Académique Documents
Professionnel Documents
Culture Documents
HYPERSENSITIVITY
Group 3 Medicine 2C
Clinical Summary
Gigi, a 2 year old girl was brought for
consult at the Out-patient department
because of poor weight gain. She also
has a history of recurrent cough and
colds occurring at least monthly. The
physicians at the OPD suspected a
primary tuberculosis and suggested a
tuberculin skin test (purified protein
derivative or PPD). After administering
the PPD on Gigi’s right volar forearm, she
was advised to come back after 2 days to
check for the presence of induration on
Guide Questions
1. What type of hypersensitivity reaction
does tuberculin skin testing exemplify?
The tuberculin reaction is a classic
example of a cell-mediated (delayed)
hypersensitivity.
When a small amount of tuberculin is
injected into the epidermis of a patient
previously exposed to Mycobacterium
tuberculosis, there is little immediate
reaction; gradually, however, induration and
redness develop and reach a peak in 24–72
hours.
Guide Questions
2. Give other examples of this type of
reaction.
Contact hypersensitivity is another
example of cell-mediated
hypersensitivity.
It occurs after sensitization with simple
chemicals , plant materials, topically applied
drugs some cosmetics, soaps, and other
substances. In all cases, small molecules
enter the skin and then, acting as haptens,
attach to body proteins to serve as
complete antigen.
Cell-mediated hypersensitivity is induced,
particularly in skin. When the skin again
Guide Questions
3. The primary cells involved in delayed
hypersensitivity reactions are monocytes
and T-cells
Cytokines
IL 12 – produced by macrophages,
differerentiation of naïve CD4 helper
Tcells to Th1 cells, produce cytokines
IFN gamma –key mediator, activates
macrophages, produce more Class II
molecules, secrete PDGF, secrete TNF,
IL1 and chemokines
IL 2 – autocrine and paracrine
proliferation of tcells and CD4 and helper
tcells
Type IV hypersensitivity
Continuation…
Other DIAGNOSTIC TESTS
TST Results
≥ 5mm close contact with known/ suspected contagious people with TB; suspected
to have TB; immunosuppressive therapy / conditions
≥10mm increased risk of disseminated TB; increased exposure to TB
Limitations of TST
Limitations of TST
Interferon-γ Release Assays
(IGRAs)
Both tests Detect interferon- γ generation
have
internal by the patient’s T cells in
controls response to specific M.
(similar to
placing a tuberculosis antigens (ESAT-6
Candida
skin test
and CFP-10).
for the
PPD).
ü T-SPOT.TB
ü QuantiFERON-TB Gold (FDA)
Interferon-γ Release Assays
(IGRAs)
Theoretic Logistical convenience
al and
Practical Lack of cross reaction with
Advantag BCG vaccination &
es
nontuberculous
As
mycobacteria.
sensitive Absence of boosting ( ↑ rxn
as TST for
active to the TST with serial
tuberculo testing)
sis
Avoidance of unreliable &
subjective measurements
Interferon-γ Release Assays
(IGRAs)
QuantiFERON-TB Gold T-SPOT.TB
Oxford Immunotec, Oxford , UK
Cellestis Ltd., Carnegie,
Australia
Enzyme-linked
immunospot
Whole blood (ELISpot) assay
enzyme-linked May work best when
used in combination
immunosorbent with a PPD to
assay (ELISA) for increase sensitivity.
measurement of Lower rate of
indeterminate results
IFN- γ & higher degree of
diagnostic sensitivity
Pharmacologic Treatment
Corticosteroids Corticosteroids
Corticosteroids Corticosteroids