IMMUNOLOGY TEXTBOOK - Merkury Podillia 2013

IMMUNOLOGICAL RESEARCH METHODS

Concept of Immune Status and Immunogram

The relevance of studying Research Methods used in clinical immunology is driven by the fact that understanding these methods and correctly interpreting their results allows for the detection of defects in specific links of The Immune System (Primary and secondary immunodeficiencies); the Diagnosis of autoaggression against the body's own substances (autoimmune diseases) and the excessive accumulation of immune complexes (autoimmune diseases); the identification of dysfunctions where certain immune pathways exhibit signs of hyperfunction at the expense of others (hypergammaglobulinemia, heavy chain disease, myeloma, etc.); the monitoring of the efficacy of immunosuppressive or immunostimulatory therapy; tissue typing and donor matching for organ transplantation, as well as monitoring immunosuppressive therapy post-transplant; the phenotyping of hemoblastoses; and the diagnosis of genetic predisposition to diseases.

The diagnosis of immune disorders includes: 1) immunological history; 2) clinical examination; 3) Laboratory research methods (immunological tests).

Immunological history. When taking an immunological history, the following data should be established:

✵ family history: presence of allergic, oncological, chronic inflammatory, endocrine, or immunoproliferative diseases in one or both parents, or recurring pathology within the pedigree;

✵ developmental and formative pathologies: complicated labor, congenital anomalies, diathesis, Rickets, artificial feeding, infections, and other early childhood pathologies;

✵ harmful environmental factors: contact with physical (including radiation), chemical, or biological factors (housing, occupational conditions), medications, biological products, exposure to magnetic fields, high or low temperatures, and chronic stress situations;

✵ previous injuries and diseases: severe or complicated injuries, Burns, and frostbite; chronic inflammatory processes, intoxications, septic conditions;

✵ chronic somatic illness, fever of unknown origin, unexplained weight loss, prolonged diarrhea;

✵ episodes of allergic reactions (seasonality, age of onset, triggering allergen);

✵ reactions to Blood transfusions and blood products;

✵ iatrogenic factors: surgical interventions (appendectomy, tonsillectomy, thymectomy during cardiac surgery, etc.), radiation and Chemotherapy for oncological diseases, administration of glucocorticoids and other hormonal agents, oral contraceptives, cytostatics, anti-inflammatory drugs (dosages, duration of use);

✵ bad habits and lifestyle features: smoking, alcohol and drug abuse, physical inactivity and a sedentary lifestyle/work habits, excessive sun exposure, poor Nutrition, stress.

✵ Pregnancy pathology (Infertility, Miscarriage).

Clinical examination data:

1. physical examination of immune system Organs and Tissues: Lymph Nodes, Spleen, Tonsils (lymphadenopathy, Splenomegaly, Thymomegaly, local or generalized hyper- or aplasia of LYMPH NODES AND tonsils);

2. Skin and integument (turgor, pustular rashes, eczema, dermatitis, neoplasms, hemorrhagic purpura, petechial rash);

3. mucous membranes and sinuses (candidiasis, ulcers, dryness, inflammation, gingivitis, sinusitis, cyanotic macules or papules);

4. bronchopulmonary system (inflammatory and obstructive processes, Bronchiectasis, fibrosis);

5. digestive and excretory systems (inflammatory processes, dyskinesia, hepatomegaly, biliary and urogenital tract pathologies);

6. neuroendocrine system (inflammatory processes of the central and Peripheral Nervous system, endocrinopathies, developmental malformations);

7. Musculoskeletal System (inflammatory joint and bone lesions, destruction, impaired motor function);

8. Cardiovascular system (bleeding tendencies, inflammatory processes, atherosclerosis, thrombosis);

9. malignant neoplasms;

10. presence of chronic diseases.

11. Features of the course of infectious processes and the Specifics of the microflora.

The relationship between Immune Response defects and susceptibility to infectious processes is presented in Tables 9 and 10.

Class="center">Table 9. Relationship between immune response defects and susceptibility to infectious processes (B. Pukhlyk, 1992)

Table 10. Relationship between immune response defects and susceptibility to non-infectious processes (B. Pukhlyk, 1992)

Notes: MBT - Mycobacterium tuberculosis, OPF - opportunistically pathogenic flora.

12. As a result of the interview and clinical examination, typical clinical manifestations of immunopathological syndromes should be identified, such as: infectious syndrome; allergic syndrome; autoimmune syndrome; primary immunodeficiency (predominantly in children); secondary immunodeficiency; immunoproliferative syndrome (Methodological Materials of the Department of Clinical Immunology and Allergology of KMAPO, 2009).

Infectious syndrome is characterized by: prolonged low-grade fever, pyrexia of unknown origin; chronic infections of ENT organs (sinusitis, otitis), recurrent lymphadenitis; recurrent and Chronic Bronchitis, chronic obstructive pulmonary disease; recurrent Pneumonia (combined with ENT infections); frequent ARVI (more than 4 times a year in adults and more than 6 times a year in children); bacterial Diseases of the skin and subcutaneous tissue (Pyoderma, furunculosis, abscesses, Phlegmon, recurrent paraproctitis in adults); parasitic infections; aphthous stomatitis, periodontal disease; recurrent purulent Conjunctivitis; recurrent herpes; chronic urogenital infections (chronic purulent vulvitis, urethritis, frequently recurrent cystitis, Chronic Pyelonephritis); dysbiosis, chronic gastroenteropathy with diarrhea of unknown origin; generalized infections.

Allergic syndrome is characterized by: skin allergopathology (atopic and contact dermatitis, urticaria, angioedema, Arthus phenomenon, eczema); allergopathology of ENT organs; Bronchial Asthma, pollinosis, allergy to food, medications, and chemical compounds.

Autoimmune syndrome is characterized by: Inflammatory Diseases of Connective Tissue, glands, and joints (rheumatoid arthritis, Sjögren's syndrome, Felty's syndrome, etc.); SLE, dermatomyositis, scleroderma; systemic vasculitis (Wegener's granulomatosis, polyarteritis nodosa, etc.); Glomerulonephritis; thyroid pathology, Insulin-dependent Diabetes Mellitus, Addison's disease, and other hormonal disorders; neurological diseases (multiple sclerosis, myasthenia gravis, etc.); Ulcerative Colitis; cytopenic blood disorders; autoimmune Liver diseases; autoimmune forms of infertility, pregnancy pathologies, severe manifestations of menopausal syndrome; certain types of psychopathology (Schizophrenia).

Primary immunodeficiency syndrome (predominantly in children) is characterized by: Louis-Bar syndrome (ataxia combined with telangiectasias, hyper- and depigmentation spots); Wiskott-Aldrich syndrome (hemorrhagic symptom complex combined with eczema and thrombocytopenia in boys); DiGeorge syndrome (seizures with hypocalcemia, facial bone and cardiovascular malformations, thymic hypoplasia); hereditary angioedema (complement C1 inhibitor deficiency).

Secondary immunodeficiency syndrome is characterized by: presence of a prolonged, torpid course of the infectious syndrome, tendency toward generalization of the process; alopecia, skin depigmentation and hyperpigmentation; AIDS; other cases of acquired immunological deficiency.

Lymphoproliferative syndrome is characterized by: tumors of the immune system (Lymphocytic Leukemia, lymphosarcoma, Hodgkin's disease, lymphomas, Kaposi's sarcoma); X-linked recessive lymphoproliferative syndrome in children: a) hyperplasia of all lymph node groups with inflammatory processes therein combined with frequent bacterial infections of other localizations; b) splenomegaly; c) history of mononucleosis.