Immunocompromised Client

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction

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A person is said to have an immune deficiency or be immunocompromised when their immune system is incapable of working at full capacity.

The term ‘immunocompromised host’ embraces a group of overlapping conditions in which the ability to respond normally to an infective challenge is in some way impaired.[1]

The immune system is how the body fights off diseases and protects itself against new infections. Therefore, someone who is immunocompromised will usually get sick more often, stay sick longer, and be more vulnerable to different types of infections.

People with weakened immune systems are at higher risk of getting severely sick from SARS-CoV-2, the virus that causes COVID-19. They may also remain infectious for a longer period of time than others with COVID-19, but we cannot confirm this until we learn more about this new virus[2].

Types Of Immunodeficiency

A person can become immunocompromised in four major ways: through a congenital disorder; through acquired conditions such as diabetes and HIV; through autoimmune diseases; and through certain medications and treatments.

Still other health conditions may weaken the immune systems. eg some studies link alcohol addiction with suppressed immune systems; Age is also a factor (those over the age of 65 have a weakened immune system, and those 80 and older are immunocompromised by definition); Lifestyle factors such as stress and lack of sleep can also weaken the immune system[3].

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Certain diseases or conditions may cause a weakened immune system placing people at greater risk of suffering complications if they become sick.  These include:

Many conditions and treatments can cause a person to have a weakened immune system, including:

Symptoms

When a person is immunocompromised they are more susceptible to infections. The major sign of having an immunodeficiency is getting repeated or serious infections that are rare, or that only cause minor problems, in the general population.[4]

Immunocompromised patients are prone to various infectious and non infectious disorders.

  • The infectious disease is the commonest presentations of these patients because of the weakening of the patient’s immune state.
  • The severity of the infection depends on the degree of the immunosuppression.
  • Some organs like respiratory pathways are more liable to infections in these patients for obvious anatomical reasons; however all organs are at risk of developing infection[6].

Clinical presentations in immunocompromised differs among patients.

  • The presentations are determined by the severity of the immunosupression, the severity of the infection and other comorbid condition.
  • Furthermore the organ involved and the type of the associated clinical state play important role in determining the presentation of the patient.
  • There are many uncommon presentations that have been reported in these patients.
  • Poor response to treatment of infection, incomplete recovery from illness, certain types of infections and malignancies are common presentations seen in immunocompromised patients[6].

Boost Immunity and Prevent Infection?

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The concept of “immune boosting” is scientifically misleading and often used to market unproven products and therapies. An analysis of popular immune-boosting posts from Instagram promoting “immune boosting” as beneficial, nearly all involved commercial interests, and many used scientific and medical rhetoric in their messaging.eg:

  • There is no current evidence that any product or practice will contribute to enhanced “immune boosting” protection against COVID-19. This lack of evidence has not stopped wellness gurus, celebrities, and commercial entities from propagating notions of boosting immunity, and messaging of this nature is readily found connected to online portrayals of COVID-19 in the popular press. There is an abundance of misinformation circulating online as presented on Instagram, one of the world’s largest social media platforms[7].

Older adults

  • At risk for malnutrition, which may contribute to their increased risk of infection. Nutritional supplementation strategies can reduce this risk and reverse some of the immune dysfunction associated with advanced age. Evidence supports use of a daily multivitamin or trace-mineral supplement that includes zinc (elemental zinc, >20 mg/day) and selenium (100 μg/day), with additional vitamin E, to achieve a daily dosage of 200 mg/day. Drug-nutrient interactions are common in elderly individuals, and care providers should be aware of these interactions[8].

Prevention of Illness

Statergies include:

  1. Dust Mask FFP2.jpg
    Severe Immunosuppression - eg. Chemotherapy, HIV, and bone marrow ablation are examples of severe immunosuppression that can make a person susceptible to fatal infections. In these types of immunosuppression the person needs to: avoid contact with people who could carry contagious illnesses, such as schoolchildren and toddlers; avoid public places or wear a mask when out in public to protect themselves from common community infections.
  2. Mild immunosuppression eg. COPD, malnutrition, cytomegalovirus (CMV) infection, alcoholism, diabetes, and kidney failure. Having a suppressed immune system exposed the client to more frequent infections which may take longer than usual to recover from. Talk to your client about ways of preventing infections if they have risk factors of immunosuppression[9]
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These are the general principles of preventing infection in patients with weak immune systems:

  • Practice good hand hygiene. Many infections are spread from bacteria or viruses that we pick up on our hands when we touch people or objects around us. Cleaning hands often (washing with soap and water or using alcohol-based hand sanitizer) is the best way to prevent the spread of infection.
  • Avoid contact with people who are sick. Even a common cold virus can make a patient with a weak immune system very sick.
  • Get vaccinated. Care providers for patients with weak immune systems should receive all recommended vaccinations, including influenza and pertussis vaccines. Patients should also receive these vaccines as long as their doctors recommend it[10].
  • Adhere to the principles shown in image at R

Prognosis

Because so many different diseases, conditions and infections can occur in patients with weak immune systems, no broadly useful prognoses are available.

  • In general, the survival outlook for patients with weak immune systems who develop infections depends on the reason why the immune system is compromised and the type of infection present.
  • Preventing and aggressively treating infections are critical steps to ensure successful treatment[10].

Conclusion

Immunocompromised patients are predisposed to a variety of clinical syndromes.

  • The manifestations depend on the cause of immunosuppression, the degree of immunosupression, the endemic infections, the system or organ with predominant injury, and other associated diseases like Malignancies and infiltrative diseases.
  • These patients may have atypical presentations. Thus there is need for surveillance and high index of suspicion of injuries/diseases in these patients to ensure early diagnosis and intervention.

References

  1. Cohen J. Infections of the immunocompromised host: Editorial overview. Current Opinion in Infectious Diseases. 1991 Jun 1;4(3):357-8.Available from;https://oxfordmedicine.com/view/10.1093/med/9780199204854.001.1/med-9780199204854-chapter-070204 (last accessed 7.11.2020)
  2. Centers for Disease Control and Prevention. If You Are Immunocompromised, Protect Yourself From COVID-19. United States of America. 2020.Available from:https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/immunocompromised.html (last accessed 7.11.2020)
  3. Healthy Women Immunocomprimised Available from:https://www.healthywomen.org/content/article/who-counts-immunocompromised-guide-high-risk-individuals (last accessed 7.11.2020)
  4. 4.0 4.1 Explore health Immunocomprimised Available from:https://www.health.com/condition/infectious-diseases/what-is-immunocompromised (last accessed 7.11.2020)
  5. QLD govt Immundeficiency Available from:https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-a-compromised-immune-system (last accessed 7.11.2020)
  6. 6.0 6.1 Okafor UH. Pattern of clinical presentations in immunocompromised patient. INTECH Open Access Publisher. 2012 Oct 10:177-90.Available from:https://www.intechopen.com/books/immunodeficiency/pattern-of-clinical-presentations-in-immunocompromised-patient (last accessed 7.11.2020)
  7. Wagner DN, Marcon AR, Caulfield T. “Immune Boosting” in the time of COVID: selling immunity on Instagram. Allergy, Asthma & Clinical Immunology. 2020 Dec;16(1):1-5.Available from:https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00474-6#Sec4 (last accessed 7.11.2020)
  8. Yoshikawa TT, High KP. Nutritional strategies to boost immunity and prevent infection in elderly individuals. Clinical infectious diseases. 2001 Dec 1;33(11):1892-900.Available from:https://academic.oup.com/cid/article/33/11/1892/446157#6675805 (last accessed 7.11.2020)
  9. Very well health Immunosuppression Available from: https://www.verywellhealth.com/different-causes-of-immunosuppression-explained-4047405 (last accessed 7.11.2020)
  10. 10.0 10.1 St Judes Immunocomprimised Available from:https://www.stjude.org/treatment/patient-resources/caregiver-resources/infection-tips/infections-immunocompromised-patients.html (last accessed 7.11.2020)