Immunodeficiency: Secondary

Abstract

Secondary immunodeficiency (SID) refers to an acquired immunodeficiency secondary to an extrinsic cause (e.g. disease, treatment) and can occur when any condition or treatment causes a reduction in number or function of immune components. Opportunistic or particularly severe infections should raise the suspicion of SID. SID is relatively common, and worldwide the most prevalent causes include malnutrition and advancing age. The aetiologies of SID can be loosely grouped into those caused by the related abnormalities of general health, underlying disease, barrier integrity or iatrogenic influences. Issues with general health that result in SID include malnutrition, advancing age, smoking and alcohol. Underlying diseases that cause SID include haematological malignancies, splenectomy/hyposplenism and some infections (e.g. human immunodeficiency virus (HIV)). Many diverse injuries, treatments or diseases can reduce barrier integrity resulting in SID, as well as a wide range of iatrogenic interventions. The treatment of SID depends on both the presentation and aetiology.

Key Concepts

  • Secondary immunodeficiency refers to an acquired immunodeficiency secondary to an extrinsic cause.
  • The aetiology of secondary immunodeficiency is often multifactorial and may present with diverse opportunistic infections.
  • Secondary immunodeficiency is common, and the most common aetiology worldwide is malnutrition.
  • Causes of secondary immunodeficiency can be loosely defined by aetiology into disorders of general health, barrier integrity, relating to underlying diseases or as iatrogenic.
  • Severe presentations of common infections and certain characteristic opportunistic infections should raise the suspicion of secondary immunodeficiency.
  • Many secondary immunodeficiencies relate to the use of medications, particularly the new generation of biological agents.
  • Infections, as well as being a result of immunodeficiency, may also cause secondary immunodeficiency.
  • The treatment of secondary immunodeficiency is complicated and dependent on both the presentation and the aetiology of the immunodeficiency.

Keywords: secondary immunodeficiency; opportunistic infection; predisposing disease; malnutrition; iatrogenic; treatment of secondary immunodeficiency

Figure 1. Causes of secondary immunodeficiency.
Figure 2. The effects of ageing on the immune system. ROS = Reactive Oxygen Species.
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Further Reading

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Kaveri S (2013) Advances in the treatment of primary and secondary immune deficiences. Current Opinion in Allergy and Clinical Immunology 13 (Suppl 2): S51–S52.

Szabo G and Saha B (2015) Alcohol's effect on host defense. Alcohol Research: Current Reviews 37 (2): 159–170.

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Bright, Philip, and Richter, Alex(May 2017) Immunodeficiency: Secondary. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0001241.pub2]