Immunosuppression: Causes, Symptoms, Complications and Treatment

Definition:

Immunosuppression, also known as immune suppression or immunocompromise, means that the immune system is not functioning properly.

So, what is the immune system? It is a combination of defenses that our bodies have to fight infections.

Several parts of our body systems function as soldiers in this fight, particularly the white blood cells in our bloodstream, along with our spleen and lymph nodes.

When this system is removed it does not work as it should, we are more vulnerable to infections.

What does this mean for health?

If your immune system is suppressed, you may be more vulnerable to infections.

You are more likely to need to see a doctor, more likely to need antibiotics, and more likely to be hospitalized for treatment if you develop an infection, than someone who is not immunosuppressed.

You are also more vulnerable to certain skin cancers if you are immunosuppressed.

Do I need regular tests?

If you take certain immunosuppressive medications, periodic blood tests will be done to verify that they are not causing more harm than good.

The tests will only be done if you develop a problem. Obtain information on the control of immunosuppressive treatments.

What is the cause of immunosuppression?

  • Age, our immune system becomes less effective as we get older.
  • Persistent diseases (chronic), immune systems tend to be less effective as certain diseases progress in the long term. Examples include severe chronic kidney disease, chronic liver disease and diabetes mellitus.
  • Medications for diseases caused by the immune system attacking itself (autoimmune conditions). Examples include rheumatoid arthritis and Crohn’s disease.
  • Medications in the form of oral steroids for conditions that cause inflammation where treatment is needed to reduce inflammation.
  • Medications that are taken to prevent rejection in people who have had organ or bone marrow transplants.
  • Treatment of chemotherapy or radiotherapy for cancer.
  • Cancers, certain cancers can cause immune suppression, particularly those that involve the blood cells that are so crucial to our immune system.
  • Lymphomas, leukemias and myeloma are cancers that can suppress the immune system.
  • Do not have a spleen, either because it has been removed or have a spleen that does not work well. This may occur due to certain conditions, such as sickle cell anemia, thalassemia major or lymphoma, or after radiation therapy.
  • HIV and AIDS. The human immunodeficiency virus (HIV) affects the immune system.
  • Rare genetic conditions that cause loss of immune function, for example, severe combined immunodeficiency syndrome, DiGeorge syndrome, Wiskott-Aldrich syndrome.

What specific medications cause immunosuppression?

Oral steroids when used in high doses for long periods of time can cause immunosuppression.

The lower doses usually do not cause problems. For an adult, a dose of 40 mg per day of prednisolone for more than a week may cause immunosuppression, but this dose varies for other steroids and for children.

Other medicines that suppress the immune system include:

  • Azatioprina.
  • Micofenolato mofetil.
  • Monoclonal antibodies, of which there are many that end in “mab”, such as bevacizumab, rituximab and trastuzumab.
  • Anti-TNF drugs
  • Methotrexate
  • Ciclosporin.
  • Tacrolimus.
  • Sirolimus.
  • Cyclophosphamide
  • Leflunomide.
  • These medications are used to treat all types of conditions, some of the most common, which include:
  • Cancers such as lymphoma or leukemia
  • Rheumatoid arthritis
  • Crohn’s disease
  • Ulcerative colitis
  • Organ transplants to prevent rejection.
  • Severe psoriasis and psoriatic arthritis.

Extraction of the spleen

The spleen is an important part of the immune system, but sometimes it has to be removed, with an operation called splenectomy.

This may need to be done if you are involved in an accident or have an injury where the spleen is broken. It may be necessary to remove it to avoid losing large amounts of blood.

Sometimes it has become too big and destroys too many blood cells. Examples where this occurs and the spleen may need to be removed include:

  • Immune thrombocytopenia
  • Hereditary spherocytosis.
  • Hereditary elliptocytosis.
  • Lymphomas and leukemias.

 

Complications

Infections can develop and spread particularly fast in people whose immune systems are suppressed.

A sore throat, for example, is more likely to turn into an infection in the chest. It is more likely to spread an individual infection to the whole body, which can make you very sick.

People who have immunosuppression also seem to be at higher risk for certain types of skin cancer.

This includes squamous cell carcinoma, melanoma and Kaposi’s sarcoma.

The reason for this is not known with certainty, it may be because the immune system helps to destroy skin cells that have been damaged by the sun.

These cells, if not eliminated by the immune system, can multiply and cause cancer.

It may also be that viruses (such as human papilloma virus – HPV or herpes virus) that are involved in some types of cancer are more likely to be present if the immune system is suppressed.

Some immunosuppressive drugs can directly affect skin cells in a way that makes them more likely to develop skin cancers.

Symptoms of immunosuppression

Most of the time, if you have immunosuppression, you do not know you have it. However, you are likely to have infections more often.

Also, when you get infections, they can be more serious and you are more likely to have complications.

You can also have unusual or unusual infections. For example, in general, healthy adults usually do not have canker sores in their mouths, unless there is a good reason for it, such as using a steroid inhaler.

However, for people with AIDS, candidiasis is common and may be widespread or severe.

Medicines that can suppress your immune system may give you other side effects. These vary and will be listed in the information they bring the medications.

If you have immunosuppression, the rules of when to go see your doctor change. With most minor infections, healthy people are encouraged to take a wait-and-see approach, treat symptoms, and visit the doctor only if they feel unwell or if the infection is not resolving itself.

However, if you have immunosuppression, even a mild infection could become severe very quickly. Therefore, it is best to consult a doctor as soon as possible instead of waiting to see how things are going.

Infections that are detected early can be treated quickly, preventing them from spreading and making you feel bad.

You are more likely to be given an antibiotic for a mild infection compared to someone who is not immunosuppressed, and it may be that, in extreme cases, this will save your life.

Therefore, consult a doctor if you think you might have an infection, such as a sore throat, cough, symptoms of a urinary tract infection, food poisoning, etc.

Seek urgent medical attention if:

  • You have a high temperature (fever) above 38 ° C.
  • You have chills or tremors.
  • In general, you feel bad with dizziness, drowsiness or confusion.
  • If you have a rash
  • The light hurts your eyes.
  • If you have seizures.
  • If you have a child who is immunosuppressed, all of the above apply, but also seek urgent medical attention if your child breathes quickly or if they do not eat or drink normally.
  • It also monitors your skin, if you develop scaly areas that do not disappear quickly with a good moisturizer, or if you have a new mole or one that has changed, consult your doctor.
  • Hopefully, there will not be any skin cancer, but if it is, the sooner it is treated, the better the result will be.

Treatment

Everything depends on the cause. For example:

HIV infection and AIDS is treated with specific anti-HIV drugs. See a separate booklet called HIV and AIDS.

Many cancers can be treated successfully, or at least delay their progression, with chemotherapy.

Transplants of stem cells (or bone marrow) are used in some situations. The damaged cells are replaced with the normal ones. This is used in some forms of cancer, as well as in some conditions of genetic immunosuppression.

The immune suppression caused by the medication should be reversed if the medication is discontinued. If immune suppression is causing harm, sometimes an alternative can be used or the dose can be reduced.

In other cases, the infection is treated quickly as it occurs, while continuing the medication, this depends on the condition being treated, and for how long the medication is used.

If you had a splenectomy, the effect lasts a lifetime, but there are ways to reduce the risk of infection.

In some conditions, such as genetic disorders of the immune system, injections of antibody proteins can be given to help the body fight infections.

Early treatment of infections is crucial if you are immunosuppressed. You will be treated for the infection. If it is not right or if it does not work, you may need hospitalization.

Do I need any specific treatment to prevent problems if I am immunosuppressed?

If your immune system is suppressed, the important thing is to take measures to avoid infection, this can be done in several ways:

  • Complete the general steps to avoid infection. For example, avoid eating foods that put you at risk for food poisoning. Handle raw meat safely. Use general hygiene measures to keep your home clean and free of germs.
  • Avoid close contact with people with infectious diseases whenever possible.
  • Make sure all routine immunizations are up to date. (Specific recommendations are made for immunosuppressed children who have their childhood vaccines).
  • Additional vaccines for people at higher risk, such as annual flu vaccine and vaccination against pneumonia and herpes zoster.
  • Some live vaccines (those that contain live germs) are not given to some people who have a suppressed immune system.
  • Some people who have undergone a splenectomy and have a particular risk of infection are advised to take a regular antibiotic, such as penicillin, every day.

Travel precautions

As you have a particular risk of infection, it is advisable to plan very carefully to travel. Make all travel vaccines recommended based on the specific location to which you are traveling.

Depending on the reason for your immunosuppression, you may be recommended against certain live vaccines.

Be careful to travel to countries with a high risk of diseases against which you can not get vaccinated.

Avoid going to places where you would not have access to good vaccines or medical care in case of getting sick.

Travel with information about your condition and medication in case you need the help of a health professional while you are away from your regular doctor.

Verify that your travel insurance covers you if you get sick. Talk to your doctor and consider taking some “preventative” antibiotics and instructions on when to take them if you are at risk for specific infections.

Take the usual precautions to avoid food poisoning and / or traveler’s diarrhea if you visit somewhere where this could be a risk.

And finally, if you travel to a hot place, use a lot of high factor sunscreen to protect your skin.