MICROBIOLOGY AND IMMUNOLOGY VMS I, 2002

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MICROBIOLOGY AND IMMUNOLOGYVMS I, 2009
PROBLEM 1 WHERE B THE T CELLS? LUC VAN KAER,
PhD
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• PROBLEM
• A physician is called to labor and delivery to
  evaluate an infant
• delivered after a term pregnancy.
• PHYSICAL EXAM
• Slight hyperteleorism (wide-set eyes).
• Low set ears and downward slanting eyes.
• Three hours after first exam, the physician is
  called because
• the child is having seizures. Laboratory
  tests reveal low
• blood calcium, and the child is successfully
  treated by
• administering calcium. The diagnosis of
  transient
• hypocalcemia is made and the child is
  discharged on the
• third day.

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• PROBLEM
• A physician is called to labor and delivery to
  evaluate an infant
• delivered after a term pregnancy.
• PHYSICAL EXAM
• Slight hyperteleorism (wide-set eyes).
• Low set ears and downward slanting eyes.
• Three hours after first exam, the physician is
  called because
• the child is having seizures. Laboratory
  tests reveal low
• blood calcium, and the child is successfully
  treated by
• administering calcium. The diagnosis of
  transient
• hypocalcemia is made and the child is
  discharged on the
• third day.

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• ONE WEEK LATER
• The child returns to the clinic flushed, with
  oral thrush, fever,
• and severe diaper rash (Candidiasis).
• LABORATORY TESTS
• White blood cell count 7,000/mm3 Normal
  5,000-15,000/mm3
• B cell count 600/mm3
  Normal 270-600/mm3
• T cell count 12/mm3
  Normal 1,400-2,700/mm3
• Peripheral blood in vitro immunoglobulin
  production - normal
• Peripheral blood in vitro T cell proliferation -
  negative

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CHEST X-RAY A chest X-ray reveals an abnormal
(right-sided) aortic arch, and the thymic shadow
is missing. DIAGNOSIS ----------------
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• TREATMENT
• 1) Treat with mycostatin by mouth for the oral
  thrush.
• 2) Treat with a topical antifungal agent for the
  diaper rash
• caused by Candida.
• 3) Administer calcium.

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QUESTIONS 1) Does the infant have a normal
immune system? 2) What components of the immune
system are affected? 3) What do the blood tests
reveal? 4) What does low calcium have to do
with impaired immunity?
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• QUESTIONS
• 5) If you did a biopsy of the bone marrow, what
  would you
• expect it to look like?
• 6) What would a biopsy of a lymph node look
  like?
• 7) What would a biopsy of the spleen look like?

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QUESTIONS 8) Is there a cure for this
disease? 9) What would be the long-term
management of this child?
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