How the protection works and what breaks in it
The immune system consists of several levels: skin and mucosal barriers, phagocyte cells, complement system, T-lymphocytes and B-lymphocytes that produce antibodies. The breakdown of each link gives its own picture. With antibody deficiency, repeated bacterial infections of the respiratory tract and ears predominate; if the functioning of T-lymphocytes is disrupted, fungal and viral infections that are resistant to treatment; with defects of phagocytes - ulcers and abscesses. That is why the doctor focuses on the type of infections, and not just their number.
- Antibody deficiency - repeated otitis, sinusitis, pneumonia
- Cellular defects - fungal and viral infections
- Phagocytosis defects - abscesses and purulent lesions
- Complement deficiency - severe meningococcal infections
- Combined forms are the most severe and appear in infancy
Primary and secondary forms
Primary immunodeficiencies are caused by genetic defects; Several hundred forms are already known, from severe, noticeable in the first months of life, to mild, detected in adults. The most common of them is common variable immune deficiency, in which immunoglobulins are reduced and repeated bronchitis and pneumonia occur. Secondary immunodeficiencies develop in initially healthy people as a result of illness or treatment and are usually reversible if the cause is eliminated. HIV infection deserves special mention, in which treatment can restore protection.
- Primary - congenital genetic defects
- Secondary - HIV, chemotherapy, hormones, cytostatics
- Immunodeficiency in diabetes and chronic kidney disease
- Reduced protection in severe malnutrition and alcoholism
- Condition after removal of the spleen
- Immunosuppression after organ transplantation
Warning signs
There are generally accepted guidelines by which a doctor suspects primary immunodeficiency. The following are alarming: repeated severe bacterial infections, lesions in unusual locations, the need for long courses of intravenous antibiotics, lack of effect from standard treatment, and in children - retardation in weight and height. An additional clue is family history: severe infections and early deaths of children in relatives. Frequent mild acute respiratory viral infections in a child attending kindergarten in themselves do not belong to these signs.
- Repeated pneumonia, otitis, sinusitis
- Deep abscesses of the skin and organs
- Persistent thrush and fungal infections
- Need for intravenous antibiotics
- Poor weight and height gain in a child
- Chronic diarrhea
- Family history
What tests are really needed?
The examination proceeds in stages and begins with a simple one. A general blood test with a leukocyte formula already shows a lot: persistently low lymphocytes or neutrophils are an important signal. The levels of immunoglobulins A, G and M are then determined, which allows us to identify the most common forms. HIV testing is recommended for all patients with repeated severe infections. An in-depth study - lymphocyte subpopulations, response to vaccines, genetic tests - is prescribed by an immunologist. Broad “immunograms” without indications are not informative.
- General blood test with formula
- Immunoglobulins A, G, M
- HIV test
- Blood glucose, protein, biochemistry
- Subpopulations of lymphocytes as prescribed by an immunologist
- Assessment of post-vaccination antibodies
- Genetic research if the primary form is suspected
Treatment and prevention of infections
Treatment depends on the form. With secondary immunodeficiencies, the main thing is to eliminate the cause: start antiretroviral therapy, adjust sugar levels, stop or reduce the dose of immunosuppressive drugs, and improve nutrition. In case of antibody deficiency, regular administration of immunoglobulins is used, which significantly reduces the incidence of severe infections. Selected patients are prescribed prophylactic antibiotics or antifungals. Vaccination is important, but live vaccines are contraindicated in some forms, so the vaccination plan is drawn up by a doctor.
- Treatment of the underlying disease
- Immunoglobulin replacement therapy
- Preventive antimicrobial drugs as prescribed by a doctor
- Vaccination taking into account the form of immunodeficiency
- Timely treatment of any infection
- Hygiene, smoking cessation, good nutrition
- Bone marrow transplantation for severe congenital forms