The immune system is composed of many interdependent cell types that collectively protect the body from bacterial,

parasitic, fungal, viral infections and from the growth of tumor cells.

Many of these cell types have specialized functions.

The cells of the immune system
can engulf bacteria, kill parasites or tumor cells, or kill viral-infected cells.

Organs of the Immune System

The organs of the immune system are stationed throughout the body. They are known as lymphoid organs because they are concerned with the growth, development, and deployment of lymphocyteswhite blood cells that are key operatives of the immune system.

Bone Marrow
All the cells of the immune system are initially derived from the bone marrow through hematopoiesis. Produces B cells, natural killer cells, granulocytes and immature thymocytes, in addition to red blood cells and platelets.

Thymus
Produce mature T cells. Immature thymocytes, also known as prothymocytes, leave the bone marrow and migrate into the thymus. Through a remarkable maturation process sometimes referred to as thymic education, T cells that are beneficial to the immune system are spared, while those T cells that might evoke a detrimental autoimmune response are eliminated. The mature T cells are then released into the bloodstream.

Spleen
An immunologic filter of the blood. Made up of B cells, T cells, macrophages, dendritic cells, natural killer cells and red blood cells. In addition to capturing foreign materials (antigens) from the blood that passes through the spleen, migratory macrophages and dendritic cells bring antigens to the spleen via the bloodstream.

Lymph Nodes
An immunologic filter for the bodily fluid known as lymph. Lymph nodes are found throughout the body. Composed mostly of T cells, B cells, dendritic cells and macrophages, the nodes drain fluid from most of our tissues. In a similar fashion as the spleen, the macrophages and dendritic cells that capture antigens present these foreign materials to T and B cells, consequently initiating an immune response.

Cells of the Immune System

Cells destined to become immune cells, like all blood cells, arise in the bone marrow from so-called stem cells.

The Cells of the Immune System

T-Cells
T helper
A pertinent coordinator of immune regulation. To augment or potentiate immune responses by activating other WBC.

T killer/suppressor
Directly killing certain tumor cells, viral-infected cells and sometimes parasites. also important in downregulation of immune responses.

The Cells of the Immune System

Natural Killer Cells Effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells.

The Cells of the Immune System

B Cells Production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells.

The Cells of the Immune System

Granulocytes
composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. Important in the removal of bacteria and parasites from the body.

The Cells of the Immune System

Macrophages
regulation of immune responses. Scavengers because they pick up and ingest foreign materials and present these antigens to other cells of the immune system such as T cells and B cells. Initiation of an immune response

Phagocytes and Granulocytes

Monocytes (2-6%) (circulate in the blood) Macrophages (found in body tissues); scavengers:secrete a wide variety of powerful chemicals: activates T cells. Neutrophils (40-75%)(circulate in blood but move into tissues PRN) (phagocytes & granulocytes:contain granules filled with potent chemicals: destroys microbes + key role in acute inflammatory reactions. Eosinophils(2-5%) -allergy, suppresses inflammation & helminthes (parasitic worm) infection, Decrease granulocyte migration Basophils(0.2-0.5%) -inflammatory mediator release Mast cells are granule-containing cells in tissue.

The Cells of the Immune System

Dendritic Cells
Usually found in the structural compartment of the lymphoid organs such as the thymus, lymph nodes and spleen. However, they are also found in the bloodstream and other tissues of the body. It is believed that they capture antigen or bring it to the lymphoid organs where an immune response is initiated.

The immune response begins when a white blood cell called a macrophage encounters a virus and consumes it. Meanwhile, other viruses look for nearby cells to infect.

Next, the macrophage digests the virus and displays pieces of the virus called antigens on its surface. Nearby cells have now become infected by the attacking viruses.

Unique among the many different helper T cells (another class of white blood cells) in the body, one particular helper T cell now recognizes the antigen displayed and binds to the macrophage.

This union stimulates the production of chemical substances -- such as interleukin-1 (IL-1) and tumor necrosis factor (TNF) by the macrophage, and interleukin2 (IL-2) and gamma interferon (IFN-y) by the T cell -- that allow intercellular communication.

As part of the continuing process, IL-2 instructs other helper T's and a different class of T cells, the killer T's, to multiply. The proliferating helper T's in turn release substances that cause B cells to multiply and produce antibodies.

The killer T cells now begin shooting holes in host cells that have been infected by viruses.

The antibodies released by the B cells bind to antigens on the surfaces of free-floating viruses. Besides making it easier for macrophages to destroy viruses, this binding signals blood components called complement to puncture holes in the viruses.

Finally, as the infection is brought under control, the activated T and B cells are turned off by suppressor T cells. However, a few "memory cells" remain behind to respond quickly if the same virus attacks again.

 Ability of a host to defend against a PARTICULAR infectious agent To be able to recognize self vs non-self Cells that belong to us vs cells that do not belong to us

Types of Immunity
1. Innate immunity genetically determined characteristics 2. Acquired immunity not hereditary

Acquired immunity 1. Natural having the disease or immunity from moms milk
a. Active exposed to infectious agent, immune system activated Get a disease & survive b. Passive receive antibodies from moms milk; immune system NOT activated Breastfeeding

2. Artificial
receive antigen from vaccine or antibodies from immunoglobulins a. Active vaccination weakened or killed antigens; immune system activated MMR. DaPT, Hib, Polio b. Passive receive antibodies from other host; immune system NOT activated Healthcare worker exposed Hepatitis B gets Hep B antibodies

Antigens & Antibodies

ANTIGENS molecules that our bodies consider foreign Large molecules ; proteins Cause an immune response Can induce formation of antibodies Found on surface of viruses, bacteria,other microorganisms, human cells

Antibodies
Protein molecules made by immune system in response to a specific antigen Antibody can bind to antigen Antibodies are made in response to a specific antigen

Specific Immune Responses

1. HUMORAL IMMUNITY
Carried out by antibodies circulating in blood Effective against bacteria, bacterial toxins, viruses not in host 2. CELL MEDIATED IMMUNITY T cells at cellular level Effective viruses in host cell, cancer, transplants, Antigens inaccessible to antibodies

General Properties
1. Recognition self vs non-self; body knows cells that are you vs cells that are not you 2. Specificity by age 2-3 body can recognize and react to a vast number of foreign substances 3. Heterogeneity ability of immune system to produce many different antibodies 4. Memory ability to recognize previously enocountered pathogen; reaction quicker; cells can last for years or decades in lymphoid tissue

Humoral Immunity
B cells recognize foreign antigen with aid of helper T cells and macrophages Form plasma cells Plasma cells secrete antibodies specific for antigens Antibodies = immunoglobulins Memory cells are made for antigen

Immunoglobulin Classes
IgG crosses placenta IgA internal body secretions IgM first antibody formed by fetus IgE binds to membranes of basophils & mast cells ; allergies IgD found on B cell membrane; antigen receptor

Cell Mediated Immunity

Macrophages ingest, digest, display antigen of pathogen Helper T cells see macrophage as foreign

Factors that modify immune responses

Age very young & old more susceptible d/t not fully developed immune system or decline of immune system Genetic factors race; blacks more susceptible to TB than whites

 Adequate diet proteins & vitamins; maintain healthy skin & mucous membranes, phagocytic activity, lymphocyte & antibody synthesis Regular moderate exercise 45 min brisk walk X 5/week - > antibody levels; NK cells >; excessive exercise depresses immune system Traumatic injuries microbes easy access, normal systems that remove microbes are impaired microbes have easier access; antibiotics destroy commensal microbes;

 Environmental factors pollution, radiation Air pollutants - respiratory, < ability to remove foreign substances; depress phagocytes; Radiation damages cells; including cells of immune system

Active Immunization
Administer vaccines or toxoids Vaccines live, attenuated pathogens; dead pathogens; parts of pathogen
Ex. Live measles, polio Dead IM polio, typhoid fever

Toxoids inactivated toxin; activates immune system, not harmful

Ex. Tetanus, diptheria

Recommended Immunizations
DaPT diptheria toxoid, acellular pertussis, tetanus toxoid MMR live rubella, rubeola, mumps viruses Poliomyelitis - live poliovirus (3 types) Hib Haemophilus influenza, type b; polysaccharide

Passive immunizations
Receive ready made antibodies Quick immunity; temporary Immune serum globulin or gamma globulins
Pooled antibodies from many individuals Mumps , measles , hepatitis A

ANTITOXINS botulism, diphtheria, tetanus

Snake or spider bites, Rh negative mom

Overview
Caused by an oversensitive immune system An allergic reaction is when the immune system reacts to substances (allergens) that are generally harmless and in most people do not cause an immune response.

 In a person with allergies, the first exposure to the allergen triggers the immune system to recognize the substance. Any exposure after that will usually result in symptoms.

 When an allergen enters the body of a person with a sensitized immune system, histamine and other chemicals are released by certain cells. This causes itching, swelling, mucus production, muscle spasms, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.

 Some disorders may be associated with allergies. These include eczema and asthma, among others. Common allergens include those that contact the skin, breathing passages, or the surface of the eye (such as pollen; see also allergy to mold, dander, dust). Food allergies and drug allergies are common. Allergic reactions can be caused by insect bites, jewelry, cosmetics, and almost any substance that contacts the body.

Signs & Symptoms

runny nose tearing eyes, burning or itching eyes red eyes, conjunctivitis swollen eyes itching nose, mouth, throat, skin, or any other area wheezing coughing difficulty breathing hives (skin wheals) skin rashes stomach cramps vomiting diarrhea headache

Prevention
Children who have been breastfed are less likely to have allergies. There is also evidence that infants exposed to certain airborne allergens (such as dust mites and cat dander) may be less likely to develop related allergies. Once allergies have developed, treating the allergies and carefully avoiding those things that cause reactions can prevent allergies in the future.

Diagnosis & Tests

Skin testing
the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. may even be an option for young children and infants, depending on the circumstances.

Diagnosis & Tests

Blood test -- also called RAST (radioallergosorbent)
measures the levels of allergy antibody, IgE, produced when your blood is mixed with a series of allergens in a laboratory. If you are allergic to a substance, the IgE levels may increase in the blood sample. may be used if you have existing skin problems like eczema, if you're on medications that are long-acting or you cannot stop taking, if you have a history of anaphylaxis, or if you prefer not to have a skin test.

Diagnosis & Tests

"Use" or "elimination" tests
suspected items are eliminated and/or introduced while the person is observed for response to the substance. often used to check for food or medication allergies.

Diagnosis & Tests

Eyelid
Occasionally, the suspected allergen is dissolved and dropped onto the lining of the lower eyelid (conjunctiva) as a means of testing for allergies. Should only be done by a physician, never the patient, since it can be harmful if done improperly.

Diagnosis & Tests

Reaction to physical stimuli
application of heat, cold, or other stimulation, and then look for an allergic response.

Other tests that may reveal allergies include:

1. Antibody/immunoglobulin (particularly IgE) levels -- when these are elevated, it indicates a "primed" immune system. 2. CBC -- may reveal an increase in eosinophils. 3. Complement levels -- may be abnormal.

Treatment
The goal is to reduce the symptoms caused by inflammation of the affected tissues. Of course, the best "treatment" is to avoid what causes your allergies in the first place. It may be impossible to completely avoid everything you are allergic to, but you can often take steps to reduce your exposure. This is especially important for food and drug allergies.

Treatment
Medications that can be used to treat allergies include the following:
Short-acting antihistamines
relieve mild to moderate symptoms but can cause drowsiness. can blunt learning in children Diphenhydramine, loratadine (Claritin)

Longer-acting antihistamines cause less drowsiness and can be equally effective, and usually do not interfere with learning. Fexofenadine (Allegra) and cetirizine (Zyrtec).

Treatment
Nasal corticosteroid sprays
very effective and safe for people with symptoms not relieved by antihistamines alone. These prescription medications include fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort AQ). .

Treatment
Decongestants
may also be helpful in reducing symptoms such as nasal congestion. should not be used for more than several days, because they can cause a "rebound" effect and make the congestion worse. Decongestants in pill form do not cause this effect.

Treatment
Allergy shots (immunotherapy)
occasionally recommended if the allergen cannot be avoided and symptoms are hard to control.

Epinephrine
for severe reactions (anaphylaxis)

 Disorders caused by an immune response against the body's own tissues.

 Develop when the immune system destroys normal body tissues. Caused by a hypersensitivity reaction The immune system reacts to normal "self" body tissues.

Symptoms & Signs

fatigue dizziness malaise (nonspecific feeling of not being well) fever, low-grade temperature elevations Specific autoimmune disease results in: destruction of an organ or tissue resulting in decreased functioning of an organ or tissue (for example, the islet cells of the pancreas are destroyed in diabetes) increase in size of an organ or tissue

Diagnosis & Tests

Signs vary according to the specific disorder. This disease may also alter the results of the following tests:
1. Erythrocyte sedimentation rate (ESR) 2. C-reactive protein (CRP)

Treatment
The goals of treatment are to reduce symptoms and control the autoimmune process while maintaining the ability to fight disease. The symptoms are treated according to the type and severity.

Treatment
Hormones or other substances normally produced by the affected organ may need to be supplemented. This may include thyroid supplements, vitamins, insulin injections, or other supplements. Disorders that affect the blood components may require blood transfusions.

Treatment
Measures to assist mobility or other functions may be needed for disorders that affect the bones, joints, or muscles.

Treatment
Autoimmunity is controlled through balanced suppression of the immune system. Corticosteroids and immunosuppressant medications (including cyclophosphamide or azathioprine) are used to reduce the immune response.

Systemic Lupus Erythematosus

A chronic, inflammatory autoimmune disorder that may affect many organ systems including the skin, joints and internal organs.

 Affects 9 times as many women as men. Occur at any age, but appears most often in people between the ages of 10 and 50 years. May also be caused by certain drugs. African Americans and Asians are affected more often than people from other races.

Symptoms & Signs

fever fatigue general discomfort, uneasiness or ill feeling (malaise) weight loss skin rash
"butterfly" rash sunlight aggravates skin rash

Symptoms & Signs

sensitivity to sunlight joint pain and swelling arthritis swollen glands muscle aches nausea and vomiting pleuritic chest pain seizures psychosis

 Additional symptoms that may be associated with this disease:

1. blood in the urine 2. coughing up blood 3. nosebleed - symptom 4. swallowing difficulty 5. skin color is patchy 6. red spots on skin 7. fingers that change color upon pressure or in the cold (Raynaud's phenomenon), numbness and tingling 8. mouth sores 9. hair loss 10.abdominal pain 11.visual disturbance

Musculoskeletal Almost all people with SLE have joint pain and most develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees. Death of bone tissue can occur in the hips and shoulders and is frequently a cause of pain in those areas.

Skin A "butterfly" rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash is usually worsened by sunlight. A more diffuse rash may appear on other body parts that are exposed to the sun. Other skin lesions or nodules can also occur.

Kidney Some people with SLE have deposits of protein within the cells (glomeruli) of the kidney.

Nervous system

Mild mental dysfunction is the most common symptom, but any area of the brain, spinal cord, or nervous system can be affected. Seizures, psychosis, organic brain syndrome, and headaches are some of the varied nervous system disorders that can occur.

Blood Venous or arterial blood clots can form Often platelets are decreased which may cause bleeding or clotting problems. Anemia of chronic disease often develops at some point in the course SLE.

Heart Inflammation of various parts of the heart may occur as pericarditis, endocarditis, or myocarditis. Chest pain and arrhythmias may result from these conditions.

Lungs Pleurisy Chest pain and shortness of breath

Diagnosis & Tests

The diagnosis of SLE is based upon the presence of at least four out of eleven typical characteristics of the disease.

Tests to determine the presence of these disease manifestations may vary but will include some of the following:

1. Antinuclear antibody (ANA) 2. Characteristic skin rash or lesions 3. Chest X-ray showing pleuritis or pericarditis 4. Listening to the chest with a stethoscope to reveal heart friction rub or pleural friction rub 5. Urinalysis to show blood, casts, or protein in the urine 6. CBC showing a decrease in some cell types 7. Kidney biopsy 8. Neurological examination

Treatment
The disease has multiple manifestations with variable severity, which determines individual treatment. There is no cure for SLE.

Treatment
Mild disease (rash, headaches, fever, arthritis, pleurisy, pericarditis) requires little therapy. Nonsteroidal anti-inflammatory medications (NSAIDS) are used to treat arthritis and pleurisy.

Treatment
Corticosteroid creams are used to treat skin rashes. Antimalarial drugs (hydroxychloroquine) and low dose corticosteroids are sometimes used for skin and arthritis symptoms.

Treatment
Sensitivity to light is treated by protective clothing, sunglasses and sunscreen.

Treatment
Severe or life-threatening manifestations often requires treatment by both rheumatologists and specialists in the specific area. Corticosteroid therapy or medications to suppress the immune system may be prescribed to control the various symptoms of severe disease. Some health care professionals use cytotoxic drugs (drugs that block cell growth) to treat people who do not have a good response to corticosteroids or who are dependent on high doses of corticosteroids.

Rheumatoid Arthritis
Involves inflammation in the lining of the joints and/or other internal organs. Typically affects many different joints. Typically chronic, which means it lasts a long time, and can be a disease of flareups.

Who Is At Risk?
Rheumatoid arthritis affects 2.1 million Americans, mostly women Onset is usually in middle-age, appears more frequently in older people, but also affects children and young adults 1.5 million women have rheumatoid arthritis compared to 600,000 men

What Are the Symptoms?

Symptoms include inflammation of joints, swelling, difficulty moving and pain. Other symptoms include:
Loss of appetite Fever Loss of energy Anemia Can affect other parts of the body. Other features include lumps (rheumatoid nodules) under the skin in areas subject to pressure (e.g., back of elbows).

What Causes It?

The cause of rheumatoid arthritis is not yet known. However, it is known that RA is an autoimmune disease.

How Is It Diagnosed?
It is important to diagnose RA early in the course of the disease, because with the use of disease-modifying drugs, the condition can be controlled in many cases. Physicians diagnose RA based on the overall pattern of symptoms, medical history, physical exam, X-rays and lab tests including a test for rheumatoid factor.

Making a Diagnosis
Antinuclear antibody (ANA) Commonly found in the blood of people who have lupus Tests to detect specific subsets of these antibodies can be used to confirm the diagnosis of a particular disease or form of arthritis.

Rheumatoid factor (RF) Designed to detect and measure the level of an antibody that acts against the blood component gamma globulin, this test is often positive in people with rheumatoid arthritis.

Uric acid Helps doctors diagnose gout

Erythrocyte sedimentation rate Also called ESR or "sed rate, Measures how fast red blood cells cling together, fall and settle (like sediment) in the bottom of a glass tube over the course of an hour. The higher the rate, the greater the amount of inflammation.

Treatment Options
Highly effective drug treatments exist for rheumatoid arthritis. Early treatment is critical. Current treatment methods focus on relieving pain, reducing inflammation, stopping or slowing joint damage, and improving patient function and well-being. Medications can be divided into two groups

Treatment Options
Symptomatic medications, such as NSAIDs and aspirin, analgesics, and corticosteroids, help reduce joint pain, stiffness and swelling. These drugs may be used in combination.

 Disease-modifying antirheumatic drugs (DMARDs) include low doses of methotrexate, leflunomide, DPenicillamine, sulfasalazine, gold therapy, minocycline, azathioprine, hydroxychloroquine (and other antimalarials), cyclosporine and biologic agents.

 People with moderate to severe RA who have not responded well to disease modifying anti-rheumatic drugs (DMARDs) may opt to try Prosorba therapy.

 In addition, treatment most often involves some combination of exercise, rest, joint protection, and physical and occupational therapy. Surgery is available for joints that are damaged and

AIDS (Acquired Immune Deficiency Syndrome)

is the final and most serious stage of HIV disease, which causes severe damage to the immune system.

Overview
AIDS is the fifth leading cause of death among persons between ages 25 and 44 in the United States. The Human Immunodeficiency Virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening illnesses and cancers.

 HIV has been found in saliva, tears, nervous system tissue, blood, semen (including pre-seminal fluid, or "pre-cum"), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been proven to transmit infection to others.

Transmission of the virus occurs:

1. Sexual contact -- including oral, vaginal, and anal sex 2. Blood -- via blood transfusions or needle sharing 3. From mother to child -- a pregnant woman can passively transmit the virus to her fetus, or a nursing mother can transmit it to her baby

 Other transmission methods are rare and include accidental needle injury, artificial insemination with donated semen, and through a donated organ.

 HIV infection is not spread by casual contact (such as hugging and touching), by touching dishes, doorknobs, or toilet seats previously touched by a person infected with the virus, during participation in sports, or by mosquitoes. It is not transmitted to a person who DONATES blood or organs However, HIV can be transmitted to the person RECEIVING blood or organs from an infected donor.

Symptoms & Signs

The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called "opportunistic infections." Common symptoms are fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.

Diagnosis & Tests

Previously, having AIDS was defined by having HIV infection and acquiring one of these additional diseases, But now it is simply defined as a CD4 count below 200.

Diagnosis & Tests

Common with CD4 count below 350/ml:
1. Herpes Simplex Virus -- causes ulcers in your mouth or genitals, occurring more frequently and more severely than previously 2. Tuberculosis -- infection by the tuberculosis bacteria that predominately affects the lungs 3. Oral or vaginal thrush -- yeast infection of the mouth or genitals 4. Herpes zoster -- ulcers over a discrete patch of skin caused by this virus 5. Non-Hodgkins Lymphoma -- cancer of the lymph glands

Diagnosis & Tests

CD4 count below 200/ml 1.Pneumocystis carinii pneumonia, "PCP pneumonia" 2.Candida esophagitis -- painful yeast infection of the esophagus

Diagnosis & Tests

CD4 count below 100/ml
Cryptococcal meningitis -- infection of the brain by this fungus AIDS Dementia -- worsening and slowing of mental function caused by HIV itself Toxoplasmosis encephalitis -- infection of the brain by this parasite, which is frequently found in cat feces Progressive multifocal leukoencephalopathy -- a viral disease of the brain caused by a virus (called the JC virus) that results in a quick decline in cognitive and motor functions Wasting Syndrome -- extreme weight loss and anorexia caused by HIV

Diagnosis & Tests

CD4 count below 50/ml Mycobacterium Avium -- a blood infection by a bacterium related to tuberculosis Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the eyes In addition to the CD4 lymphocyte count, chest X-rays, Pap smears, and other tests are useful in managing HIV disease. Gay men who engage in receptive anal sex may wish to consider anal Pap smears to detect potential cancers.

OPPORTUNISTIC INFECTIONS

Bacterial Infections
Mycobacterium avium Complex (MAC) MAC is often transmitted through the water supply but there is no definite way to avoid contamination. The organism may exist in the body without causing disease, but in persons with AIDS, infection throughout the body is common. Most often it starts in the intestinal tract. Symptoms include night sweats, fever, weight loss, and diarrhea.

 Tuberculosis (TB) TB has become a serious health problem for HIV infected persons. In some areas, forms of TB that don't get better with treatment (resistant) are now occurring. Many people are first infected early in life, but the infection does not show symptoms until much later. It becomes active when HIV weakens the immune system. TB is highly contagious and can be spread through coughing or sneezing. TB confined to the lungs is called pulmonary TB. TB that effects other areas of the body is called extrapulmonary. Symptoms include fatigue, fever, night sweats, weight loss, and a cough producing mucus and sometimes blood.

 Salmonellosis (Food poisoning) Salmonella is acquired by eating contaminated food or drinking contaminated water, particularly undercooked chicken or eggs. Therefore, HIV infected people should avoid food made with raw eggs such as eggnog, homemade ice cream, and some salad dressings. Salmonella can also be found in a person's stool, therefore infection can also occur through oral-anal sexual contact. Symptoms include stomach cramps, fever, loss of appetite, and diarrhea that may be severe or bloody.

Viral Infections
Cytomegalovirus (CMV) CMV is a common virus that is related to the Herpes Simplex virus. In healthy people, the virus does not show symptoms (remains dormant). But in the HIV infected person, the virus multiplies and causes infection throughout the body. When it infects the brain and nervous system, it can cause an inflammation of the brain (encephalitis). It causes pneumonia when in the lungs and stomach cramps and diarrhea when in the intestines. CMV that infects the liver can cause hepatitis. The most common form infects the eyes and causes an inflammation known as CMV Retinitis. Symptoms include headache, change in mental status, cough, abdominal cramps, diarrhea, vision changes such as spots, floaters or tunnel vision.

 Herpes Simplex Virus Two types of Herpes simplex virus cause problems for the HIV infected person. Type one (HSV-1) cause cold sores or blisters on the mouth and face. Type two (HSV2) causes similar sores but they appear on the genitals and anal area. Symptoms include fluid filled blisters that break and crust over. These blisters can be painful, swollen or itchy. Other symptoms can include fever, fatigue or headache.

 Varicella-Zoster virus (shingles) Shingles is the same virus that causes chickenpox. Anyone whose has had chickenpox in their lifetime can get shingles. Symptoms include the presence of small very painful blisters that follow nerve pathways, usually along one side of the body.

 Hepatitis Hepatitis is an inflammation of the liver is of three types; Hepatitis A, B, and C. Hepatitis A can be spread through unsanitary living conditions, sex or contaminated food. Hepatitis B is spread through infected blood and through sexual contact. A vaccination is available to prevent Hepatitis B. Symptoms include fever, abdominal pain, and a yellow discoloration of the skin and eyes (jaundice).

 Epstein-Barr virus (EBV) EBV is a virus similar to Herpes that is known to cause mononucleosis ("Mono"). Symptoms are primarily extreme fatigue

 Ano-genital Warts Ano-genital warts effect the anal and genital areas and are spread quickly through sexual contact. Symptoms include the presence of raised bumps are protruding pieces of skin in the anal and genital areas.

 Molluscum Contagiosum These painless warts can occur anywhere on the body but are most common on the face. Their major problem is mostly cosmetic. Symptoms are the presence of small, white, wart like bumps most often found on the face.

Fungal Infections
Candidiasis Candidiasis is a form of yeast and are of three types; oral (thrush), esophageal, and vaginal. Symptoms of oral thrush are the presence of white patches inside the mouth, on the tongue and upper throat. Sore throat and a change in taste can also be present. Chest pain and difficulty swallowing characterize Esophageal thrush. Vaginal itching, burning, and thick white vaginal discharge characterizes recurrent vaginal candidiasis.

 Cryptococcal Meningitis This fungal infection causes an inflammation of the covering of the spinal cord and brain. It is acquired by inhaling dust contaminated with the fungus, usually from some types of bird droppings. Symptoms can be vague, but include fever, blurred vision with photophobia (lights hurting the eyes), mental confusion, headaches, or a stiff or aching neck.

 Histoplasmosis This infection is most often found in the Midwest, especially Indiana and the Ohio River Valley. There are no drugs currently available to prevent the infection. Symptoms include fever, swollen glands, cough, shortness of breath, weight loss, weakness and anemia.

Pneumonias
Pneumocystis carinii pneumonia (PCP) Pneumocystis carinii is a common organism that rarely causes problems in people with healthy immune system. But in the HIV infected person, it causes PCP, the most common and one of the deadliest opportunistic infections. Most often it strikes when the CD4 count drops below 200. For this reason, your doctor will begin antibiotics to prevent PCP infection when your CD4 count is near or below 200. Early Symptoms include fatigue and shortness of breath. As the infection intensifies, rapid breathing, dry cough, fever, chills, night sweats, and weight loss occurs.

Pneumonias
Pneumonia (bacterial) HIV infected people sometimes experience bacterial pnemonias early in the course of their infection. Bacterial pneumonia develops over the course of days whereas PCP takes more time to develop. A vaccine can be given by your doctor to decrease your risk of bacterial (pneumococcus) pneumonia. Symptoms include chest pain, a cough producing yellow or green thick sputum, and shortness of breath.

Protozoal (parasitic) infections

Toxoplasmosis About 50% of the US population have been infected with toxoplasma gondii, but the infection usually shows no symptoms in a person with a healthy immune system. But in the HIV infected patient it causes Toxoplasmosis. The primary way one is infected is by eating undercooked meat; therefore HIV infected people should make sure their meat is thoroughly cooked before eating. Symptoms may resemble other HIV illnesses and include persistent, dull headache, subtle alterations in mental state, fever, seizure, or stroke-like syndromes.

 Cryptosporidiosis Cryptosporidiosis is a highly infectious intestinal parasite found most commonly among farm and domesticated animals. It is transmitted through contaminated food and water. Symptoms usually develop gradually and fluctuate in severity. They include watery diarrhea lasting for months, weight loss, abdominal cramps, nausea, vomiting, fever, and headache. Isosporiasis This organism is most often found in contaminated food and water, especially in Latin America or developing countries. Symptoms include chronic, watery diarrhea.

 Isosporiasis This organism is most often found in contaminated food and water, especially in Latin America or developing countries. Symptoms include chronic, watery diarrhea.

Prevention
Prevention of AIDS requires foresight and selfdiscipline. The requirements often seem personally restrictive, but they are effective and can save your life. 1. Do not have sexual intercourse with:
People known or suspected to be infected with AIDS Multiple partners A person who has multiple partners People who use IV drugs

Prevention
2. Do not use intravenous drugs. 3. Avoid exposure to blood from injuries or nosebleeds where the HIV status of the bleeding individual is unknown.
Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.

Prevention
4. Anyone who tests positive for HIV may pass the disease on to others and should not donate blood, plasma, body organs, or sperm. 5. HIV positive women should be counseled before becoming pregnant about the risk to unborn children and medical advances which may help prevent the fetus from becoming infected.

Prevention
6. Mothers who are HIV positive should not breast feed. 7. "Safe sex" practices, such as latex condoms, are highly effective in preventing HIV transmission.
HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

Treatment
There is no cure for AIDS at this time. However, several treatments are available that can delay the progression of disease for many years and improve the quality of life of those who have developed symptoms.

Treatment
Antiviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed Highly Active Anti-Retroviral Therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream (as measured by a blood test called the viral load). This can help the immune system bounce back for a while and improve T-cell counts.