LECTURE NOTES: IMMUNOLOGY/INFECTIOUS DISEASES (NUS 214)

IMMUNOLOGY: THE IMMUNE SYSTEM

INTRODUCTION

The immune system is a network of cells, tissues, and organs that work together to

defend the body against attacks by “foreign” invaders. These are primarily microbes

i.e. tiny organisms such as bacteria, parasites, and fungi that can cause infections.

Viruses also cause infections, but are too primitive to be classified as living

organisms. The human body provides an ideal environment for many microbes. It is

the immune system’s job to keep them out or, failing that, to seek out and destroy

them. When the immune system hits the wrong target, however, it can unleash a

torrent of disorders, including allergic diseases, arthritis, and a form of diabetes. If the

immune system is crippled, other kinds of diseases result.

The immune system is amazingly complex. It can recognize and remember millions of

different enemies, and it can produce secretions (release of fluids) and cells to match

up with and wipe out nearly all of them.

The secret to its success is an elaborate and dynamic communications network.

Millions and millions of cells, organized into sets and subsets, gather like clouds of

bees swarming around a hive and pass information back and forth in response to an

infection. Once immune cells receive the alarm, they become activated and begin to

produce powerful chemicals. These substances allow the cells to regulate their own

growth and behaviour, enlist other immune cells, and direct the new recruits to trouble

spots.
SELF AND NONSELF

The key to a healthy immune system is its remarkable ability to distinguish between

the body’s own cells, recognized as “self,” and foreign cells, or “non-self.” The

body’s immune defenses normally coexist peacefully with cells that carry distinctive

“self” marker molecules. But when immune defenders encounter foreign cells or

organisms carrying markers that say “non-self,” they quickly launch an attack.

Anything that can trigger this immune response is called an antigen. An antigen can

be a microbe such as a virus, or a part of a microbe such as a molecule. Tissues or

cells from another person (except an identical twin) also carry non-self markers and

act as foreign antigens. This explains why tissue transplants may be rejected.

In abnormal situations, the immune system can mistake self for non-self and launch an

attack against the body’s own cells or tissues. The result is called an autoimmune

disease. Some forms of arthritis and diabetes are autoimmune diseases. In other cases,

the immune system responds to a seemingly harmless foreign substance such as

ragweed pollen. The result is allergy, and this kind of antigen is called an allergen.
THE STRUCTURE OF THE IMMUNE SYSTEM

The organs of the immune system are positioned throughout the body. They are called

lymphoid organs because they are home to lymphocytes, small white blood cells that

are the key players in the immune system. Bone marrow, the soft tissue in the hollow

center of bones, is the ultimate source of all blood cells, including lymphocytes.

The thymus is a lymphoid organ that lies behind the breastbone. Lymphocytes known

as T lymphocytes or T cells (“T” stands for “thymus”) mature in the thymus and then

migrate to other tissues. B lymphocytes, also known as B cells, become activated and

mature into plasma cells, which make and release antibodies.

The organs of the

immune system are
positioned throughout the
body.

Lymphocytes can travel throughout the body using the blood vessels. The cells can

also travel through a system of lymphatic vessels that closely parallels the body’s

veins and arteries.

Immune cells, microbes, and foreign antigens enter the lymph nodes via incoming

lymphatic vessels or the lymph nodes’ tiny blood vessels. All lymphocytes exit lymph

nodes through outgoing lymphatic vessels. Once in the bloodstream, lymphocytes are

transported to tissues throughout the body. They patrol everywhere for foreign

antigens, then gradually drift back into the lymphatic system to begin the cycle all

over again.

The spleen is a flattened organ at the upper left of the abdomen. Like the lymph

nodes, the spleen contains specialized compartments where immune cells gather and

work. The spleen serves as a meeting ground where immune defenses confront

antigens.

Other clumps of lymphoid tissue are found in many parts of the body, especially in the

linings of the digestive tract, airways, and lungs - territories that serve as gateways to

the body. These tissues include the tonsils, adenoids, and appendix.

TYPES OF IMMUNITY (ARMS OF THE IMMUNE SYTEM)

Long ago, physicians realized that people who had recovered from the plague would

never get it again—they had acquired immunity. This is because some of the activated

T and B cells had become memory cells. Memory cells ensure that the next time a

person meets up with the same antigen, the immune system is already set to defeat it.

Immunity can be strong or weak, short-lived or long-lasting, depending on

 The type of antigen it encounters,

 The amount of antigen, and

 The route by which the antigen enters the body.

Immunity can also be influenced by inherited genes. When faced with the same

antigen, some individuals will respond forcefully, others feebly, and some not at all.

Generally, humans have three types of immunity — Innate, Adaptive, and Passive:

1) INNATE IMMUNITY:

Everyone is born with innate (or natural) immunity, a type of general protection.

Many of the germs that affect other species don't harm us. For example, the viruses

that cause leukemia in cats or distemper in dogs don't affect humans. Innate immunity

works both ways because some viruses that make humans ill — such as the virus that

causes HIV/AIDS — don't make cats or dogs sick.

Innate immunity also includes the external barriers of the body, like the skin and

mucous membranes (like those that line the nose, throat, and gastrointestinal tract),

which are the first line of defense in preventing diseases from entering the body. If

this outer defensive wall is broken (as through a cut), the skin attempts to heal the

break quickly and special immune cells on the skin attack invading germs.

Anatomical barrier Additional defense mechanism

Skin Sweat, desquamation, flushing, organic acids

Peristalsis, gastric acid, bile acids, lysozymes,

Gastrointestinal tract
flushing, gut flora

Respiratory airways and

Mucociliary elevator, surfactant
lungs

Nasopharynx Mucus, saliva, lysozyme

Eyes Tears
 2) ADAPTIVE IMMUNITY

The second kind of protection is adaptive (or active) immunity, which develops

throughout our lives. Adaptive immunity involves the lymphocytes and develops as

people are exposed to diseases or immunized against diseases through vaccination.

3) PASSIVE IMMUNITY

Passive immunity is "borrowed" from another source and it lasts for a short time. For

example, antibodies in a mother's breast milk provide a baby with temporary

immunity to diseases the mother has been exposed to. This can help protect the baby

against infection during the early years of childhood.

Everyone's immune system is different. Some people never seem to get infections,

whereas others seem to be sick all the time. As people get older, they usually become

immune to more germs as the immune system comes into contact with more and more

of them. That's why adults and teens tend to get fewer colds than kids — their bodies

have learned to recognize and immediately attack many of the viruses that cause

colds.
IMMUNE TOLERANCE

Immune tolerance is the tendency of T or B lymphocytes (cells) to ignore the body’s

own tissues. Maintaining tolerance is important because it prevents the immune

system from attacking its fellow cells. Scientists are hard at work trying to understand

how the immune system knows when to respond and when to ignore an antigen.

VACCINES

For many years, healthcare providers have used vaccination to help the body’s

immune system prepare for future attacks. Vaccines consist of killed or modified

microbes, components of microbes, or microbial DNA that trick the body into

thinking an infection has occurred.

A vaccinated person’s immune system attacks the harmless vaccine and prepares for

invasions against the kind of microbe the vaccine contained. In this way, the person

becomes immunized against the microbe. Vaccination remains one of the best ways to

prevent infectious diseases, and vaccines have an excellent safety record. Previously

devastating diseases such as smallpox, polio, and whooping cough have been greatly

controlled or eliminated through worldwide vaccination programs.

IMMUNE CELLS AND THEIR PRODUCTS

The immune system stores a huge store of cells, not only lymphocytes but also cell-

devouring phagocytes and their relatives. Some immune cells take on all intruders,

whereas others are trained on highly specific targets. To work effectively, most

immune cells need the cooperation of their comrades. Sometimes immune cells
communicate by direct physical contact, and sometimes they communicate releasing

chemical messengers.

The immune system stores just a few of each kind of the different cells needed to

recognize millions of possible enemies. When an antigen first appears, the few

immune cells that can respond to it multiply into a full-scale army of cells. After their

job is done, the immune cells fade away, leaving guards behind to watch for future

attacks.

All immune cells begin as immature stem cells in the bone marrow. They respond to

different cytokines and other chemical signals to grow into specific immune cell types

such as T cells, B cells, or phagocytes.

The Complement System

The first part of the immune system that meets invaders such as bacteria is a group of

proteins called the complement system. These proteins flow freely in the blood and can

quickly reach the site of an invasion where they can react directly with antigens -

molecules that the body recognizes as foreign substances. When activated, the

complement proteins can

 Trigger inflammation
 Attract eater cells such as macrophages to the area
 Coat intruders so that eater cells are more likely to devour them
 Kill intruders
A. Phagocytes.

This is a group of immune cells specialized in finding and "eating" bacteria, viruses,

and dead or injured body cells. There are three main types, the granulocyte, the

macrophage, and the dendritic cell.

a) Granulocytes: The granulocytes often take the first stand during an infection.

They attack any invaders in large numbers, and "eat" until they die. The pus in

an infected wound consists chiefly of dead granulocytes. A small part of the

granulocyte community is specialized in attacking larger parasites such as

worms.

b) Macrophages: The macrophages ("big eaters") are slower to respond to

invaders than the granulocytes, but they are larger, live longer, and have far

greater capacities. Macrophages also play a key part in alerting the rest of the

immune system of invaders. Macrophages start out as white blood cells called

monocytes. Monocytes that leave the blood stream turn into macrophages.

c) Dendritic cells: The dendritic cells are "eater" cells and devour intruders, like

the granulocytes and the macrophages. And like the macrophages, the dendritic

cells help with the activation of the rest of the immune system. They are also

capable of filtering body fluids to clear them of foreign organisms and

particles.
B) Lymphocytes (T cells and B cells):

White blood cells called lymphocytes originate in the bone marrow but migrate to

parts of the lymphatic system such as the lymph nodes, spleen, and thymus. There are

two main types of lymphatic cells, T cells and B cells. The lymphatic system also

involves a transportation system - lymph vessels - for transportation and storage of

lymphocyte cells within the body. The lymphatic system feeds cells into the body and

filters out dead cells and invading organisms such as bacteria.

On the surface of each lymphatic cell are receptors that enable them to recognize

foreign substances. These receptors are very specialized - each can match only one

specific antigen.

To understand the receptors, think of a hand that can only grab one specific item.

Imagine that your hands could only pick up apples. You would be a true apple-picking

champion - but you wouldn't be able to pick up anything else.

In your body, each single receptor equals a hand in search of its "apple." The

lymphocyte cells travel through your body until they find an antigen of the right size

and shape to match their specific receptors. It might seem limiting that the receptors of

each lymphocyte cell can only match one specific type of antigen, but the body makes

up for this by producing so many different lymphocyte cells that the immune system

can recognize nearly all invaders.

a) B CELLS:

B cells work chiefly by secreting substances called antibodies into the body’s fluids.

Antibodies ambush foreign antigens circulating in the bloodstream. They are

powerless, however, to penetrate cells. The job of attacking target cells - either cells

that have been infected by viruses or cells that have been distorted by cancer - is left

to T cells or other immune cells (described below).

Each B cell is programmed to make one specific antibody. For example, one B cell

will make an antibody that blocks a virus that causes the common cold, while another

produces an antibody that attacks a bacterium that causes pneumonia.

The B lymphocyte cell searches for antigen matching its receptors. If it finds such

antigen it connects to it, and inside the B cell a triggering signal is set off. The B cell

now needs proteins produced by helper T cells to become fully activated. When this

happens, the B cell starts to divide to produce clones of itself. During this process, two

new cell types are created, plasma cells and B memory cells.

i) Plasma cells:

The plasma cell is specialized in producing a specific protein, called an antibody,

which will respond to the same antigen that matched the B cell receptor. Antibodies

are released from the plasma cell so that they can seek out intruders and help destroy

them. Plasma cells produce antibodies at an amazing rate and can release tens of

thousands of antibodies per second.

When the Y-shaped antibody finds a matching antigen, it attaches to it. The attached

antibodies serve as an appetizing coating for eater cells such as the macrophage.

Antibodies also neutralize toxins and incapacitate viruses, preventing them from

infecting new cells. Each branch of the Y-shaped antibody can bind to a different
antigen, so while one branch binds to an antigen on one cell, the other branch could

bind to another cell - in this way pathogens are gathered into larger groups that are

easier for phagocyte cells to devour. Bacteria and other pathogens covered with

antibodies are also more likely to be attacked by the proteins from the complement

system.

Plasma cell antibodies produced include;

 Immunoglobulin G, or IgG, is a kind of antibody that works efficiently to coat

microbes, speeding their uptake by other cells in the immune system.
 IgM is very effective at killing bacteria.
 IgA concentrates in body fluids - tears, saliva, and the secretions of the
respiratory and digestive tracts - guarding the entrances to the body.
 IgE, whose natural job probably is to protect against parasitic infections, is
responsible for the symptoms of allergy.
 IgD remains attached to B cells and plays a key role in initiating early B cell
responses.

ii) Memory B cells:

The Memory Cells are the second cell type produced by the division of B cells. These

cells have a prolonged life span and can thereby "remember" specific intruders. T cells

can also produce memory cells with an even longer life span than B memory cells.

The second time an intruder tries to invade the body, B and T memory cells help the
immune system to activate much faster. The invaders are wiped out before the

infected human feels any symptoms. The body has achieved immunity against the

invader.

b) T CELLS:

Unlike B cells, T cells do not recognize free-floating antigens. Rather, their surfaces

contain specialized antibody-like receptors that see fragments of antigens on the

surfaces of infected or cancerous cells. T cells contribute to immune defenses in two

major ways: some direct and regulate immune responses, whereas others directly

attack infected or cancerous cells. T cells come in two different types, helper cells

and killer cells. They are named T cells after the thymus, an organ situated under the

breastbone. T cells are produced in the bone marrow and later move to the thymus

where they mature.

 i) Helper T (Th) Cells:

Helper T cells are the major driving force and the main regulators of the immune

defense. Their primary task is to activate B cells and killer T cells. However, the

helper T cells themselves must be activated. This happens when a macrophage or

dendritic cell, which has eaten an invader, travels to the nearest lymph node to present

information about the captured pathogen. The phagocyte displays an antigen fragment

from the invader on its own surface, a process called antigen presentation. When the

receptor of a helper T cell recognizes the antigen, the T cell is activated. Once

activated, helper T cells start to divide and to produce proteins that activate B and T

cells as well as other immune cells.

ii) Killer Cells

 Killer T Cells:

Killer T cells also called - Cytotoxic T lymphocytes (CTLs) - perform a different

function. These cells directly attack other cells carrying certain foreign or abnormal

molecules on their surfaces. CTLs are especially useful for attacking viruses because

viruses often hide from other parts of the immune system while they grow inside
infected cells. CTLs recognize small fragments of these viruses peeking out from the

cell membrane and launch an attack to kill the infected cell.

In most cases, T cells only recognize an antigen if it is carried on the surface of a cell

by one of the body’s own major histocompatibility complex or MHC molecules.

MHC molecules are proteins recognized by T cells when they distinguish between self

and non-self. A self-MHC molecule provides a recognizable scaffolding to present a

foreign antigen to the T cell. In humans, MHC antigens are called human leukocyte

antigens, or HLA.

Although MHC molecules are required for T cell responses against foreign invaders,

they also create problems during organ transplantations. Virtually every cell in the

body is covered with MHC proteins, but each person has a different set of these

proteins on his or her cells. If a T cell recognizes a non-self MHC molecule on another

cell, it will destroy the cell. Therefore, doctors must match organ recipients with

donors who have the closest MHC makeup. Otherwise the recipient’s T cells will

likely attack the transplanted organ, leading to graft rejection.

  Natural killer (NK) cells

Natural killer (NK) cells are another kind of lethal white cell, or lymphocyte. Like

CTLs, NK cells are armed with granules filled with potent chemicals. But CTLs look

for antigen fragments bound to self-MHC molecules, whereas NK cells recognize

cells lacking self-MHC molecules. Thus, NK cells have the potential to attack many

types of foreign cells.

Both kinds of killer cells slay on contact. The deadly assassins bind to their targets,

aim their weapons, and then deliver a lethal burst of chemicals.

T cells aid the normal processes of the immune system. If NK T cells fail to function

properly, asthma, certain autoimmune diseases - including type 1 diabetes - or the

growth of cancers may result.

PHAGOCYTES AND THEIR RELATIVES

Phagocytes are large white cells that can swallow and digest microbes and other

foreign particles.

 Monocytes are phagocytes that circulate in the blood. When monocytes

migrate into tissues, they develop into macrophages. Specialized types of

macrophages can be found in many organs, including the lungs, kidneys, brain,

and liver.

Macrophages play many roles. As scavengers, they rid the body of worn-out

cells and other debris. They display bits of foreign antigen in a way that draws

the attention of matching lymphocytes and, in that respect, resemble dendritic

cells. And they mix out an amazing variety of powerful chemical signals,

known as monokines, which are vital to the immune response.

  Granulocytes are another kind of immune cell. They contain granules filled

with potent chemicals, which allow the granulocytes to destroy

microorganisms. Some of these chemicals, such as histamine, also contribute to

inflammation and allergy.

One type of granulocyte, the neutrophil, is also a phagocyte. Neutrophils use

their prepackaged chemicals to break down the microbes they ingest.

Eosinophils and basophils are granulocytes that “degranulate” by spraying

their chemicals onto harmful cells or microbes nearby.

 Mast cells function much like basophils, except they are not blood cells.

Rather, they are found in the lungs, skin, tongue, and linings of the nose and

intestinal tract, where they contribute to the symptoms of allergy.

CYTOKINES

Cells of the immune system communicate with one another by releasing and

responding to chemical messengers called cytokines. These proteins are secreted by

immune cells and act on other cells to coordinate appropriate immune responses.

Cytokines include a diverse assortment of interleukins, interferons, and growth

factors.
Some cytokines are chemical switches that turn certain immune cell types on and off.

One cytokine, interleukin 2 (IL-2), triggers the immune system to produce T cells. IL-

2’s immunity-boosting properties have traditionally made it a promising treatment for

several illnesses. Clinical studies are underway to test its benefits in diseases such as

cancer, hepatitis C, and HIV infection and AIDS. Scientists are studying other

cytokines to see whether they can also be used to treat diseases.

One group of cytokines chemically attracts specific cell types. These so-called

chemokines are released by cells at a site of injury or infection and call other immune

cells to the region to help repair the damage or fight off the invader. Chemokines often

play a key role in inflammation and are a promising target for new drugs to help

regulate immune responses.

COMPLEMENT

The complement system is made up of about 25 proteins that work together to assist,

or “complement,” the action of antibodies in destroying bacteria. Complement also

helps to rid the body of antibody-coated antigens (antigen-antibody complexes).

Complement proteins, which cause blood vessels to become dilated and then leaky,

contribute to the redness, warmth, swelling, pain, and loss of function that characterize

an inflammatory response.
MOUNTING AN IMMUNE RESPONSE

Infections are the most common cause of human disease. They range from the

common cold to weakening conditions like chronic hepatitis to life-threatening

diseases such as AIDS. Disease-causing microbes (pathogens) attempting to get into

the body must first move past the body’s external armor, usually the skin or cells

lining the body’s internal passageways.

The skin provides an impressive barrier to invading microbes. It is generally

penetrable only through cuts or tiny abrasions. The digestive and respiratory tracts -

both portals of entry for a number of microbes - also have their own levels of

protection. Microbes entering the nose often cause the nasal surfaces to secrete more

protective mucus, and attempts to enter the nose or lungs can trigger a sneeze or cough

reflex to force microbial invaders out of the respiratory passageways. The stomach

contains a strong acid that destroys many pathogens that are swallowed with food.

If microbes survive the body’s front-line defenses, they still have to find a way

through the walls of the digestive, respiratory, or urogenital passageways to the

underlying cells. These passageways are lined with tightly packed epithelial cells
covered in a layer of mucus, effectively blocking the transport of many pathogens into

deeper cell layers. Mucosal surfaces also secrete a special class of antibody called

IgA, which in many cases is the first type of antibody to encounter an invading

microbe. Underneath the epithelial layer a variety of immune cells, including

macrophages, B cells, and T cells, lie in wait for any microbe that might bypass the

barriers at the surface.

Next, invaders must escape a series of general defenses of the innate immune system,

which are ready to attack without regard for specific antigen markers. These include

patrolling phagocytes, NK T cells, and complement.

Microbes cross the general barriers then confront specific weapons of the adaptive

immune system tailored just for them. These specific weapons, which include both

antibodies and T cells, are equipped with singular receptor structures that allow them

to recognize and interact with their designated targets.

BACTERIA, VIRUSES, AND PARASITES

The most common disease-causing microbes are bacteria, viruses, and parasites. Each

uses a different tactic to infect a person, and, therefore, each is frustrated by different

components of the immune system.

Most bacteria live in the spaces between cells and are readily attacked by antibodies.

When antibodies attach to a bacterium, they send signals to complement proteins and

phagocytic cells to destroy the bound microbes. Some bacteria are eaten directly by

phagocytes, which signal to certain T cells to join the attack.

All viruses, plus a few types of bacteria and parasites, must enter cells of the body to

survive, requiring a different kind of immune defense. Infected cells use their MHC
molecules to put pieces of the invading microbes on their surfaces, flagging down

CTLs to destroy the infected cells. Antibodies also can assist in the immune response

by attaching to and clearing viruses before they have a chance to enter cells.

Parasites live either inside or outside cells. Intracellular parasites such as the organism

that causes malaria can trigger T cell responses. Extracellular parasites are often much

larger than bacteria or viruses and require a much broader immune attack. Parasitic

infections often trigger an inflammatory response in which eosinophils, basophils, and

other specialized granule-containing cells rush to the scene and release their stores of

toxic chemicals in an attempt to destroy the invaders. Antibodies also play a role in

this attack, attracting the granule-filled cells to the site of infection.

 DISORDERS OF THE IMMUNE SYSTEM

Generally, disorders of the immune system are classified into 4 types

(Hypersensitivity type I, II, III and IV) as a result of the causes, the sites and the

duration of the hypersensitivity reactions.

1) Hypersensitivity type I (Allergic Diseases)

Also known as IgE-Mediated or anaphylactic hypersensitivity, the most common

types of allergic diseases occur when the immune system responds to a false alarm. In

an allergic person, a normally harmless material such as grass pollen, food particles,

mold, or house dust mites is mistaken for a threat and attacked abnormally.

Allergies such as pollen allergy are related to the antibody known as IgE. Like other

antibodies, each IgE antibody is specific; one acts against oak pollen and another

against ragweed, for example.

 2) Hypersensitivity type II (Autoimmune Diseases)

It is also known as the antibody-dependent reaction. Sometimes the immune

system’s recognition apparatus breaks down, and the body begins to manufacture T

cells and antibodies directed against self-antigens in its own cells and tissues. As a

result, healthy cells and tissues are destroyed, which leaves the person’s body unable

to perform important functions.

Misguided T cells and autoantibodies, as they are known, contribute to many

autoimmune diseases. For instance, T cells that attack certain kinds of cells in the

pancreas contribute to a form of diabetes, whereas an autoantibody known as

rheumatoid factor is common in people with rheumatoid arthritis. People with

systemic lupus erythematosus (SLE) have antibodies to many types of their own

cells and cell components. SLE patients can develop a severe rash, serious kidney

inflammation, and disorders of other important tissues and organs.

No one knows exactly what causes an autoimmune disease, but multiple factors are

likely to be involved. These include elements in the environment, such as viruses,

certain drugs, and sunlight, all of which may damage or alter normal body cells.

Hormones are suspected of playing a role because most autoimmune diseases are far

more common in women than in men. Heredity, too, seems to be important. Many

people with autoimmune diseases have characteristic types of self-marker molecules.

Misguided T cells can attack

insulin-producing cells of the
pancreas, contributing to an
autoimmune form of diabetes.
 3) Hypersensitivity type III (Immune Complex Diseases)

Immune complexes are clusters of interlocking antigens and antibodies. Normally,

immune complexes are rapidly removed from the bloodstream. Sometimes, however,

they continue to circulate and eventually become trapped in the tissues of the kidneys,

lungs, skin, joints, or blood vessels. There, they set off reactions with complement that

lead to inflammation and tissue damage. Immune complexes work their mischief in

many diseases. These include malaria and viral hepatitis, as well as many autoimmune

diseases.

Antigen-antibody complexes can become trapped in, and damage, the

kidneys and other organs.

4) Hypersensitivity type IV (Immune Deficiency Disorders)

It is also known as the delayed type hypersensitivity reaction. When the immune

system is missing one or more of its parts, the result is an immune deficiency disorder.

These disorders can be inherited, acquired through infection, or produced as a side

effect by drugs such as those used to treat people with cancer or those who have

received transplants.
Temporary immune deficiencies can develop in the wake of common virus infections,

including influenza, infectious mononucleosis, and measles. Immune responses can

also be depressed by blood transfusions, surgery, malnutrition, smoking, and stress.

Some children are born with poorly functioning immune systems. Some have flaws in

the B cell system and cannot produce antibodies. Others, whose thymus are either

missing or small and abnormal, lack T cells. Very rarely, infants are born lacking all

of the major immune defenses. This condition is known as severe combined immune

deficiency disease or SCID.

AIDS is an immune deficiency disorder caused by a virus (HIV) that infects

immune cells. HIV can destroy or disable vital T cells, paving the way for a variety of

immunologic shortcomings. The virus also can hide out for long periods in immune

cells. As the immune defenses weaken, a person develops AIDS and falls prey to

unusual, often life-threatening infections and rare cancers.

The AIDS virus takes over the machinery of the

T cells it infects, using the cells to make new
viruses.