come into contact with that may transport a pathogen

what are the 6 phases in the HIV life cycle?

binding, fusion, reverse transcription, integration, assembly, budding

how does HIV become AIDS in the body?

primary infection of HIV migrating to lymphoid tissue leads to systemic spread. body controls initial infection, but as previously infected CD4+ T cells replicate they copy some of the HIV DNA from the integration phase of the HIV , leading to extensive viral replication, which causes destruction of CD4+ cells; this destruction of lymphoid tissue leads to AIDS

what are 6 different clinical manifestations of HIV (from 6 different categories)?

inflammatory joint disorders, peripheral neuropathy, opportunistic infection, delayed wound healing, renal failure

what is HAART

highly active antiretroviral therapy

what does HAART do?

control HIV so it is less likely to progress to AIDS

which drugs target phase 1 of the HIV life cycle?

CCR5 antagonists and postattachment inhibitors

which drugs target phase 2 of the HIV life cycle?

fusion inhibitors

which drugs target phase 3 of the HIV life cycle?

NRTIs and NNRTIs

which drugs target phase 4 of the HIV life cycle?

integrase inhibitors

which drugs target phase 7 of the HIV life cycle?

protease inhibitors (PIs)

what does PT management of HIV/AIDS look like?

helping them remain as functionally independent as possible

what causes autoimmune diseases?

when we have generated antibodies and T cells in response to self

true or false: if you have one autoimmune disease, you are unlikely to develop another one

false

there is a strong correlation between which later development of autoimmune disease and contraction of which viral infection?

Epstein-Barr virus

What are 3 risk factors for autoimmune diseases?

hormones, environment, genetics

are autoimmune diseases more common in males or females?

females

what is the pathophysiology of systemic lupus erthymatosus?

development of self-antibodies leading to deposition of antigen-antibody complexes in the tissue, causing increase of inflammation and tissue damage

SLE is more common in (young/old) (men/women) and has a strong component of _____ susceptibility

young, women, genetic

what are 5 clinical manifestations of SLE?

joint pain/inflammation, butterfly malar rash, vasculitis, headaches, mucous membrane lesions and ulcers

what does it look like to manage SLE with PT?

maintaining activity and function while minimizing pain and flare ups

what is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)? (in general)

unexplained fatigue of greater than or equal to 6 months in duration

true or false: ME/CFS has very specific diagnostic criteria but is often overdiagnosed

true

what causes ME/CFS?

it is a post-viral condition not caused by a single disease process

what percentage of individuals with ME/CFS are female?

75%

what percentage of people with ME/CFS report an infecitton as the trrigger for their symptoms?

75%

what is the believed etiology of ME/CFS?

dysfunction of interaction between immune system and neuroendocrine system

what does it mean to be a diagnosis of exclusion?

criteria are met AND all other disease processes that cause similar symptoms are ruled out before diagnosis is made

individuals with symptoms of CFS for ____ years or (more/less) are more likely to improve

2, less

what perrcentage of individuals with CFS experience full ermission?

5-10%

what does PT management of ME/CFS look like?

very carefully controlled and graded exercise, with lots of patient education on activity pacing and ergonomic support

what are the 4 classes of hypersensitivity disorders? (in order 1-4)

IgE-mediated reaction, tissue-specific reaction, immune complex-mediated reaction, cell-mediated reaction

which of the 4 hypersensitivity disorder classes has a delayed rate of development and no antibodies nor complement involved?

cell-mediated reaction (type 4)

what are type 1 hypersensitivity disorders?

IgE-mediated antibody binds with receptors on basophils and mast cells to releease histamine, causing an allergic reaction

what are the 5 mechanisms of type 2 hypersensitivity disorders?

lysis of target cell via adaptive immunity, phagocytosis of target cell, complement promotes neutrophil activity, NK cells attack, antibody prevents normal cell function

what are type 3 hypersensitivity disorders?

formation of antigen-antibody immune complexes in blood and deposited in vessels and extravascular tissue, triggering attempts to remove it which then damage the tissue

what are type 4 hypersensitivity disorders?

body uses T lymphocyte mediated reactions rather than antibody reactions

why are type 4 hypersensitivity disorders delayed?

they have to wait for the activation of helper and cytotoxic T cells in the adaptive immunity pathway

what 2 types of hypersensitivity disorders have symptoms that depend on the tissue that is affected?

type 2 and 4

what is fibromyalgia?

disruption of neuro-immuno-endocrine function causing muscle pain

true or false: fibromyalgia is a subset of ME/CFS

false (distinct disease processes)

___% of individuals affected by fibromyalgia are (men/women)

90, women

what are 2 primary goals of the medical treatment of fibromyalgia?

pain management and improving quality of sleep

what are 2 main approaches to PT treatment of fibromyalgia?

pain management and graded exercise

what is isoimmune disease?

transplant rejection

what causes isoimmune disease?

incompatibility of cell surface antigens

what are 4 lab values to supervise in immune system function?

white blood cell count, platelets, red blood cell count, hemoglobin

what is the normal range for WBC count?

<2,500 or >30,000

what is the normal range for platelets?

<50,000 or >1 million

what is the normal range for RBC count?

4.2-6.1

what is the normal range for hemoglobin?

<5 or >20

anemia refers to a low value of ___ or ____

RBCs, hemoglobin

“thrombo-” is in reference to:

platelets