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Immunodeficiency is a change in immunity caused by defects in one or more immune response mechanisms. They are divided into primary (innate) and secondary (acquired).
Primary immunodeficiency: immune disorders with which a person is born, they are associated with genetic defects in the development of the immune system.
Secondary immunodeficiency (SID): acquired disorders of the immune system. They are not the result of a genetic defect and develop at a late stage of intrauterine development of a child or in adults when the body is exposed to some damaging factor.
Secondary immunodeficiency is a clinical and immunological syndrome that develops against the background of a previously normally functioning immune system, characterized by a steady decline in its quantitative and functional indicators.
Causes of secondary immunodeficiency.
Secondary immunodeficiency develops as a result of impaired immunity under the influence of various adverse factors, both external and internal. The reasons for their occurrence are very diverse:
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Acute and chronic infections – bacterial, viral, parasitic, helminthic.
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Violation of a healthy lifestyle – violation of sleep and rest, poor nutrition (lack of protein, trace elements, vitamins; exhaustion, cachexia, obesity; physical and emotional stress.
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Violation of neurohormonal regulation – stressful effects (severe injuries, operations, physical overload, mental trauma, etc.).
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Loss of protein from the body – chronic diseases of the gastrointestinal tract, accompanied by prolonged diarrhea (loose stools), kidney diseases with impaired function.
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Loss of immunocompetent cells and immunoglobulins – bleeding, burns, injuries.
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Malignant neoplasm.
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Autoimmune disease.
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Natural immunodeficiency – early childhood, old age, pregnancy.
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External and internal intoxication – poisoning, thyrotoxicosis, decompensated diabetes mellitus.
External influences:
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physical - ionizing and electromagnetic radiation, microwave, etc.
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chemical – taking medications (cytostatics, immunosuppressants, corticosteroids, antibiotics, etc.), chemotherapy, drugs, herbicides, pesticides, alcohol, etc.
Depending on the causes of development, there are three forms of secondary immunodeficiency:
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acquired;
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induced;
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spontaneous.
The most famous and striking example of an acquired form of secondary immunodeficiency is acquired immunodeficiency syndrome (AIDS), which develops as a result of damage to the immune system by the human immunodeficiency virus (HIV).
The induced form of secondary immunodeficiency: develops as a result of exposure to radioactive or x-ray radiation, stress, trauma, surgery, cytotoxic substances (that is, harmful to the cells of the body), as well as some long-term medications: corticosteroids, immunosuppressants.
Induced immunodeficiency also includes immune disorders that occur in patients with diabetes, chronic liver and kidney diseases, diseases of the blood-forming organs, and malignancies.
The spontaneous form of secondary immunodeficiency states: is characterized by the absence of obvious causes that could cause a violation of the immune system.
This pathology of the immune system is manifested in the form of often recurrent or chronic infectious and inflammatory diseases of the respiratory system, gastrointestinal tract, genitourinary system, skin, soft tissues, which are often caused by so-called opportunistic microorganisms.
In clinical terms, the spontaneous form is the dominant, that is, the most common form of secondary immunodeficiency.
The generalized analysis of infections that most often occur in patients with secondary immunodeficiency makes it possible to divide them into two categories:
The first category: is characterized by disorders associated with changes in the function of humoral immunity and phagocytic activity of immunocompetent cells. It manifests itself as a deficiency of immunoglobulins, complement components and a decrease in phagocyte activity, which leads to a high susceptibility to repeated recurrent infections caused by capsular bacteria with pyogenic (pyogenic) properties-Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, etc.;
The second category: is characterized by violations in the cellular immunity system, which is accompanied by increased sensitivity to opportunistic microorganisms. In healthy people, resistance to them quickly develops, but in patients with insufficient T-cell function, such microbes (mainly intracellular viruses or parasites) can cause generalized and even fatal infections.
The initial state of the body plays an important role in the chronization of the infectious process. Concomitant acute and chronic diseases, metabolic disorders, old age and other similar factors may lead to the timely removal of the pathogen from the body and an effective immune response will not occur.
Thus, the formation of a persistent, that is, a chronic, persistent, long-term infectious process is largely determined not only by an imbalance in the immune response system, but also by a decrease in the reserve capabilities of the body as a whole.
In the formation or aggravation of existing immunological shifts in infectious diseases, a large negative impact is made by antibiotics that implement various immunosuppressive (depressing) effects.
Moreover, uncontrolled abuse of antimicrobial, antiviral or antifungal drugs leads to the appearance of mutations that provoke the formation of a syndrome of resistance (resistance) to this drug.
Clinically, secondary immunodeficiency is expressed in an increased susceptibility of the body to infections.
Infectious diseases occur often, are difficult and very long. The patient develops a tendency to a prolonged, recurrent course.
Secondary immunodeficiency is a set of clinical symptoms combined with changes in immunological parameters during laboratory testing of the immune status (immunograms).
For correct diagnosis of this condition, there must be fairly clear clinical and laboratory criteria.
Based on the above, it is impossible to talk about secondary immunodeficiency in the absence of clinical manifestations of diseases or any pathological syndromes. The presence of a person with only reduced immune system indicators without clinical manifestations is considered as a state of" risk " of secondary immunodeficiency. These people need to be under medical supervision.
Against the background of immunodeficiency, naturally, the course of any disease becomes complicated, and the effectiveness of therapy decreases.
Therefore, the attending physician, in order to choose the optimal program of combined immunotherapy, should discuss with the patient the problem of the volume of laboratory examination. It should clearly represent the basic clinical and pathogenetic approach to the treatment of the patient, taking into account the set of sequential processes that determine the mechanisms of the onset and course of the disease.
When developing a laboratory diagnostic program for patients with chronic infectious diseases associated with secondary immunodeficiency, it is necessary to analyze two categories of parameters – the state of their own immune status and the spectrum of infectious pathogens that in this particular case could be involved in the formation of the SID.
Types of secondary immunodeficiency.
Secondary immunodeficiency is usually classified according to the severity, nature of immune disorders, prevalence, time of occurrence, etiological (causal) signs.
By duration:
By changes in immune status indicators:
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violations of cellular (T-link) immunity;
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violation of the B-cell link;
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violation in the phagocytosis system;
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violation in the complement system;
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violations of the link of natural killers;
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violations in the production of immunoglobulins.
By prevalence:
Severity:
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Compensated (mild) secondary immunodeficiency is accompanied by increased susceptibility to infections, which manifests itself in the form of frequent colds, pneumonias, pyodermas.
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Subcompensated (moderate severity) secondary immunodeficiency - accompanied by a tendency to chronicle infectious processes (clinical features) - chronic bronchitis, pneumonia and pyelonephritis.
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Decompensated (severe) secondary immunodeficiency - manifests itself as the development of generalized infections, that is, affecting the entire body, caused by opportunistic flora, malignant neoplasms (typical example is HIV infection and AIDS).
Within the framework of modern ideas about the causes of development, secondary immunodeficiency is also commonly distinguished:
By time of occurrence:
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Postnatal (occurring after birth) secondary immunodeficiency - make up the most numerous and diverse group of SID.
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Antenatal secondary immunodeficiency – for example, non-hereditary, somatic forms of primary and congenital immunodeficiency syndromes.
Perinatal secondary immunodeficiency - occurring in the early postnatal (intrauterine) period as a result of the action of a certain provoking factor (hemolytic disease of newborns).
According to etiological signs, that is, depending on the nature of the disease:
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in protozoal and worm infestations;
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for bacterial infections;
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in viral infections;
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with ionizing radiation;
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in combined forms of infectious pathology;
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when eating disorders;
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in autoimmune diseases;
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in diseases of metabolism;
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for malignant neoplasms;
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for allergic diseases;
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for infections caused by intracellular parasites (opportunistic infections);
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for chronic diseases of the lungs, genitourinary tract, gastrointestinal tract, etc.;
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people who are actively engaged in sports;
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in the elderly;
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in postoperative period;
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as a result of accumulated stress;
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induced by taking medications.
It is necessary to allocate a separate line in the classification of two forms of SID, namely: secondary immunodeficiency as a result of accumulated stress and secondary immunodeficiency as a factor of sport, later United into one category of sports stress immunodeficiency-a new, independent form of SID.
It is known that a decrease in immunity is an early and pronounced symptom of a violation of the adaptation of the athlete's body, and sports immunodeficiency can be either provoked by stressors of sports activity and the environment, or spontaneous – without a visible cause.
The suppression of the athlete's body defenses in a stressful immunodeficiency state is accompanied by a decrease in the number of immunocompetent cells, mostly neutrophils and T-lymphocytes, the suppression of their functional activity and, as a result, a drop in the level of interleukins and interferons.
Indicators of the humoral link of immunity change to a lesser extent, and B-lymphocytes can even increase their activity for a certain time. However, the most extreme manifestation of B-lymphocyte function is a condition in which for a short time the athlete's body almost completely disappears serum immunoglobulins.
Sports stress immunodeficiency: is a real phenomenon that belongs to the category of early signs of a violation of an athlete's adaptation to the conditions of sports activity and embodies a powerful pathogenetic mechanism for the development of a number of diseases.
Thus, secondary immunodeficiency is a violation of the immune system that develops after the birth of a child and is characterized by chronic infectious and inflammatory diseases that are resistant to traditional therapy.
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