Module Book Clinical Immunology - med.unhas.ac.id .Clinical Immunology Module coordinators: Dr. M.

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Transcript of Module Book Clinical Immunology - med.unhas.ac.id .Clinical Immunology Module coordinators: Dr. M.

ClinicalImmunology

M O D U L E B O O K

Bachelor Medicine, Third year Course year 2014-2015

2014 Alle rechten voorbehouden LUMC Behoudens de in of krachtens de Auteurswet van 1912 gestelde uitzonderingen, mag niets uit deze uitgave worden verveelvoudigd en/of openbaar gemaakt worden door middel van druk, Photographkopie, microfilm, web-publishing of op welke andere wijze dan ook en evenmin in een gegevensopzoeksysteem worden opgeslagen zonder voorafgaande schriftelijke toestemming van de houder van de copyrights. Voor vragen of informatie kunt u contact opnemen met: Directoraat Onderwijs en Opleidingen, PB 9600, 2300 RC Leiden

Clinical Immunology

Modulecoordinators:

Dr. M. Bax LUMC, Department of Rheumatology Email: m.bax@lumc.nl Dr. R.G.M. Bredius LUMC, Department of Paediatrics Email: r.g.m.bredius@lumc.nl Dr. A. Lankester LUMC, Department of Paediatrics Email: a.lankester@lumc.nl

M O D U L E B O O K

Bachelor Medicine, third year Course year 2014-2015

Contents

Modulecommitteeandteachers 1

Preface 5

Introductionandgeneralinformation 7

Themes 17

Introductioninimmunemediateddisease 18

Diagnosticsinimmunologicaldisorders 32

Neuroimmunology 40

Rheumatology 45

Pulmonology 49

Nephrology 52

Finalreportpatientcase 56

InnovativeTherapies 58

Appendices 70

Instructionsforfinalreportweek8 70

Assessmentcriteriagrantproposalposterpresentation 71

Assessmentform 73

Guidelinesdiagnosisreport 74

Oralpresentationlabvisit 75

Oralpresentationpatientcasus 76

Reportneuroimmunology 77

Oralpresentationrheumaticdisease 78

Oralpresentationpulmonology 79

Reportnephrology 80

1

ModulecommitteeandteachersModulecoordinators

Dr.M.BaxLUMC,Dept.ofRheumatologyEmail:M.Bax@lumc.nlDr.K.L.L.HabetsLUMC,Dept.ofRheumatologyEmail:K.L.L.Habets@lumc.nlDr.R.G.M.BrediusLUMC,Dept.ofPaediatricsEmail:R.G.M.Bredius@lumc.nlDr.A.LankesterLUMC,Dept.ofPaediatricsEmail:A.Lankester@lumc.nl

Logisticalsupport

Ondersteuningblokonderwijs@lumc.nl

Modulecommittee

Dr.H.H.SmitsDept.ofParasitologyEmail:H.H.Smits@lumc.nlDr.J.J.C.deVriesDept.ofMedicalMicrobiologyEmail:J.J.C.de_Vries@lumc.nlDr.J.A.BakkerDept.ofClinicalchemistryEmail:J.A.Bakker@lumc.nlDr.B.E.P.B.BallieuxDept.ofClinicalchemistryEmail:B.E.P.B.Ballieux@lumc.nlProf.dr.J.J.G.M.VerschuurenDept.ofNeurologyEmail:J.J.G.M.Verschuuren@lumc.nlDr.J.J.PlompDept.ofNeurologyEmail:J.J.Plomp@lumc.nlDr.J.K.deVriesBouwstraDept.ofRheumatologyEmail:J.K.de_VriesBouwstra@lumc.nl

Prof.dr.R.E.M.ToesDept.ofRheumatologyEmail:R.E.M.Toes@lumc.nlProf.dr.C.TaubeDept.ofPulmonologyEmail:C.Taube@lumc.nlProf.dr.P.S.HiemstraDept.ofPulmonologyEmail:P.S.Hiemstra@lumc.nlDr.A.P.J.deVriesDept.ofNephrologyEmail:A.P.J.de_Vries@lumc.nlProf.dr.C.vanKootenDept.ofNephrologyEmail:C.van_Kooten@lumc.nlDr.B.G.A.GuigasDept.ofParasitologyEmail:B.G.A.Guigas@lumc.nl

2

Secretariat

Mw.N.E.SchenkLagendijkLUMC,Dept.ofRheumatologyPhone:0715263423Email:N.E.SchenkLagendijk@lumc.nl

Teachers

LT=lecture,PR=practical,PD=patientdemonstration,WG=workgroupDr.A.AartsmaRusDept.ofhumangenetics

LT

Drs.G.D.AmatngalimDept.Pulmonology,LUMC

LT

Dr.U.A.BadrisingDept.ofNeurology,LUMC

LT,WG,PD

Dr.J.A.BakkerDept.ofClinicalChemistry,LUMC

LT,PR

Dr.B.E.P.B.BallieuxDept.ofClinicalChemistry,LUMC

LT,PR

Dr.M.BaxDept.ofRheumatology,LUMC

PR

Dr.V.BekkerDept.ofPaediatrics

LT

Dr.M.deBoerDept.ofInfectiousdiseases

LT

Dr.E.L.E.M.BollenDept.ofNeurology,LUMC

LT,WG,PD

Mw.B.C.M.BosvanNoortDept.Pulmonology,LUMC

LT

Drs.H.BouwsmaDept.ofNephrology,LUMC

PD

Dr.R.G.M.BrediusDept.ofPaediatrics,LUMC

LT,WG

Dr.C.M.CobbaertDept.ofClinicalChemistry,LUMC

LT

Prof.dr.A.F.CohenDept.ofNephrology,LUMC

LT

Profdr.D.P.EngbertsDept.Ethics&Law

LT

Prof.dr.J.W.deFijterDept.ofNephrology,LUMC

LT

Dr.F.A.vanGaalenDept.ofRheumatology,LUMC

LT,WG

Profdr.H.J.GuchelaarDept.KFT

LT

Dr.B.G.A.GuigasDept.ofParasitology

LT

Dr.K.L.L.HabetsDept.ofRheumatology,LUMC

PR

Dr.T.vanHallDept.ofClinicaloncology)

LT

Dr.L.M.tHart(MCB) WG

Dept.OfMolecularcellbiologyProf.dr.P.S.HiemstraDept.ofPulmonology,LUMC

LT,PR,WG

Drs.P.C.E.HissinkMullerDept.ofPaediatrics,LUMC

LT

Dr. C.H.HokkeDept.ofParasitology

LT

Dr.S.KleijnDept.Pulmonology,LUMC

LT

Prof.dr.F.KoningDept.ofImmunohematologyandBloodbank,LUMC

LT

Drs.P.KhedoeDept.Pulmonology,LUMC

LT

Prof.dr.C.vanKootenDept.ofNephrology,LUMC

LT

Dr. F.KroonDept.ofInfectiousdiseases

LT

Dr.A.LankesterDept.ofPaediatrics,LUMC

LT,WG

Dr.A.F.LipkaDept.ofRheumatology

LT,WG,PD

Dr.E.LoprioreDept.ofPaediatrics,LUMC

LT

Prof.dr.R.M.MaizelsEdinburgh,UK

LT

Dr.M.L.MearinManriqueDept.ofPaediatrics,LUMC

LT

Drs.D.J.A.R.MoesDept.ofClinicalPharmacyandToxicology

LT

Mr.I.deNooijerLURIS

LT

Dr.F.A.OssendorpDept.ofImmunohematologyandBloodbank,LUMC

LT

Dr.J.J.PlompDept.ofNeurology,LUMC

PR,LT

Prof.Dr. T.RabelinkDept.ofNephrology,LUMC

LT

Drs.S.R.S.RamaiDept.Pulmonology,LUMC

LT

Dr.M.E.J.Reijnders LT

3

Dept.ofNephrology,LUMCDr.D.L.RoelenDept.ofImmunohematologyandBloodbank,LUMC

LT

Dr.J.N.SamsomDeptofPaediatricGastroenterology,ErasmusMC

LT

Mw.A.vanSchadewijkDept.Pulmonology,LUMC

PD

Dr.K.SchimmelDept.KFT

LT

Ir.R.SchotDept.Pulmonology,LUMC

PR

Dr.A.M.SlatsDept.Pulmonology,LUMC

LT

Dr.J.J.SchweizerDept.ofPaediatrics)

LT

Profdr.F.J.StaalDept.ofImmunohematologyandBloodbank,LUMC

LT

Dr.B.C.StoelDept.Pulmonology,LUMC

PR

Dr.Y.K.O.TengDept.ofNephrology,LUMC

LT

Prof.dr.R.E.M.ToesDept.ofRheumatology,LUMC

LT,WG

Prof.dr.C.TaubeDept.Pulmonology,LUMC

LT,PD

Dr.M.D.J.vanTolDept.ofPaediatrics,LUMC

LT,PR

Dr.L.A.TrouwDept.ofRheumatology,LUMC

LT,PR

Dr.J.VellingaCrucell

LT

Drs.E.P.M.vanderVlugtDept.Pulmonology,LUMC

LT

Dr.E.vandeVosseDept.ofInfectiousdiseases,LUMC

LT

Dr.A.P.J.deVriesDept.ofNephrology,LUMC

LT,PR

Dr.J.J.C.deVriesDept.ofMedicalMicrobiology,LUMC

LT

Dr.J.K.deVriesBouwstraDept.ofRheumatology,LUMC

LT,PR,PD,WG

Dr.M.deVriesDept.ofPaediatrics

LT

Prof.dr.J.J.G.M.VerschuurenDept.ofNeurology,LUMC

LT,WG,PD

Drs.Y.vanWijckDept.Pulmonology,LUMC

LT

Dr.L.N.A.WillemsDept.Pulmonology,LUMC

LT,PD

Dr.D.vanderWoudeDept.ofRheumatology,LUMC

LT,PR,PD,WG

Drs.M.ZarconeDept.Pulmonology,LUMC

LT

Dr.M.C.vanZelmDept.ofMolecularImmunology,ErasmusMC

LT

5

PrefaceThehumanimmunesystemisintendedtorecognizenonself,harmfulentitiesinordertoeliminatethem to avoid damage. Upon reexposure to the same pathogenic entity, a faster and strongerimmune response occurs, known asmemory. Thememory response has been used throughouthistorytoconferimmunity,evenbeforeourunderstandingofthephysiologicalbasisoftheimmuneresponse.Alreadymorethan2000yearsago,Thucydideswrote inhisHistoryofthePeloponnesianWarthatpersonswhohadbeenexposedtoplaguepreviouslywereprotectedagainstdisease.Muchlater, in the 18th century, Edward Jenner postulated that the pus in the blisters from cowpoxprotectedmilkmaids fromsmallpox.He tested thishypothesisby inoculatinganeightyearoldboywithpusfromcowpoxblistersinbotharms.Theboydevelopedfeverandsomeuneasiness,butnotafullblown infection.A fewmonths later, Jenner challenged thisboywith live smallpoxand foundthattheboywasprotectedagainstthisinfection.In the next years, basic knowledge on the immune system improved, and especially geneticallyinherited primarily immunodeficiencys has provided valuable insights into the functioning of theimmune system. The study of immunology provides the opportunity in medicine to relate thefindingsofbasic scientific investigations to clinicalproblems.Currentlyweknow that the immunesystemhastheimportanttasktomaintainadelicatebalancebetweenthepotencytodestroyforeigncells and viruses,while refraining from destruction of the host's own tissue.When the immunesystem is not able tomount a sufficient defense of the host, this is considered as an immunedeficiency (e.g.HIV infectionandSCID),whereas if the immunesystemacts toovigorously,allergymight be induced or the immune systemmight start to attack the host, initiating autoimmunediseases(e.g.RheumatoidarthritisandMyastheniagravis).During this10weekscourse,manydifferentdisciplines involved in immunemediateddiseasesareoffered, includingParasitology,MedicalMicrobiology,Neurology,Rheumatology,Pulmonology,andNephrology.Inthefirsttwoweeksofthishalfminor,casestudiesdescribingrealeventsfromrecordsof different hospitals are presented, illustrating in a clinical context essential points about thefundamentalmechanismsof immunity.Subsequently, clinicians,basic researchers,andpatientsofdifferentdepartments involved in immunemediateddiseaseswillbe introduced.Attheendofthismodule,thestudentisabletounderstandimmunemediatedmechanismsleadingtodisease,andisprepared to present a research proposal with stateofart laboratory techniques to investigatespecificcomponentsof the immune system relat