Samenvatting infectie en afweer DEEL 2 hfdst 11-24.
Bekijk zeker ook samenvatting deel 1 hfdst 1 - 10.
Veel succes met studeren !
Zit je krab bij kas, stuur me gerust een berichtje, dan regelen we een prijsje ;).
Inhoud
11. Antilichamen en T celreceptoren ................................................................................................................................ 5
11.1.Polyklonale antistoffen .......................................................................................................................................... 5
11.2. Monoklonale antistoffen ...................................................................................................................................... 6
11.3. Gehumaniseerde monoklonale antistoffen.......................................................................................................... 6
11.4. Enzyme-linked immunosorbent assay – ELISA !!! ................................................................................................ 7
11.5. Flowcytometrie of FACS: fluorescentie-geactiveerde cel sortering .................................................................... 7
11.6. Diagnostiek: anemie door rode bloedcel destructie ............................................................................................ 8
11.7. Passieve immunisatie ........................................................................................................................................... 9
11.8. Antilichaam engineering ..................................................................................................................................... 10
11.9. Chimere antigeen receptoren of CARs ............................................................................................................... 12
11.10. Transfer van virale immuniteit ......................................................................................................................... 13
12. Diagnostiek ................................................................................................................................................................ 14
12.1.Inleiding ............................................................................................................................................................... 14
12.1.1. De taken van het medisch microbiologisch/virologische labo .................................................................... 14
12.1.2. Microbiologische etiologie aantonen: met welke technieken? .................................................................. 14
12.2.Directe detectie ................................................................................................................................................... 15
12.2.1. Microscopie ................................................................................................................................................. 15
12.2.2. Niet-microscopische methoden .................................................................................................................. 16
12.3.Detectie na amplificatie....................................................................................................................................... 17
12.3.1. Basistechniek voor kweek van micro-organismen ...................................................................................... 17
12.3.2. Identificatie van de opgegroeide bacteriën ................................................................................................ 17
12.3.3. Kweek van moeilijker kweekbare micro-organismen ................................................................................. 18
12.3.4. Interpretatie in het bacteriologisch onderzoek........................................................................................... 18
12.3.5. Detectie na moleculaire amplificatie = PCR ............................................................................................. 20
12.4. Serologie ............................................................................................................................................................. 21
13. T cel immuniteit ......................................................................................................................................................... 23
13.1. Fase 5: ontmoeten van het antigeen (T cellen) .................................................................................................. 23
13.1.1. APC: dendritische cellen .............................................................................................................................. 23
13.1.2. T cel activatie ............................................................................................................................................... 25
13.2. Fase 6: effector functie (T cellen) (NK cellen)..................................................................................................... 28
13.2.1. The stages of activation of CD4 T cells ........................................................................................................ 28
13.2.2. CTL: cytotoxische T cel (CD8) ....................................................................................................................... 36
13.2.3. NK: natural killer cel..................................................................................................................................... 38
14. Humorale immuniteit ................................................................................................................................................ 40
14.1. Fase 5: ontmoeten van het antigeen (B cellen).................................................................................................. 40
14.1.1. B cel stimulatie ............................................................................................................................................ 40
14.1.2. Thymus independent (TI) response ............................................................................................................. 41
14.1.3. Thymus dependent (TD) response .............................................................................................................. 42
GENEESKUNDE : 3E BACH : INFECTIE EN AFWEER : IMMUNOLOGIE 1
, 14.1.4. Mucosale immuniteit ................................................................................................................................... 47
14.2. Fase 6: effector functie (antilichamen) .............................................................................................................. 50
14.2.1 Ig isotypes en verdeling over lichaam ........................................................................................................... 50
14.2.2 Neutralisatie ............................................................................................................................................ 52
14.2.3 Complement dependent cytotoxicity(CDC) ............................................................................................. 53
14.2.4 Opsonisatie .............................................................................................................................................. 53
14.2.5 Antibody-dependent cellular cytotoxicity/fagocytosis ........................................................................... 54
14.2.6 Atopische respons ................................................................................................................................... 54
15. De acute virale infectie .............................................................................................................................................. 55
15.1.Verloop van een infectie ..................................................................................................................................... 55
15.2. Eigenschappen van een acute virale infectie ..................................................................................................... 55
15.3. Influenza A virus ................................................................................................................................................. 56
15.15. Antigene shift en drift .................................................................................................................................. 59
15.16. Epidemiologie vogel influenza A virussen ................................................................................................... 59
15.17. Spaanse Griep (1918)................................................................................................................................... 60
15.18. Circulerende Influenza stammen en pandemiën in 20ste eeuw ................................................................. 60
15.19. Humane besmetting door vogelgriepvirussen ............................................................................................ 60
16. Infecties met extracellulaire pathogenen.................................................................................................................. 61
16.1. E. coli en zijn niche.............................................................................................................................................. 61
16.2. Conditionele infecties met ‘commensale’ E. coli ............................................................................................... 61
16.3. Afweer tegen pyogene bacteriën ....................................................................................................................... 62
16.3.1. Inflammatoire response op een bacteriële infectie: de inflammatoire respons ........................................ 62
16.3.2. Effector Arm ................................................................................................................................................ 62
16.3.3. Inflammatoire response op een bacteriële infectie: bloedbeeld ................................................................ 63
16.3.4. Complicaties: abces ..................................................................................................................................... 63
16.3.5. Complicaties: septische shock ..................................................................................................................... 63
16.4. Infecties met pathogene E. coli stammen .......................................................................................................... 63
16.4.1. Uro-pathogene E. coli .................................................................................................................................. 64
16.4.2. Gastro-intestinale infecties door E. coli....................................................................................................... 64
16.4.3. STEC shigatoxin producerende E. coli.......................................................................................................... 64
16.5.Diagnose van E. coli infecties .............................................................................................................................. 65
16.6. Behandeling van E. coli infecties ........................................................................................................................ 65
17. Infectie met intracellulaire pathogenen .................................................................................................................... 66
17.1. Casus ................................................................................................................................................................... 66
17.2. Inleiding TUBERCULOSE TBC ............................................................................................................................... 66
17.3. Epidemiologie ..................................................................................................................................................... 66
17.4. Mycobacteriën en M. tuberculosis: biologie en situering ........................................................................... 66
17.4.1. Mycobacteriën: een celwand met een dikke laag mycolzuren ................................................................... 66
17.4.2. Andere bacteriën die intracellulaire infecties veroorzaken ........................................................................ 66
17.5.Pathogenese van tuberculose ............................................................................................................................. 67
GENEESKUNDE : 3E BACH : INFECTIE EN AFWEER : IMMUNOLOGIE 2
, 17.5.1. Pathogenese van tbc ................................................................................................................................... 67
17.5.2. Tuberculose: de verschillende klinische vormen van tuberculosis ............................................................. 68
17.6.Diagnostiek .......................................................................................................................................................... 69
17.6.1. Monster-afname .......................................................................................................................................... 69
17.6.2. Microscopie op zuurvaste kleuring.............................................................................................................. 69
17.6.3. Detectie van Tbc door kweek ...................................................................................................................... 69
17.6.4. Non-culture detectie ................................................................................................................................... 69
17.6.5. Immuundiagnostiek ..................................................................................................................................... 70
17.7. Verplichte aangifte ............................................................................................................................................. 70
18. Infecties met fungi ..................................................................................................................................................... 71
18.1. Fungi: gisten en schimmels................................................................................................................................. 71
18.2.Infecties met Candida sp. (candidiase of candidose) .......................................................................................... 72
18.3. immuunreactie tegen gisten en schimmels........................................................................................................ 72
18.4. Aspergillus spp. en aspergillose .......................................................................................................................... 73
18.5. De diagnose van mycosen .................................................................................................................................. 73
18.6. Behandeling van mycosen: antimycotische middelen ....................................................................................... 74
19. Infecties met protozoa .............................................................................................................................................. 75
19.1.Algemene introductie .......................................................................................................................................... 75
19.1.1. Protozoa: ééncellige dieren, 2 tot 100 µm .................................................................................................. 75
19.1.2. Protozoa: belang van (evasie van) immuunrespons.................................................................................... 76
19.2. Toxoplasmose ..................................................................................................................................................... 77
19.3.Malaria................................................................................................................................................................. 79
19.3.1. Verspreiding malaria.................................................................................................................................... 79
20. Worminfecties , atopie en importpathologie ............................................................................................................ 82
20.1. Casus ................................................................................................................................................................... 82
20.2. Importpathologie ................................................................................................................................................ 82
20.3. Parasitaire wormen ............................................................................................................................................ 83
20.4. Immuniteit tegen wormen ................................................................................................................................. 87
20.4.1 effectororm : eosinofiel ................................................................................................................................ 87
20.4.2 effectorarm : mastcel ................................................................................................................................... 87
20.5. Darm-nematoden ............................................................................................................................................... 90
20.6. Behandeling van parasitosen.............................................................................................................................. 91
20.7. Insecten(arthropoden) ....................................................................................................................................... 93
20.8 Prionen : infectieuze foute eiwitconformaties .................................................................................................... 93
21. De chronische virale infectie ..................................................................................................................................... 94
21.1. Chronische virale infectie ................................................................................................................................... 94
21.2. Humaan immunodeficiëntie virus (HIV) ............................................................................................................. 94
21.2.1. HIV infectie .................................................................................................................................................. 94
21.2.2. Transmissie HIV ........................................................................................................................................... 95
21.2.3. HIV immuunpathologie................................................................................................................................ 95
GENEESKUNDE : 3E BACH : INFECTIE EN AFWEER : IMMUNOLOGIE 3
, 21.2.4. AIDS.............................................................................................................................................................. 96
21.2.5. Diagnose HIV infectie................................................................................................................................... 96
21.2.6. Behandeling HIV infectie: specifieke inhibitoren ........................................................................................ 97
21.3. Levenscyclus retrovirus ............................................................................................................................... 98
21.4. Immuunevasie door virussen ...................................................................................................................... 99
21.5. Persistentie ................................................................................................................................................ 103
21.6. Pathogenese .............................................................................................................................................. 104
22.Immuun geheugen en vaccinatie ............................................................................................................................. 105
22.1.Immuun respons en immuun geheugen ........................................................................................................... 105
22.2. Vaccinatie ......................................................................................................................................................... 111
22.2.1. Samenstelling vaccin.................................................................................................................................. 112
22.2.2. Soorten vaccins .......................................................................................................................................... 112
22.2.3. Vaccin optimalisatie/therapeutisch vaccineren ........................................................................................ 118
23. Immunodeficiëntie en immuunmodulatie .............................................................................................................. 119
23.1. De aangeboren/primaire immuundeficiënties ................................................................................................. 119
23.1.1. Severe combined immunodeficiency of SCID ............................................................................................ 119
23.1.2. MHC klasse I, II deficiëntie......................................................................................................................... 120
23.1.3. Zuiver B cel defect ..................................................................................................................................... 121
23.1.4. Andere immuundeficiënties ...................................................................................................................... 122
23.1.5 Drie pathways van complement activatie. ................................................................................................ 122
23.1.6. Diagnose van immuundeficiëntie .............................................................................................................. 123
23.2. Vatbaarheid voor specifieke kiemen ................................................................................................................ 124
23.2.1. Extracellulaire/pyogene infecties .............................................................................................................. 124
23.2.2. Verhoogde gevoeligheid voor intracellulaire pathogenen ........................................................................ 125
23.2.3. Virale infecties ........................................................................................................................................... 126
23.2.4. Oppervlakkige gistinfecties........................................................................................................................ 127
23.2.5. Diepe schimmel- en gistinfecties (niet zo belangrijk) ................................................................................ 127
24. Immunologie van kanker (EXAMEN !!) .................................................................................................................... 128
24.1 KANKER IMMUNOTHERAPIE .............................................................................................................................. 130
Allogene stamceltransplantatie en doron lymfocyteninfucie ............................................................................... 130
Tumor infiltrating lymfocytose (TIL) ...................................................................................................................... 131
Checkpoint inhibitors............................................................................................................................................. 132
24.2 TUMOR ANTIGENEN .......................................................................................................................................... 133
TUMOR ASSOCIATED ANTIGENEN TSA .................................................................................................................. 133
ALLO ANTIGENEN................................................................................................................................................... 134
TUMOR SPECIFIEKE ANTIGENEN TAA .................................................................................................................... 135
GENEESKUNDE : 3E BACH : INFECTIE EN AFWEER : IMMUNOLOGIE 4
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