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The Immune System of the Respiratory Tract

The Immune System of the Respiratory Tract. Waldeyer’s Ring. MALT Tissue. The MALT tissues relevant to the respiratory system are: NALT (Waldeyer’s ring of tonsilar tissue from the upper nasopharynx (adenoids) to the posterior tongue – inducer and effector LALT laryngeal lymphoid tissue

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The Immune System of the Respiratory Tract

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  1. The Immune System of the Respiratory Tract

  2. Waldeyer’s Ring

  3. MALT Tissue • The MALT tissues relevant to the respiratory system are: • NALT (Waldeyer’s ring of tonsilar tissue from the upper nasopharynx (adenoids) to the posterior tongue – inducer and effector • LALT laryngeal lymphoid tissue • BALT (bronchus associated lymphoid tissue: found in peribronchial, perivascular and interstitial areas of the lung

  4. Impairment of Defences • Impaired epiglottic closure: stroke, seizure, drug abuse, normal sleep -> aspiration of oropharyngeal flora • Alcohol • Impairs epiglottic and cough reflex • Alters colonisation of oropharynx – G+ve to G-ve • Decreased neutrophil mobilisation & effectiveness • Blocks TNF response to endotoxin • Induces macrophage secretion of IL10 (antiinflammatory) • Tobacco impairs mucociliary & macrophage functions

  5. Impairment of Defences • Mycoplasma and H.influenza • Impair ciliary function • Influenza A • Destroys cilia causing mucus buildup and 2nd infections • Extrapulmonary sepsis decreases lung clearance of bacteria • Burn inhalation injury with ventilator support (50% incidence of pneumonia, 37% mortality rate). • Drugs: especially cancer chemotherapy, immunosuppressants, proton pump and H2 inhibitors • Other factors that impair pulmonary host defenses include old age, premature birth, hypoxaemia, acidosis, toxic inhalations, pulmonary oedema, malnutrition • Lymphadenopathy due to compression from sarcoidosis, solid tumours • Bronchial obstruction due to adenocarcinoma • Systemic disease: diabetes, renal failure, GORD, COAD, CHF, HIV • Splenectomy: encapsulated bacteria like S.pneumoniae must be opsonised then removed by splenic macrophages, or else!

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