IMMUNOLOGY TEXTBOOK - Merkury Podillia 2013

ACQUIRED IMMUNODEFICIENCY STATES

Secondary Immunodeficiencies in Childhood

Factors contributing to secondary immunological insufficiency in children include antenatal fetal development abnormalities, such as gestosis in the First and Second halves of Pregnancy, various maternal illnesses (especially During the first trimester), occupational hazards in parents, bad habits (alcohol, nicotine, drugs, toxic substances), and psycho-emotional stress. A clear triggering moment for secondary immunodeficiency is delivery pathology—most frequently premature births with A large number of contributory factors, placental abruption during labor, pharmacological pain relief, postpartum Hemorrhage, genital infections, etc. The vast majority of children with acquired immunodeficiencies exhibit signs and symptoms of perinatal Brain injury, manifested by Apgar score deviations and neurological symptoms, along with frequent pustular Skin conditions, gastrointestinal dysfunctions, and respiratory disorders during the neonatal period. The frequency of the latter clinical symptoms correlates with artificial and early mixed feeding. Intrauterine infections also contribute to The Development of immunodeficiency disorders in children. In early childhood, immune system deficiency leads to an increased susceptibility to food allergies, unusual reactions to vaccination and medications. For a certain period, such a child remains clinically healthy, while the underlying secondary immunodeficiency is masked by various atypical symptom complexes.

Children requiring immunological evaluation for secondary immunodeficiencies should be prioritized primarily from the group of frequently and chronically ill patients. For instance, severe purulent-septic infections, particularly clinical Sepsis, are accompanied by combined immunological insufficiency in children.

Secondary immunodeficiencies in children may manifest clinically as any infection, such as Pneumonia resistant to conventional therapy, or chronic foci of infection. A typical clinical mask of secondary immunodeficiency is prolonged subfebrile Temperature when its cause cannot be identified clinically or through Laboratory tests. In secondary immunodeficiencies affecting the T-Cell lymphocyte system, the clinical equivalent may include recurrent fungal infections of the mucous membranes of the respiratory tract, gastrointestinal tract, Urinary Tract, as well as cutaneous candidiasis. Lymphadenopathy that is not a symptom of a specific nosology may also serve as a manifestation of immunodeficiency and a clinical indication for an immunological examination.

Persistent changes in peripheral Blood—such as lymphopenia, neutropenia, thrombocytopenia, and hypogammaglobulinemia lasting long after recovery—indicate the presence of secondary immunodeficiency and require immunotherapy and immunorehabilitation.

Immune system deficits can occur at any level of the Immune Response, presenting as isolated to a single component or function, combined, or multi-component.

Immune disorders in secondary immunodeficiencies in children can vary significantly:

a) increased activity of non-specific and specific suppressor Cells, which may manifest as suppressed Functions of T- and B-lymphocytes (demonstrating a statistically significant decrease compared to the norm);

b) hyperstimulation of one or more populations of T- and B-lymphocytes, as well as neutrophils bearing various receptors (regarding neutrophils, a variant of secondary immunodeficiency may involve a decrease in the count or function of one or several of their subpopulations);

c) dysimmunoglobulinemia with a predominant decrease or increase in one, several, or all classes;

d) alterations in the functional state of peripheral blood neutrophils, characterized by a dissociation between engulfment and Digestion processes, leading to incomplete phagocytosis against the Background of increased cellular metabolic activity;

e) disorders within the cytokine system.

The clinical manifestations of secondary immunodeficiencies in children can also be diverse, yet they are typically characterized by the following infectious syndromes:

1. Recurrent acute respiratory viral infections.

2. Bacterial and fungal infections of the mucous membranes and skin.

3. Pneumonia and Bronchitis of bacterial Etiology.

4. Diseases resistant to conventional antibacterial therapy.

5. Adverse reactions to drug administration and Vaccines.

6. Prolonged subfebrile temperature and fever of unknown origin.

7. Chronic foci of infection accompanied by intoxication and impaired neuropsychological and physical development.

8. Recurrent pustular skin diseases, history of sepsis.

9. Lymphadenopathy, hepatosplenomegaly.

10. Thymus hyperplasia syndrome.

11. Thymic-lymphatic syndrome.

12. Chronic diarrhea.

13. Perinatal Nervous system injuries complicated by infection.

14. Conditions following intrauterine infection.

15. Hypotrophy refractory to standard therapy, accompanied by infection.

16. Modulation of peripheral blood parameters against the background of clinical health, dysproteinemia.

17. Purulent-septic diseases.

18. Infectious rhinitis, pharyngitis, tonsillitis, post-tonsillectomy syndrome.

Principles of Treatment of secondary immunodeficiencies. Stages of treatment and immunorehabilitation of patients with secondary immunodeficiencies:

1. Elimination of the etiological factor.

2. Antimicrobial therapy.

3. Replacement immunotherapy.

4. Prevention of infection.

5. Immunocorrective therapy.

6. Anti-relapse immunocorrection and immunorehabilitation.

The treatment of secondary immunodeficiencies is guided by relevant protocols.