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Immunodeficiency
: Types of Immunity
(Humoral immunity ( antibody-mainly B cells
( cell mediated ( mainly T-cells
More than 70 types of leukocytes are recognized defined by their cluster of differentiation ( CD )
. antigens
Immunodeficiency: it's a state result from a defect in the immune response usually acquired ( secondary
.( immunodeficiency ) and rarely genetics ( primary
Any components of the system could be affected. But the most important effect of immunodeficiency is
.( abnormal susceptibility to infections ( especially opportunistic infections
: Secondary
.HIV
.Idiopathic CD4 T lymphocytopenia
.Immunosuppressive therapy
.Leucopenia, neutropenia, agranulocytosis
.Asplenic patients
.Chronic diseases associated with immune defects
Complications of immunodeficiency
.
Infections affecting many part of the body and many systems : it varies in character ( severity )
: depending on
.Nature of immune defect so not all immune deficient pt are the same
.Type of microorganism
.( Treatment ( like broad spectrum antibiotics increases the chance of fungal infection
.( Neoplasms: kaposi's sarcoma ( caused by herpes virus 8 ), lymphomas, SSC ( cervix and anus
.Other : thrombocytopenia, lupus erythromatosis, drug allergy, encephalopathy
: General management
.Taking adequate history and physical examination
.Full blood count including differential leukocyte count
.Total serum protein levels
.Evaluation of B cell ,T cell , and phagocytes function
.Evaluation of complement system
: Prevention of AIDS
safe protected sex
Cessation of needle sharing
Screening blood and tissue before transfer to recipient
.The use of antiretroviral drugs for children born to HIV-infected mothers
Clinical features : range from asymptomatic infection due to immunodeficiency and severe clinical
.illness
Infection with HIV may be accompanied by an acute HIV syndrome 3-6 weeks later , with feature
.similar o glandular fever, sometimes with neurological involvement or with rash or mouth ulcers
.May remain asymptomatic for 10 years but the patients are seropositive and can transmit the disease
.Persistant generalized lymphoadenopathy it's a sign of immunodeficiency
General management
Diagnosis through history,clinical examination and lab investigation (CD4/CD8) ratio and the normal
.value of this ratio is 2:1 but in immunodeficiency it may become 1:2
Confidential patient counseling
1st step is to test HIV to detect the antibodies to HIV ( detectable from 6-8 weeks ) antibody to HIV
means the patient that the patient has been infected with the virus, it implies a carrier state but doesn't
.indicate immunity to HIV
.The absence of the antibody to HIV does not always mean that infection is absent
.In case of doubt, HIV antigens or nucleic acid can be detected in the blood earlier than antibodies
.No effective treatment
Dental aspect
.It's unethical to withhold treatment from any patient
. Dental treatment should be carried out with precaution
Pt with profound Immunodeficiency may require antibiotic cover before surgery or after maxillofacial
.injury
. Aspirin should be avoided because it may aggravate bleeding tendency
. Needle stick injury should be avoided
.Oral manifestations include ; candidosis , hairy leukoplakia , Kaposi sarcoma , viral infection
Immunosuppressive therapy
: Immunosuppressive drugs are widely used in
.Organ transplant
.Autoimmune disease
.Control some tumors
.Connective tissue diseases
Immunosuppressive drugs like : corticosteroids and calcineurin-inhibitors such as ciclosporin and
. tacrolimus. And other cytotoxic drugs like azathioprine , cyclophosphamide and clorambucil
.This Immunosuppressive drugs mostly effective against cell-mediated responses and autoantibodies
.Pt on these drugs are strongly prone to infection and liable to neoplasms
: Dental aspects
Antimicrobial prophylaxis may be needed
.Oral fungal infection are commonly seen in these patients
Consult the physician before the surgery may need coverage ( usually double the dose ) to avoid adrenal
.insufficiency
. Clinical features : Agranulocytosis is sudden in onset , with fever , weakness and sore throat
.Gingival, oral and pharyngeal ulcerations with pseudomembrane formation
. Lymphoadenopathy and rashes
.Later, haemorrhagic necrosis of MM, respiratory infections
.Purpura and bleeding
: General management
.Diagnosis is confirmed by blood examination and marrow biopsy
.Treatment depend on the underlying cause
.The main measure is to control infection and to avoid septicemia
.Granulocyte colony stimulating factors (GCSF) are available any may be benefit
: Dental aspect
.Main oral manifestations are infections and ulcers
.Periodontal diseases may be accelerated
.Oral infections may be the source of septicemia and sometimes may be fatal
.Oral infections can be controlled by topical or systemic antibiotics or sometimes by antiseptics
.If broad spectrum antibiotics are used antifungal agents should be used
.Dental surgical procedures should be covered with antibiotics
.Hemorrhagic tendency with thrombocytopenia
.Take into consideration the risks associated with corticosteroid therapy
Asplenic patients
:Functions of spleen
.It's important for controlling the quality of erythrocytes in the circulation
.It's the site of sequestration of effete erythrocytes
It's essential for the production of Opsonins and thus important in phagocytosis and antibody
.production
Etiology
: Splenectomy ( remove the spleen ) is done in
.Hemolytic anemia
.Splenic injury in abdominal trauma
.Idiopathic thrombocytopenic purpura
:Clinical feature
Asplenia predispose to infections
Children are 10 times more likely than adults to develop sepsis
.Infections after splenectomy only rarely emanates from the oral flora
.May develop malignant tumors
: Dental aspects
.No indication for antimicrobial prophylaxis before dental procedures
.Exclude thrombocytopenia and corticosteroid therapy
Diabetes mellitus: most common chronic disease associated with immune defects, and delayed healing,
.defective phagocytosis
. Cancers of lymphoid or hematopoietic tissues: specialy as a consequence of their treatment
Infections : eg HIV
The more severe congenital immune defects often cause early death so they are not relevant to dental
.practice except if the pt is treated with bone marrow transplantation
: Clinical features
Recurrent bacterial or viral respiratory infections
GIT infections
Autoimmune disease are abnormally frequent in these patients
: Dental aspects
( No evidence that caries or periodontal disease are increased in these pt ( IgA is secreted in the saliva
Occasionally associated with oral ulcers and herpes labials
: Mucocilliary syndrome
Defect in the cilia of the respiratory tract that may lead to chronic sinusitis or other respiratory
.infections
The End
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