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11/13/2017

innate vs. adaptive


innate defenses
Host Defenses nonspecific defenses
part 1 – cellular adaptive defenses
specific defenses
Ch. 16

Cellular Defenses Leukocytes


Blood neutrophils
fluid portion (60%) aka PMNs (polymorphonucler leukocytes)
• plasma phagocytic
formed elements (40%)
• erythrocytes (RBCs)
• leukocytes (WBCs)
• platelets/thrombocytes
(for clotting)

Phagocytosis:
Leukocytes
Intracellular Killing
neutrophils
active in initial infection
can enter tissues
↑ if bacterial

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Leukocytes Leukocytes
eosinophils basophils
somewhat phagocytic release histamine
↑ if parasites or allergy role in allergies & inflammation

Leukocytes Leukocytes
monocytes lymphocytes
mature into macrophages (phagocytic) part of adaptive immunity: B and T cells
↑ if viral

WBC Differential Count ("Diff") Coulter Counter


Normal Values - automated reader & printout
neutrophils 40-75%
(bands – immature form) (1-5%)
lymphocytes 20-45%

monocytes 2-10%

eosinophils 1-6%

basophils 0-1%

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leprosy leprosy
etiologic agent two forms:
Mycobacterium leprae tuberculoid
• "anesthetic"
• acid-fast (waxy cell wall) bacterium
• affects skin pigment
• intracellular infection (macrophages) • nerve damage
• v. slow growing • incubation: 2-5 years

leprosy leprosy
two forms: diagnosis
lepromatous skin scraping
• granulomas • acid fast stain
• due to host cellular
defenses: macrophages won't grow in lab*
“wall off”
• incubation: 9-12 years

leprosy
treatment
long-term antibiotics* (6-12 mos.)
• MDT (multi-drug therapy) *
offered free in endemic countries

no vaccine

*drug resistance not a problem


worldwide ~180,000 new cases in 2012
(rates going down)

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Tuberculosis Tuberculosis - progression


Ch. 21
Infection 90%
Mycobacterium tuberculosis Latent TB
another acid-fast bacterial infection
10%
Active TB
ancient disease
no treatment (70% in 10 yrs*)
“consumption” Treatment
*faster if HIV pos.

“white plague”
Death
Recovery

Tuberculosis Tuberculosis

pulmonary TB extrapulmonary TB
many asymptomatic = latent TB children, immunosuppressed pts.
mycobacteria in macrophages • bones, meningitis, urogenital etc.
granulomas: walled off “tubercles” miliary TB
• bacteria dormant, noninfectious • systemic spread
can reactivate and/or spread • most fatal

Tuberculosis Tuberculosis

control
screening
• Mantoux (tuberculin) test

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Tuberculosis Tuberculosis

control control
treatment vaccine
• antibiotics, long-term (6-9 months – “regular” TB) • BCG (Bacillus Calmette-Guerin)
• not in U.S. – worldwide commonly used in children
• Variable effectiveness

Tuberculosis Tuberculosis

drug-resistance
MDR-TB (multiple)
• resistant to top 2 drugs (rifampicin & isoniazid)
XDR-TB* (extensively)
• resistant to 3 of 6 drugs
TDR-TB (totally)
• resistant to ALL current drugs

*going back to older drugs for these – more side


effects (some: deafness, depression, psychosis)

Tuberculosis – new cases per


Tuberculosis
100,000 population
1 in 3 infected worldwide
9 million new cases/year
leading killer of HIV +
U.S. & Europe historically: major killer
2013 ~10,000 new cases in U.S.