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134     PART 2: General Management of the Patient
















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                                                   M cell                                 T lymphocyte


                                                                                             Macrophage

                                                                                            Intraepithelial
                                                                                            lymphocyte
                                                              Macrophage
                                                           Lymphocyte   Plasma
                                        Thymus           Dendritic cell  cell              Dendritic
                                        bone marrow
                                                                                            cell
                                                                    Eosinophil
                                                                                           Mast cell
                                       Lymphatics


                                        Mesenteric                         Blood    MALT
                                        lymph node                                  Respiratory tract
                                                                                    Genitourinary tract
                                                                 Systemic           Lactating breast
                                                                 Circulation        Salivary glands
                                                                 (Including spleen)  Lacrimal glands
                                                       Gut lumen

                                                              Antigens







                                                            L

                                                 A            Ma         A

                                                         M


                                                   L  L    L   Ma    Basal membrane
                                                                  L
                                                        D    L  L     L
                                                     L            D
                                                           L
                                                       L             L
                                                             L
                                                                 L
                 FIGURE 20-2.  Pattern of immune response involving CD4 helper T cells.











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