Clinical and immunological characteristics of secondary immunodeficiencies observed in clinical practice

BACKGROUND: Despite the increasing number of patients with secondary immunodeficiencies, reliable data on their prevalence, diagnostic criteria, and treatment are lacking, which underscores the requirement for research in this area.

AIM: To characterize the clinical and immunological features, and treatment approaches for various forms of secondary immunodeficiencies observed in clinical practice.

METHODS: A retrospective analysis of medical records from 180 patients with a confirmed diagnosis of secondary immunodeficiency was conducted. The database included information on primary and comorbid conditions, the scope of administered therapy, characterization of secondary immunodeficiencies clinical signs, data from general clinical and immunological investigations, and specific treatment options for immunodeficiency.

RESULTS: Three groups of patients with secondary immunodeficiencies were identified: group 1 — 51 (34.0 %) patients with oncohematological diseases, group 2 — 33 (22.0 %) patients with chronic bacterial infections, group 3 — 41 (27.3 %) patients with chronic viral infections. In group 1, lymphomas accounted for 82.3 % of the underlying pathologies. Manifestations of infectious syndrome in 80.3 % were associated with respiratory tract disorders, with pneumonia diagnosed in 21.5 %. This cohort showed a significant B-lymphocytopenia, associated with reduced immunoglobulin G levels, alongside phagocytosis depression. Immunodeficiency was managed with intravenous immunoglobulin.

In group 2, respiratory tract, skin, and soft tissue lesions (57.6 % and 36.4 %, respectively) occurred in the setting of depressed phagocytosis, necessitating more frequent antibacterial therapy. However, patients with oncohematological diseases had 3.2 times higher odds of developing recurrent infections requiring prolonged or parenteral antibiotic therapy (odds ratio 3.257 [confidence interval 1.303–8.142]; p = 0.01300). For immunodeficiency correction, azoximer bromide was prescribed to 66.6 % of patients.

The majority of patients in group 3 (97.5 %; n = 40) had infection induced by various types of herpes viruses, with frequent relapses and resistance to standard therapy. Laboratory assessment revealed reduced phagocytic indices

CONCLUSION: The study demonstrates the relevance of the problem of secondary immunodeficiencies in clinical practice, which requires a multidisciplinary approach and the involvement of physicians of various specialties, followed by rational patient referral to a specialized clinical immunology center.