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Being Immunocompromised: What Does it Mean?

CPD
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Published: 24 March 2020

Cover image for article: Being Immunocompromised: What Does it Mean?

People who are immunocompromised are affected more frequently and severely by infections.

The term immunocompromised (or immunosuppressed) refers to people who have an ‘immunodeficiency’ or a weakened immune system, meaning their ability to fight infections and diseases is reduced (NIS n.d.)

There are two types of immunodeficiency:

  1. Primary immunodeficiencies: chronic, genetic disorders causing an individual to be born without some immune defences or with an impaired immune system; and
  2. Secondary immunodeficiencies: immunodeficiencies acquired from environmental factors such a disease.

(Mayo Clinic 2020; British Society for Immunology 2017)

immuno infection
People who are immunocompromised have an ‘immunodeficiency’ or a weakened immune system, meaning their ability to fight infections and diseases is reduced

Primary Immunodeficiencies

Primary immunodeficiencies comprise over 400 disorders that are caused by defects in the immune system. Consequently, the immune system functions less efficiently than normal, potentially causing complications. These disorders are often inherited (ASCIA 2019).

Primary immunodeficiencies may be mild and evade detection for years, or they may be severe enough to be noticed right at birth (Mayo Clinic 2020).

They fall broadly into one of six categories depending on which part of the immune system has been impacted:

  1. Humoral immunity (B cell) deficiencies, which account for about 50 to 60% of primary immunodeficiencies;
  2. Cellular immunity (T cell) deficiencies, which account for about 5 to 10% of primary immunodeficiencies;
  3. Combination humoral and cellular immunity deficiencies, which account for about 20% of primary immunodeficiencies;
    • This category includes Severe Combined Immunodeficiency (SCID), which causes opportunistic infections and failure to thrive in infants due to little-to-no immune function. It is serious and can be fatal unless diagnosed and treated early.
  4. Phagocytic cell defects, which account for about 15% of primary immunodeficiencies;
  5. Complement deficiencies, which are rare and account for 2% or less of primary deficiencies; and
  6. Unknown.

(Mayo Clinic 2020; Fernandez 2019; British Society for Immunology 2017)

Secondary Immunodeficiencies

Secondary immunodeficiencies are more common than primary immunodeficiencies. They are acquired after the immune system is weakened by an external factor (Primary Immunodeficiency UK 2017). These causes may include:

  • HIV infection;
  • Malnutrition; and
  • Immunosuppressive treatments such as chemotherapy.
immuno chemotherapy
A secondary immunodeficiency may be acquired after undergoing an immunosuppressive treatment such as chemotherapy.

(British Society for Immunology 2017; Fernandez 2019)

Secondary immunodeficiencies may also affect critically ill, older or hospitalised people (Fernandez 2019).

Risk Factors for Immunodeficiency

Currently, the only known risk factor for primary immunodeficiency is having a family history of a primary immunodeficiency disorder (Mayo Clinic 2020).

Diagnosing primary immunodeficiencies

  • Blood tests can be used to measure if a person has a normal level of blood cells and immune system cells. They can also determine if the immune system is responding properly.
  • Prenatal or DNA tests may be used.

(Mayo Clinic 2020)

Symptoms and Effects of Immunodeficiency

Symptoms and effects may vary depending on the type of immunodeficiency. They can include:

  • Infections that are:
    • More frequent, persistent or harder to treat than what is typical;
    • Opportunistic (infections that occur more often or are more severe in immunocompromised people);
    • Caused by unusual bacteria, viruses, fungi or parasites.
  • Frequent and recurring pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections;
  • Inflammation and infection of internal organs;
  • Blood disorders (e.g. anaemia, low platelet count);
  • Digestive issues (e.g. cramping, nausea);
  • Delayed growth and development;
  • Autoimmune disorders;
  • Cancer;
  • Damage to the heart, lungs, nervous system or digestive tract; and
  • Death from a serious infection.

(Mayo Clinic 2020; AIDSinfo 2019; ASCIA 2019)

Additionally, those who are immunocompromised are more at risk of illness and death from some vaccine-preventable illnesses (Australian Immunisation Handbook 2019).

How Can Immunocompromised People Prevent Infection?

  • Practice good hygiene;
  • Avoid contact with people who are sick;
  • Receive vaccinations as per the advice of you own GP;
  • Maintain dental hygiene and health;
  • Maintain a healthy, balanced diet;
  • Regular physical exercise;
  • Avoid risky food items (e.g. unpasteurised milk, raw meat, cross-contaminated food);
  • Take precautionary measures around animals and pets, especially if they are sick;
  • Take precautionary measures with travel;
  • Prevent insect bites;
  • Practice safe sex;
  • Get enough sleep; and
  • Manage stress.

(Mayo Clinic 2020; Canadian Paediatric Society 2019)

immuno hygiene
Immunocompromised people can help to prevent infection by practicing good hygiene.

Treating Immunodeficiency

Please note that immunodeficiency treatment will differ based on many factors including the type of immunodeficiency, the individual and treatment options available.

Primary immunodeficiency disorders may be treated in several ways:

  • Managing, treating and preventing infections contracted by the individual;
  • Therapies to boost the immune system; and
  • Stem cell transplantation, which provides an individual with a normally functioning immune system.

(Mayo Clinic 2020)

Secondary immunodeficiencies can potentially be resolved if the underlying condition is treated (Primary Immunodeficiency UK 2017).

Additional Resources

COVID-19

Multiple Choice Questions

Q1. How many primary immunodeficiency disorders are there?

  1. Over 100.
  2. Over 200.
  3. Over 300.
  4. Over 400.

Q2. True or false? Secondary immunodeficiencies are acquired from environmental factors.

  1. True
  2. False

Q3. True or false? Primary immunodeficiencies are genetic.

  1. True
  2. False
References

(Answers: d, a, a)

Author

Portrait of Ausmed Editorial Team
Ausmed Editorial Team

Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile

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150 Total Rating(s)

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Linda Paku
06 Apr 2020

great refresher

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James Parkinson
02 Apr 2020

Basic but thougher

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Mel Ford
02 Apr 2020

This is an article that is a basic introduction to this area

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Zarah Schulz
02 Apr 2020

Great 4 minute brain exercise to consume helpful information

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Susan Lesmond
02 Apr 2020

Interesting and informative educational update re Being Immunocompromised.

Portrait of Julia Harvey
Julia Harvey
02 Apr 2020

Quick concise overview.

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Gillian calladine
01 Apr 2020

very informative filled a gap in my knowledge

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Brenda Curran
30 Mar 2020

A good reminder about what immunocompromised means in our community .

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Janet Gill
30 Mar 2020

excellent reading for a short overview

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Gillian Whitington
30 Mar 2020

Great resource!