Essentials of Clinical Immunology E-Book

Helen Chapel

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: essentials
• Sprache: Englisch

Seitenzahl: 1003

Veröffentlichungsjahr: 2013

Beschreibung

Essentials of Clinical Immunology provides the most up-to-date, core information required to understand diseases with an immunological basis. Clinically focussed, the sixth edition of this classic text presents theoretical and practical information in a simple yet thorough way. Essentials of Clinical Immunology covers the underlying pathophysiology, the signs and symptoms of disease, the investigations required and guidance on the management of patients. Perfect for clinical medical students, junior doctors and medical professionals seeking a refresher in the role of immunology in clinical medicine, this comprehensive text features fully updated clinical information, boxes with key points, real-life case histories to illustrate key concepts and an index of contents at the start of each chapter. A companion website at www.immunologyclinic.com provides additional learning tools, including more case studies, interactive multiple-choice questions and answers, all of the photographs and illustrations from the book, links to useful websites, and a selection of review articles from the journal Clinical and Experimental Immunology. This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.

Leseprobe

Table of Contents

Title page

Copyright page

Preface to the Sixth Edition

Preface to the First Edition

How to Use Your Textbook

Features contained within your textbook

The anytime, anywhere textbook

About the Companion Website

Key to Illustrations

Chapter 1

1.1 Introduction

1.2 Key molecules

1.3 Functional basis of innate responses

1.4 Functional basis of the adaptive immune responses

1.5 Physiological outcomes of immune responses

1.6 Tissue damage caused by the immune system

1.7 Organization of the immune system: an overview

1.8 Conclusions

Chapter 2: Infection

2.1 Introduction

2.2 Normal resistance to infection

2.3 Viral infection

2.4 Bacterial infection

2.5 Mycobacterial infection

2.6 Fungal infection

2.7 Parasitic infection

Chapter 3: Immunodeficiency

3.1 Introduction

3.2 Primary antibody deficiencies [PADs]

3.3 Combined primary T- and B-cell immunodeficiencies

3.4 Primary defects in non-specific immunity

3.5 Secondary immunodeficiency

Chapter 4: Anaphylaxis and Allergy

4.1 Introduction

4.2 Immediate (type I) hypersensitivity

4.3 Atopy

4.4 Anaphylaxis

4.5 Allergic conjunctivitis

4.6 Respiratory allergy

4.7 Food allergy and intolerance

4.8 Skin disease and allergy

Chapter 5: Autoimmunity

5.1 Definition of autoimmunity and autoimmune disease

5.2 Patterns of autoimmune disease

5.3 Who gets autoimmune disease?

5.4 What prevents autoimmunity?

5.5 How does tolerance break down?

5.6 What triggers autoimmunity?

5.7 Mechanisms of tissue damage

5.8 Treatment of autoimmune disease

Chapter 6: Lymphoproliferative Disorders

6.1 Introduction

6.2 Biology of malignant transformation in haematopoietic cells

6.3 Leukaemia

6.4 Lymphomas

6.5 Plasma cell dyscrasias

Chapter 7: Immune Manipulation

7.1 Introduction

7.2 Immunosuppression

7.3 Immunization against infection

7.4 Immune potentiation other than vaccines

Chapter 8: Transplantation

8.1 Introduction

8.2 Histocompatibility genetics in humans

8.3 Renal transplantation

8.4 Other types of transplantation

8.5 Haematopoietic stem cell transplantation

Chapter 9: Kidney Diseases

9.1 Introduction

9.2 Clinical syndromes

9.3 Classifications of glomerulonephritis

9.4 Asymptomatic haematuria

9.5 Acute glomerulonephritis

9.6 Chronic glomerulonephritis

9.7 Rapidly progressive glomerulonephritis

9.8 Nephrotic syndrome

9.9 Tubulointerstitial nephropathy

9.10 Chronic renal failure

9.11 Recurrent glomerulonephritis in transplanted kidneys

Chapter 10: Joints and Muscles

10.1 Introduction

10.2 Patterns of joint disease

10.3 Arthritis and infection

10.4 Rheumatoid arthritis [RA]

10.5 Seronegative spondyloarthritis

10.6 Chronic arthritis in children

10.7 Systemic lupus erythematosus

10.8 Other ‘connective tissue’ diseases

10.9 Systemic vasculitis

10.10 Inflammatory muscle disease or myositis

10.11 Hereditary periodic fevers

Chapter 11: Skin Diseases

11.1 Introduction

11.2 Infections and the skin

11.3 T-cell-mediated skin disease

11.4 Autoimmune skin disease

11.5 Systemic diseases with skin involvement

Chapter 12: Eye Diseases

12.1 Introduction

12.2 Conjunctivitis

12.4 Scleritis

12.5 Uveitis

Chapter 13: Chest Diseases

13.1 Introduction

13.2 Respiratory infections

13.3 Granulomatous diseases

13.4 Interstitial lung disease

13.5 Connective tissue disease and the lung

13.6 Pulmonary vasculitis

13.7 Cardiac disease

13.8 Coronary artery disease

13.9 Diseases of the great vessels

Chapter 14: Gastrointestinal and Liver Diseases

14.1 Introduction

14.2 Infection and the gut

14.3 Gastritis

14.4 Food-induced gastrointestinal disease

14.5 Autoimmune enteropathy

14.6 Inflammatory bowel disease

14.7 Viral hepatitis

14.8 Autoimmune liver diseases

Chapter 15: Endocrinology and Diabetes

15.1 Introduction

15.2 Mechanisms of endocrine autoimmunity

15.3 Thyroid disease

15.4 Diabetes mellitus

15.5 Adrenal disease

15.6 Parathyroid disease

15.7 Gonadal disease

15.8 Infertility

15.9 Pituitary disease

15.10 Autoimmune polyendocrine disease

Chapter 16: Non-Malignant Haematological Diseases

16.1 Introduction

16.2 Autoimmune haemolytic anaemias

16.3 Immune thrombocytopenia

16.4 Immune neutropenia

16.5 Haematopoietic progenitor cells

16.6 Immune disorders of coagulation

16.7 Blood transfusion

Chapter 17: Neuroimmunology

17.1 Introduction

17.2 Infections

17.3 Demyelinating diseases of the central nervous system

17.4 Autoimmune diseases of the neuromuscular junction

17.5 Immune-mediated neuropathies

17.6 Paraneoplastic syndromes

17.7 Cerebral systemic lupus erythematosus

Chapter 18: Immunological Diseases in Pregnancy

18.1 Introduction

18.2 Pregnancy and maternal infection

18.3 Protection of the fetus and neonate against infection

18.4 Disorders of pregnancy

18.5 Clinical relevance of antibodies to reproductive components

Chapter 19: Techniques in Clinical Immunology

19.1 Introduction

19.2 Investigation of immunoglobulins

19.3 Investigation of complement and immune complex disorders

19.4 Antibodies to microbial antigens

19.5 Detection of autoantibodies

19.6 Tests for allergy and hypersensitivity

19.7 Assessment of lymphocytes

19.8 Assessment of neutrophils and monocytes

19.9 Recombinant DNA technology in clinical immunology

19.10 Histocompatibility testing

Appendix: Further Resources

Index

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First published 1984

ELBS edition 1986

Second edition 1988

Third edition 1993

Fourth edition 1999

Fifth edition 2006

Sixth edition 2014

Library of Congress Cataloging-in-Publication Data

Chapel, Helen, author.

Essentials of clinical immunology / Helen Chapel, Mansel Haeney, Siraj Misbah, Neil Snowden. – Sixth edition.

p. ; cm.

Preceded by: Essentials of clinical immunology / Helen Chapel … [et al.]. 5th ed. 2006.

Includes bibliographical references and index.

ISBN 978-1-118-47295-8 (pbk. : alk. paper) – ISBN 978-1-118-48784-6 – ISBN 978-1-118-48785-3 – ISBN 978-1-118-48786-0 (emobi) – ISBN 978-1-118-48787-7 (epub) – ISBN 978-1-118-48788-4 (epdf)

I. Haeney, Mansel, author. II. Misbah, Siraj A., author. III. Snowden, Neil, author. IV. Title.

[DNLM: 1. Immunity–immunology. 2. Immune System Phenomena–physiology. QW 540]

RC582

616.07'9–dc23

2013024794

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Tim Vernon / Science Photo Library

Cover design by Visual Philosophy

Preface to the Sixth Edition

This is the last edition of the book in this format and the first as a digital edition; some progress since the first edition in 1984. During this time there have been fantastic advances in basic immunology and clinical applications, so that many of the earlier concepts are outmoded, redundant or just wrong. Keeping up to date is an increasingly time consuming and difficult task, not least to keep pruning exciting new findings in basic immunology that do not yet add much to our overall understanding of the important role of the immune system in health and disease.

Since the fifth edition in 2006, Mansel Haeney has finally retired completely and sadly could not be persuaded that his help would be invaluable (it would have been); I have missed the laughter generated over many years about ‘pompous text’ and ‘over-researched detail’. In addition, Neil Snowden has moved to full-time rheumatology and clinical administration and was not able to take part and Siraj Misbah has become Clinical Lead in Immunology and is active on any number of national and international committees. So that left only one of the four, who is therefore responsible for all the mistakes in this edition.

Blackwell Scientific – now Wiley-Blackwell – were very persuasive and hence assistance was found in the form of Tom Hills, a Rhodes scholar from New Zealand, formerly an MSc student on the Integrated Immunology course in Oxford and currently a DPhil student. Tom has read and updated all the clinical chapters with me, as well as providing enthusiasm and encouragement to complete the task. I am indebted to him.

I am also grateful to Vojtech Thon, Associate Professor in Brno, who has not only translated this edition into the Czech language but checked the English version as he went along; a mammoth task that he has undertaken with great determination and precision. My grateful thanks to him too.

This edition includes a rewrite of Chapter 1 since there is so much new information about Basic Immunology compared with only 6 years ago. The chapter on Pregnancy has been revised to include associated immunological diseases only, since the basic immunology of pregnancy is an area of specialised interest rather than mainstream Clinical Immunology. For the same reason, I have resisted adding a whole chapter on Tumour Immunology (though this can be found in the French edition for those who are really keen!), settling instead to expand the chapter on Immune Manipulation. For students who may read older texts, I have left in comments on some of the now outdated tests or therapies and, where I can, have provided explanations as to why they have been superseded, so that students are not misled. The biggest change in the clinical sections relates to the genetic insights provided by the many genome-wide association studies (GWAS) now undertaken for most immunological diseases. These studies have provided both new understanding and many ‘red herrings’. The rapid growth in primary immunodeficiencies and the discovery of the many new genes in various complex conditions have shown that many of the genes mutated in primary immunodeficiencies are multifunctional; furthermore, some are involved in several important/central pathways whilst others are redundant. It has been difficult to choose those that are important to students of Clinical Immunology and I have included only a small selection of examples.

As before, the bold type in the text indicates the content of each paragraph; really important points are identified by italics. Since several student reviews, while generous in their comments, requested more MCQs for each section, these are on the website, with answers as before: www.immunologyclinic.com.

My thanks for help with particular chapters go to Beth Psaila (also my daughter-in-law), who rewrote much of the lymphoproliferation chapter, Georg Hollander, who kept me straight on autoimmunity and tolerance as well as new basic concepts, Meilyn Hew for reading the practical chapter and Siraj Misbah for making sure that my rheumatology was up to date.

This edition would not have happened without Martin Davies at Wiley-Blackwell, who talked me into it, and Karen Moore, who edited the final revised version. I thank them for their persistence and help in achieving a final edition.

Finally, I thank my family once again – and, I promise, for the last time. They have been most long-suffering, allowing ‘the seeming endless intrusion of Clinical Immunology into their lives’ – as Mansel wrote for the first edition in 1984.

Helen Chapel

Preface to the First Edition

Immunology is now a well-developed basic science and much is known of the normal physiology of the immune system in both mice and men. The application of this knowledge to human pathology has lagged behind research, and immunologists are often accused of practising a science which has little relevance to clinical medicine. It is hoped that this book will point out to both medical students and practising clinicians that clinical immunology is a subject which is useful for the diagnosis and management of a great number and variety of human disease.

We have written this book from a clinical point of view. Diseases are discussed by organ involvement, and illustrative case histories are used to show the usefulness (or otherwise) of immunological investigations in the management of these patients. While practising clinicians may find the case histories irksome, we hope they will find the application of immunology illuminating and interesting. The student should gain some perspective of clinical immunology from the case histories, which are selected for their relevance to the topic we are discussing, as this is not a textbook of general medicine. We have pointed out those cases in which the disease presented in an unusual way.

Those who have forgotten, or who need some revision of, basic immunological ideas will find them condensed in Chapter 1. This chapter is not intended to supplant longer texts of basic immunology but merely to provide a springboard for chapters which follow. Professor Andrew McMichael kindly contributed to this chapter and ensured that it was up-to-date. It is important that people who use and request immunological tests should have some idea of their complexity, sensitivity, reliability and expense. Students who are unfamiliar with immunological methods will find that Chapter 17 describes the techniques involved.

Helen Chapel

Mansel Haeney

1984

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About the Companion Website

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Interactive multiple-choice questionsAdditional case studies and figures to test your knowledgeCase studies from the book with additional figures for you to use for revisionAll figures from the book in PowerPoint formatUseful website linksWiley E-Text access instructionsA selection of review articles from the journal Clinical and Experimental Immunology

Key to Illustrations

Throughout the illustrations standard forms have been used for commonly-occurring cells and pathways. A key to these is given in the figure below.

Chapter 1

Basic Components: Structure and Function

Key topics

1.1 Introduction 1.2 Key molecules 1.2.1 Molecules recognized by immune systems 1.2.2 Recognition molecules 1.2.3 Accessory molecules 1.2.4 Effector molecules for immunity 1.2.5 Receptors for effector functions 1.2.6 Adhesion molecules 1.3 Functional basis of innate responses 1.3.1 Endothelial cells 1.3.2 Neutrophil polymorphonuclear leucocytes 1.3.3 Macrophages 1.3.4 Dendritic cells 1.3.5 Complement 1.3.6 Antibody-dependent cell-mediated cytotoxicity 1.3.7 Natural killer cells 1.4 Functional basis of the adaptive immune responses 1.4.1 Antigen processing 1.4.2 T cell mediated activation responses 1.4.3 Antibody production 1.5 Physiological outcomes of immune responses 1.5.1 Killing of target cells (virally infected/tumour cells) 1.5.2 Direct functions of antibody 1.5.3 Indirect functions of antibody 1.5.4 Regulation 1.6 Tissue damage caused by the immune system 1.6.1 Inflammation: a brief overview 1.7 Organization of the immune system: an overview 1.8 Conclusions

Visit the companion website at www.immunologyclinic.com to download cases on these topics.

1.1 Introduction

The immune system evolved as a defence against infectious diseases. Individuals with markedly deficient immune responses, if untreated, succumb to infections in early life. There is, therefore, a selective evolutionary pressure for a really efficient immune system. Although innate systems are fast in response to pathogens, the evolution to adaptive responses provided greater efficiency. However a parallel evolution in pathogens means that all species, plants, insects, fish, birds and mammals, have continued to improve their defence mechanisms over millions of years, giving rise to some redundancies as well as resulting in apparent complexity. The aim of this chapter is to provide an initial description of the molecules involved, moving onto the role of each in the immune processes rather than the more traditional sequence of anatomical structure, cellular composition and then molecular components. It is hoped that this gives a sense of their relationship in terms of immediacy and dependency as well as the parallel evolution of the two immune systems. An immune response consists of five parts:

1. recognition of material recognized as foreign and dangerous;

2. an early innate (non-specific) response to this recognition;

3. a slower specific response to a particular antigen, known as adaptive responses;

4. non-specific augmentation of this response;

5. memory of specific immune responses, providing a quicker and larger response when that particular antigen is encountered the second time.

Innate immunity, though phylogenetically older and important in terms of speed of a response, is less efficient. Humoral components (soluble molecules in the plasma) and cells in blood and tissues are involved. Such responses are normally accompanied by inflammation and occur within a few hours of stimulation (Table 1.1).

Table 1.1 Components of innate and adaptive immunity

FeaturesInnateAdaptiveForeign molecules recognizedStructures shared by microbes, recognized as patterns (e.g. repeated glycoproteins) PAMPsWide range of very particular molecules or fragments of molecules on all types of extrinsic and modified self structuresNature of recognition receptorsGermline encoded – limited PRRsSomatic mutation results in wide range of specificities and affinitiesSpeed of responseImmediateTime for cell movement and interaction between cell typesMemoryNoneEfficientHumoral componentsComplement componentsAntibodiesCellular componentsDendritic cells, neutrophils, macrophages, NK cells, NKT cells, B1 cells, epithelial cells, mast cellsLymphocytes – T (Th1, Th2, Th17, T regs) BiNKT cells, γδ T cells

Adaptive immune responses are also divided into humoral and cellular responses. Adaptive humoral responses result in the generation of antibodies reactive with a particular antigen. Antibodies are proteins with similar structures, known collectively as immunoglobulins (Ig). They can be transferred passively to another individual by injection of serum. In contrast, only cells can transfer cellular immunity. Good examples of cellular immune responses are the rejection of a graft by lymphoid cells as well as graft-versus-host disease, where viable transferred cells attack an immunologically compromised recipient that is unable to fight back.