Secondary Immunodeficiency, HIV Infection and AIDS

Secondary Immunodeficiency, Anti-IFN-y Autoantibody-Associated Steroids
Immunodeficiency
HIV Infection & AIDS Similar to SCID
● Similar to AID but CD4 levels DO NOT decrease ● Cell-mediated immunity defect (T cell)*
Immunodeficiency ● IFN-y: produced by Th1 & NK cells ● B cell & neutrophil defect
1. Primary (congenital) immunodeficiencies ● Th1 target:
1) Intracellular pathogen*
(PID): genetic defect 2) Mycobacterium*
2. Secondary immunodeficiencies: acquired 3) Dimorphic fungi Immunosenescence: Old Age

Differential Diagnosis ● Phagocytosis ↓
HIV ● HIV-negative
● Chemotaxis ↓
● Recurrent caused by non-tuberculous
Mycobacterium or Salmonella ● T cell function ↓, proliferation function (Th1) ↓
● Acute Retroviral Syndrome: severe flu-like
symptoms, lymphadenopathy, exanthem, diarrhea, ● Reactive skin lesions
myalgia (2 wks)
● AIDS-related cancer: Kaposi sarcoma, cervical DM Type II
cancer, lymphoma Asplenia & Hyposplenism
● More prone to infection: bone and joint infections,
Differential Diagnosis
● Increased risk of infection & thromboembolism endocarditis, candidiasis, sepsis, cellulitis
● Mononucleosis-like syndrome (symptoms similar
1) Insufficient opsonizing filter function of spleen ● Phagocytosis & opsonization dysfunction
to EBV esp. atypical lymphocytes); however HIV has
2) Delayed/impaired prod. of immunoglobulin
risk factors and more acute
3) Lack of splenic macrophages Causative Agent
● Test for Ab to differentiate from syphilis
● Candida spp.
Overwhelming Post-Splenectomy Infection (OPSI)
Diagnosis ● Burkholderia pseudomallei: ฝี ทีต
่ บ
ั ม ้าม อีสาน
● Encapsulated gram-negative: N. meningitidis, H.
● 4th generation ELISA: ELISA + p24 (rapid detection) gram-negative bacilli ในเลือด thalassemia โรคไต safety pin
influenzae
● Western blot: gold standard (slow) appearance
● Gram-positive: pneumococcal infection
● RNA test from plasma; DNA test from blood ● Rhizopus spp.
Prior to Treatment ● Uropathogenic E. coli
● CD4 count: track immunity Chemotherapy: Febrile Neutropenia
● Viral load: determine treatment efficacy (should
decrease a certain amt within 4 wks) ● Bacteria ย ้ายไปทีจ
่ ากจุดทีม
่ แ
ี ผลไปทีอ
่ น
ื่ Other Infections
● CBC: prepare for ART ้
● Febrile Neutropenia: ภาวะ neutrophil ต่ำทำให ้ติดเชือ
● Metabolic profile & serology for Hep A, B, C ง่ายไม่คอ
่ ยแสดงอาการ Uremia & Dialysis
Treatment *e.g. S. pyogenes usually throat but w/ neutropenia → enters ● Phagocytosis ↓, DC number & APC function ↓, T cell
bloodstream & cause unusual site infections
Initiate ART as soon as possible (CD4, CD8) ↓, T reg ↓, Naive T cell ↓
● Mainly uses integrase inhibitor Pathogen
● Aim: กด virus ให ้นานทีส
่ ด
ุ , ยกระดับ CD4 ให ้ภูมก
ิ ลับขึน
้ ● E. coli, Pseudomonas Cirrhosis
มา, ลดโรคแทรกซ ้อน, prevent transmission ● Extracellular pathogen: Staphylococcus, Enteric ● Neutrophils, monocytes, B cell, T cell
pathogen, Candida, Aspergillus (if prolonged)
Malnutrition
Symptoms ● Innate & adaptive
● Fever, mucositis (อักเสบของ cell เยีย ่ บุ) ● Produce leptin → start of dysfunction
● ใส่สาย catheter, ถ ้าเป็ นนานไม่ดข
ี น
ึ้ ติดเชือ้ ราในปอดได ้
ง่าย (invasive pulmonary aspergillosis)