Immunology and Infection

Module details

Title

Immunology and Infection

Type

Specialist

Module code

SLS140

Credits

10

Requirement

Compulsory

Aim of this module

These modules provide the trainees in Clinical Immunology and Histocompatibility and Immunogenetics with the knowledge that underpins the specialist modules in Clinical Immunology, and provide trainees with the knowledge and understanding that underpins and is applied to work-based learning.

 This module will provide the trainee with knowledge, understanding and clinical significance of immunity as applied to infection and cancer. The trainee will become familiar with methods and strategies to investigate immunity and gain experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Select the appropriate immunological assay to investigate the status of the immune system in protecting the patient against a range of bacteria, viruses and fungi.	Action View
# 2	Learning outcome 1,2,3	Competency Apply methods to specified quality standards for all the following investigations: acute phase reactants complement measurement of immunoglobulins functional assays to detect humoral immune responses to pathogens nephelometry ELISA/ImmunoCAP Luminex (if available) flow cytometry (if available).	Action View
# 3	Learning outcome 4	Competency Interpret immunological data in light of clinical details and be aware of the process of authorising written reports on patients with a variety of common infections, prior to and during therapy, including all of the following: viral infections bacterial infections fungal infections infection after secondary immunodeficiency.	Action View
# 4	Learning outcome 4	Competency Identify cases requiring urgent intervention and be able to suggest what clinical advice on follow-up and/or further management could be offered.	Action View
# 5	Learning outcome 5	Competency Identify relevant clinical investigations from other disciplines that will impact on the interpretation of the immunological investigation.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform analysis of patients serum to determine level of IgG antibody to tetanus	DOPS
Perform analysis of patients serum to determine level of IgG antibody to haemophilius influenza	DOPS
Perform analysis of a patients serum to determine level of IgG antibody to pneumococcal polysaccharides	DOPS
Perform analysis of a patients serum to determine level of IgG antibody to individual polysaccharide serotypes of pneumococcus	DOPS
Perform analysis of a patients serum to determine level of IgG antibody to different fungal organisms	DOPS
Perform the assay either by flow or by NBT to assess if neutrophils are functioning	DOPS
Perform the assay to determine the C3 and C4 levels in a patient sample	DOPS
Perform the C100 or C50 assay to see if the classical pathway of complement is working in a patient	DOPS
Perform the AP50 AP100 assay to see if the alternative pathway of complement is working in a patient	DOPS
Perform TCR v beta analysis	DOPS
Take a history where the patient is suspected of having an immunodeficiency disorder specifically ask about bacterial and other infections	OCE
Where the patient is suspected of having an immunodeficiency disorder specifically observe the blood being taken for specific antibody assays to infectious agents	OCE
Where the patient is suspected of having an immunodeficiency disorder specifically observe if the patient is being given a test immunisation and note when the patient will have to return to have blood taken to assess the immune response to the vaccine	OCE
Attend an infectious paediatric clinic observe the history taking of a child with a history of infection and take a patient history on a volunteer	OCE
Attend an adult haematology clinic where haematological patients may have secondary immunodeficency and specifically note the types of infections they may have	OCE
Obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer	OCE

Learning outcomes

1. Select immunology tests to investigate the role of the immunity system against infection.
2. Undertake clinical and laboratory investigation of the immune system relating to defence against infection.
3. Select and perform immunology tests to investigate the role of the immune system against infection.
4. Interpret and report clinical immunological tests in the correct clinical context.
5. Work in partnership with other clinical specialisms to investigate the immune system in infection.

Learning outcomes

1. Discuss the role of the immune system in defence against infection.
2. Discuss the role of the immune system in cancer and malignancy.
3. Describe the design, operation and performance of the tests and assays used to investigate the immune system in defence against infection.
4. Describe the design, operation and performance of the tests and assays used to investigate the immune system in cancer, particularly in haematological malignancies.
5. Describe the partnership between clinical immunology and other clinical specialisms in the investigation of the immune system in infection and haematological malignancy and patient care.

Indicative content

• Microbial immunity
  • Inflammation (mediators; acute inflammatory response; ongoing inflammatory processes; regulation of inflammation; chronic inflammatory responses)
  • Viral infections (immune defences; viral counter defences; human immunodeficiency virus and autoimmune deficiency syndromes [AIDS])
  • Bacterial infections (immune defences; bacterial counter defences)
  • Parasite infections (immune defences; parasite counter defences)
  • Fungal infections (immune defences; fungal counter defences)
  • Immunisation and vaccination
  • Secondary immunodeficiency of infection
• Cancer immunity
  • Tumour antigens (virally controlled antigens; silent antigens; mutant antigens; differentiation antigens; major histocompatibility complex [MHC] antigens)
  • Innate immune responses (macrophages; natural killer [NK] cells)
  • Acquired immune responses (cytotoxic T cells)
  • Tumour counter defence mechanisms
  • Cancer immunotherapy (cytokines; monoclonal antibodies; antibody dependent cell-mediated cytotoxicity [ADCC]; immunisation; tumour vaccines)
  • Immunological diagnosis of cancers (immunofluorescence; immunogenetics; tumour markers)
  • Secondary immunodeficiency

Activities

• Observe a range of platforms used in Clinical Immunology to assess the integrity of the immune system in infection and discuss the strengths and weaknesses of each platform with your training supervisor.
• Attend multidisciplinary review meetings where the results from patients with disorders of the immune system are discussed, and prepare a portfolio of relevant cases, reflecting on the contribution immunology investigations make to the clinical outcome for each patient.
• Critically appraise the internal quality control and external quality assessment performance of three different markers of immune function.
• Visit a microbiology laboratory and discuss the sources of requests and the methods used to investigate common infections with your training supervisor.
• Describe the partnership between Clinical Immunology and other clinical specialism in the investigation of the immune system in infection and the effect of multidisciplinary working on the patient’s management.