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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Immunology
|MainCategory=Immunology
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|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|Prompt=A 24 year old male patient, with no past medical history, presents to the emergency department (ED) complaining of abdominal pain and watery diarrhea of several days duration. The patient is found to have amebic cysts on stool analysis. Which of the following cytokines is most likely activated in this patient's condition?
|Prompt=A 24-year-old man, with no significant past medical history, presents to the emergency department (ED) with complaints of abdominal pain and bloody diarrhea of several days duration. The patient is found to have amoebic cysts on stool analysis. Which of the following cytokines is most likely elevated in this patient?
|Explanation=The patient is presenting with a parasitic infection. In this case, the patient is expected to have eosinophilia due to the main role eosinophils play in parasitic infections with the use of major basic protein and peroxidase. Eosinophils are induced to grow and to differentiate by specific cytokines, namely interleukin  (IL)-5. Other cytokines play different pro-inflammatory roles, such as IL-8 in neutrophil chemotaxis and IL-4 in differentiation into Th2 cells, whereas others have anti-inflammatory roles, such as IL-10 and TGF-beta that are secreted by Treg cells.
|Explanation=Amoebic cysts in a patient with bloody diarrhea and abdominal pain is diagnostic of amoebic dysentery. Amebic dysentery is most common among travelers to developing countries and may be confused with traveler's diarrhea (although it is usually more severe). Intestinal amoebiasis is a parasitic infection, and eosinophilia is one of the classical signs observed among infected patients. Eosinophils play a major role in controlling parasitic infections by producing major basic protein and peroxidase. Eosinophils are induced to grow and to differentiate by specific cytokines, namely interleukin  (IL)-5. Other cytokines play different pro-inflammatory roles, such as IL-8 in neutrophil chemotaxis and IL-4 in differentiation into Th2 cells, whereas others have anti-inflammatory roles, such as IL-10 and TGF-beta that are secreted by Treg cells.
 
|AnswerA=IL-8
|AnswerA=IL-8
|AnswerAExp=IL-8 is a chemotactic factor for neutrophils.
|AnswerAExp=IL-8 is a chemotactic factor for neutrophils.
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|AnswerEExp=IL-10 is secreted by Treg cells and is activated in inhibit inflammation.
|AnswerEExp=IL-10 is secreted by Treg cells and is activated in inhibit inflammation.
|EducationalObjectives=IL-5 is activated in parasitic infections to enhance growth and differentiation of eosinophils.
|EducationalObjectives=IL-5 is activated in parasitic infections to enhance growth and differentiation of eosinophils.
|References=First Aid 2015 page 207
|References=Takatsu K, Nakajima H. IL-5 and eosinophilia. Curr Opin Immunol. 2008;20(3):288-94.<br>
First Aid 2015 page 207
|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Eosinophil, Eosinophilia, Eosinophils, Major basic protein, Peroxidase, Amoebiasis, Amebiasis, Entamoeba histolytica, Gastroenteritis, Parasitic, Interleukin, Interleukin 5, IL-5, IL5
|WBRKeyword=Eosinophil, Eosinophilia, Eosinophils, Major basic protein, Peroxidase, Amoebiasis, Amebiasis, Entamoeba histolytica, Gastroenteritis, Parasitic, Interleukin, Interleukin 5, IL-5, IL5
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 21:42, 15 August 2015

 
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Immunology
Sub Category SubCategory::Infectious Disease
Prompt [[Prompt::A 24-year-old man, with no significant past medical history, presents to the emergency department (ED) with complaints of abdominal pain and bloody diarrhea of several days duration. The patient is found to have amoebic cysts on stool analysis. Which of the following cytokines is most likely elevated in this patient?]]
Answer A AnswerA::IL-8
Answer A Explanation AnswerAExp::IL-8 is a chemotactic factor for neutrophils.
Answer B AnswerB::IL-2
Answer B Explanation AnswerBExp::IL-2 stimulates growth of helper, cytotoxic, and regulatory T cells.
Answer C AnswerC::IL-4
Answer C Explanation AnswerCExp::IL-4 induces differentiation into Th2 cells and growth of B cells. It also enhances class switching into IgE
Answer D AnswerD::IL-5
Answer D Explanation AnswerDExp::IL-5 is activated to promote differentiation of B cells. It allows class switching into IgA and allows growth and differentiation of eosinophils.
Answer E AnswerE::IL-10
Answer E Explanation AnswerEExp::IL-10 is secreted by Treg cells and is activated in inhibit inflammation.
Right Answer RightAnswer::D
Explanation [[Explanation::Amoebic cysts in a patient with bloody diarrhea and abdominal pain is diagnostic of amoebic dysentery. Amebic dysentery is most common among travelers to developing countries and may be confused with traveler's diarrhea (although it is usually more severe). Intestinal amoebiasis is a parasitic infection, and eosinophilia is one of the classical signs observed among infected patients. Eosinophils play a major role in controlling parasitic infections by producing major basic protein and peroxidase. Eosinophils are induced to grow and to differentiate by specific cytokines, namely interleukin (IL)-5. Other cytokines play different pro-inflammatory roles, such as IL-8 in neutrophil chemotaxis and IL-4 in differentiation into Th2 cells, whereas others have anti-inflammatory roles, such as IL-10 and TGF-beta that are secreted by Treg cells.

Educational Objective: IL-5 is activated in parasitic infections to enhance growth and differentiation of eosinophils.
References: Takatsu K, Nakajima H. IL-5 and eosinophilia. Curr Opin Immunol. 2008;20(3):288-94.
First Aid 2015 page 207]]

Approved Approved::Yes
Keyword WBRKeyword::Eosinophil, WBRKeyword::Eosinophilia, WBRKeyword::Eosinophils, WBRKeyword::Major basic protein, WBRKeyword::Peroxidase, WBRKeyword::Amoebiasis, WBRKeyword::Amebiasis, WBRKeyword::Entamoeba histolytica, WBRKeyword::Gastroenteritis, WBRKeyword::Parasitic, WBRKeyword::Interleukin, WBRKeyword::Interleukin 5, WBRKeyword::IL-5, WBRKeyword::IL5
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