Do you often suffer from sinusitis, pneumonia? It could be immunodeficiency – explained what it is

When can immunodeficiency be suspected, how does it manifest itself? What to do in case of suspicion? Where to apply? Prof. allergists-clinical immunologists of VUL Santaras clinics told about it. Laura Malinauskiene and dr. Kotryna in Linauskiene.

You can find the full recording of the interview on the Facebook account of VUL Santaras clinics, as well as on the YouTube channel. Portal 15 minutes provides a summary of the broadcast.

What is immunodeficiency?

According to Professor L. Malinauskienė, it is important to understand that the immune system is made up of many components: “You can imagine it as a house made of bricks – these are the components. If one brick falls, the house does not collapse. But if many bricks fall out, then a hole appears. In terms of health, this means that a person begins to suffer from infectious diseases, which may be unusual or common, but by no means insurmountable – the person does not recover from the disease in any way, because the immune system tries to work, and when it works, it can lead to many mistakes. These can be autoimmune diseases – when the body starts to damage itself. There may also be malignant diseases. In other words, the diseases that can occur due to a disorder of the immune system are very diverse. And because of this, they are not easy to diagnose if the cause is a defect in the immune system.

Also participating in the live broadcast was Dr. K. Linauskienė noticed that people often confuse the terms “weak immunity” and “immunodeficiency”. It is not the same.

“If we talk about primary immunodeficiency, it is a congenital thing. Therefore, such people often suffer from colds, and these are not simple infections for them – they often need antibiotics, one, another, and finally even hospital treatment,” said Dr. K. Linauskienė.

Secondary or acquired immunodeficiency is a consequence of various diseases, such as hematological ones. It can also occur when the patient has had “targeted therapy”. This type of treatment is currently gaining popularity in medicine. It helps to overcome various diseases that were previously difficult to treat, unfortunately, at the same time it damages the immune system and such a patient becomes an easy target for infections.

According to doctors, bacteria are the most dangerous for people with congenital or acquired immunodeficiency. “A virus is a parasite that needs to keep its host alive. And the corpse is good for bacteria. It can rage so much that it can completely destroy the body”, – prof. illustrated the differences vividly. L. Malinauskienė.

Human immunodeficiency virus (HIV) is probably the most heard of. In this case, the virus “eats” certain cells of the immune system, and as a result, the immune system is no longer able to fight infections that have entered the body.

“<...> The immune system is not a single organ. It’s a complex thing with lots of cells, a complex organization, and it’s all over the body, from the tips of the fingers to the brain. As a result, it is not so easy to examine it and it is difficult to correct it if there is a problem”, said Prof. L. Malinauskienė.

A virus is a parasite that needs its host to stay alive. And the bacterium is also good for the corpse.”

One of the signs is hospital treatment

How to find out if the patient has weakened immunity, or it could be immunodeficiency? Answering this question, allergist-clinical immunologists told how the research is going.

“Looking at the whole. Find out what are the predominant infections that make the patient sick. If they are bacterial, this would be a more serious signal. If a person often needs to drink antibiotics and has to be treated in a hospital, this may already be a sign. The nature of the diseases can also tell a lot. If a person’s immunity has a defect, it is expected that he will not get sick in the way we are used to – he will not, for example, have a high temperature. He will be unhealthy, but the course of the disease will be slow,” said Prof. L. Malimauskienė.

Her colleague added that often the sluggish course of the disease can become complicated, which may even result in such a patient being in intensive care.

“When patients come to us with suspected immune system disorders, we review how often they are given antibiotics, diagnosed with pneumonia. The e-health system is very useful, because in many cases the patients themselves are not able to say everything during the consultation <...>“, said Dr. K. Linauskienė.

Can the fact that a person is sick practically all year indicate immunodeficiency or the onset of diseases caused by it? According to doctors, immunodeficiencies are rare diseases. Far more often it turns out that the reasons for the patient’s health condition are completely different.

“Let’s say a person often suffers from chronic sinusitis. Very often, it turns out that the cause is chronic inflammation of the nasal mucosa due to allergic rhinitis. In this case, by treating the allergy, we will help the person to stop suffering from chronic sinusitis. Sometimes the cause is polyps that have grown in the nose, due to which the patient practically never recovers from sinusitis. In other words, doctors must first think about the more common medical conditions that cause the infection to recur. And only later to suspect immunodeficiency”, emphasized Prof. L. Malinauskienė added that the fact that infections are recurring and the possible reasons for that should be discussed with the family doctor first. In case of suspicion, he should suggest where to look for help next.

If, after consultation with an allergist-clinical immunologist, it is decided that the cause of the patient’s illness may be immunodeficiency, special tests are performed.

“Everything starts with the patient’s medical history and document review. And then there are various tests: allergological, immune cell counting, etc. Each patient’s symptoms are taken into account and tests are assigned individually, often in consultation with specialists from other fields,” said Dr. K. Linauskienė.

Once it is determined that the immunodeficiency is primary, that is, due to a gene disorder, doctors say that they can better predict how the patient will fare, what the risk is for his children and relatives, who may also have that gene.

“If, for example, immunodeficiency was caused by a certain treatment, medication, the prognosis is already different – it may be a temporary condition, as the immune system will be able to recover. If it is a disease due to which the patient loses a lot of protein (e.g. frequent diarrhea), we, doctors, can help him <...>“, explained prof. L. Malinauskienė.

The younger the patient, the easier it is to treat

A primary immunodeficiency center operates in VUL Santaras clinics. The doctors working there also consult patients with secondary immunodeficiency. The primary immunodeficiency center currently has approximately 100 adult patients. Another 40-year-old was diagnosed with secondary immunodeficiency.

Such a center also operates in Kaunas, so there are a total of two of them in Lithuania.

Speaking about primary immunodeficiency, the doctors explained that it is classified as a rare disease. However, the recovery rates of patients are very good.

“In some cases, for example, if it is a very young child, we can cure the primary immunodeficiency completely – we transplant the bone marrow and it disappears for the rest of its life. Replacement therapy is more often used in adults. For example, if immunoglobulin is missing, we can add it. It is really important to detect immunodeficiency before complications develop. If the patient often suffers from infectious diseases, they damage the organs – for example, the bronchi may collapse and the lungs may no longer be so affective. In this case, we will no longer restore that bronchus, even after prescribing treatment for immunodeficiency,” explained Prof. L. Malinauskienė.

Compared to other European countries, Lithuania stands out in that the majority of cases of primary immunodeficiency are diagnosed in adult patients. “Elsewhere, it is diagnosed in children, so we have room for improvement,” noted Dr. K. Linauskienė, who also explained how primary (congenital) immunodeficiency is determined in children:

“If we talk about severe immunodeficiency, it indicates a life-threatening condition. Most often, symptoms appear in the first months of life – during the first six months. There may be a sluggish course of infection, which is why the baby appears in the intensive care unit. Doctors at Santara Clinics Children’s Hospital are well aware that such a course of the disease is a pathology, so they usually perform immunological tests and in most cases detect immunodeficiency.”

The dream of allergists-clinical immunologists is to include primary immunodeficiency in the universal screening of newborns. This is already being done in some European Union countries.

“Basically, this is the same drop of blood that is taken from the baby’s heel,” the doctors said.

You can find the full recording of the interview on the Facebook account of VUL Santaras clinics, as well as on the YouTube channel.