Treatment of immunodeficiency tubercles. Union Clinic. Diagnosis and treatment of immunodeficiency conditions. Complications after immunodeficiency

Immunodeficiencies are understood as conditions of a weakened immune system, and therefore people suffering from immunodeficiencies are much more likely to suffer from infectious diseases, while the course of the infection is usually more serious and less treatable compared to healthy people.

Depending on the origin, all immunodeficiencies are usually divided into primary (hereditary) and secondary (acquired).Primary immunodeficiencies

Primary immunodeficiencies are inherited diseases of the immune system. Such genetic defects occur in one child out of 10,000. To date, about 150 such genetic defects have been deciphered, leading to serious disturbances in the functioning of the immune system.

Symptoms of immunodeficiency

The leading manifestation of both primary and secondary immunodeficiencies are chronic infectious diseases. Infections can affect the ENT organs, upper and lower respiratory tract, skin, etc.

Infectious diseases, their manifestations and severity depend on the type of immunodeficiency. As mentioned above, there are about 150 types of primary immunodeficiency and several dozen secondary immunodeficiencies, while some forms have features of the course of the disease; the prognosis of the disease may differ significantly.

Sometimes immunodeficiencies can also contribute to the development of allergic and autoimmune diseases.

Primary immunodeficiencies

Primary immunodeficiencies are hereditary diseases that are transmitted from parents to children. Some forms may manifest themselves at a very early age, others may remain hidden for many years.

Genetic defects that cause primary immunodeficiency conditions can be divided into the following groups:

• humoral immunodeficiencies (lack of production of antibodies or immunoglobulins);
• cellular (usually lymphocytic) immunodeficiencies;
• defects in phagocytosis (capture of bacteria by leukocytes);
• defects in the complement system (proteins that promote the destruction of foreign cells);
• combined immunodeficiencies;
• other immunodeficiencies associated with breakdowns of the main components of the immune system.

Secondary immunodeficiencies

Secondary immunodeficiencies are acquired diseases of the immune system, as well as primary immunodeficiencies associated with weakened immunity and an increased incidence of infectious diseases. Perhaps the best known secondary immunodeficiency is AIDS resulting from HIV infection.

Secondary immunodeficiencies can be associated with infections (HIV, severe purulent infections...), medications (prednisolone, cytostatics), radiation, and some chronic diseases (diabetes mellitus).

That is, any action aimed at weakening our immune system can lead to secondary immunodeficiency. However, the rate of development of immunodeficiency and its inevitability can vary greatly, for example, with HIV infection, the development of immunodeficiency is inevitable, while not all people with diabetes may have an immunodeficiency state even years after the onset of the disease.

Prevention of immunodeficiencies

Due to the hereditary nature of primary immunodeficiencies, there is no prevention for this group of diseases.

Prevention of secondary immunodeficiencies mainly comes down to avoiding HIV infection (protected sex, use of sterile medical instruments, etc.).

Complications of immunodeficiencies

The main complications of both primary and secondary immunodeficiencies are severe infectious diseases: pneumonia, sepsis, abscesses... Taking into account the very large heterogeneity of these diseases, the prognosis and possible complications should be determined individually.

Diagnosis of immunodeficiencies

A prerequisite for identifying immunodeficiency is a chronic (often recurrent) infection. In most cases, the simplest tests can reveal serious damage in the immune system: the total (absolute) number of leukocytes, as well as their subtypes of neutrophils, lymphocytes and monocytes, the level of serum immunoglobulins IgG, IgA , IgM, test for human immunodeficiency virus (HIV).

Much less frequently, there is a need to diagnose more subtle elements of the immune system: phagocytic activity of macrophages, subtypes of B and T lymphocytes (determination of so-called CD markers) and their ability to divide, production of inflammatory factors (cytokines), determination of elements of the complement system, etc. .

Treatment of primary immunodeficiency

Depending on the severity of immunodeficiency and its type, treatment may have its own characteristics.

Important points are to assess the feasibility of using live vaccines, stopping smoking and drinking alcohol, prescribing broad-spectrum antibiotics for bacterial infections or modern antiviral drugs for diseases caused by viruses.

Immunocorrection is possible:

• using bone marrow transplantation (an important organ of the immune system);
• replenishment of individual elements of the immune system, for example, immunoglobulins;

Treatment of secondary immunodeficiency

The treatment of secondary immunodeficiency is based on the following general principles:

• infection control;
• vaccination (if indicated);
• replacement therapy, for example, with immunoglobulins;
• use of immunomodulators.

Immunodeficiency– this is a decrease in the functional activity of the main components of the immune system, leading to a disruption of the body’s defense against microbes, and manifested in increased infectious morbidity.

In the modern world, in a megacity, an immunodeficiency state can develop in any person. The danger of this condition lies in its untimely recognition and treatment, which leads to severe infections, autoimmune diseases and oncological processes.

Immunodeficiency conditions are divided into congenital and acquired or secondary (SID). Basically, we encounter secondary immunodeficiencies, and each of us has experienced this condition at least once in our lives. SID refers to disorders of the immune system that develop in old age and, as is commonly believed, are not the result of any genetic defect.

Forms VIEW

Signs VIEW

Signs of VID by which a doctor or the patient himself may suspect an immunodeficiency state

1. Recurrent virus-bacterial infections, characterized by:

• chronic course;
• incomplete recovery;
• unstable remission;
• unusual pathogens (opportunistic flora, opportunistic infection with reduced virulence, with multiple resistance to antibiotics).

2. Age, presence of blood relatives with primary immunodeficiency;

3. Unusual reactions to live, attenuated vaccines;

4. Upon examination, the patient may be diagnosed with developmental insufficiency or developmental delay, chronic diarrhea, low-grade fever, enlarged or complete absence of lymph nodes of the tonsils, thymus, skin abscesses, dermatitis, mucosal candidiasis, congenital malformation, impaired development of the facial skull, short stature (dwarfism) ), increased fatigue;

5. Iatrogenic interventions: chemotherapy, splenectomy, radiation;

6. Prolonged physical and/or psycho-emotional stress;

7. Allergy;

8. Autoimmune diseases;

9. Tumors.

Objectives of immunological research

• confirm the presence of immunodeficiency;
• determine the severity of violations;
• identify the broken link;
• evaluate the possibilities of selecting an immunocorrector;
• evaluate the prognosis of the effectiveness of immunotherapy.

Immunotherapy

After a full immunostudy, the immunologist prescribes therapy.

Immunotherapy (correction of immunity)- treatment aimed at strengthening weakened immune defenses, correcting imbalances in ongoing immune reactions, weakening pathologically active immune processes and suppressing auto-aggressive immune reactions. Not all types of immune defense are effective against a specific infectious agent, but only some.

It is necessary to stimulate those parts of the immune system that are effective in protecting against a specific infection that the patient has.

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Immunodeficiency - what is it?

Doctors note that patients are increasingly being diagnosed with serious diseases that are difficult to treat. Immune deficiency, or scientifically known as immunodeficiency, is a pathological condition in which the immune system does not work properly. Both adults and children experience the described disorders. What is this condition? How dangerous is it?

Immunodeficiency is characterized by a decrease in activity or the inability of the body to create a protective reaction due to the loss of the cellular or humoral immune component.

This condition can be congenital or acquired. In many cases, IDS (especially if not treated) is irreversible, however, the disease can also have a transitive (temporary) form.

Causes of immunodeficiency in humans

The factors causing IDS have not yet been fully studied. However, scientists are constantly studying this issue to prevent the onset and progression of immunodeficiency.

Immunodeficiency, causes:

The cause can only be identified through a comprehensive hematological diagnosis. First of all, the patient is sent to donate blood to assess cellular immunity indicators. During the analysis, the relative and absolute number of protective cells is calculated.

Immunodeficiency can be primary, secondary and combined. Each disease associated with IDS has a specific and individual severity.

If pathological signs occur, it is important to promptly consult your doctor to receive recommendations for further treatment.

Primary immunodeficiency (PID), features

It is a complex genetic disease that manifests itself in the first few months after birth (40% of cases), in early infancy (up to two years - 30%), in childhood and adolescence (20%), less often - after 20 years (10%).

It should be understood that patients do not suffer from IDS, but from those infectious and concomitant pathologies that the immune system is unable to suppress. In this regard, patients may experience the following:

• Polytopic process. This is multiple damage to tissues and organs. Thus, the patient may simultaneously experience pathological changes, for example, in the skin and urinary system.
• Difficulty in treating a particular disease. The pathology often becomes chronic with frequent relapses (repetitions). Diseases are rapid and progressive.
• High susceptibility to all infections, leading to polyetiology. In other words, one disease can be caused by several pathogens at once.
• The usual therapeutic course does not give the full effect, so the dosage of the drug is selected individually, often in loading doses. However, it is very difficult to cleanse the body of the pathogen, so carriage and a latent course of the disease are often observed.

Primary immunodeficiency is a congenital condition, the beginnings of which were formed in utero. Unfortunately, screening during pregnancy does not detect severe anomalies at the initial stage.

This condition develops under the influence of an external factor. Secondary immunodeficiency is not a genetic disorder; it is first diagnosed with equal frequency in both childhood and adulthood.

Factors causing acquired immunodeficiency:

• deterioration of the ecological environment;
• microwave and ionizing radiation;
• acute or chronic poisoning with chemicals, heavy metals, pesticides, low-quality or expired food;
• long-term treatment with drugs that affect the functioning of the immune system;
• frequent and excessive mental stress, psycho-emotional stress, worries.

The above factors negatively affect immune resistance, therefore, such patients, in comparison with healthy ones, will more often suffer from infectious and oncological pathologies.

Main reasons, which may cause secondary immunodeficiency are listed below.

Errors in nutrition - The human body is very sensitive to a lack of vitamins, minerals, proteins, amino acids, fats, and carbohydrates. These elements are necessary to create a blood cell and maintain its function. In addition, the normal functioning of the immune system requires a lot of energy, which comes with food.

All chronic diseases negatively affect the immune defense, worsening resistance to foreign agents penetrating into the body from the external environment. In the chronic course of infectious pathology, the hematopoietic function is inhibited, therefore the production of young protective cells is significantly reduced.

Adrenal hormones. An excessive increase in hormones inhibits the function of immune resistance. A malfunction occurs when material metabolism is disrupted.

A short-term condition, as a defensive reaction, is observed due to severe surgical procedures or severe injury. For this reason, patients undergoing surgery are susceptible to infectious diseases for several months.

Physiological characteristics of the body:

• prematurity;
• children from 1 year to 5 years;
• pregnancy and lactation period;
• old age

Features in people of these categories are characterized by suppression of immune function. The fact is that the body begins to work intensively in order to bear additional load to perform its function or survive.

Malignant neoplasms. First of all, we are talking about blood cancer - leukemia. With this disease, there is an active production of protective non-functional cells that cannot provide full immunity.

Also a dangerous pathology is damage to the red bone marrow, which is responsible for hematopoiesis and replacement of its structure with a malignant focus or metastases.

Along with this, all other oncological diseases cause a significant blow to the protective function, but disorders appear much later and have less pronounced symptoms.

HIV – human immunodeficiency virus. By suppressing the immune system, it leads to a dangerous disease - AIDS. All the patient's lymph nodes are enlarged, oral ulcers often recur, candidiasis, diarrhea, bronchitis, pneumonia, sinusitis, purulent myositis, and meningitis are diagnosed.

The immunodeficiency virus affects the defense response, so patients die from diseases that a healthy body can hardly resist, and even more so when weakened by HIV infection (tuberculosis, oncology, sepsis, etc.).

Combined immunodeficiency (CID)

It is the most severe and rare disease that is very difficult to cure. CID is a group of hereditary pathologies that lead to complex disorders of immune resistance.

As a rule, changes occur in several types of lymphocytes (for example, T and B), whereas with PID only one type of lymphocyte is affected.

CID manifests itself in early childhood. The child does not gain weight well and is delayed in growth and development. These children are highly susceptible to infections: the first attacks may begin immediately after birth (for example, pneumonia, diarrhea, candidiasis, omphalitis).

As a rule, after recovery, a relapse occurs after a few days or the body is affected by another pathology of a viral, bacterial or fungal nature.

Treatment of primary immunodeficiency

Today, medicine has not yet invented a universal medicine that helps to completely overcome all types of immunodeficiency conditions. However, therapy is proposed aimed at relieving and eliminating negative symptoms, increasing lymphocyte protection and improving quality of life.

This is a complex therapy, selected on an individual basis. The patient's life expectancy, as a rule, depends entirely on the timely and regular use of medications.

Treatment of primary immunodeficiency is achieved by:

• prevention and concomitant therapy of infectious diseases in the early stages;
• improving protection by bone marrow transplantation, immunoglobulin replacement, neutrophil mass transfusion;
• increasing lymphocyte function in the form of cytokine treatment;
  introduction of nucleic acids (gene therapy) in order to prevent or stop the development of a pathological process at the chromosomal level;
• vitamin therapy to support immunity.

If the course of the disease worsens, you should inform your doctor about this.

Treatment of secondary immunodeficiency

As a rule, the aggressiveness of secondary immunodeficiency states is not severe. Treatment is aimed at eliminating the cause of IDS.

Therapeutic focus:

• for infections - elimination of the source of inflammation (with the help of antibacterial and antiviral drugs);
• to increase immune defense - immunostimulants;
• if IDS was caused by a lack of vitamins, then a long course of treatment with vitamins and minerals is prescribed;
• human immunodeficiency virus - treatment consists of highly active antiretroviral therapy;
• for malignant tumors - surgical removal of a focus of atypical structure (if possible), chemotherapy, radiotherapy,
• tomotherapy and other modern methods of treatment.

In addition, if you have diabetes, you should carefully monitor your health: adhere to a low-carbohydrate diet, regularly test your sugar levels at home, take insulin tablets or administer subcutaneous injections in a timely manner.

Treatment of CID

Treatment for primary and combined forms of immunodeficiency is very similar. The most effective treatment method is considered to be a bone marrow transplant (if T-lymphocytes are damaged).

• Today, transplantation is successfully carried out in many countries to help overcome an aggressive genetic disease.

Prognosis: what awaits the patient

The patient must be provided with high-quality medical care in the early stages of the disease. If we are talking about a genetic pathology, then it should be identified as early as possible by taking many tests and undergoing a comprehensive examination.

Children who suffer from PID or CID from birth and do not receive appropriate treatment have a low survival rate to two years.

In case of HIV infection, it is important to regularly test for antibodies to the human immunodeficiency virus in order to control the course of the disease and prevent sudden progression.

According to the World Health Organization, 70% of Russians have reduced immunity. And, as you know, a person with a weakened immune system is extremely sensitive to various infections and has a more difficult time suffering from various diseases. However, in most cases, it is impossible to figure out what the causes are and to cure immunodeficiency without the help of a specialist.

Great health!

Immunodeficiency is a persistent decrease in the function of the immune system and resistance to bacteria and viruses. There are primary immunodeficiencies (congenital) that develop in infancy. Such pathological conditions are extremely rare. It occurs much more often secondary immunodeficiency, which develops against the background of poor ecology, poor nutrition, long-term use of medications, chronic diseases, abuse of alcohol, cigarettes, drugs, constant lack of sleep, severe stress, also affects the development of secondary immunodeficiency, etc.

The immune system also experiences a serious burden in the event of serious diseases (for example, staphylococcus, pneumococcus, herpes, chronic viral hepatitis, rubella, toxoplasmosis). Immunoreactivity is disrupted, increased sensitivity to microbial antigens develops, and intoxication of the body appears. And with a disease such as diabetes, the processes of cell division and differentiation, including cells of the immune system, are disrupted, and due to increased glucose in the blood, harmful bacteria multiply. As a result, susceptibility to harmful pathogens increases significantly, and the patient suffers from constant recurrent infections. Therefore, when serious diseases occur, it is necessary not only to treat the main problem, but also to strengthen the body, otherwise the immune system may develop a “crack,” which subsequently threatens complications.

However, there are diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma) that lead to persistent immunodeficiency, which is very difficult to combat, and treatment sometimes lasts for years.

Diagnosis of immunodeficiencies

In the presence of chronic foci of infection, recurrent diseases and the ineffectiveness of standard methods of therapy, secondary immunodeficiency can be assumed. In such a situation it is necessary diagnosis of immunodeficiencies: You should consult an immunologist who will prescribe tests and tests at two levels. Level 1 tests are approximate and help identify gross defects in the immune system. Level 2 tests are functional and are aimed at identifying a specific “breakdown” in the immune system.

Treatment of immunodeficiency

After diagnosing immunodeficiencies and receiving the results, the doctor will develop tactics treatment of secondary immunodeficiency. If the problem arose due to an unbalanced diet, he will prescribe a specific diet in combination with a complex of vitamins, minerals and dietary supplements containing the necessary components. And if immunodeficiency is a consequence of a chronic disease, then therapy will most likely begin with the treatment of a chronic source of infection.

Immunodeficiency is a condition characterized by a decrease in the function of the immune system and the body's resistance to various infections.

From the point of view of etiology (reasons for the development of the disease), we distinguish between primary and secondary immunodeficiencies.

1. Primary immunodeficiencies is a group of diseases that is characterized by a decrease in the function of the immune system, occurring against the background of various genetic disorders. Primary immunodeficiencies are quite rare, about 1-2 cases per 500,000 people. With primary immunodeficiencies, individual components of immunity may be disrupted: the cellular component, the humoral response, the phagocyte and compliment system. For example, immunodeficiencies with impaired cellular immunity include diseases such as agamaglobulinemia, DiGiorgio syndrome, Wiskott-Aldrich syndrome, and Bruton's disease. Impaired function of micro and macrophages are observed during chronic granulomatosis, Chediak-Higashi syndrome. Immunodeficiencies associated with a violation of the compliment system are based on a deficiency in the synthesis of one of the factors of this system. Primary immunodeficiencies are present throughout life. Patients with primary immunodeficiency, as a rule, die from various infectious complications.
2. Secondary immunodeficiencies are much more common than primary ones. Typically, secondary immunodeficiencies develop against the background of exposure to adverse environmental factors or various infections. As in the case of primary immunodeficiencies, in secondary immunodeficiencies either individual components of the immune system or the entire system as a whole can be disrupted. Most secondary immunodeficiencies (except those caused by infection with the HIV virus) are reversible and respond well to treatment. Below we will consider in more detail the importance of various unfavorable factors in the development of secondary immunodeficiencies, as well as the principles of their diagnosis and treatment.

Causes of development of secondary immunodeficiency
Factors that can cause secondary immunodeficiency are very diverse. Secondary immunodeficiency can be caused by both environmental factors and internal factors of the body.

In general, all unfavorable environmental factors that can disrupt the body's metabolism can cause the development of secondary immunodeficiency. The most common environmental factors that cause immunodeficiency include environmental pollution, ionizing and microwave radiation, poisoning, long-term use of certain medications, chronic stress and fatigue. A common feature of the factors described above is a complex negative impact on all body systems, including the immune system. In addition, factors such as ionizing radiation have a selective inhibitory effect on the immune system associated with inhibition of the hematopoietic system. People living or working in a polluted environment are more likely to suffer from various infectious diseases and more often suffer from cancer. It is obvious that such an increase in morbidity in this category of people is associated with a decrease in the activity of the immune system.

Internal factors that can provoke secondary immunodeficiency include:

Diagnosis of immunodeficiency
Primary immunodeficiency usually appears immediately after the birth of a child or some time after it. To accurately determine the type of pathology, a series of complex immunological and genetic analyzes are carried out - this helps to determine the location of the violation of the immune defense (cellular or humoral link), as well as determine the type of mutation that caused the disease.

Secondary immunodeficiencies can develop at any period of life. Immunodeficiency can be suspected in the case of frequently recurrent infections, the transition of an infectious disease to a chronic form, the ineffectiveness of conventional treatment, or a slight but prolonged increase in body temperature. Various analyzes and tests help to establish an accurate diagnosis of immunodeficiency: a general blood count, determination of blood protein fractions, specific immunological tests.

Treatment of immunodeficiency
Treatment of primary immunodeficiencies is a complex task. To prescribe complex treatment, it is necessary to establish an accurate diagnosis with identification of the impaired link of immune defense. If there is a lack of immunoglobulins, lifelong replacement therapy is carried out with sera containing antibodies or regular donor plasma. Immunostimulating therapy with drugs such as Bronchomunal, Ribomunil, Taktivin is also used.

If infectious complications occur, treatment with antibiotics, antiviral or antifungal drugs is prescribed.

With secondary immunodeficiencies, disorders of the immune system are less pronounced than with primary ones. As a rule, secondary immunodeficiencies are transient. In this regard, the treatment of secondary immunodeficiencies is much simpler and more effective compared to the treatment of primary disorders of the immune system.

Typically, treatment of secondary immunodeficiency begins with identifying and eliminating the cause of its occurrence (see above). For example, treatment of immunodeficiency against the background of chronic infections begins with the sanitation of foci of chronic inflammation.

Immunodeficiency against the background of vitamin and mineral deficiency begins to be treated with the help of complexes of vitamins and minerals and various dietary supplements (dietary supplements) containing these elements. The restorative abilities of the immune system are great, so eliminating the cause of immunodeficiency usually leads to restoration of the immune system.

To speed up recovery and specifically stimulate the immune system, a course of treatment with immunostimulating drugs is carried out. At the moment, a large number of different immunostimulating drugs are known, with different mechanisms of action. The preparations Ribomunil, Christine and Biostim contain antigens of various bacteria and, when introduced into the body, stimulate the production of antibodies and the differentiation of active clones of lymphocytes. Timalin, Taktivin - contain biologically active substances extracted from the thymus gland of animals. Cordyceps is the most effective immunomodulator, normalizing the immune system as a whole. These drugs have a selective stimulating effect on a subpopulation of T lymphocytes. Sodium nucleinate stimulates the synthesis of nucleic acids (DNA and RNA), cell division and differentiation. Various types of interferons increase the body's overall resistance and are successfully used in the treatment of various viral diseases.

Immunomodulatory substances of plant origin deserve special attention: Immunal, rosea Echinacea extract, and especially Cordyceps.

Bibliography:

• Khaitov R.M., Secondary immunodeficiencies: clinical picture, diagnosis, treatment, 1999
• Kirzon S.S. Clinical immunology and allergology, M.: Medicine, 1990
• Modern problems of allergology, immunology and immunopharmacology, M., 2002

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