Essentials of Clinical Immunology

Cover......Page 1
Title page......Page 3
Copyright page
......Page 4
Contents......Page 5
Preface to the Sixth Edition......Page 6
Preface to the First Edition......Page 7
How to Use Your Textbook......Page 8
About the Companion Website......Page 11
Key to Illustrations......Page 12
Chapter 1: Basic Components: Structure and Function......Page 13
1.2 Key molecules......Page 14
1.2.2 Recognition molecules......Page 16
1.2.3 Accessory molecules......Page 22
1.2.4 Effector molecules for immunity......Page 23
1.2.5 Receptors for effector functions......Page 25
1.2.6 Adhesion molecules......Page 27
1.3.3 Macrophages......Page 29
1.3.4 Dendritic cells......Page 30
1.3.5 Complement......Page 32
1.3.6 Antibody-dependent cell-mediated cytotoxicity......Page 34
1.3.7 Natural killer cells......Page 35
1.4.2 T cell mediated responses......Page 36
1.4.3 Antibody production......Page 39
1.5.3 Indirect functions of antibody......Page 40
1.6.1 Inflammation: a brief overview......Page 41
1.7 Organization of the immune system: an overview......Page 42
1.8 Conclusions......Page 45
Chapter 2: Infection......Page 46
2.2.1 Non-specific resistance......Page 47
2.3.1 Epstein–Barr virus infection......Page 49
2.3.2 Herpes viruses in general......Page 50
2.3.3 Direct effects of viruses......Page 52
2.3.4 Viral strategies to evade the immune response......Page 53
2.4.1 Normal immune responses to bacterial infections......Page 54
2.4.3 Bacterial evasion of immune defences......Page 55
2.4.4 Bystander damage caused by the immune response to bacterial infection......Page 56
2.5.1 Mycobacterial infections......Page 57
2.5.3 Mycobacterial evasion of the immune response......Page 59
2.6.1 Mechanisms of immunity to fungal infections......Page 60
2.7.1 Protozoal infection......Page 62
2.7.3 Protozoal evasion of immune responses......Page 63
2.7.6 Helminth evasion of immune responses......Page 64
2.7.7 Bystander damage caused by immune reactions to protozoa and helminths......Page 65
Chapter 3: Immunodeficiency......Page 66
3.2.1 Diagnosis of primary antibody deficiencies......Page 67
3.2.2 Types of primary antibody deficiency (see Table 3.2 and Box 3.2)......Page 69
3.2.5 Management of antibody deficiencies......Page 77
3.3.2 Management of defects in cellular immunity......Page 78
3.4.1 Functional defects in monocytes and dendritic cells......Page 82
3.4.2 Defects in neutrophil function......Page 83
3.4.4 Complex innate disorders......Page 86
3.4.5 Complement deficiency......Page 87
3.5.1 Secondary causes of immunodeficiency......Page 88
3.5.2 Acquired immune deficiency syndrome......Page 89
3.5.4 The clinical spectrum of human immunodeficiency virus infection......Page 90
3.5.5 Immunopathogenesis of acquired immune deficiency syndrome......Page 91
3.5.7 Therapeutic options in acquired immune deficiency syndrome......Page 94
3.5.8 Infections in the immunosuppressed host......Page 96
Chapter 4: Anaphylaxis and Allergy......Page 98
4.2 Immediate (type I) hypersensitivity......Page 99
4.3 Atopy......Page 100
4.4.1 Anaphylaxis......Page 101
4.4.2 Anaphylactoid reactions......Page 102
4.5.1 Seasonal (hay fever) and perennial (vernal) conjunctivitis......Page 104
4.6.1 Allergic rhinitis......Page 105
4.6.2 Asthma......Page 106
4.7 Food allergy and intolerance......Page 109
4.7.1 Food allergy and intolerance......Page 110
4.8.1 Urticaria and angioedema......Page 112
4.8.2 Atopic eczema......Page 114
4.8.3 Contact dermatitis......Page 116
Chapter 5: Autoimmunity......Page 117
5.2.2 Non-organ-specific autoimmune disease......Page 118
5.2.3 IgG 4-related disease......Page 119
5.3 Who gets autoimmune disease?......Page 120
5.4.2 Thymic tolerance......Page 121
5.4.3 Peripheral tolerance......Page 123
5.4.4 B-cell tolerance......Page 125
5.5 How does tolerance break down?......Page 126
5.6.1 Genetic factors......Page 127
5.6.2 Environmental factors......Page 128
5.7 Mechanisms of tissue damage......Page 130
5.8 Treatment of autoimmune disease......Page 131
Chapter 6: Lymphoproliferative Disorders......Page 133
6.3 Leukaemia......Page 134
6.3.1 Acute lymphoblastic leukaemia......Page 135
6.3.2 Chronic lymphocytic leukaemia......Page 138
6.4 Lymphomas......Page 140
6.4.1 Hodgkin’s disease......Page 141
6.4.2 Non-Hodgkin’s lymphoma......Page 142
6.5.1 Benign paraproteinaemia or monoclonal gammopathy of unknown significance......Page 143
6.5.2 Multiple myeloma......Page 145
6.5.3 Waldenström’s macroglobulinaemia......Page 147
6.5.4 Other plasma cell dyscrasias......Page 148
Chapter 7: Immune Manipulation......Page 149
7.2.1 Drugs......Page 150
7.2.2 Polyclonal antibodies for prevention of responses......Page 153
7.2.4 Monoclonal antibodies for specific immunomodulation......Page 154
7.2.5 Other uses of monoclonal antibodies......Page 159
7.3 Immunization against infection......Page 160
7.3.1 Theoretical basis of immunization......Page 161
7.3.2 Adjuvants......Page 162
7.3.3 Routine immunization......Page 163
7.3.5 Passive immunization......Page 164
7.4.1 Cytokine therapy......Page 165
7.4.2 Gene therapy......Page 166
7.4.3 Cancer immunotherapy......Page 167
Chapter 8: Transplantation......Page 169
8.3 Renal transplantation......Page 170
8.3.2 Post-transplantation period......Page 171
8.3.3 Clinical rejection......Page 173
8.3.4 Immunopathology of rejection (the allograft response)......Page 174
8.3.5 Graft survival......Page 175
8.3.6 Complications......Page 176
8.4.2 Heart transplantation......Page 177
8.5 Haematopoietic stem cell transplantation......Page 178
8.5.2 Management of the patient......Page 179
8.5.3 Complications of allogeneic HSCT and their prevention: graft-versus-host disease and infection......Page 180
8.5.4 Results......Page 181
Chapter 9: Kidney Diseases......Page 183
9.2 Clinical syndromes......Page 184
9.3 Classifications of glomerulonephritis......Page 185
9.4.1 IgA nephropathy......Page 186
9.5.1 Acute immune-complex nephritis......Page 188
9.5.2 Acute post-infectious glomerulonephritis......Page 189
9.6.1 Chronic immune-complex glomerulonephritis......Page 190
9.6.2 Membranoproliferative glomerulonephritis (mesangiocapillary glomerulonephritis)......Page 192
9.6.3 Lupus nephritis......Page 195
9.7.1 Anti-glomerular basement membrane disease......Page 196
9.7.2 Antineutrophil cytoplasmic antibody-associated glomerulonephritis......Page 197
9.8 Nephrotic syndrome......Page 198
9.8.1 Minimal-change nephropathy......Page 199
9.8.3 Membranous glomerulonephritis......Page 200
9.8.4 Amyloid disease......Page 201
9.9 Tubulointerstitial nephropathy......Page 202
9.9.1 Acute drug-induced tubulointerstitial nephritis......Page 203
9.9.3 Other immunologically mediated tubulointerstitial nephritides......Page 204
9.11 Recurrent glomerulonephritis in transplanted kidneys......Page 205
Chapter 10: Joints and Muscles......Page 206
10.3 Arthritis and infection......Page 207
10.3.1 Septic arthritis......Page 208
10.4.2 Serology......Page 209
10.4.4 Immunopathogenesis......Page 210
10.4.5 Aetiology......Page 212
10.4.7 Management......Page 213
10.5.1 Ankylosing spondylitis......Page 214
10.5.2 Other seronegative spondyloarthritides......Page 215
10.5.3 Other seronegative arthritides......Page 216
10.6 Chronic arthritis in children......Page 217
10.7.1 Clinical features......Page 218
10.7.5 Management of systemic lupus erythematosus......Page 219
10.7.6 Prognosis......Page 221
10.7.7 Aetiology and pathogenesis......Page 222
10.8.1 Mixed connective tissue disease......Page 224
10.9.1 Polyarteritis nodosa......Page 225
10.9.2 Polymyalgia rheumatica and giant cell (temporal) arteritis......Page 227
10.9.3 Other vasculitides......Page 228
10.11 Hereditary periodic fevers......Page 229
Chapter 11: Skin Diseases......Page 231
11.2 Infections and the skin......Page 232
11.3.1 Contact dermatitis......Page 233
11.3.3 Psoriasis......Page 236
11.4.1 Bullous skin diseases......Page 237
11.5.1 Cī inhibitor deficiency......Page 240
11.5.2 Vasculitis......Page 241
11.5.4 Lupus erythematosus......Page 243
11.5.5 Systemic sclerosis......Page 244
Chapter 12: Eye Diseases......Page 248
The globe......Page 249
12.2.1 Conjunctival infection......Page 250
12.2.4 Stevens–Johnson syndrome......Page 251
12.2.5 Other causes of conjunctivitis......Page 252
12.5 Uveitis......Page 253
12.5.1 Anterior uveitis......Page 254
12.5.3 Uveitis following trauma......Page 255
Chapter 13: Chest Diseases......Page 257
13.2 Respiratory infections......Page 258
13.2.1 Infection in the immunocompetent host......Page 259
13.3.1 Formation of a granuloma......Page 260
13.3.2 Tuberculosis......Page 262
13.3.3 Sarcoidosis......Page 263
13.4 Interstitial lung disease......Page 264
13.4.1 Pulmonary eosinophilia......Page 265
13.4.2 Extrinsic allergic alveolitis......Page 266
13.4.3 Idiopathic interstitial pneumonias......Page 268
13.6 Pulmonary vasculitis......Page 270
13.7.1 Pericarditis......Page 271
13.8 Coronary artery disease......Page 272
13.9 Diseases of the great vessels......Page 273
Chapter 14: Gastrointestinal and Liver Diseases......Page 275
14.1.1 Normal immune mechanisms......Page 276
14.1.2 Spectrum of the intestinal immune response......Page 277
14.2.1 Infection and the gut......Page 279
14.3.1 Atrophic gastritis and pernicious anaemia......Page 280
14.4.1 Food allergy......Page 282
14.4.2 Coeliac disease......Page 283
14.5 Autoimmune enteropathy......Page 286
14.6.1 Crohn’s disease and ulcerative colitis......Page 287
14.7.1 Hepatitis A......Page 289
14.7.2 Hepatitis B......Page 290
14.7.3 Hepatitis C......Page 293
14.7.4 Other hepatitis viruses......Page 294
14.8.1 Chronic active hepatitis......Page 295
14.8.2 Primary biliary cirrhosis......Page 296
14.8.3 Associated syndromes......Page 298
14.8.5 Drug-induced liver disease......Page 299
Chapter 15: Endocrinology and Diabetes......Page 300
15.2 Mechanisms of endocrine autoimmunity......Page 301
15.3.1 Thyrotoxicosis......Page 302
15.3.2 Hashimoto’s thyroiditis......Page 304
15.3.3 Idiopathic thyroid atrophy (myxoedema)......Page 305
15.4.2 Immunopathogenesis of Type 1 diabetes mellitus......Page 306
15.4.5 Are immunological tests useful?......Page 308
15.5.1 Autoimmune adrenal disease......Page 309
15.10 Autoimmune polyendocrine disease......Page 310
Chapter 16: Non-Malignant Haematological Diseases......Page 312
16.2 Autoimmune haemolytic anaemias......Page 313
16.2.1 Warm antibody haemolytic anaemias......Page 314
16.2.3 Drug-induced autoimmune haemolytic anaemias......Page 316
16.3 Immune thrombocytopenia......Page 317
16.3.1 Autoimmune immune thrombocytopenia......Page 318
16.5 Haematopoietic progenitor cells......Page 320
16.6.2 Other antibodies to coagulation factors......Page 321
16.7.2 Risks of blood transfusion......Page 322
17.1 Introduction......Page 324
17.2 Infections......Page 325
17.3.1 Multiple sclerosis......Page 326
17.4.1 Myasthenia gravis......Page 330
17.5.1 Acute idiopathic polyneuritis (Guillain–Barré syndrome)......Page 332
17.5.2 Chronic inflammatory peripheral neuropathies......Page 333
17.6 Paraneoplastic syndromes......Page 334
17.7 Cerebral systemic lupus erythematosus......Page 335
Chapter 18: Immunological Diseases in Pregnancy......Page 336
18.3.2 Placental transfer of IgG......Page 337
18.3.4 Reducing particular risks to the fetus/neonate from maternal infection......Page 339
18.4.1 Recurrent abortions......Page 340
18.4.4 Fetal diseases due to alloimmunization......Page 341
18.5.1 Antibodies to hormones......Page 342
18.5.2 Antibodies to sperm......Page 343
Chapter 19: Techniques in Clinical Immunology......Page 344
19.2.1 Quantitation of immunoglobulins......Page 345
19.2.2 Qualitative investigation of immunoglobulins......Page 347
19.3.1 Assays for individual components......Page 349
19.3.4 Functional assays......Page 350
19.5.1 In serum......Page 351
19.6 Tests for allergy and hypersensitivity......Page 354
19.6.3 Serum tryptase......Page 355
19.7 Assessment of lymphocytes......Page 356
19.7.2 Functional tests......Page 357
19.8.2 Functional tests......Page 358
19.9.1 DNA analysis......Page 359
19.9.3 Genomics and microarrays......Page 361
19.10 Histocompatibility testing......Page 362
Appendix: Further Resources......Page 363
Index......Page 365