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proLékaře.cz / Journals / Internal Medicine / 2019 - 2

Secondary immunodeficiency as a consequence of chronic diseases

Czech version

Authors: Zita Chovancová
Authors‘ workplace: Ústav klinické imunologie a alergologie LF MU a FN u sv. Anny v Brně
Published in: Vnitř Lék 2019; 65(2): 117-124
Category:

Overview

Secondary immunodeficiencies (SID) represents heterogeneous group of acquired impairment of immune system function with diverse etiology. It is mostly a combined disorder of both humoral and cellular component of the innate and adaptive immune response. SID occurs mainly in adulthood. Among the most important causes of SID development belong diabetes mellitus, impairment of liver and kidney functions, protein-energy malnutrition, splenic defects and immunosenescence. These deficiencies of immunity are clinically manifested by an increased frequency or unusual complications of common infections and occasionally by the occurrence of opportunistic infections. Diagnostic procedure is based on blood count and differential leukocyte count, biochemical examination, including determination of total protein and albumin concentrations, and biochemical urine analysis to eliminate protein losses. If clinically significant secondary defect of the immune system is suspected, immunological examination is indicated. Patients with clinical symptoms of SID can be treated with prophylactic antibiotic therapy, vaccination, substitution immunoglobulin therapy, or by immune system modifiers.

Keywords:

hyposplenism – immunosenescence – malnutrition – renal function impairment – secondary immunodeficiency

Sources

  1. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999; 26(3–4): 259–265. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1574–695X.1999.tb01397.x>.

  2. Hostetter MK. Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes 1990; 39(3): 271–275.

  3. Geerlings SE, Brouwer EC, Gaastra W et al. Effect of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals. J Med Microbiol 1999; 48(6): 535–539. Dostupné z DOI: <http://dx.doi.org/10.1099/00222615–48–6–535>.

  4. Uko G, Christiansen FT, Dawkins RL et al. Low serum C4 concentrations in insulin dependent diabetes mellitus. Br Med J (Clin Res Ed) 1983; 286(6379): 1748–1749.

  5. Maisonneuve P, Agodoa L, Gellert R et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999; 354(9173): 93–99.

  6. Betjes MG, Langerak AW, van der Spek A et al. Premature aging of circulating T cells in patients with end-stage renal disease. Kidney Int 2011; 80(2): 208–217. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.2011.110>.

  7. Girndt M, Ulrich C, Kaul H et al. Uremia-associated immune defect: the IL-10-CRP axis. Kidney Int Suppl 2003; (84): S76-S79. Dostupné z DOI: <http://dx.doi.org/10.1046/j.1523–1755.63.s84.14.x>.

  8. Kim JU, Kim M, Kim S et al. Dendritic Cell Dysfunction in Patients with End-stage Renal Disease. Immune Netw 2017; 17(3): 152–162. Dostupné z DOI: <http://dx.doi.org/10.4110/in.2017.17.3.152>.

  9. Racanelli V, Rehermann B. The liver as an immunological organ. Hepatology 2006; 43(2 Suppl 1): S54-S62. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.21060>.

  10. Robinson MW, Harmon C, O‘Farrelly C. Liver immunology and its role in inflammation and homeostasis. Cell Mol Immunol 2016; 13(3): 267–276. Dostupné z DOI: <http://dx.doi.org/10.1038/cmi.2016.3>.

  11. Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014; 61(6): 1385–1396. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2014.08.010>.

  12. Girón JA, Alvarez-Mon M, Menéndez-Caro JL et al. Increased spontaneous and lymphokine-conditioned IgA and IgG synthesis by B cells from alcoholic cirrhotic patients. Hepatology 1992; 16(3): 664–670.

  13. Snyder S, John JS. Workup for proteinuria. Prim Care 2014; 41(4): 719–735. Dostupné z DOI: <http://dx.doi.org/10.1016/j.pop.2014.08.010>.

  14. Umar SB, DiBaise JK. Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol 2010; 105(1): 43–49, quiz 50. Dostupné z DOI: <http://dx.doi.org/10.1038/ajg.2009.561>.

  15. Takeda H, Ishihama K, Fukui T et al. Significance of rapid turnover proteins in protein-losing gastroenteropathy. Hepatogastroenterology 2003; 50(54): 1963–1965.

  16. William BM, Corazza GR. Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology 2007; 12(1): 1–13.

  17. Siebert A, Gensicka-Kowalewska M, Cholewinski G et al. Tuftsin – Properties and Analogs. Curr Med Chem 2017; 24(34): 3711–3727. Dostupné z DOI: <http://dx.doi.org/10.2174/0929867324666170725140826>.

  18. Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol 2010; 125(2 Suppl 2): S195-S203. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jaci.2009.08.040>.

  19. King H, Shumacker HB. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 1952; 136(2): 239–242.

  20. Price VE, Dutta S, Blanchette VS et al. The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: practice considerations at the Hospital for Sick Children, Toronto. Pediatr Blood Cancer 2006; 46(5): 597–603. Dostupné z DOI: <http://dx.doi.org/10.1002/pbc.20477>.

  21. Rubin LG, Levin MJ, Ljungman P et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58(3): 309–318. Dostupné z DOI: <http://dx.doi.org/10.1093/cid/cit816>. Erratum in Clin Infect Dis 2014; 59(1): 144.

  22. Kim HS, Kriegel G, Aronson MD. Improving the preventive care of asplenic patients. Am J Med 2012; 125(5): 454–456. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2011.11.009>.

  23. Arnott A, Jones P, Franklin LJ et al. A registry for patients with asplenia/hyposplenism reduces the risk of infections with encapsulated organisms. Clin Infect Dis 2018; 67(4): 557–561. Dostupné z DOI: <http://dx.doi.org/10.1093/cid/ciy141>.

  24. Guyonnet S, Rolland Y. Screening for Malnutrition in Older People. Clin Geriatr Med 2015; 31(3): 429–437. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cger.2015.04.009>.

  25. Rytter MJ, Kolte L, Briend A et al. The immune system in children with malnutrition – a systematic review. PLoS One 2014; 9(8): e105017. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0105017>.

  26. Lesourd B. Nutritional factors and immunological ageing. Proc Nutr Soc 2006; 65(3): 319–325.

  27. Ahluwalia N, Mastro AM, Ball R et al. Cytokine production by stimulated mononuclear cells did not change with aging in apparently healthy, well-nourished women. Mech Ageing Dev 2001; 122(12): 1269–1279.

  28. Dewan SK, Zheng SB, Xia SJ et al. Senescent remodeling of the immune system and its contribution to the predisposition of the elderly to infections. Chin Med J (Engl) 2012; 125(18): 3325–3331.

  29. Wasserman M, Levinstein M, Keller E et al. Utility of fever, white blood cells, and differential count in predicting bacterial infections in the elderly. J Am Geriatr Soc 1989; 37(6): 537–543.

  30. Norman DC. Clinical Features of Infection in Older Adults. Clin Geriatr Med 2016; 32(3): 433–441. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cger.2016.02.005>.

  31. Gomez CR, Nomellini V, Faunce DE et al. Innate immunity and aging. Exp Gerontol 2008; 43(8): 718–728. Dostupné z DOI: <http://dx.doi.org/10.1016/j.exger.2008.05.016>.

  32. Rink L, Cakman I, Kirchner H. Altered cytokine production in the elderly. Mech Ageing Dev 1998; 102(2–3): 199–209.

  33. Goronzy JJ, Li G, Yu M et al. Signaling pathways in aged T cells – a reflection of T cell differentiation, cell senescence and host environment. Semin Immunol 2012; 24(5): 365–372. Dostupné z DOI: <http://dx.doi.org/10.1016/j.smim.2012.04.003>.

  34. Saule P, Trauet J, Dutriez V et al. Accumulation of memory T cells from childhood to old age: central and effector memory cells in CD4(+) versus effector memory and terminally differentiated memory cells in CD8(+) compartment. Mech Ageing Dev 2006; 127(3): 274–281. Dostupné z DOI: <http://dx.doi.org/10.1016/j.mad.2005.11.001>.

  35. Maijó M, Clements SJ, Ivory K et al. Nutrition, diet and immunosenescence. Mech Ageing Dev 2014; 136–137: 116–128. Dostupné z DOI: <http://dx.doi.org/10.1016/j.mad.2013.12.003>.

  36. Dunn-Walters DK. The ageing human B cell repertoire: a failure of selection? Clin Exp Immunol 2016; 183(1): 50–56. Dostupné z DOI: <http://dx.doi.org/10.1111/cei.12700>.

  37. Nikolich-Zugich J. Ageing and life-long maintenance of T-cell subsets in the face of latent persistent infections. Nat Rev Immunol 2008; 8(7): 512–522. Dostupné z DOI: <http://dx.doi.org/10.1038/nri2318>.

  38. Arreaza EE, Gibbons JJ, Siskind GW et al. Lower antibody response to tetanus toxoid associated with higher auto-anti-idiotypic antibody in old compared with young humans. Clin Exp Immunol 1993; 92(1): 169–173.

  39. Weksler ME. Immune senescence: deficiency or dysregulation. Nutr Rev 1995; 53(4 Pt 2): S3-S7.

  40. Mazari L, Lesourd BM. Nutritional influences on immune response in healthy aged persons. Mech Ageing Dev 1998; 104(1): 25–40.

  41. Hakim FT, Gress RE. Immunosenescence: deficits in adaptive immunity in the elderly. Tissue Antigens 2007; 70(3): 179–189. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1399–0039.2007.00891.x>.

  42. Pollizzi KN, Powell JD. Integrating canonical and metabolic signalling programmes in the regulation of T cell responses. Nat Rev Immunol 2014; 14(7): 435–446. Dostupné z DOI: <http://dx.doi.org/10.1038/nri3701>.

  43. Yaqoob P. Ageing alters the impact of nutrition on immune function. Proc Nutr Soc 2017; 76(3): 347–351. Dostupné z DOI: <http://dx.doi.org/10.1017/S0029665116000781>.

  44. Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011; 378(9785): 86–97. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)61493–6>.

  45. Brigden ML. Detection, education and management of the asplenic or hyposplenic patient. Am Fam Physician 2001; 63(3): 499–506, 508.

Labels
Diabetology Endocrinology Internal medicine
Defensive and damaging inflammation: basic characteristics
IL-1 family cytokines in chronic inflammatory disorders
Heterogeneity of lymphocytes as central operating units of the immune system
Microbiota, immunity and immunologically-mediated diseases
Primary immunodeficiencies in adults
Treatment of antibody immunodeficiency
Adverse effects of immunoglobulin therapy
Current trends in immunosuppressive treatment
The role of allergology in internal medicine today and vice versa
Anaphylactic symptoms and anaphylactic shock
Article was published in

Internal Medicine

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2019 Issue 2
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