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Immunodeficiency


Overview :

The immune system is the body's main method for fighting infections. Any defect in the immune system decreases a person's ability to fight infections. A person with an immunodeficiency disorder may get more frequent infections, heal more slowly, and have a higher incidence of some cancers.

The normal immune system involves a complex interaction of certain types of cells that can recognize and attack "foreign" invaders, such as bacteria, viruses, and fungi. It also plays a role in fighting cancer. The immune system has both innate and adaptive components. Innate immunity is made up of immune protections people are born with. Adaptive immunity develops throughout life. It adapts to fight off specific invading organisms. Adaptive immunity is divided into two components: humoral immunity and cellular immunity.

The innate immune system is made up of the skin (which acts as a barrier to prevent organisms from entering the body), white blood cells called phagocytes, a system of proteins called the complement system, and chemicals called interferons. When phagocytes encounter an invading organism, they surround and engulf it to destroy it. The complement system also attacks bacteria. The elements in the complement system create a hole in the outer layer of the target cell, which leads to the death of the cell.

The adaptive component of the immune system is extremely complex, and is still not entirely understood. Basically, it has the ability to recognize an organism or tumor cell as not being a normal part of the body, and to develop a response to attempt to eliminate it.

The humoral response of adaptive immunity involves a type of cell called B lymphocytes. B lymphocytes manufacture proteins called antibodies (which are also called immunoglobulins). Antibodies attach themselves to the invading foreign substance. This allows the phagocytes to begin engulfing and destroying the organism. The action of antibodies also activates the complement system. The humoral response is particularly useful for attacking bacteria.

The cellular response of adaptive immunity is useful for attacking viruses, some parasites, and possibly cancer cells. The main type of cell in the cellular response is T lymphocytes. There are helper T lymphocytes and killer T lymphocytes. The helper T lymphocytes play a role in recognizing invading organisms, and they also help killer T lymphocytes to multiply. As the name suggests, killer T lymphocytes act to destroy the target organism.

Defects can occur in any component of the immune system or in more than one component (combined immunodeficiency). Different immunodeficiency diseases involve different components of the immune system. The defects can be inherited and/or present at birth (congenital) or acquired.

Congenital immunodeficiency disorders

Congenital immunodeficiency is present at the time of birth, and is the result of genetic defects. These immunodeficiency disorders are also called primary immunodeficiencies. Even though more than 70 different types of congenital immunodeficiency disorders have been identified, they rarely occur. About 50,000 new cases are diagnosed in the United States each year. Congenital immunodeficiencies may occur as a result of defects in B lymphocytes, T lymphocytes, or both. They also can occur in the innate immune system.

HUMORAL IMMUNITY DISORDERS. Bruton's agammaglobulinemia, also known as X-linked agammaglobulinemia, a congenital immunodeficiency disorder. The defect results in a decrease or absence of B lymphocytes, and therefore a decreased ability to make antibodies. People with this disorder are particularly susceptible to infections of the throat, skin, middle ear, and lungs. It is seen only in males because it is caused by a genetic defect on the X chromosome. Since males have only one X chromosome, they always have the defect if the gene is present. Females can have the defective gene, but since they have two X chromosomes, there will be a normal gene on the other X chromosome to counter it. Women may pass the defective gene on to their male children.

B LYMPHOCYTE DEFICIENCIES. If there is an abnormality in either the development or function of B lymphocytes, the ability to make antibodies will be impaired. This allows the body to be susceptible to recurrent infections.

A type of B lymphocyte deficiency involves a group of disorders called selective immunoglobulin deficiency syndomes. Immunoglobulin is another name for antibody, and there are five different types of immunoglobulins (called IgA, IgG, IgM, IgD, and IgE). The most common type of immunoglobulin deficiency is selective IgA deficiency, occurring in about one in every 500 white persons. The amounts of the other antibody types are normal. Some patients with selective IgA deficiency experience no symptoms, while others have occasional lung infections and diarrhea. In another immunoglobulin disorder, IgG and IgA antibodies are deficient and there is increased IgM. People with this disorder tend to get severe bacterial infections.

Common variable immunodeficiency is another type of B lymphocyte deficiency. In this disorder, the production of one or more of the immunoglobulin types is decreased and the antibody response to infections is impaired. It generally develops around the age of 10-20. The symptoms vary among affected people. Most people with this disorder have frequent infections, and some also will experience anemia and rheumatoid arthritis. Many people with common variable immunodeficiency develop cancer.

T LYMPHOCYTE DEFICIENCIES. Severe defects in the ability of T lymphocytes to mature results in impaired immune responses to infections with viruses, fungi, and certain types of bacteria. These infections are usually severe and can be fatal.

DiGeorge syndrome is a T lymphocyte deficiency that starts during fetal development and is the result of a deletion in a particular chromosome. Children with DiGeorge syndrome either do not have a thymus or have an underdeveloped thymus. Since the thymus is a major organ that directs the production of T-lymphocytes, these patients have very low numbers of T-lymphocytes. They are susceptible to recurrent infections, and usually have physical abnormalities as well. For example, they may have low-set ears, a small receding jawbone, and wide-spaced eyes. People with DiGeorge syndrome are particularly susceptible to viral and fungal infections.

In some cases, no treatment is required for DiGeorge syndrome because T lymphocyte production improves. Either an underdeveloped thymus begins to produce more T lymphocytes or organ sites other than the thymus compensate by producing more T lymphocytes.

COMBINED IMMUNODEFICIENCIES. Some types of immunodeficiency disorders affect both B lymphocytes and T lymphocytes. For example, severe combined immunodeficiency disease (SCID) is caused by the defective development or function of these two types of lymphocytes. It results in impaired humoral and cellular immune responses. SCID usually is recognized during the first year of life. It tends to cause a fungal infection of the mouth (thrush), diarrhea, failure to thrive, and serious infections. If not treated with a bone marrow transplant, a person with SCID will generally die from infections before age two. In 2003, a report showed a new form of severe SCID with severe mutation of T receptor cells.

DISORDERS OF INNATE IMMUNITY. Disorders of innate immunity affect phagocytes or the complement system. These disorders also result in recurrent infections.

Acquired immunodeficiency disorders

Acquired immunodeficiency is more common than congenital immunodeficiency. It is the result of an infectious process or other disease. For example, the human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). However, this is not the most common cause of acquired immunodeficiency.

Acquired immunodeficiency often occurs as a complication of other conditions and diseases. For example, the most common causes of acquired immunodeficiency are malnutrition, some types of cancer, and infections. People who weigh less than 70% of the average weight of persons of the same age and gender are considered to be malnourished. Examples of types of infections that can lead to immunodeficiency are chickenpox, cytomegalovirus, German measles, measles, tuberculosis, infectious mononucleosis (Epstein-Barr virus), chronic hepatitis, lupus, and bacterial and fungal infections.

In 2003, a new infection emerged that produces immunodeficiency. Severe acute respiratory syndrome (SARS) mysteriously appeared in a hospital in China. It eventually affected 8,000 people in Asia and Canada, killing 800 altogether. The virus is characterized by fever, lower respiratory tract symptoms, and abnormal chest x rays. However, it also produces immunodeficiency. No cases of the disease were reported from July 2003 through December 2003, but scientists feared it would reappear.

Sometimes, acquired immunodeficiency is brought on by drugs used to treat another condition. For example, patients who have an organ transplant are given drugs to suppress the immune system so the body will not reject the organ. Also, some chemotherapy drugs, which are given to treat cancer, have the side effect of killing cells of the immune system. During the period of time that these drugs are being taken, the risk of infection increases. It usually returns to normal after the person stops taking the drugs.




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