Secondary immunodeficiency due to underlying disease states, environmental exposures, and miscellaneous causes
- Francisco A Bonilla, MD, PhD
Francisco A Bonilla, MD, PhD
- Section Editor — Immunology and Immunodeficiency
- Associate Professor of Pediatrics
- Harvard Medical School
Immune system function is altered by many conditions, which primarily impair function of other organ systems (table 1). As with primary immunodeficiency, secondary immune dysfunction leads to an increased incidence of infection and malignancy and the occurrence of autoimmune disease.
The mechanisms and sequelae of the immune dysfunction, occurring as the result of biochemical abnormalities, environmental exposures, miscellaneous disorders, and infections other than human immunodeficiency virus (HIV), will be reviewed here. Secondary immunodeficiencies resulting from immunosuppressive agents and malignancy are discussed separately. (See "Secondary immunodeficiency induced by biologic therapies".)
HIV infection and the acquired immunodeficiency syndrome (AIDS) constitute an entire discipline by themselves and are discussed separately in the appropriate topic reviews.
DISORDERS OF BIOCHEMICAL HOMEOSTASIS
Disease processes that lead to chronic imbalances in hormones, nutrients, and toxic metabolic waste products in body fluids may have profound effects on the function of one or more components of the immune system. There are a great many diagnostic entities that may be grouped under this broad heading. It may be that many have unknown effects on immune function. A few disorders where clinically significant immune dysfunction is regularly encountered are presented in this section.
Diabetes mellitus — Neutrophil dysfunction underlies much of the predisposition to bacterial and fungal infections found in patients with diabetes [1-3]. In addition, poor peripheral circulation leads to skin ulceration and diminished delivery of neutrophils to sites of microbial entry. Some characteristic infectious complications of diabetes include disseminated candidiasis, rhinopulmonary zygomycosis (mucormycosis), malignant otitis due to Pseudomonas aeruginosa, and melioidosis (Burkholderia pseudomallei). Bacterial infections of surgical sites are also increased in patients with diabetes, possibly related to the deleterious effect of hyperglycemia on chemotaxis, phagocytosis, and adherence of granulocytes. Issues related to infection in patients with diabetes mellitus are reviewed in more detail separately. (See "Susceptibility to infections in persons with diabetes mellitus".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DISORDERS OF BIOCHEMICAL HOMEOSTASIS
- Diabetes mellitus
- Dialysis and uremia
- DISORDERS OF PROTEIN LOSS
- Nephrotic syndrome
- Peritoneal dialysis
- Protein-losing enteropathies
- - Intestinal lymphangiectasia
- Other disorders
- ENVIRONMENTAL EXPOSURES
- Ionizing radiation
- Ultraviolet radiation
- Toxic chemicals
- ALLOGENEIC BLOOD TRANSFUSION
- SPLENECTOMY OR HYPOSPLENISM
- NORMAL LIFE STAGES AND EVENTS
- INFECTIONS (OTHER THAN HIV)
- Viral infections
- - Measles
- - Herpesviruses
- Bacterial infections
- Mycobacterial infections
- Parasite infestation
- - Malaria
- SUMMARY AND RECOMMENDATIONS