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2.2. later Blater B--ly ly →→ IgM with help of TIgM with help of T--ly IgGly IgG3.3. g+g+ bacteria bacteria –– phagocytosisphagocytosis4.4. gg--bacteria (LPS) bacteria (LPS) –– susceptible to membrane lysis by susceptible to membrane lysis by
complement, cytotoxic cellscomplement, cytotoxic cells–– toxin production toxin production –– neutralising antibodiesneutralising antibodies–– mucosal IgAmucosal IgA–– complement activation by specific antibodiescomplement activation by specific antibodies
–– transient decrease after viral infectiontransient decrease after viral infection
•• measles, rubella...measles, rubella...
–– production failure of myeloid cell in bone marrow (pharmacotheraproduction failure of myeloid cell in bone marrow (pharmacotherapy, py, irradiation)irradiation)
Cellular immunity disordersCellular immunity disorders Infection in transplant recipientsInfection in transplant recipients
•• immunosupressiveimmunosupressive therapy therapy →→ graft tolerance graft tolerance –– combinations combinations -- cyclosporine, cyclosporine, azathioprineazathioprine, , gusperimegusperime and and
corticosteroids; tacrolimus corticosteroids; tacrolimus ččii mykofenolatmykofenolat mofetilmofetil, event. with anti, event. with anti--lymphocyte antibodies and lymphocyte antibodies and actinotherapyactinotherapy
•• mechanisms mechanisms –– susceptibility of the graft (locus susceptibility of the graft (locus minorisminoris resistentiaeresistentiae))–– exposition to specific exposition to specific agensagens (nosocomial)(nosocomial)–– microorganisms in the graft microorganisms in the graft –– latent donor infectionlatent donor infection
–– memory lymphocytes a plasmatic cells partially keep the memory lymphocytes a plasmatic cells partially keep the functionality and antibodiesfunctionality and antibodies´́ halfhalf--life is several weeks, but life is several weeks, but there are no reactions to new antigenic stimulus, stops there are no reactions to new antigenic stimulus, stops prolipherationprolipheration and differentiation of lymphocytes and and differentiation of lymphocytes and cellular immunity starts malfunctioningcellular immunity starts malfunctioning
•• reactivation of latent infections reactivation of latent infections –– herpetic viruses, herpetic viruses, adenoviruses, tuberculosis, toxoplasmosisadenoviruses, tuberculosis, toxoplasmosis
•• risk of opportunistic infections risk of opportunistic infections –– Listeria, Aspergillus, Listeria, Aspergillus, Pneumocystis...Pneumocystis...
–– incidence of opportunistic infection 1 incidence of opportunistic infection 1 –– 6 months post 6 months post chemotherapychemotherapy
Beneš, Infekce, 2009
Infection after aggressive Infection after aggressive
cytostatic therapycytostatic therapy
•• highhigh--dose cytostaticdose cytostatic thth.. event. with corticosteroidsevent. with corticosteroids
–– especially haematooncological malignancyespecially haematooncological malignancy
–– severe autoimmune diseasessevere autoimmune diseases
–– transplant medicine transplant medicine –– stem cellsstem cells
•• damage to dividing cellsdamage to dividing cells
–– rapid onset of neutropeniarapid onset of neutropenia
–– mucositismucositis•• painful inflammation and ulceration of oral cavity and gut mucospainful inflammation and ulceration of oral cavity and gut mucosa a
–– development on 3th to 5th day (max 10th day) and slow development on 3th to 5th day (max 10th day) and slow retreat in several weeksretreat in several weeks Beneš, Infekce, 2009
•• drugs influencing intercellular communication drugs influencing intercellular communication -- interleukinesinterleukines and other and other signal moleculessignal molecules
–– deterioration of infection process, in longdeterioration of infection process, in long--term administration term administration possible activation of latent infections (TBC) and atypical infepossible activation of latent infections (TBC) and atypical infections ctions pneumocystispneumocystis pneumonipneumoniaa, invasive fungal diseases, , invasive fungal diseases, listeriosislisteriosis, , mycobacteriosismycobacteriosis
Beneš, Infekce, 2009
Infection on Infection on corticosteroidscorticosteroids
Janeway 2007
Infection on Infection on corticosteroidscorticosteroids
•• complexcomplex interventionintervention in in immuneimmune mechanismsmechanisms (B(B-- andand TT--lymphocyteslymphocytes, , neutrophilesneutrophiles, monocytes , monocytes andand productionproduction ofof cytokinescytokines))
•• intracellularintracellular pathogenspathogens•• severityseverity ofof immunosupressionimmunosupression correlatedcorrelated withwith the the dailydaily dosagedosage•• AetiologyAetiology::
•• ClinicClinic:: PeracutePeracute pneumococcalpneumococcal sepse (sepsis acutissima, sepse (sepsis acutissima, overwhelming pneumococcal sepsis syndrome, overwhelming overwhelming pneumococcal sepsis syndrome, overwhelming postsplenectomy infection, OPSI), severe postsplenectomy infection, OPSI), severe malariamalaria, , babesiosisbabesiosis
•• ProphylaxisProphylaxis:: VaccinationVaccination, , chemoprophylaxischemoprophylaxis (penicilin, co(penicilin, co--amoxicilin, kotrimoxazol) post amoxicilin, kotrimoxazol) post splenectomysplenectomy (<3 roky) (<3 roky) andand in in asplenicasplenic childrenchildren (<5 (<5 yrsyrs).).
Rozsypal, 2008
5
Infections in diabetesInfections in diabetes
Definition:Definition: malfunction malfunction of of fagocytfagocyteses because of intracellular because of intracellular absence of absence of gglucosalucosa
•• infections are prolonged and infections are prolonged and visvis versa the infection can lead versa the infection can lead to diabetes decompensationto diabetes decompensation
TThheraperapyy:: necessity ofnecessity of euglyeuglycecemimiaa..
Rozsypal, 2008
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