Wiskott-Aldrich syndrome

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Wiskott-Aldrich syndrome

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Thymus histology
Spleen histology
Lymph node histology
Introduction to the immune system
Cytokines
Innate immune system
Complement system
T-cell development
B-cell development
MHC class I and MHC class II molecules
T-cell activation
B-cell activation, differentiation, and contraction
Cell-mediated immunity of CD4 cells
Cell-mediated immunity of natural killer and CD8 cells
Antibody classes
Somatic hypermutation and affinity maturation
VDJ rearrangement
Contracting the immune response and peripheral tolerance
B- and T-cell memory
Anergy, exhaustion, and clonal deletion
Vaccinations
Type I hypersensitivity
Type II hypersensitivity
Type III hypersensitivity
Type IV hypersensitivity
Sepsis
Neonatal sepsis
Abscesses
Food allergy
Anaphylaxis
Asthma
Immune thrombocytopenia
Autoimmune hemolytic anemia
Hemolytic disease of the newborn
Rheumatic heart disease
Myasthenia gravis
Graves disease
Pemphigus vulgaris
Serum sickness
Systemic lupus erythematosus
Poststreptococcal glomerulonephritis
Graft-versus-host disease
Contact dermatitis
Transplant rejection
Cytomegalovirus infection after transplant (NORD)
Post-transplant lymphoproliferative disorders (NORD)
X-linked agammaglobulinemia
Selective immunoglobulin A deficiency
Common variable immunodeficiency
IgG subclass deficiency
Hyperimmunoglobulin E syndrome
Isolated primary immunoglobulin M deficiency
Thymic aplasia
DiGeorge syndrome
Severe combined immunodeficiency
Adenosine deaminase deficiency
Ataxia-telangiectasia
Hyper IgM syndrome
Wiskott-Aldrich syndrome
Leukocyte adhesion deficiency
Chediak-Higashi syndrome
Chronic granulomatous disease
Complement deficiency
Hereditary angioedema
Asplenia
Thymoma
Ruptured spleen
Immunodeficiencies: T-cell and B-cell disorders: Pathology review
Immunodeficiencies: Combined T-cell and B-cell disorders: Pathology review
Immunodeficiencies: Phagocyte and complement dysfunction: Pathology review
Glucocorticoids
Bacterial structure and functions
Staphylococcus epidermidis
Staphylococcus aureus
Staphylococcus saprophyticus
Streptococcus viridans
Streptococcus pneumoniae
Streptococcus pyogenes (Group A Strep)
Streptococcus agalactiae (Group B Strep)
Enterococcus
Clostridium perfringens
Clostridium botulinum (Botulism)
Clostridium difficile (Pseudomembranous colitis)
Clostridium tetani (Tetanus)
Bacillus cereus (Food poisoning)
Listeria monocytogenes
Corynebacterium diphtheriae (Diphtheria)
Bacillus anthracis (Anthrax)
Nocardia
Actinomyces israelii
Escherichia coli
Salmonella (non-typhoidal)
Salmonella typhi (typhoid fever)
Pseudomonas aeruginosa
Enterobacter
Klebsiella pneumoniae
Shigella
Proteus mirabilis
Yersinia enterocolitica
Legionella pneumophila (Legionnaires disease and Pontiac fever)
Serratia marcescens
Bacteroides fragilis
Yersinia pestis (Plague)
Vibrio cholerae (Cholera)
Helicobacter pylori
Campylobacter jejuni
Neisseria meningitidis
Neisseria gonorrhoeae
Moraxella catarrhalis
Francisella tularensis (Tularemia)
Bordetella pertussis (Whooping cough)
Brucella
Haemophilus influenzae
Haemophilus ducreyi (Chancroid)
Pasteurella multocida
Mycobacterium tuberculosis (Tuberculosis)
Mycobacterium leprae
Mycobacterium avium complex (NORD)
Mycoplasma pneumoniae
Chlamydia pneumoniae
Chlamydia trachomatis
Borrelia burgdorferi (Lyme disease)
Borrelia species (Relapsing fever)
Leptospira
Treponema pallidum (Syphilis)
Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species
Coxiella burnetii (Q fever)
Ehrlichia and Anaplasma
Gardnerella vaginalis (Bacterial vaginosis)
Viral structure and functions
Varicella zoster virus
Cytomegalovirus
Epstein-Barr virus (Infectious mononucleosis)
Human herpesvirus 8 (Kaposi sarcoma)
Herpes simplex virus
Human herpesvirus 6 (Roseola)
Adenovirus
Parvovirus B19
Human papillomavirus
Poxvirus (Smallpox and Molluscum contagiosum)
BK virus (Hemorrhagic cystitis)
JC virus (Progressive multifocal leukoencephalopathy)
Poliovirus
Coxsackievirus
Rhinovirus
Hepatitis A and Hepatitis E virus
Hepatitis D virus
Influenza virus
Mumps virus
Measles virus
Respiratory syncytial virus
Human parainfluenza viruses
Dengue virus
Yellow fever virus
Zika virus
Hepatitis C virus
West Nile virus
Norovirus
Rotavirus
Coronaviruses
HIV (AIDS)
Human T-lymphotropic virus
Ebola virus
Rabies virus
Rubella virus
Eastern and Western equine encephalitis virus
Lymphocytic choriomeningitis virus
Hantavirus
Prions (Spongiform encephalopathy)
Coccidioidomycosis and paracoccidioidomycosis
Histoplasmosis
Blastomycosis
Pneumocystis jirovecii (Pneumocystis pneumonia)
Candida
Mucormycosis
Aspergillus fumigatus
Sporothrix schenckii
Cryptococcus neoformans
Malassezia (Tinea versicolor and Seborrhoeic dermatitis)
Plasmodium species (Malaria)
Babesia
Giardia lamblia
Entamoeba histolytica (Amebiasis)
Cryptosporidium
Acanthamoeba
Naegleria fowleri (Primary amebic meningoencephalitis)
Toxoplasma gondii (Toxoplasmosis)
Trypanosoma brucei
Trypanosoma cruzi (Chagas disease)
Trichomonas vaginalis
Leishmania
Loa loa (Eye worm)
Toxocara canis (Visceral larva migrans)
Onchocerca volvulus (River blindness)
Ascaris lumbricoides
Anisakis
Angiostrongylus (Eosinophilic meningitis)
Ancylostoma duodenale and Necator americanus
Strongyloides stercoralis
Guinea worm (Dracunculiasis)
Wuchereria bancrofti (Lymphatic filariasis)
Trichinella spiralis
Enterobius vermicularis (Pinworm)
Trichuris trichiura (Whipworm)
Echinococcus granulosus (Hydatid disease)
Diphyllobothrium latum
Paragonimus westermani
Clonorchis sinensis
Schistosomes
Pediculus humanus and Phthirus pubis (Lice)
Sarcoptes scabiei (Scabies)
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Mechanisms of antibiotic resistance
Integrase and entry inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Hepatitis medications
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Neuraminidase inhibitors
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Antimalarials
Anti-mite and louse medications
Advanced cardiac life support (ACLS): Clinical
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Coronary artery disease: Clinical
Heart failure: Clinical
Syncope: Clinical
Pericardial disease: Clinical
Valvular heart disease: Clinical
Chest trauma: Clinical
Shock: Clinical
Peripheral vascular disease: Clinical
Leg ulcers: Clinical
Aortic aneurysms and dissections: Clinical
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Muscarinic antagonists
Sympathomimetics: Direct agonists
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Loop diuretics
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Positive inotropic medications
Antiplatelet medications
Blistering skin disorders: Clinical
Bites and stings: Clinical
Burns: Clinical
Diabetes mellitus: Clinical
Hyperthyroidism: Clinical
Hypothyroidism and thyroiditis: Clinical
Parathyroid conditions and calcium imbalance: Clinical
Adrenal insufficiency: Clinical
Neck trauma: Clinical
Insulins
Mineralocorticoids and mineralocorticoid antagonists
Abdominal pain: Clinical
Appendicitis: Clinical
Gastrointestinal bleeding: Clinical
Peptic ulcers and stomach cancer: Clinical
Inflammatory bowel disease: Clinical
Diverticular disease: Clinical
Gallbladder disorders: Clinical
Pancreatitis: Clinical
Cirrhosis: Clinical
Hernias: Clinical
Bowel obstruction: Clinical
Abdominal trauma: Clinical
Laxatives and cathartics
Antidiarrheals
Acid reducing medications
Blood products and transfusion: Clinical
Venous thromboembolism: Clinical
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Thrombolytics
Fever of unknown origin: Clinical
Infective endocarditis: Clinical
Pneumonia: Clinical
Tuberculosis: Pathology review
Diarrhea: Clinical
Urinary tract infections: Clinical
Meningitis, encephalitis and brain abscesses: Clinical
Skin and soft tissue infections: Clinical
Hypernatremia: Clinical
Hyponatremia: Clinical
Hyperkalemia: Clinical
Hypokalemia: Clinical
Metabolic and respiratory acidosis: Clinical
Metabolic and respiratory alkalosis: Clinical
Toxidromes: Clinical
Medication overdoses and toxicities: Pathology review
Environmental and chemical toxicities: Pathology review
Acute kidney injury: Clinical
Kidney stones: Clinical
Stroke: Clinical
Seizures: Clinical
Headaches: Clinical
Traumatic brain injury: Clinical
Lower back pain: Clinical
Spinal cord disorders: Pathology review
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Osmotic diuretics
Opioid agonists, mixed agonist-antagonists and partial agonists
Opioid antagonists
Asthma: Clinical
Chronic obstructive pulmonary disease (COPD): Clinical
Acute respiratory distress syndrome: Clinical
Pleural effusion: Clinical
Pneumothorax: Clinical
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Pulmonary corticosteroids and mast cell inhibitors
Joint pain: Clinical
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Bones, joints and muscles of the back
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Antigout medications
Pediatric allergies: Clinical
Kawasaki disease: Clinical
Congenital TORCH infections: Pathology review
Pediatric infectious rashes: Clinical
Pediatric bone and joint infections: Clinical
Sjogren syndrome: Clinical
Vasculitis: Clinical
Rheumatoid arthritis: Clinical
Seronegative arthritis: Clinical
Systemic lupus erythematosus (SLE): Clinical
Inflammatory myopathies: Clinical
ECG axis
ECG basics
Normal heart sounds
Abnormal heart sounds
Cardiac conduction system
Cardiac conduction velocity
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Vasculitis

Flashcards

Wiskott-Aldrich syndrome

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Questions

USMLE® Step 1 style questions USMLE

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A 2-year-old boy is brought to his primary pediatrician for evaluation of recurrent infections. The parents report the patient had two episodes of severe pneumonia, an episode of otitis media, and herpes labialis in the past nine months. He was born at 38 weeks gestation to a 28-year-old otherwise healthy woman. He eats and drinks normally and has achieved the normal developmental milestones. Vitals are within normal limits. Physical examination demonstrates a well-developed and well-nourished child with fair complexion. He has eczema on his cheeks and trunk as well as petechiae on the bilateral lower extremities. Laboratory evaluation reveals a leukocyte count of 8,000/mm3 and a platelet count of 70,000/mm3. Flow cytometry of peripheral lymphocytes reveal absence of the WAS protein. Which of the following immunologic processes is most likely affected given this patient's findings?

Transcript

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Wiskott-Aldrich syndrome is also called eczema-thrombocytopenia-immunodeficiency syndrome.

So, one by one, there’s eczema, also called atopic dermatitis, which is characterized by dry red patches arising on the skin.

There’s a type of thrombocytopenia called microthrombocytopenia because not only are there very few platelets, but the platelets are also small in size.

And there’s a problem with the immune system that leads to repeated infections.

All of the hematopoietic cells, which are cells in the bone marrow, produce Wiskott-Aldrich syndrome protein, or WASp for short.

There’s also a gene - called the WIPF1 gene, which encodes a protein called WAS/WASL-interacting protein family member 1, which helps stabilize Wiskott-Aldrich protein.

So WASp, aside from having a really long name that shortens down to the name of a scary flying insect - helps to reorganize the cell’s cytoskeleton, and therefore its overall shape.

The cytoskeleton can change by either adding to or removing actin proteins from the end of an actin chain.

The chain grows longer in the direction that a cell wants to move and shortens on the side that a cell wants to move away from.

This helps with various cellular activities like phagocytosis and cellular division.

Platelets specifically rely on this functionality, because they originate from large precursor cells called megakaryocytes.

This megakaryocyte has many long arms - like a squid - and the cytoskeleton changes shape so that these arms can detach to form cellular fragments called platelets.

The platelets then go off to form clots at damaged sites in the blood vessels, to stop bleeding.

Another cell type are the T-cells, which are a type of immune cell, also rely on the cytoskeleton being able to change shape.

When they encounter a pathogen, T-cells form pseudopods or false legs that reach out and synapse or communicate with other cells.

Think of it like they’re shaking hands to exchange information.

Helper T cells get activated when they form an immunological synapse with antigen presenting cells.

And once they’re activated, helper T-cells activate B-cells which generate antibodies which help destroy the pathogen.

Next up are the cytotoxic T-cells and natural killer cells, which also reorganize their cytoskeleton to form an immunological synapse with various body cells to do surveillance, and find out if they’re healthy or if they’re infected or cancerous.

If an unhealthy cell is discovered, the immune cells make that unhealthy cell undergo apoptosis, or programmed cell death.

Together, the T-cells, B-cells, and natural killer cells protect the body from pathogens as well as cancer.

There are also T-cells called regulatory T cells or T-regs, which downregulate the other T cells to limit the immune response and prevent autoimmune conditions from arising.

T-regs also rely on reorganizing their cytoskeleton to function normally. Finally, there are the phagocytic cells like monocytes, macrophages, and dendritic cells, which form small foot processes to make their way towards cytokines.

These phagocytic cells are like little bloodhounds and following a cytokine trail.

These cells also perform phagocytosis, to swallow up debris, dead cells, and bacteria, so that it can be processed and destroyed.

In Wiskott-Aldrich syndrome, a mutation in the gene results in a Wiskott-Aldrich protein that can’t function normally.

Key Takeaways

Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency disorder that primarily affects males. The condition is caused by mutations in the WAS gene, which encodes for the Wiskott-Aldrich syndrome protein (WASP). The signs and symptoms of Wiskott-Aldrich syndrome can vary widely, but often include recurrent infections due to a weakened immune system, eczema, easy bruising or bleeding due to decreased platelets and abnormal clotting, autoimmune disorders such as rheumatoid arthritis or autoimmune hemolytic anemia, and increased risk of developing certain types of cancer, including lymphoma and leukemia.

Sources

  1. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  2. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  3. "Yen & Jaffe's Reproductive Endocrinology" Saunders W.B. (2018)
  4. "Bates' Guide to Physical Examination and History Taking" LWW (2016)
  5. "Robbins Basic Pathology" Elsevier (2017)
  6. "Membrane grease eases platelet maturation" Blood (2015)
  7. "Mutations of the Wiskott-Aldrich Syndrome Protein (WASP): hotspots, effect on transcription, and translation and phenotype/genotype correlation" Blood (2004)
  8. "Clinical course of patients with WASP gene mutations" Blood (2004)