Immunodeficiency: Causes, Consequences, and Management of Immunosuppression

The Immunodeficiency is defined as inadequate or deficient functioning of the immune system. This state can be caused by various factors such as hereditary syndromes, Unlike other, administration of certain medications, underlying medical conditions, pregnancy, the natural aging process, and many other causes. This deficiency can manifest at multiple stages of the immune response, which can lead to the following complications:

• Development of severe **infections** by bacteria, fungi, and viruses.
• Difficulty or failure in growth and development in babies and children.
• Recurrent or unusual infections caused by opportunistic **organisms**.
• Significant delays in recovery after suffering an illness.
• Emergence of non-infectious skin disorders, such as **granulomatous** disease.
• Increased risk of developing certain types of cancers, such as B-cell **lymphoma** and Kaposi's **sarcoma**.

It is essential that individuals diagnosed with immunodeficiency be evaluated quickly if they present with symptoms of illness, and that any detected **infection** be managed aggressively and as a priority.

Drug-Induced Immunosuppression

Immunosuppression constitutes a generalized weakening of the body's immune response, frequently caused as a side effect or therapeutic purpose of administering immunosuppressive drugs. immunosuppressive. Although the immune system remains active, its efficiency and response capacity decrease notably.

Among the drugs commonly classified as immunosuppressants are:

• Corticosteroids steroids (in children, doses greater than 2 mg/kg/day for 2 weeks, or > 1 mg/kg/day for more than 4 weeks).
• (such as isotretinoin or acitretin).
• Cyclosporine.
• Azathioprine.
• The antibiotic Dapsone.
• Cyclophosphamide.
• Drugs used in chemotherapy.
• Specific biological agents.

It is important to note that low doses or short courses of systemic steroids are generally not considered significantly immunosuppressive. Similarly, methotrexate administered in low concentrations to treat dermatological conditions acts primarily as an anti-inflammatory agent, vasoconstriction, having only a mild immunosuppressive effect.

It is crucial to prioritize appropriate vaccination of people with immunodeficiency against all vaccine-preventable diseases according to the schedule.

Step 1: Comprehensive Review of Vaccination History

Effective immunization is achieved through both natural infection and vaccination. Before starting any immunosuppressive therapy, it is vital to determine the patient's immunological history:

• Identification of previous vaccines received. It is necessary to consider that vaccination recommendations and schedules vary significantly between countries and generations; older individuals may not have records of all vaccines included in the current schedule.
• Confirmation of the history of chickenpox (varicella) and other diseases already vaccine-preventable.
• Assessment of the risk of exposure to tuberculosis (TB), considering factors such as family history or history of travel to high-prevalence geographic areas.

Taking as a reference the National Immunization Program funded by the government of New Zealand (2018), recommended vaccines include:

• Diphtheria, Pertussis, Tetanus [DTaP]: Administered at 6 weeks, 3 months, 5 months, 4 years, and 11 years. Additionally, Tetanus and Diphtheria are administered during pregnancy, and [Td] at 45 and 65 years of age.
• Polio [IPV]: Given at 6 weeks, 3 months, 5 months, and 4 years of age.
• B Virus Hepatitis B [HepB]: Doses at 6 weeks, 3 months, and 5 months of age.
• Pneumococcus [PCV 10-valent] and Haemophilus [Hib]: Given at 6 weeks, 3 months, 5 months, and 15 months of age.
• Rotavirus [RV1]: Doses at 6 weeks and 3 months.
• Mumps, Measles, and Rubella [MMR]: At 15 months and 4 years.
• Human Papillomavirus (HPV9): At 11 or 12 years of age.
• Chickenpox [VV]: At 15 months.
• Herpes Zoster Virus [HZV]: At 65 years of age.
• Flu Vaccine: Recommended during pregnancy and annually starting at age 65.
• Occasionally additional vaccines are added, such as those against prevalent strains predominant of meningococcus.

Specific vaccines for international travel may include Hepatitis A, Cholera, and Yellow Fever (the latter is usually not funded).

The administration of live injectable vaccines (such as MMR, oral Polio –not IPV–, Varicella, Herpes Zoster, Yellow Fever, and BCG), as well as live oral vaccines (Rotavirus, Typhoid) and the nasal influenza vaccine, should be avoided while the patient is undergoing treatment with immunosuppressive medications, as these could cause severe reactions.

Step 2: Performing Appropriate Diagnostic Tests

If the patient is about to start treatment with a cytotoxic, drug, such as cyclophosphamide or some other specific therapy, it is necessary to carry out a series of prior diagnostic tests to establish a baseline for immunological health.