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Type I hypersensitivity
Autoimmune hemolytic anemia
Hemolytic disease of the newborn
Rheumatic heart disease
Type II hypersensitivity
Systemic lupus erythematosus
Type III hypersensitivity
Type IV hypersensitivity
Common variable immunodeficiency
Hyperimmunoglobulin E syndrome
IgG subclass deficiency
Isolated primary immunoglobulin M deficiency
Selective immunoglobulin A deficiency
Adenosine deaminase deficiency
Hyper IgM syndrome
Severe combined immunodeficiency
Cytomegalovirus infection after transplant (NORD)
Post-transplant lymphoproliferative disorders (NORD)
Chronic granulomatous disease
Leukocyte adhesion deficiency
Blood transfusion reactions and transplant rejection: Pathology review
Immunodeficiencies: Combined T-cell and B-cell disorders: Pathology review
Immunodeficiencies: Phagocyte and complement dysfunction: Pathology review
Immunodeficiencies: T-cell and B-cell disorders: Pathology review
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Chronic Granulomatous Disease
Phagocytic Cell Disorders
chronic granulomatous disease p. 107
catalase-positive microbes p. 183
immunodeficiencies and p. 115
recombinant cytokines for p. NaN
respiratory burst in p. 107
With chronic granulomatous disease, granulomatous refers to the development of small nodules called granulomas.
Granulomas are collections of immune cells, especially phagocytes, which cluster together when they can't kill invading pathogens, like bacteria or fungi.
So chronic granulomatous disease is an immunodeficiency where phagocytes are unable to kill pathogens, and instead they form granulomas throughout the body.
Normally, when a pathogen invades the body, phagocytes, like neutrophils and macrophages, are the first on the scene.
When a phagocyte detects a pathogen, it stretches itself out as if it had two little arms.
These arms wrap around the pathogen and seal themselves back up, forming a vesicle inside the phagocyte called a phagosome.
Because the phagosome is lined by what was previously part of the phagocyte's surface membrane, whatever structures were previously surface-bound, like this protein complex called NADPH oxidase, end up inside the phagosome.
The phagocyte also has other organelles, like lysosomes, which are full of digestive enzymes that can destroy a pathogen.
When a lysosome fuses with a phagosome, it forms a phagolysosome, and lysosomal enzymes start to destroy the pathogen.
The lysosomal enzymes also activate NADPH oxidase, which came from the phagosome, causing NADPH to undergo oxidation, and lose one of its electrons.
Nearby oxygen molecules can grab these electrons to become reduced and form superoxide ions, or O2- ions.
Another enzyme, superoxide dismutase, can take these ions and combine them with hydrogen ions to form hydrogen peroxide, or H2O2.
This process of producing superoxide ions and hydrogen peroxide is called the respiratory burst.
These ions and molecules destroy pathogens by damaging their cell membranes and proteins.
Chronic granulomatous disease (CGD) is a genetic condition, in which neutrophils and macrophages cannot create superoxide radicals to kill engulfed germs. There is a mutation in NADPH oxidase genes. People with CGD have problems fighting infections because they don't have enough neutrophils to fight bacteria and other germs.
People with CGD often get recurrent and severe infections, especially in their lungs, ears, and sinuses. They may also develop skin abscesses or sores that don't heal properly. People with CGD struggle to fight off infections caused by catalase-positive bacteria, such as S. aureus, Serratia, Klebsiella, Aspergillus, and Burkholderia.
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