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Immunology
Immunology
140
Medical
Graduate
02/28/2010

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Term
True or false: CD4 T cells' activation of CD8 T cells requires co-stimulation from the same antigen presenting cell
Definition
True, CD8 T cells aren't fully effective until stimulated by CD4 T cells (Th1) bound to the same APC
Term
CD40-CD40R binding on an APC induces expression of this co-stimulatory transmembrane protein, which binds to CD8 cells
Definition
B7
Term
CD4 T cells bound to B cells via MHC II secrete these three interleukins to aid in B cell activation
Definition
IL4, IL5, IL6
Term
These factors in order, make up the "intrinsic pathway" of clot formation
Definition
XII, XI, IX, VII, X-> with V, forms the prothrombin activator that cleaves prothrombin to form thrombin, which can then auto-catalyze prothrombin-thrombin formation and primary removes 4 peptides from fibrinogen to enable the formation of fibrin polymers, the clot
Term
This factor activates factor X directly
Definition
Factor VII, making up the "extrinsic pathway" of clot formation, it itself is activated by the release of tissue factor from damaged endothelium and/or inflammatory cells
Term
What is the clinical significance of an elevated PT?
Definition
Liver dysfunction, as factors VII, X, prothrombin and fibrinogen are all synthesized in the liver, also, monitoring warfarin therapy with PT is useful as warfarin depresses synthesis of the above factors for hours after administration
Term
aPTT is most useful in monitoring anti-coagulant therapy with this agent.
Definition
Heparin, a set of glycoprotein polymers that bind to factor IX, X, Thrombin etc. and prevent them from activating fibrinogen ultimately
Term
A fast, IgE mediated response to antigen triggering vasoactive amines (i.e. histamine)
Definition
Type 1 hypersensitivity reaction, mild as hayfever or serious as anaphylactic shock
Term
IgM and IgG-complement membrane attack complexes form in response to antigen that causes lysis or phagocytosis, ie cytotoxic response
Definition
Type II hypersensitivity reaction
Term

IgG antibody and antigen activate complement (immune complexes), which attracts neutrophils, which release lysosomal enzymes.

Definition
Type III hypersensitivty reactions, like SLE
Term
CD4+ T Cell mediated reaction, sensitized lymphocytes encounter antigen and release cytokines causing inflammation.
Definition
Type IV hypersensitivity reaction, like in DMI, hashimoto's thyroiditis, guillan-barre, can be remembered with the four T's: T-cells, Transplant rejection, Touch (contact dermatitis), TB skin tests
Term
Released by CD4+ cells following exposure to antigen, this cytokine recruits macrophages to the site of reaction, increasing the number of epithelioid cells
Definition
Interferon-gamma, ultimately leads to granuloma formation
Term
What are the two fates of granulomata?
Definition
Fibrosis or involution
Term
The systemic changes associated with inflammation, especially in pts who have infections are collectively called the (), or the ()
Definition
acute phase response or systemic inflammatory response syndrome
Term
Which bacterial product is usually the cause of SIRS?
Definition
lipopolysaccharide from the cell wall of gram - bacteria, or LPS
Term
T or F: Fever is a respone to substances called pyrogens that act by stimlating prostaglandin synthesis in the vascular and perivascular cells of the hypothalamus
Definition
True
Term
T or F: LPS can be considered an exogenous pyrogen
Definition
True
Term
What two cytokines are usually thought of as endogenous pyrogens?
Definition
IL1 and TNFa
Term
Which enzymes are stimulated by pyrogens to produce prostaglandins from amino acids?
Definition
cyclooxygenases (COX)
Term
Name one hypothesis for the + effect of fever on bacterial infection
Definition
Fever may induce heat shock proteins that enhance lymphocyte responses to microbial antigens
Term
T or F: CRP, fibrinogen, and serum amyloid A protein are all considered acute phase reactants
Definition
True
Term
What is the biochemical basis for measuring the erythrocyte sedimentation rate?
Definition
The rise in fibrinogen during acute inflammation causes erythrocytes to form stacks that sediment more rapidly per unit gravity than do individual erythrocytes, hence the ESR is elevated in systemic inflammation
Term
What cytokines are responsible for leukocytosis from rapid release of leukocytes from the post-mitotic marrow pool?
Definition
IL1 and TNFa
Term
T or F: Viral infections such as infectious mononucleosis, mumps and reubella produce leukocytosis by virtue of an increase in the number of eosinophils
Definition
False, lymphocytes
Term
T or F: High levels of TNFa cause disseminated intravascular coagulation
Definition
True
Term
LPS and TNFa induce () expression on endothelial cells, which initiates coagulation; the same agents inhibit natural anticoagulation mechanisms by decreasing the expression of ()
Definition
Tissue factor, tissue factor pathway inhibitor
Term
T or F: cytokines cause liver injury and impaired liver function
Definition
True
Term
In sepsis, overproduction of () by cytokine activated cardiac myocytes and vascular SM cells leads to heart failure, loss of perfusion and pressure and ultimatle hemodynamic collapse
Definition
Nitrous oxide (NO)
Term
T or F: Tissue injury in response to LPS can also result from the activation of neutrophils before they exit the vasculature
Definition
True
Term
The clinical triad of (), (), and () is described as septic shock
Definition
DIC, hypoglycemia and cardiovascular collapse
Term
Lung damage from acute systemic inflammation is commonly referred to as ()
Definition
Acute respiratory distress syndrome
Term
T or F: Sepsis is the leading cause of death in US ICUs
Definition
True
Term
T or F: 70% of sepsis cases are caused by gram negative rods bacteria
Definition
True
Term
Which TLR is responsible for recognizing LPS?
Definition
TLR4
Term
T or F: TLR4 directly inhibits TFPI in endothelial cells of vasculature inducing a hypercoagulable state
Definition
True
Term
T or F: LPS cannot directly activate compliment, it must first activate neutrophils and monocytes
Definition
False, it can directly activate compliment
Term
In addition to IL1 and TNFa, what other cytokine is predominately involved in response to LPS?
Definition
IL6
Term
T or F: Even in the non-progressive stage of shock vital organ perfusion is compromised
Definition
False, it is maintained, once signs of organ dysfunction arise the progressive stage has been reached, survival is not possible at the irreversible stage
Term
() undergo reactive changes whenever they are challenged by microbial agents, cell debris or foreign matter introduced into wounds or circulation.
Definition
Lymph nodes
Term
Acute lymphadenitis is most often seen in the () region due to microbial drainage from the teeth or (), and in the axillary region and inguinal region secondary to infections in the ()
Definition
cervical, tonsils, upper and lower extremities
Term
T or F: The abdominal symptoms of mesenteric lymphadenitis mimic those of appendicitis
Definition
True
Term
T or F: Systemic viral infections rarely produce lymphadenopathy, but system bacterial infections usually produce it.
Definition
False, in children especially systemic viral infections can cause lymphadenopathy
Term
The macroscopic appearance of a lymph node in lymphadenitis is (), () and engorged. There is a prominence of () follicles, with large () containing numerous mitotic figures.
Definition
gray-red, swollen, lymphoid, germinal centers
Term
When pyogenic organisms cause lymphadenitis, the centers of the follicles undergo (), sometimes the entire node can be turned into a (). Less severe reactions show a () infiltrate in the follicles and neutrophils can be found in the ()
Definition
necrosis, suppurative mass, neutrophilic, lymphoid sinuses
Term
T or F: Inflamed lymph nodes undergo hyperplasia but not hypertrophy
Definition
False, undergo both
Term
Lymph nodes with acute lymphadenitis are enlarged because of () and edema. As a consequence they are (tender/not tender) due to capsule stretch
Definition
Cellular infiltration, tender
Term
Sometimes an inflamed lymph node can penetrate the skin and cause (), particularly when the nodes have undergone () necrosis.
Definition
Draining sinuses or sinus fistulas, suppurative
Term
The tonsils and adenoids are lymphoid tissue, also known as:
Definition
Waldeyer's ring
Term
Follicular hyperplasia in non-specific lymphadenitis is caused by stimul of this () arm of the immune system. It is distinguished by the appeariance of large, round or oblong ()-cell rich (), aka (), surrounded by a collar of small, resting naive B cells called the ()
Definition
Humoral (antibodies), B cell germinal centers, secondary follicles, mantle zone
Term
Within germinal centers two distinct regions are visible, a dark zone containing proliferating () cells and a light zone composed of B cells with () or cleaved nuclear contours, aka ()
Definition
B, irregular, centrocytes
Term
() macrophages are present throughout the follicle in lymphadenitiis, so named because they are filled with phagocytosed nuclear debris.
Definition
Tingible body
Term
In lymphadenitis, there is often striking () of the mononuclear phagocytic cells in the lymphatic ()
Definition
Hyperplasia, sinuses
Term
Specific causes of follicular hyperplasia include:
Definition
Rheumatoid arthritis, toxoplasma and early HIV
Term
What 3 features can distinguish follicular hyperplasia due to systemic inflammation from follicular lymphoma?
Definition
In follicular hyperplasia there is preservation of lymph node architecture like sinusoids and interfollicular T-cell zones, marked variation in size and shape of lymphoid nodules and the presence of frequent mitotic figures, phagocytic macrophages and light and dark zones. These things tend to not be in neoplastic nodes.
Term
Follicular hyperplasia is sometimes accompanied by (), where marginal zone B cells accumulate in a rim external to the mantle zone of germinal centers. The marginal zone B cells are sometimes called () due to the folded nuclei and are probably memory B cells.
Definition
Marginal zone B-cell hyperplasia
Term
() in lymphadenitis is seen in stimuli that cause a cellular immune response.It is characterized by reactive changes within the T-cell regions of the lymph node that encroach on the B-cell follicles.
Definition
Paracortical lymphoid hyperplasia
Term
The interfollicular regions of the lymph node, during paracortical lymphoid hyperplasia, contain a number of activated () cells, three to four times the size of resting lymphocites, round nuclei, open chromatin several nucleoli and moderate amounts of pale cytoplasm. There is also hypertrophy of () cells and a mixed infiltrate composed of () and sometimes ().
Definition
T cells, vascular endolthelial, macrophages, eosinophils
Term
Paracortical lymphoid hyperplasia is most often seen in:
Definition
Drug-induced reactions like Dilantin, acute viral infections esp. mononucleosis, and post-vaccine, if the reaction is especially vigorous further study is needed to rule out neoplasm
Term
() or reticular hyperplasia refers to the distention and prominence of lymphatic sinusoids. This form of hyperplasia is nonspecific but may be prominent in nodes draining cancers, such as () of the breast. The lining lymphatic endothelial cells are markedly (hypertrophied/hyperplasia), resulting in distention of the sinuses. 
Definition
Sinus histiocytosis, carcinoma, hypertrophied
Term
The three main components of the innate immune system are:
Definition
The complement system, professional phagocytes e.g. neutrophils and macrophages, natural killer cells
Term
In the () system about 20 different proteins work together to destroy invaders and signal other immune system players that an attack is starting.
Definition
Complement
Term
Proteins of the complement system are produced mainly by the () but are present in high concentrations in the blood and tissues. () is the most abundant protein of the complement system and is a part of all three pathways.
Definition
Liver, C3
Term
The alternative pathway is antibody (dependent/independent) involves C3 being spontaneously hydrolyzed to form () and ().
Definition
independent, C3a and C3b
Term
In the alternative pathway, C3() reacts with a molecule on a bacteria's surface, then binds with protein (), the protein () converts protein B to protein Bb to make C3bBb, which is also known as the enzyme ()
Definition
C3b, B, D, C3 convertase
Term
In the alternative pathway, C3 convertase works on () to break it into C3a and C3b, at which point C3b can again be activated by protein (), creating a positive feedback loop.
Definition
C3, B
Term
In the lectin pathway, the response is dependent on (), a carbohydrate molecule on the surface of many pathogens including yeast, viruses, bacteria and parasites. () binds the mannose of these cells.
Definition
Mannose, mannose-binding lectin
Term
MBL binds with (), which together bind the surface of the pathogen and convert C3 into C3b and regenerating the cycle.
Definition
mannose-binding lectin associated serine protease
Term
The classical pathway is () dependent, requiring either () or () to initiate the cascade
Definition
Antibody, IgM or some IgG molecules
Term
In the classical pathway, two or more () complexes, each comprised of around 30 proteins, must congregate and become activated. IgM uses its () region to bind the antigen and its () region to bind the C1 aggregate.
Definition
C1, Fab, Fc
Term
In the classical pathway, once IgM binds 2+ C1 complexes, () and () complex to create C3 convertase.
Definition
C2, C4
Term
How does IgM activation of the classical pathway differ from IgG activation of the classical pathway?
Definition
IgM is a pentamer, meaning it can bind up to 5 C1 complexes on its Fc regions at once. IgG is a monomer, and can only bind one, so at least 2 IgGs must be attached both the antigen and each to a C1 to activate the pathway, in short there must be a lot of IgG in the serum to activate the classical pathway
Term
T or F: Antibodies extend the functional capacity of the complement system by enabling its activation for any antigen that has an antibody
Definition
True
Term
All three pathways of the complement system terminate in the creation of (), which can cut () into its component parts, () and (). () combines with C6-9 to form the (). The () portion of the MAC polymerizes on the surface of the antigen and forms a pore in the cell membrane, leading to lysis.
Definition
C3 convertase, C5, C5a and C5b, C5b, membrane attack complex, C9
Term
These two complement proteins () and (), lead to a local inflammatory response by acting as chemoattractants, attracting activated macrophages and (). They're also called () and contribute to anaphylactic shock.
Definition
C3a and C5a, neutrophils, anaphyltoxins
Term
() can be clipped to become inactivated (), which cannot create a MAC but does opsonize the foreign element such that phagocytes are more likely to digest the material.
Definition
C3b
Term
In the alternative pathway, lots of complement proteins protect against errant behavior. () can be deactivated by enzymes on human cell membranes and () can be destroyed by proteins after coming into contact with () on human cells, finally () can remove the MAC if it does end up on a human cell
Definition
C3b, C3 convertase, Decay accelerating factor (DAF), CD59
Term
() inhibitor prevents self-activation of the classical pathway
Definition
C1 esterase, usually antibodies bind to human cells only in pathology
Term
() are the phagocytic cells of the tissues and are found in lungs, skin, intestines and any other tissue exposed to the outside world.
Definition
Macrophages
Term
Macrophages at rest function as garbage collectors, clearing tissues of naturally dying cells, they express few () receptors thus making them poor APCs for CD4+ T cells
Definition
Term
When activated by () secreted by () and () cells, macrophages start to phagyctose more of the surrounding material and up-regulate their production of MHC II, making them better APCs.
Definition
Interferon-gamma, CD4, natural killer
Term
() and () can hyperactivate macrophages via direct contact, where macrophages become solely phagocytic and growing in size, via increasing the number of () in the cytosol as well as production of (). Lysosomal contents can also be ejcted onto parasites too big to phagocytose.
Definition
LPS, mannose, lysosomes, reactive oxygen species
Term
Hyperactivated macrophages secrete (), which can kill virus-infected cells and tumor cells and activate other immune system cells. They also produce () which can activate NK cells.
Definition
TNF-alpha, IL-12
Term
() are the phagocytes of the blood, they live only () days at a time once exiting the bone marrow and die by apoptosis. They (do/do not) act as an APC. They are activated in tissues and are inactive in blood.
Definition
Neutrophils, 5, do not
Term
Neutrophils in circulaiton express a surface protein called (), of which Sialyl Lewis-x is an example. Endothelial cells of the circulatory systme express a membrane protein called (). When () and () are secreted by macrophages, however, endothelial cells produce selectins along with ICAM.
Definition
Selectin ligand or SLIG, ICAM, IL-1 and TNF-a
Term
Selectin proteins on the surface of vascular endothelium and selectin ligands on the neutrophil act like velcro and slow down the circulating neutrophils (rolling), where they look for () or (), triggering the appearance of () on the neutrophil surface to bind ICAM.
Definition
C5a, LPS, integrin (LFA-1)
Term
The process by which neutrophils squeeze through vascular endothelial cells into tissues is called () and is aided by the () protein on the endothelial cells
Definition
diapedesis, PECAM-1
Term
Neutrophils are attracted to sites of infection by:
Definition
f-met peptides, C5a, IL-8, LTB4, Kallikrein
Term
() ingest antigens in tissues and carry them to the lympho nodes for presentation. They are the best APC's.
Definition
Dendritic cells
Term
() cells are produced in the bone marrow and live for no more than a week. They circulate as inactive lymphocytes but are activated during infection and enter tissues in the same way neutrophils do, just with different proteins.
Definition
Natural killer cells
Term
Name NK cells two main functions in fighting infection:
Definition
Secrete cytokines like IFN-gamma and IL-2, destroy infected cells or tumor cells, bacteria, parasites and fungi by inducing apopotosis with granzymes and perforins or through Fas-FasL interactions
Term
NK Cells are inhibited by a receptor that recognizes () molecules on cell surfaces, which are found everywhere in the human body except RBCs. THey lack () cell receptors and thus do not use MHC to identify infected cells. They are activated by the cytokines (), (), (), (), and ()
Definition
MHC 1, T cell receptors, LPS, IFN alpha, IFN beta, TNF, IL-12
Term
Macrophages secrete (), () and (), important proteins in the alternative pathway of complement activation
Definition
C3, B, D
Term
The most common cause of lymphangitis is:
Definition
GAS
Term
Systemic manifestations of septicemia or bacteremia are:
Definition
Fever, chills, malaise
Term
Nodular lymphangitis is caused by (), a subcutaneous mycotic infection, leading toa chain of suppurating lymphocutaneous nodules
Definition
Sporothrix schenckii
Term
Lymphedema is caused by () of lymphatic drainage, leading accumulation of interstitial fluid in the area (distal/proximal) to the obstruction
Definition
obstruction, distal
Term
Persistence of lymphedema leads to () subcutaneous interstitial fibrous tissues, with subsequent enlargement of the affected part, induration, () appearance of the skin and ulceration
Definition
increased, peau d'orange
Term
List seven common causes of lymphedema:
Definition
Breast lymphedema secondary to malignancy (peau d'orange), surgery that removes lymph nodes, LGV, filariasis from Wucheria bancroftii, postirradiation, postinflammatory thrombosis and scarring, chylous ascites following rupture of obstructed lymphatics
Term
Treatment for lymphedema is:
Definition
Apply complex decongestive therapy: elevation, limb massage and compression
Term
Most inherited immunodeficiency diseases are caused by () gene defects
Definition
recessive
Term
Inherited problems with complement components, the () response can be impaired, and accumulation of () occurs
Definition
antibody, immune
Term
() is responsible for recruitment of inflammatory cells, smooth muscle contraction, histamine release and chemotactic signals.
Definition
C3a
Term
() is responsible for binding to the pathogen's surface and signaling macrophages to increase phagocytic activity, binding immune-complexes and formation of the MAC
Definition
C3b
Term
When an encapsulated bacteria is coated with antibodies and (), macrophages are more efficient at phagyctosing those bacteria. IgM binds its () region to the antigen and its () region to the complement complex, leading to a cascade effect where () is activated.
Definition
C3b, Fab, Fc, C3 convertase
Term
T or F: Even without complement, it is very difficult for antibody-antigen binds to be reversed.
Definition
False, it is more reversible without complement
Term
Defects in () increase susceptibility to a wide range of pyogenic infections due to loss of opsonization.
Definition
C3
Term
() is an inherited immune deficiency resulting from a deficiency of adenosine deaminase, interrupting DNA synthesis and lymphocte production.
Definition
Severe combined immune deficiency (SCID
Term
DiGeorge syndrome results from a () deletion, resulting in a failure to develop the () and () pharyngeal pouches
Definition
22q11, 3, 4
Term
() syndrome presents with tetany, recurrent viral and fungal infections due to a T-cell deficiency, heart and great vessel defects
Definition
DiGeorge Syndrome
Term
The most common form of SCID is a defective () receptor, an X-linked disorder
Definition
IL2 leading to less T-cell activation
Term
Mutations in the region on chromosome 6p23 can result in these two types of inherited immune deficiences.
Definition
MHC I and MHC II deficiency
Term
This inherited immune deficiency is X-linked, and results in a defective antibody response to polysaccharide antigens, and is associated with eczema and thrombocytopenia.
Definition
Wiskott-Aldrich, defect in the WASP gene
Term
There are many different complement deficiencies, but defects in C3 or C5-C9 can all result in susceptibility to bacterial infection, especially () spp.
Definition
Neisseria (meningitis and gonorrhea)
Term
Patients with () and () deficiencies have diseases resembling systemic lupus erythematosus or other autoimmune diseases. () deficiency is the most common complement defect and is frequently asymptomatic.
Definition
C2, C4, C2
Term
Hereditary angioedema is associated with which complement defect?
Definition
C1 inhibitor, this is a rare deficiency
Term
Mutations in the gene for () tyrosine kinase disrupt B cell development, making individuals more susceptible to bacterial and viral infection.
Definition
Btk, X-linked agamma-globulinemia
Term
Defects in the CD40L prevent (), necessary to make IgG, IgA and IgE, a process initiated by CD4 T cells. What disease is this seen in?
Definition
Isotype switching, X-linked hyper IgM syndrome, since IgM predominates
Term
Inherited deficiencies in IgA synthesis predispose to what type of infections?
Definition
Respiratory infections especially, any infection of mucosal membranes
Term
Defects in () and () lead to immune complex deposition in the blood, lymph and ECF, which can directly damage tissues as well as activating phagocytes causing further inflammation and tissue damage.
Definition
C3b and C4b
Term
() inhibits the conversion of C3-C3b, if absent C3 reserves are rapidly depleted.
Definition
Plasma protein factor I
Term
() normally enhances the alternative pathway. without it, patients have heightened susceptibility to Neisseria due to inhibition of MAC and bacterial lysis.
Definition
Factor P
Term
() or CD59 normally inhibits the alternative pathway. Defects lead to enhanced activation of the alternative pathway and autoimmune-like conditions, like paroxysmal nocturnal hemoglobinuria.
Definition
Decay-accelerating factor due to complement-mediate lysis of erythrocytes.
Term
T or F: overactivity of vasoactive C2 fragment leads to increased capillary permeability and can lead to death from epiglottis swelling.
Definition
True, angioedema
Term
Patients with severe liver disease are at risk for what type of infections?
Definition
Pyogenic bacterial infections from a loss of complement synthesis
Term
Complement protein () opsonizes, while () and () act as anaphylactic agents
Definition
C3b, C3a, C5a
Term
() are leukocytes well suited for working under anaerobic conditions in diseased tissues.
Definition
PMNs
Term
Trace the lineage of PMNs starting in the bone marrow:
Definition
Pluripotent stem cell, myeloblast, promyelocyte, myelocyte, metamyelocyte, band, PMN
Term
Hypersegmented PMNs are a sign of () or () deficiency
Definition
B12, folate
Term
Under normal conditoins, () of the PMN pool is in the marrow, () in the vessels, and the remainder in ()
Definition
90, 3, tissues
Term
() graniules contain the myeloperoxidase enzyme, as well as lysozyme and other degradative enzymes. They are formed at the () stage.
Definition
Primary or azurophilic, promyelocyte
Term
() granules contain lactoferrin and proteases, nucleases, and lipases, formed at the () stage
Definition
secondary or specific, myelocyte
Term
T or F: like macrophages, PMNs can regenerate granules and survive in tissues for weeks
Definition
False, once the granules are gone they die and are digested
Term
List some surface receptors PMns have that can recognize common pathogen antigens.
Definition
Mannose, sialic acid, glycan, LPS, C3b
Term
Phagocytosis by PMNs is aided by the binding of () antibodies to the bacteria. Then the () is triggered, resulting in the production of microbicidal agents like (), (), and (). 
Definition
IgG, respiratory burst, superoxide, hydrogen peroxide, nitric oxide
Term
Hydrogen peroxide is more toxic than superoxide to bacteria but can be circumvented by what bacterial strategy?
Definition

Catalase, which can break H202 into water, produced by

S. aureus for instance 

Term
Over production of () in an acute inflammatory reaction can cause the hypotension seen in septic shock from vasodilation of peripheral blood vessels.
Definition
Nitric oxide.
Term
The most important oxygen-dependent mechanism of killing microorganisms after engulfing them is the production of () ion from chloride and hydrogen peroxide, catalyzed by ()
Definition
hypochlorite, myeloperoxidase
Term
People deficient in myeloperoxidase can kill bacteria slowly due to the (), but catalase positive organisms or organisms with this enzyme () that inactivates superoxide radical formation, frequently cause disase.
Definition
respiratory burst, superoxide dismutase
Term
Oxygen-independent mechanisms of killing bacteria are important under anaerobic conditions, list some of these methods.
Definition
Lactoferrin chelates iron from bacteria, lysozyme degrades peptidoglycan in the cell wall, cationic protiens that damage cell membranes and low pH
Term
Organisms like (), () and () are all preferentially ingested by macrophages instead of PMNs, remaining viable and multiplying within these cells in granulomas
Definition
M. tuberculae, brucella, toxoplasma gondii
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