Module Convenors: Professor Allan Cripps and Emeritus Professor Jennifer Rolland

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1 Module Code: Module Title: IMM IV Infectious Disease and Tumor Immunology Module Convenors: Professor Allan Cripps and Emeritus Professor Jennifer Rolland Discipline Committee: Professor Allan Cripps Dr Karla Lemmert Emeritus Professor Jennifer Rolland Date Module Outline reviewed: August 28, 2007 Date Module Outline modified: Date Module Outline modified: August 28, 2007 May 17, 2011 Date Module outline modified: December 3, 2013 Page 1

2 A. Objectives This Module addresses the pathophysiology of infectious disease and the technology platforms used in laboratory diagnosis of infection. The module is also designed so that the candidate gains an understanding of the biology of human cancer including the link between infectious agents and some tumors. It is assumed that the candidate undertaking this module has a good grounding in biological science and has successfully completed Module I Principles of Human Immunology. B. Interrelationship of the Module to Other Modules This Module builds on the basic knowledge gained in Modules IMM I and IMM II and develops in further detail how immunity to infection is acquired, expands on the hostparasite relationship, disease processes, role of infection, and evasion of immune surveillance and extends tumour immunology. C. Brief Description This Module addresses the biological basis of infection and cancer. Measures of the immune response in these disease states are examined. Diagnostic procedures which cover most of the platform technologies required to diagnose and monitor diseases are studied and reinforced by specific procedural examples. D. Content 1. Inflammation Acute inflammation o Features of acute inflammation o Factors associated with an acute inflammatory response o Control of acute inflammation Inflammation as a result of immune reactions o Type I (Immediate) hypersensitivity o Type II (Cytotoxic) hypersensitivity o Type III (Immune complex) hypersensitivity o Type IV (Delayed) hypersensitivity Establishment of chronic inflammation The role of cytokines in acute and chronic inflammatory processes Objective: To understand the basis of acute and chronic inflammatory responses 2. Immunity to Viruses Virus infection of the host Candidates are expected to have an understanding of how viruses infect host cells through attachment to specific cell surface receptors. Viral replication within the host The immune response to viruses Candidates should have a conceptual understanding of innate and acquired immune responses to viruses Mechanisms by which viruses can evade host immune defences Page 2

3 The immunopathology of influenza, Human immunodeficiency virus (HIV), hepatitis, measles and Epstein-Barr virus (EBV). Candidates should have specific knowledge of the immunopathology for these 5 viruses as examples of organisms that can cause serious human disease. Candidates should revise sections 1.2 and 1.4 of Module 2 Human Immunodeficiency Disorders related to diagnosis and monitoring of HIV. Objective: To understand the general principles of viral infection, immune responses to viruses and the immunopathology of influenza, HIV, hepatitis, measles and EBV 3. Immunity to Bacteria Bacterial infection of the host Candidates are expected to have an understanding of how both Gram positive and Gram negative bacteria infect the human host. Immune defence mechanisms against bacteria Candidates should revise sections 1.2 and 1.3 and all of sections 2 and 3 of Module 1 Principles of Human Immunology. For the purpose of Module IV candidates will be expected to have significantly expanded their knowledge with respect to both the innate and acquired immune responses to bacteria. o Interaction of bacteria with the inane immune system through pathogen-associated molecular patterns (PAMPs) o Interaction between the innate and acquired immunity o Acquired immunity o Bacterial superantigens o Heat shock proteins and danger signals in response to bacterial infection o Toll receptors The immunopathology of Corynebacterium diphtheria, Clostridium tetuni, Helicobacter pylori, Streptococcus pneumonia, Borrelia bargdorfer and Mycobacterium tuberculosis Candidates should have specific knowledge of the immunopathology of these 6 bacteria as examples of microbes that can cause serious human disease. 4. Immunity to Fungi, Protozoa and Helminths. Candidates should have an understanding of the concepts of immunity and mechanisms of immune evasion to the following organisms as examples of human disease. Fungi - Candida albicans - Aspergillus firmigatus Protozoa - Toxoplasma gondii - Plasmodium falciparum - Giardia lamblia Helminths - Echinococcus granulosus - Echnococcus multilocularis Page 3

4 5. Diagnostic Procedures for Inflammation, Allergy and Infectious Diseases 5.1 Platform technologies Candidates should be technically familiar with an understand the theoretical basis of the following platform technologies: enzyme linked immunosorbent assays, immunoblot analysis, standard serological tests using solid phase support and agglutination, molecular detection such as the polymerase chain reaction (PCR), toxin neutralisation assays, indirect fluorescent antibody assays, complement fixation tests. Candidates need to have specific knowledge of the assays listed in 5.2 and laboratory procedures to diagnose the organisms listed in sections 5.4 and Acute phase proteins such as: o C-reaction protein o Complement components o 1-antitrypsin 5.3 Total IgE and specific IgE antibodies 5.4 Viral infections o Influenza o HIV o Hepatitis o Measles o EBV 5.5 Bacterial infections o Corynebacterium diphtheria o Clostridium tetani o Helicobacter pylori o Streptococcus pneumonia o Borrelia burgdorfer o Mycobacterium tuberculosis 5.6 Fungi, Protozoa and Helminth infection Candidates need only be aware of the general principles of diagnostic procedures for these organisms o Candida albicans o Aspergillus firmigatus o Toxoplasma gondii o Plasmodium falciparum o Giardia lamblia o Echinococcus granulosus o Echnococcus multilocularis 6. Tumor Immunology The genetic basis of cancer Tumors as allografts The immune response to tumors Objective: To understand the biological mechanisms of how solid tumors develop and grow in the host Page 4

5 7. Laboratory diagnostic procedures to detect tumors The following tumor markers are commonly used to diagnose and monitor tumor growth Breast : CA15.3, CA27.29 Prostate: PSA Ovarian : CA-125 Colorectal : CEA Pancreatic : CA19.9 Liver : alphafetoprotein (AFP) Objective: To have specific knowledge of technologies required to detect and monitor tumors and specifically those listed above. 8. Links between microbial infection and cancer. A number of infections have been linked to the development of human cancer. Candidates are expected to be aware of the current associations between: Helicobacter pylori and stomach cancer Human papilloma virus and cervical cancer Epstein Barr Virus and thoracic cancer and malignancies of the immune system and the biological basis of those associations Objective: To understand the mechanisms of how infection may lead to malignancy 9. Immunisation. Principles of immunisation o Active immunisation o Passive immunisation Types of vaccine o Live inactivated o Inactivated (recombinant antigen, viral particle, outer membrane vesicle) o Conjugated subunit o Unconjugated subunit o DNA o anti-idiotypic Adjuvants Routes of immunisation Adverse reactions Immunisation against infectious disease Immunisation against cancer E. Rationale for Content Objective: To understand the immunological basis of immunisation Infections and cancer are leading causes of morbidity and mortality in the world today. The laboratory is core to the diagnosis and monitoring of these diseases. An understanding of the mechanisms which underpin the pathophysiology of infection and the cause and course of tumors is necessary knowledge for today s laboratory scientist. Knowledge of the technologies and their limitations is fundamental to the clinical setting. Page 5

6 F. Examination Under the Fellowship Regulations, a 3-hour written examination will be held at the completion of each Module. Each examination will contain a mixture of short answer questions and essay style questions. In some examinations, clinical and laboratory management case based scenarios will be included in the question mix. Questions will be divided across the topic themes. Examination for this Module will focus on an overall understanding of the immunological basis for the autoimmunity and transplantation, the clinical presentation and diagnosis of each disorder and the respective diagnostic tests and quality assurance for diagnosing and monitoring therapies. The examination will consist of: Two essay questions, each with a total value of 35 marks; suggested time allocation 30 minutes per essay total 60 minutes. Twenty short answer questions, each worth five marks total value for the short answer questions 100 marks; suggested time allocation five minutes per question total 100 minutes. Twenty minutes for re-reading and review There will be an initial reading time of fifteen minutes, during which no writing will be permitted. G. Texts and Supporting Material The following texts all provide an excellent resource for this module. It is suggested that you glance through the texts and select one that appeals to you and you purchase that text. You should, from time to time, consult the other texts in the library to broaden your reading. 1. Elgert KD Immunology: Understanding the immune system (2nd Edn) Wiley & Sons, 2011 ISBN: MRG O'Gorman and Donnenberg AD Handbook of Human Immunology (2nd edn) CRC Press, Florida, 2008 ISBN: Male D, Brostoff J, Roth D and Roitt I Immunology (8 th Edn) Saunders, 2012 ISBN: Detrick B, Hamilton RG, Folds JD, editors Manual of Molecular and Clinical Laboratory Immunology (7 th Edn) ASM Press Washington, 2006 ISBN: Keogan MT, Wallace EM, O Leary P Concise Clinical Immunology for Healthcare Professionals Routledge Press, 2006 ISBN: Kindt TJ, Goldsby RA, Osborne BA Kuby Immunology (6 th Edn) WH Freeman and Company, 2007 ISBN: Page 6

7 H. Appointment of Mentor Each candidate is required to nominate a mentor for the Module at the time of application for entry and into the Fellowship Program. If a candidate is unable to nominate a mentor then the candidate should contact the Module Convenor for assistance. The appointment of a mentor is made by the Examinations Council. I. Module Communications Module Convenors: Professor Allan Cripps Pro-Vice Chancellor (Health) Griffith Health Griffith University Gold Coast campus QLD 4222 Phone Fax allan.cripps@griffith.edu.au and Emeritus Professor Jennifer Rolland Department of Immunology Monash University Level 2, Monash University Building, AMREP Melbourne VIC 3004 Phone jennifer.rolland@monash.edu Discipline Committee: Professor Allan Cripps Dr Karla Lemmert Emeritus Professor Jennifer Rolland J. Candidate Feedback Immediately following notification of the examination result each candidate will be asked to complete a feedback questionnaire on the Module. However, feedback at anytime during the study of the Module is encouraged through the mentor or directly to the Module Convenor. Page 7