01 May Mary, a 3-year-old girl, had her spleen removed after a motor vehicle acci
Mary, a 3-year-old girl, had her spleen removed after a motor vehicle accident, in which both parents died. When she was transferred to the emergency department of a nearby hospital, it became apparent that her spleen had ruptured and the surgeon had no option but to remove it. Mary recovered well from the surgery, but her next of kin, who knows that the spleen is important in immune responses, wants to know how removal of the spleen will affect her immunologically, and so you arrange for a consultation with an immunologist.
1. What is the immunologic role of the spleen? To what types of infections will Mary be particularly susceptible? (2 pts)
2. Explain how a simple act such as brushing or flossing teeth could pose a problem for Mary now that her spleen has been removed. (1 pt)
3. Mary’s record showed that she had received most of the vaccines that were recommended. The immunologist recommended immunization with the polysaccharide pneumococcal vaccine (Pneumovax 23). Explain why. (1 pt)
4. Discuss risks of immunization with the polysaccharide vaccine Pneumovax. (1 pt)
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Case 2 (8 pts)
Mark is a 7-month-old boy who was born at term (40 weeks) weighing 4kg, physically normal and apparently healthy. Although Mark was well the first couple of months of life, the last 3 months have shattered the illusion that Mark is healthy and normal. Mark has been plagued with fungal (diaper rash, oral candidiasis), viral (upper respiratory tract infections), and bacterial (otitis media) infections, all of which resolved with appropriate pharmacologic intervention. Mark has received routine childhood immunization, which his mother hoped would reduce the number of infections. Not surprising, referred to a pediatrician who noted that Mark had (once again) a diaper rash and candidiasis and an upper respiratory tract infection. Despite these infections, his tonsils and lymph nodes were barely detectable upon physical examination. The pediatrician ordered a number of tests that included a complete blood cell count with differential, serum immunoglobulin (Ig), and a chest radiograph. The blood cell count indicated a low leukocyte count, profound lymphopenia, and a very low serum IgG value.
1. This patient has a history of infection with bacteria, fungi, and viruses. What lymphoid defect is suggested when a patient has a history of bacterial infections? Fungal and viral infections? (3 pts)
2. What is the rationale for requesting a complete blood cell count with differential? (1 pt)
3. What is the significance of the small tonsils and barely detectable lymph nodes? This could have been predicted given the very low levels of serum Ig. Explain. (1 pt)
4. How can the fact that this child has been immunized be used to determine if B cell function is intact? (1 pt)
5. You suspect a lymphocyte imm
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