qns 2
A 15-year-old girl is brought to the physician because of a 1-week history of vaginal discharge and a 2-day history of sore throat and white spots in her mouth. She has had recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2-year history of type 1 diabetes mellitus and a 1-year history of autoimmune thyroiditis. Medications include insulin and levothyroxine. Examination shows oral candidiasis. Pelvic examination shows a thick white vaginal discharge. Microscopic examination shows budding yeast. Which of the following is the most likely mechanism of her recurrent candidal infections?
A
) Autoimmune destruction of the thymus
B
) Blunting of the inflammatory response from complement deficiency
C
) Deficiency in anticandidal antibodies
D
) Impaired cell-mediated immunity
E
) Inability of macrophage to present candidal antigen
a
i did the same thing but it was wrong
I thought this girl has lots of autoimmune problem: DM+autoimmune thyroiditis; might have other autoimmune disorders. Is it IgA def.: so B?
my thinking way was wrong. Ans should be B, I think.
1. problem since childhood: therefore must be some congenital immunodef. disorder;
2. always candidal infection in resp.tract, GI tract, and Urinogeni.tract, so membrance protection mechanism must be wrong;
3. therefore, must be selective IgA defi.----B
4. selective IgA often asso with autoimmune.
A,D,E should have some other infections except candida. C: never heard of anticandidal antibody, do you?
kuloth wrote:
A 15-year-old girl is brought to the physician because of a 1-week history of vaginal discharge and a 2-day history of sore throat and white spots in her mouth. She has had recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2-year history of type 1 diabetes mellitus and a 1-year history of autoimmune thyroiditis. Medications include insulin and levothyroxine. Examination shows oral candidiasis. Pelvic examination shows a thick white vaginal discharge. Microscopic examination shows budding yeast. Which of the following is the most likely mechanism of her recurrent candidal infections?
A
) Autoimmune destruction of the thymus
B
) Blunting of the inflammatory response from complement deficiency
C
) Deficiency in anticandidal antibodies
D
) Impaired cell-mediated immunity
E
) Inability of macrophage to present candidal antigen
i think the correct answer is D....
kuloth wrote:
A 15-year-old girl is brought to the physician because of a 1-week history of vaginal discharge and a 2-day history of sore throat and white spots in her mouth. She has had recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2-year history of type 1 diabetes mellitus and a 1-year history of autoimmune thyroiditis. Medications include insulin and levothyroxine. Examination shows oral candidiasis. Pelvic examination shows a thick white vaginal discharge. Microscopic examination shows budding yeast. Which of the following is the most likely mechanism of her recurrent candidal infections?
A
) Autoimmune destruction of the thymus
B
) Blunting of the inflammatory response from complement deficiency
C
) Deficiency in anticandidal antibodies
D
) Impaired cell-mediated immunity
E
) Inability of macrophage to present candidal antigen
answer here is D.... impaired cell mediated immunity specifically T-cell, fungal, viral, parasitic infections think impaired T cell-mediated immunity, much like DiGeorge; If it was recurrent bacterial, think XLA (X-Linked aggammaglobulinemia. Something similar to this came out in my exam
why not A, B,C,E then?
If D, e.g. HIV-AIDS, should not be only recurrent candidal infection, right?
i think the correct answer is D, which truly explains the condition (the question is just saying impaired cell mediated immunity, not complete absence). the only other strong option is A but i have never read of complement deficiencies specifically causing fungal infections...anyways i may be incorrect.
kuloth wrote:
A 15-year-old girl is brought to the physician because of a 1-week history of vaginal discharge and a 2-day history of sore throat and white spots in her mouth. She has had recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2-year history of type 1 diabetes mellitus and a 1-year history of autoimmune thyroiditis. Medications include insulin and levothyroxine. Examination shows oral candidiasis. Pelvic examination shows a thick white vaginal discharge. Microscopic examination shows budding yeast. Which of the following is the most likely mechanism of her recurrent candidal infections?
A
) Autoimmune destruction of the thymus
B
) Blunting of the inflammatory response from complement deficiency
C
) Deficiency in anticandidal antibodies
D
) Impaired cell-mediated immunity
E
) Inability of macrophage to present candidal antigen
The Answer is "D"
kuloth wrote:
A 15-year-old girl is brought to the physician because of a 1-week history of vaginal discharge and a 2-day history of sore throat and white spots in her mouth. She has had recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2-year history of type 1 diabetes mellitus and a 1-year history of autoimmune thyroiditis. Medications include insulin and levothyroxine. Examination shows oral candidiasis. Pelvic examination shows a thick white vaginal discharge. Microscopic examination shows budding yeast. Which of the following is the most likely mechanism of her recurrent candidal infections?
A
) Autoimmune destruction of the thymus
B
) Blunting of the inflammatory response from complement deficiency
C
) Deficiency in anticandidal antibodies
D
) Impaired cell-mediated immunity
E
) Inability of macrophage to present candidal antigen
why cant it be (a)? she has got all autoimmune disorders and it is only probable that she has autoimmune destruction of thymus too. for eg, in autoimmune destruction of endocrine pancreas, we could also find pernicious anemia. i agree option d is also correct, but shouldn't (a) fit in more. with (d) you gotta have parathyroid hypoplasia or even other bacterial infections too.
its definetly D, patient has a T cell deficiency, losing cell mediated response. Its not A because for this question, E clearly fits better. Also the absence of the thymus isn't the specific reason for her recurrent infection with Candida....
NeKh52879554 wrote:
its definetly D, patient has a T cell deficiency, losing cell mediated response. Its not A because for this question, E clearly fits better. Also the absence of the thymus isn't the specific reason for her recurrent infection with Candida....
it's D, bcz she has MPO deficiency (myeloperoxidase) which is a variant of CGD (chr granulomatous dz). Key Px is asymptomatic Pts that get recurrent Candidia infxns.
source: Pathoma inflammation/immuno lecture (ch2)
The patient is suffering from a disorder called Chronic mucocutaneous candidiasis. There is no unifying underlying genetic mutation in all patients suffering from this disorders. However, the phenotypic commonalities include recurrent candidal infections of the skin, nails, mucous membranes; multiple immune system abnormalities; autoimmunity of multiple organs, predominantly endocrine glands such as the parathyroids and adrenals. The exact pathogenesis for the recurrent candidal infections is not so clear cut - it likely varies depending on the underlying mutation and may involve both innate & adaptive immunity deficits. However, evidence indicates underlying dysfunction of the T-cell population. They demonstrate dysfunctional self-tolerance (evidenced by the autoimmunity). Additionally, some studies in vitro studies have shown that T-cells from these patients become anergic when stimulated with candidal antigens. Finally, many patients have significantly reduced numbers of circulating T cells. As a result, I'd guess the best answer is 'D' impaired cell-mediated immunity
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