Second-Year Medicine

Block 1: Immunity, Inflammation and Infection

Block Objectives

First two sections of course policy document intended for students.

Course Goals and Subject Matter

Our primary goal in this course is to ensure that you finish with a well rounded, appropriately deep, interdisciplinary understanding of the biological basis and pharmacotherapy of infectious, immune-mediated, inflammatory, and rheumatic disease. This will necessarily entail learning basic principles of several disciplines that had little or no exposure last year: immunology, microbiology, pathology, and pharmacology. The emphasis on pathophysiology of disease, mostly confined to CBL in Year 1, now becomes greater and more pervasive. Consideration of disease in human populations—epidemiology and public health—also increases, especially in relation to infectious disease. There is a brief reappearance of radiologic anatomy, in connection with rheumatic disease. We continually work to integrate the coverage of related disease processes by different disciplines, and to examine your learning using integrative questions.

Scope of the Course

Together with your Year 1 studies of normal structure and function, the fundamental principles of immunology, microbiology, pathology, and pharmacology that you learn in this course form the underpinnings of all of the organ-system courses that come later in the year. We choose to cover specific infectious diseases in this course based on their ability to illustrate basic principles. There will be more coverage of infectious disease, including its microbiology, immune response, treatment, and epidemiology, in the appropriate organ system blocks, especially in the gastrointestinal and respiratory systems. Finally, the course includes the definitive coverage of disease of the skin and musculoskeletal systems appearing in Year 2.

Outline of Course Subject Matter:

Topic outline

Basic principles of infection
1. Relevant biological properties of broad groups of pathogens
  1. General biology of pathogens, with heaviest emphasis on bacteria and viruses
  2. Pathogenic mechanisms
2. Modes of transmission and colonization; epidemiologic patterns; the normal flora
3. Steps in the infectious process; alternative modes of progression and outcomes
4. Involvement of the immune system in infectious disease
  1. For recovery and protection
  2. As a pathophysiological mechanism
Nonspecific and specific host defenses

General physical, chemical, and cellular defenses; nonspecific recognition of pathogens
Antiviral interferon response
Inflammation
Immune response
1. Fundamental principles of Immunology
  1. Lymphoid organs and lymphocyte development
  2. The humoral and cell-mediated responses
  3. Control of the immune response
  4. Effector mechanisms, including complement
  5. Assays of immunity
2. Applications of immunology
  1. Transplantation
  2. Vaccines
3. General (organ-system nonspecific) principles of immunopathology
  1. Hypersensitivity
  2. Autoimmunity
  3. Immunodeficiency

Antimicrobial drug therapeutics of bacterial and viral infections (antifungal, antimycobacterial, and antiparasitic drugs are deferred until relevant organ system blocks)
1. Principles
2. Drug classes
3. Therapy of different types of infections
Paradigmatic examples of bacterial and viral infections
1. Bacterial toxinoses: cholera, diphtheria, botulism, tetanus
2. Mucosal bacterial infection: pertussis, mycoplasmal disease
3. Invasive bacterial infection: group A streptococcal infection; staphylococcal infection; clostridial infection
4. Intracellular bacterial infection: rickettsioses, chlamydial diseases, legionellosis, listeriosis
5. Chronic systemic bacterial infection: spirochetoses
6. Local viral infection: influenza; adenovirus infection
7. Systemic viral infection: poliomyelitis; smallpox, yellow fever;
8. Latent viral infection: herpesviruses and their infections
9. Pediatric viral infections: paramyxoviruses, rubella, etc.
In-depth coverage of selected specific pathogens and the diseases they cause, including the features of specific sub-groups of pathogens. (This is largely a re-statement of section 4, above, in taxonomic terms. Other major pathogens and groups, e.g., Enterobacteriaceae, mycobacteria, systemic fungi, almost all parasites, are deferred until relevant organ-system blocks.)
1. streptococci
2. staphylococci
3. clostridia
4. corynebacteria
5. mycoplasmas
6. rickettsiae
7. chlamydiae
8. spirochetes
9. orthomyxoviruses
10. paramyxoviruses
11. adenoviruses
12. flaviviruses (and arboviruses in general)
13. arenaviruses
14. orthopoxviruses
15. picornaviruses
16. herpesviruses
17. Candida
18. dermatophyte fungi
19. Toxoplasma
20. Leishmania
Special topics in infectious disease
1. a. HIV/AIDS, including virology, pathogenesis, epidemiology, and chemotherapy
2. Bioterrorism, including microbiological and public health aspects
3. Emerging infectious diseases, including the spread of antibiotic resistance
4. Nosocomial infections and hospital infection control
5. Sexually transmitted infections
Fundamental principles of pathology and pharmacology that are needed before coverage of inflammation, infectious pathology, and antimicrobial pharmacology can proceed.
1. general cellular pathology
  1. cell injury, including hypoxia
  2. cell death, including apoptosis and types of necrosis
  3. intracellular and extracellular accumulations (e.g., fat, amyloid)
2. effects of changes in circulation on tissues
  1. ischemia
  2. congestion/edema
  3. hemostasis/thrombosis
3. principles of drug action and metabolism
4. pharmacokinetics
5. drug receptors
The skin and musculoskeletal systems as loci of disease, with special emphasis on rheumatic diseases
1. Epidemiology & natural history
2. Pathophysiology
3. Diagnosis
  1. Physical
  2. Histopathological
  3. Laboratory
  4. Radiological
4. Principles of therapy, including pharmacology of relevant drugs