Chapter 63: Adult Immune Problems

The immune response operates through two primary mechanisms: B lymphocytes coordinate humoral immunity to mount rapid defenses against acute bacterial and viral infections, while T lymphocytes orchestrate cellular immunity to combat slow-developing infections and coordinate delayed hypersensitivity reactions. Immunity exists on a spectrum from innate defenses present at birth, including physical barriers and inflammatory responses, to acquired immunity that develops either passively through maternal antibodies or actively through disease exposure and vaccination. Diagnostic evaluation of immune dysfunction relies on specific laboratory markers such as antinuclear antibody and anti-double-stranded DNA testing for systemic lupus erythematosus identification, CD4 cell counts for monitoring human immunodeficiency virus progression, and skin testing for allergen identification. Hypersensitivity disorders represent pathological immune responses, with anaphylaxis requiring immediate airway management and epinephrine administration, while latex allergies demand recognition of cross-reactivity with certain fruits. Immunodeficiency conditions, whether primary genetic disorders or acquired through human immunodeficiency virus infection leading to acquired immunodeficiency syndrome, necessitate infection prevention as the central nursing priority, with particular attention to opportunistic infections and malignancy risks. Autoimmune diseases emerge when immune mechanisms attack the body's own tissues, including systemic lupus erythematosus affecting multiple organ systems with characteristic rashes and renal involvement, scleroderma causing progressive skin and organ fibrosis, pemphigus producing severe blistering, and Goodpasture's syndrome targeting lung and kidney tissue. Infectious processes like Lyme disease, transmitted through tick vectors, present with distinctive clinical stages and require careful diagnostic timing since serological testing yields unreliable results within the first weeks following exposure.