Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Monocytes, Macrophages, and Dendritic Cells

Mononuclear phagocytes (monocytes, macrophages) are distributed across all body tissues and play a central role in maintaining immunologic and metabolic homeostasis. They are essential for innate host defense against infection, tissue repair and remodeling, and the antigen-specific adaptive immune response. No human has been identified as having congenital absence of this cell line, probably because macrophages are required to remove primitive tissues during fetal development as…

Neutrophils

The Phagocytic Inflammatory Response The phagocyte system includes both granulocytes (neutrophils, eosinophils, and basophils) and mononuclear phagocytes (monocytes and tissue macrophages). Neutrophils and mononuclear phagocytes share primary functions, including the defining properties of large-particle ingestion and microbial killing. Phagocytes participate primarily in the innate immune response but also help initiate acquired immunity. Mononuclear phagocytes, including tissue macrophages and circulating monocytes, are discussed in Chapter 154 .…

Immunodeficiencies Affecting Multiple Cell Types

The manifestations of immune deficiencies that affect multiple cell types range from profound to mild; these conditions can present with severe infection, recurrent infections, unusual infections, or autoimmunity. The most profound disorder is severe combined immunodeficiency. Other combined immunodeficiencies include defects of innate immunity and defects leading to immune dysregulation; the latter category is typically associated with profound autoimmunity. Combined immunodeficiencies are characterized by a predisposition…

Primary Defects of Cellular Immunity

Defects in cellular immunity, historically referred to T-cell defects, comprise a large number of distinct immune deficiencies. The manifestations usually include prolonged viral infections, opportunistic fungal or mycobacterial infections, and a predisposition to autoimmunity. To facilitate conceptualization of this large and complex category, this chapter describes immunodeficiencies where the defect primarily affects T cells and those where the defect alters function of many cell types. Chapter…

Primary Defects of Antibody Production

Of the primary immunodeficiency diseases, those affecting antibody production are the most prevalent. Selective absence of IgA is the most common defect, with rates ranging from 1 in 333 to 1 in 18,000 persons among different races and ethnicities. Patients with antibody deficiency are usually recognized because they have recurrent infections with encapsulated bacteria, predominantly in the upper and lower respiratory tracts. Some individuals with selective…

Lymphocyte Development and Function

Defense against infectious agents is secured through a combination of anatomic physical barriers, including the skin, mucous membranes, mucous blanket, and ciliated epithelial cells, and the components of the immune system. The immune system of vertebrates integrates 2 fundamental response mechanisms. Innate (natural) immunity is rapid and utilizes receptors encoded in the germline. The innate defenses comprise cell-intrinsic responses to viral infections, leukocyte responses to pathogens,…

Evaluation of Suspected Immunodeficiency

Primary care physicians must have a high index of suspicion to diagnose immune system defects early enough to institute appropriate treatment before irreversible damage develops. Diagnosis can be difficult because most affected patients do not have abnormal physical features. The most typical manifestation of immunodeficiency in children is recurrent sinopulmonary infections. Although infections are common in children in general, an infection exceeding the expected frequency and…

Chronic Overlapping Pain Conditions

This chapter was made possible with the support of an Advancing Healthier Wisconsin 5520298 grant. In chronic overlapping pain conditions ( COPCs ), several painful symptoms affecting different body systems coexist without clear underlying pathophysiology. Other terms for COPCs include medically unexplained symptoms , functional somatic syndromes (FSS), and central sensitivity syndromes . These disorders are probably highly prevalent; for example, 2 COPCs, irritable bowel syndrome…

Sexually Transmitted Infections

Age-specific rates of many sexually transmitted infections ( STIs ) are highest among sexually experienced adolescents and young adults, after controlling for sexual activity. Although some STI pathogens present as STI syndromes with a specific constellation of symptoms, most are asymptomatic and only detected by a laboratory test. The approach to prevention and control of these infections lies in education, screening, and early diagnosis and treatment.…

Adolescent Sexual Assault

Sexual assault is an act of violence that may or may not involve rape. Rape, also an act of violence, is not an act of sex. Rape is historically defined as coercive sexual intercourse involving physical force or psychological manipulation of a female or a male. Recognizing that sexual intercourse is not a requirement for the definition, the U.S. Department of Justice (DOJ) defines rape as…

Adolescent Pregnancy

Epidemiology There has been a trend of decreasing teen births and pregnancies since 1991 ( Figs. 144.1 and 144.2 ). Teen birthrates in the United States are at a historic low secondary to increased use of contraception at first intercourse and use of dual methods of condoms and hormonal contraception among sexually active teenagers. Despite these data, the United States continues to lead other industrialized countries…

Contraception

The untoward consequences of sexual activity, including unintended pregnancy (see Chapter 144 ) and sexually transmitted infections (STIs; Chapter 146 ), are experienced by adolescents at unacceptably high rates. Adolescents often do not seek reproductive healthcare until 6-12 mo after initiating sex; many will become pregnant and/or acquire an STI during this interval. Early and appropriate counseling and educational interventions with adolescents, including direct discussion of unwanted…

Menstrual Problems

See also Chapter 565 . Menstrual disturbances, including delayed onset, irregularity, heavy flow, and pain, occur in 75% of females during adolescence. Menstrual problems vary in presentation. For adolescents with minor variations from normal ( Table 142.1 ), an explanation of symptoms and reassurance may be all that is needed. Severe dysmenorrhea or prolonged menstrual bleeding can be not only frightening, but a cause of persistent…

Substance Abuse

Although varying in percentages by nation and culture, a substantial proportion of adolescents will engage in the use of a wide range of substances, including alcohol, tobacco, natural and synthetic marijuana, opiates, and stimulants. Their reactions to and the consequences of these exposures are influenced by a complex interaction among biologic and psychosocial development, environmental messages, legality, and societal attitudes. The potential for adverse outcomes even…

Violent Behavior

Violence is recognized by the World Health Organization (WHO) as a leading worldwide public health problem. WHO defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychologic harm, maldevelopment or deprivation” (see Chapter 14 ). Youths may…

Delivery of Healthcare to Adolescents

Healthcare providers play an important role in nurturing healthy behaviors among adolescents, because the leading causes of death and disability among adolescents are preventable. Adolescence provides a unique opportunity to prevent or modify health conditions arising from behaviors that develop in the 2nd decade of life and that can lead to substantial morbidity and mortality, such as trauma, cardiovascular and pulmonary disease, type 2 diabetes, reproductive…

Transgender Care

Transgender individuals have a gender identity that differs significantly from the sex they were assigned at birth (see Chapter 133 ). They may experience gender dysphoria , defined as clinically significant distress or impairment in social, school/occupational, or other important areas of functioning associated with incongruence between one's experienced/expressed gender and assigned gender, for at least 6 mo in duration. Gender-affirming care has been shown to alleviate…