Inflammation,
Infection, & Immunity
Allie Arguello
Inflammation and
Causes
• Innate & automatic
• Response to cell injury
• Causes
• Trauma
• Infection
• Ischemia
• Extreme heat & cold
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Cardinal signs
Rubor (redness)
Tumor (swelling)
Calor (heat)
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BY-SA.
Dolor (pain)
Functio laesa (loss of function)
Cell of Inflammation
• Endothelial Cells
• Line blood vessels
• Produce vasoactive substances
• Selectively permeable
• Platelets
• Release inflammatory mediators
• Affect endothelial permeability
and alter endothelial
properties (more sticky)
• Clotting
• Aspirin is an anti-platelet
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Cells of Inflammation
• Granulocytes
1. Neutrophils: First to appear, most
numerous
2. Eosinophils: appear later; allergic rxns
3. Basophils: allergic rxns by IgE (antibody)
4. Mast Cells: activated to release histamine
and cytokines
• Agranulocytes
1. Monocytes: circulate and differentiate
into macrophages when needed
2. Macrophages: phagocytosis
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Vascular Stage
Acute
Inflammation
• Vasodilation
• Permeability
Cellular Stage
• Leukocytes migrate
Leukocyte Activation and Phagocytosis
• Opsonization
• Microbe killing
Immediate and brief vasoconstriction
• Stops bleeding
Vascular
Stage
2. Vasodilation
• Increases blood flow
• Redness & warmth
3. Increased Capillary Permeability
• Allows exudate (filled with proteins and
mediators) to escape into tissue to do work
• Swelling, pain, and loss of function
Cellular Stage
1. Margination: Leukocytes "roll" along
endothelial cells
2. Adhesion: Adhere to vessel wall
3. Transmigration: Slip between cells to get
into tissues
• Chemotaxis guides the cell to the point of
injury
• Cytokines and other mediators "tell"
WBCs where to go through chemical
signaling
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Leukocyte Activation and
Phagocytosis
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• Opsonization: "flagging" invading
microbes
• Makes it easier for phagocytes to
find and kill
•
Phagocytosis
• Engulf, kill, and digest using
enzymes
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Inflammatory mediators
• Leukotrienes: Contract smooth muscle, constrict airways, increase vessel
permeability
• Prostaglandins: Vasodilate, increase permeability, mediate pain and
swelling, bronchoconstrict, attract leukocytes
• Thromboxane: Clotting (promotes platelets), bronchoconstrict,
vasoconstrict
• Histamine: Vasodilate, increase permeability, pro-inflammatory
• Complement: Plasma protein cascade, promotes leukocytes and phagocytosis
• Bradykinin: Increase permeability; cause pain
Corticosteroids
and NSAIDS
• Corticosteroids: Inhibit Arachidonic
Acid
• No leukotrienes, prostaglandins,
or thromboxane
• Aspirin and NSAIDS: Inhibit
Cyclooxygenase Pathway
• No prostaglandins or
thromboxane
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Types of Exudates
• Serous: watery, low protein
• Hemorrhagic: contains
RBCs/blood
• Purulent: pus, cellular debris
• Infection!
• Fibrinous: fibrinogen; thick
meshwork
Chronic vs Acute
Inflammation
Acute
• Short, limited
• Neutrophils primarily present
Chronic
• Continual, weeks to years
• Macrophages and
lymphocytes come in and stay
• Fibroblasts
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Systemic
Inflammation
• Affects the ENTIRE body
• GI, respiratory, weight, BP, HR
• Acute phase response
• WBCs go up or down
• Fever
• Sepsis/shock
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Fever
• Hypothalamus tries to kill microbes by
increased body temperature
• Cooling, fluids, antipyretics (COX inhibitors)
• Elderly: Change in mental status
• Slight alterations can mean big problems; baseline
is lower
• Children
• Very common, often no cause
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Sepsis and Shock
• Overwhelmed with microbes
• Inflammation is out of control
• Extreme release of mediators
• Systemic vasodilation: BP
drop
• Systemic capillary
permeability: BP drop
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Question Time!
Answer: A, B, D
• The nurse is teaching a client experiencing inflammation. Which
sign of inflammation should the nurse include in the teaching?
(Select all that apply.)
A. Pain
B. Swelling
C. Paresthesia
D. Redness
E. Paralysis
Answer: B, C, E
• The nurse is caring for a client with localized inflammation.
Which finding should the nurse expect to assess in this client?
(Select all that apply.)
A. White blood cell count of 15,000
B. Palpable warmth of the extremity
C. Tenderness with palpation or movement
D. Oral temperature of 101
degrees °F
E. Localized edema
Answer: D
• A nurse in the acute care setting is caring for a patient who has
rubor (flush) of an area of injury on the left lower extremity. What is
the cause for this finding?
A.) Exudate
B.) Neutrophils
C.) Extravasation
D.) Vasodilation
Answer: C
• A patient arrives in the emergency department reporting fever
for 24 hours and lower right quadrant abdominal pain. After
laboratory studies are performed, what does the nurse
determine indicates the patient has a bacterial infection?
a.) Increased platelet count
b.) Decreased blood urea nitrogen
c.) Increased number of band neutrophils
d.) Increased number of segmented myelocytes
Answer: B
• What is the body's initial response to injury?
a. immune response
b. inflammatory response
c. repair and regeneration
d. hyperplasia and hypertrophy
Answer: C
• The directed movement of white blood cells to the area of injury
is called?
a. pavementing
b. margination
c. chemotaxis
d. hyperemia
Answer: C
• All of the following are systemic manifestations of inflammation
except?
a. leukocytosis
b. fever
c. hyperemia and erythema
d. lymphadenopathy
Answer: vasodilation, permeability
Histamine causes ___ of arterioles and increase the ___ of venules
Answer: Acute
• A parent brings a child to the emergency department with newly
formed blisters from touching a hot pan covering the majority of
both palms; they are red and feel hot to the touch. Which type
of inflammatory manifestation is this?
Answer: C,D,F
• Which of the following are symptoms of a systemic infection?
(Select all that apply.)
a. Redness.
b. Edema.
c. Fatigue.
d. Fever.
e. Pain or tenderness.
f. Nausea and vomiting.
Answer: B
• Edema occurs in inflammation due to:
A. Constriction of small veins in the surrounding area.
B. Leakage of plasma from capillaries.
C. Increased phagocytic action of white blood cells.
D. Concentration of injurious agents.
Answer: A
• The nurse assesses a surgical patient the morning of the first
postoperative day. Signs of a local inflammatory response that
the nurse EXPECTS to find include:
• A. Slight redness and heat of the incision.
• B. Leukocytosis with elevated monocytes.
• C. Pain and serous drainage of the incision.
• D. Fever and increased pulse and respiratory rate.
Immunity
• Innate
• Natural
• Born with
• Adaptive
• Slower
• More effective and specific
Innate vs
Adaptive
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Mediators
• Cytokines: both innate and adaptive
• Tumor necrosis factor a: inflammation, fever,
acute-phase response
• Kills through apoptosis
• Activates neutrophils and endothelial cells
• Chemokines: for migration and activation of
immune/inflammatory cells
• Colony-stimulating factors: growth and
development of bone marrow progenitors
• Produce more neutrophils, RBCs
• Bone marrow suppression= decreased cell
production
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Innate Immunity
1. Epithelial barrier
• Skin
2. Phagocytic Cells
• Neutrophils and macrophages
3. Dendritic Cells
• Translate innate into adaptive immunity
• Capture "image" of pathogen
4. NK Cells
• Early defense against foreign cells (especially virally infected and
cancer cells)
5. Plasma Proteins
MHC and NK Cells
• Major histocompatibility
complex: shown on normal cells
to recognize as self (like a lock
and key)
• Virally infected/tumor cells don't
have this complex
• NK cells notices the MHC receptor
isn't present
• Cell gets killed
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Innate
Mediators
• Opsonin
• Make phagocytosis easier
• Cytokines
• Acute-phase proteins
• C-Reactive protein
• Increases with chronic
inflammation (ex. High cholesterol)
• Complement System
• In blood
• Cytolysis, opsonization, chemotaxis,
anaphylaxis
• Aggregates bacteria=easier to kill
Adaptive Immunity
• Recognizes invaders
• Remembers invaders
• Second
exposure=Faster and
larger response;
more effective
defense
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• Lymphocytes: B and T
cells
• Humoral and CellMediated Immunity
Humoral vs. CellMediated
• Humoral
• B lymphocytes
• Extra-cellular microbes and
toxins
• Cell-Mediated
• T lymphocytes
• Intracellular microbes and
viruses
Antigens and Antibodies
• Antigen: foreign substance
• Cause immune response
• Examples?
• Antibody: recognize
antigens
• Made by B-cells
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APCs
• Macrophages and Dendritic Cells
• Find antigen, capture it, present it to
T cells to start adaptive immunity
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T-Lymphocytes
• CD4 and CD8
• CD4=Helper T cells; direct signals
• CD8=Cytotoxic T cells; destroy
• Regulatory T-cells: inhibit harmful
lymphocyte growth
• Activate T and B cells
• Intracellular viral infections (HIV)
• Reject foreign tissue
• Delayed hypersensitivity rxns
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B-Lymphocytes
• Plasma cells
• Release antibodies
• Memory cells
• Remember antigens for quicker
response
• Antibodies
• Recognize and bind pathogens
and to alert body
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Immunoglobulins
• IgG: protect newborn (crosses placenta)
• IgA: body secretions (breast milk)
• IgM: early immunity; first encounter with pathogen
• IgD: on B-lymphocytes, mature B cells
• IgE: parasitic, allergic, and hypersensitivity rxns
• Mast cells, basophils
https://www.toppr.com/ask/
content/concept/immunoglo
bulins-268707/
Active vs Passive Immunity
• Active: long lasting; memory cells respond to next exposure
• Immunization
• Flu shot
• Having disease
• Having flu in the past
• Passive: short-term
• Transferred from another source
• Mother to infant through breast milk (IgG)
• Antibody serum
• Injected with antibodies not made by you
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Lymphoid Organs
• Central
• Bone marrow: Produce both
lymphocytes; B-cells mature
• Thymus: T-cells mature
• Peripheral
• Trap and process antigens
• Increased likelihood of
making a defense
• Lymph nodes, tonsils
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Immune Response in
the Older Adult
• More susceptible
• Less adaptation and immunity
• Less T-cells
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Questions
Answer: A
• Enhancement of phagocytosis is called?
a. opsonization
b. abfraction
c. transudate
d. chemotaxis
Answer: E
• Antibody mediated immunity (Humeral immunity) complements
the inflammatory response because:
a. It is specific and has the ability to recognize previous antigens
b. Is quick acting, responding to a recognized antigen within 6
hours
c. Is delayed in its response to a recognized antigen, taking 1-3
days
d. a&b
e. a&c
Answer: C
• In the course of the normal immune response, antigens of any
type are:
a. Reproduced.
b. Strengthened.
c. Neutralized.
d. Changed to "memory cells"
Answer: B
• You are caring for a patient who has a severe rash and itching
from poison ivy in the lower legs. This reaction is best
understood as an example of cell mediated immunity. The cell
type involved in this type of immunity are:
a. B lymphocytes
b. T lymphocytes
c. Natural killer cells
d. Antibodies
Answer: B
• Your adult patient is scheduled to receive an influenza
vaccination. She asks "how do those things work anyway?" Select
the best response.
a. "They work by giving you antibodies so you will be immune
immediately if exposed in the future to the same antigen."
b. "Immunizations work by sensitizing your body to prepare
antibodies against this virus if exposed in the future to the same
antigen."
c. "Trust me, they work and you need one!"
d. "Immunizations work by activating cytokines which are part of
the immune response."
Answer: C
• The complement system is responsible for
a.) blood clotting
b.) production of pain
c.) destruction of microorganisms
d.) increased extracellular fluid volume
Answer: A
• Antibodies are produced by
a.) memory B-lymphocytes
b.) helper T-lymphocytes
c.) macrophages
d.) plasma cells
Answer: B
• Which cells of the innate immune system stimulate specific
response from the adaptive immune response?
a.) cytotoxic T-lymphocytes
b.) macrophages
c.) memory T-lymphocytes
d.) helper T-lymphocytes
Answer: D
• Which T-lymphocytes activate the B-cell response?
a.) suppressor T-cells
b.) cytotoxic T-cells
c.) memory T-cells
d.) helper T-cells
Answer: Thymus; bone marrow
• T-lymphocytes mature in ________ ; and B-lymphocytes mature
in _____
Answer: C
• The level of this antibody is raised in allergic reactions
a.) IgA
b.) IgG
c.) IgE
d.) IgM
Answer: IgG
• This antibody can cross the placenta
Answer: IgM
• The first antibody to arrive is usually _____
Hypersensitivity Disorders
• Type I, IgE-mediated disorders
• Type II, antibody-mediated disorders
• Type III, complement-mediated immune disorders
• Type IV, T-cell–mediated disorders
Type 1: IgE Mediated
• First exposure: Makes antibodies (IgE)
• Second Exposure: allergen binds to
antibodies
• Causes mast cells to degranulate
(histamine)=tissue injury
• Immediate and confined
• Fixed antibody on mast cells, freely
floating antigen
• Examples
• Allergic asthma, allergic rhinitis,
hives
• Food allergies
Type 2: Cytotoxic
Hypersensitivity
• IgG or IgM
• Antigen is on cell, marks it for attack
• Fixed antigen, freely floating antibody
• Complement gets activated
• Forms Membrane Attack Complex (MAC)
• Macrophage destroys
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• Examples
• Mismatched blood transfusion reactions
• Hemolytic disease of the newborn (Rh
incompatibility)
• Myasthenia Gravis
Type 3: Immune Complex Allergic
Disorders
• Antigen and antibody come
together=inflammatory response
• IgG and IgM
• Immune complexes deposit on walls of
blood vessels and tissues and activate
complement
• DepositThe deposit site gets damaged
• Examples
• Systemic lupus erythematosus
• Serum sickness
• Arthus rxn
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Type 4: Cell Mediated
Hypersensitivity
• Delayed-type
• T-cells, not antibodies
• T helper cells release
cytokines, activate macrophages
• Examples
• Contact dermatitis (latex, poison
ivy)
• Multiple sclerosis
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MHC 1 vs 2
• MHCs function to identify self
vs. non-self cells
• Bind fragments of antigen
and display them on their cell
surface so that T-lymphocytes
can recognize them
MHC 1
MHC 2
On most cells
Only on APCs
Intracellular
pathogens
Extracellular
pathogens
Best review
videos!!
• Type 1 Hypersensitivity
• Type 2 Hypersensitivity
• Type 3 Hypersensitivity
• Type 4 Hypersensitivity
Transplanted Tissue
Types
1.
Allogeneic
• Related or unrelated;
but similar HLA types
2. Syngeneic
• Identical twins
3. Autologous
• Same person
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Questions!!
Answer: Anaphylactic/ Type 1
• After receiving an intravenous dose of Vancomycin, your patient
begins to complain of shortness of breath and tongue swelling.
This would be an example of what type of reaction?
Answer: B
• The nursing instructor asks the student nurse to explain a type IV
hypersensitivity reaction. Which statement by the student best
describes type IV hypersensitivity?
A. "It is a reaction of immune globulin (Ig)G with the host cell
membrane or antigen."
B. "The reaction of sensitized T-cells with antigen and release of
lymphokines activate macrophages and induce inflammation."
C. "It results in release of mediators, especially histamine,
because of the reaction of IgE antibody on mast cells."
D. "An immune complex of antigen and antibodies is formed and
deposited in the walls of blood vessels."
Answer: C
• Which statement is true about pathologic conditions of the
immune system?
a. Allergies result when the immune system loses its ability to
react to antigens.
b. In immunodeficiency, the body's immune system overreacts to
foreign antigens.
c. In autoimmune diseases such as Lupus or Rheumatoid Arthritis,
the body's immune system treats some of the body's own tissues
as foreign invaders.
d. None of the above.
Answer: B
• A nurse is reviewing the chart of a newborn treated for hemolytic
disease. Which statement shows the nurse's understanding of
the cause of the disease?
A. "Neutrophils attempt to phagocytize the RBCs."
B. "antibodies bound with an antigen activate the cascade
destroying the RBCs."
C. "Complement activation causes the release of inflammatory
chemical mediators resulting in RBC destruction."
D. "Endogenous antigens stimulate a type II reaction resulting in
lysis of the RBC."
Answer: Type 3
• Which hypersensitivity reaction damages tissues through the
deposition of immune complexes in tissue walls?
HIV
• Virus that attacks CD4 cells
• Immunity becomes compromised
• Transmission
• Sexual contact, blood-blood contact, mother to child
•
Phases
1. Primary Infection
• Flu-like
• Days-weeks after contracting
2. Chronic
• Latent, asymptomatic
• Years
3. AIDS
• CD4 count <200
• Very vulnerable to infections
Modes of Transmission
• Penetration
• Ex. Infected splinter
• Direct Contact
• Ex. Kissing --> mononucleosis
• Ingestion
• Ex. E. coli food poisoning
• Inhalation
• Ex. Influenza
Sources
• Nosocomial=from hospital
• Community acquired=outside of
hospital
• Endogenous: from inside body,
normal flora becomes infectious
• Exogenous: from outside body
• Fomite: inanimate object
containing an infection
• Ex. Table surface
Disease Course
1.
Incubation
• Infection -> Symptom onset; where infection grows
2.
Prodromal
• Early, nonspecific symptoms
• Usually becomes contagious, but often unaware of illness
3.
Acute
• Peak symptoms
• Immune response in full force
4.
Convalescent
• Recovery, starting to feel better
5.
Resolution
• Symptoms and infection gone
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Bioterrorism
• Category A: highest risk; easily transmitted, high mortality, harder treatment
• Plague, Anthrax, Smallpox, Tularemia, Viral hemorrhagic agents (Ebola),
Botulism
• Category B: 2nd priority
• Food/water-borne diseases (Salmonella, E.coli), zoonotic infections, Viral
encephalitis, castor bean toxin aka Richin toxin
• Category C: 3rd priority, includes emerging pathogens of note
• Mycobacteria Tuberculosis, Nipah and hantavirus, tick-borne disease, yellow
fever, Cryptosporidium parvum
Questions!
Answer: D
• A patient tests positive for COVID-19 but has not yet begun showing
symptoms. What stage of infection is this patient in?
• a.) Prodromal
• b.) Convalescent
• c.) Nonspecific
• d.) Incubation