When You Just Can’t Fight It Anymore

I’m often asked about #immunodeficiency–does my body fight infection like it’s supposed to? Is this baby’s immune system normal? Obviously, probably not. Fortunately, #Stevens Johnson syndrome is quite rare, but antibody deficiency is NOT rare and many strategies can be performed to improve the situation.

example of Stevens Johnson syndrome

I often start the conversation about #immunodeficiency: “are you worried about how well you fight infection?” Since immunodeficiency comes in many flavors, there are no absolutes to checking the immune system, but here’s some pointers that are helpful. Remember, the body fights infection in compartments, so test for something in each compartment and you’ll hit a home run with the bases loaded.

  1.  The severity of infection matters to your immune system.  What I mean by this is simple; the worse your illness, the more likely you are to have immunodeficiency.  So, if you have documented #pneumonia every year, that’s a serious offense whereas mild upper respiratory infections can get off pretty easy with one week of the sniffles, congestion, and no antibiotics. (the absence of antibiotics is important) Serious infections include: pneumonia, meningitis, sepsis, cellulitis (children), and sinuses that never heals.
  2.  Family history in medicine is important for one reason: it’s your genes. Researchers are discovering that almost every “immunodeficiency” is associated with a #genetic defect of some type. Good news, bad news here. The good news is that many genetic disorders can be diagnosed by a simple lab test available from your doctor’s office or better yet, 23andme! The bad news is genetic therapy is a little ways off and sometimes you find out that supportive care (and no cure) is all you can do with your problem. Kind of like meeting the woman of your dreams in 4th grade!
  3.  Look for horses not zebras!  Common illnesses are most common (duh), and when someone you know is affected by unusual symptoms, start asking questions. Questions such as, “why is my fever lasting so long (>1 week)”, “antibiotics don’t seem to make any difference”, or “my son has meningitis–is this normal?”  Don’t feel like questions are annoying; a good doctor will listen and search with you for the hidden answer.
Your job is to solve the puzzle!

I mentioned earlier that the body fights infection using compartments. Lab tests are available for each compartment and  so let’s have a look.

  1.  #Antibody production. You remember all of those childhood vaccines? Vaccines are given in order to increase antibody production to recognize and “fight” an invading organism. Think of antibodies as sentinels that alert the rest of the body when you have an infection. Doctors track your response to a vaccine or live infection by checking your antibody levels: IgG, IgA, IgM, Pneumococcal levels to mention a few. Fortunately, your body doesn’t lie, and if antibody levels are low, something is probably wrong.
  2. #Lymphocytes. These cells of the immune system can be thought of as “traffic cops” to direct resources and respond to any emergency that arises when you’re sick (105 degree fever is definitely an emergency).  Armed with a large array of weapons to identify those sneaky little #flu bugs, T-lymphocytes can destroy viruses and bring fresh recruits to the battlefield to help you recover from your illness much faster than without them. Chemotherapy will often destroy lymphocytes and this is why cancer patients have to be so vigilant with fever and the ever present concern with a raging infection that burns out of control.
  3.  #Neutrophils. Remember the Pacman game of the 70’s? Now you understand the function of our body’s neutrophils. They gobble up whatever shouldn’t be there to get rid of the infection. Laboratory tests are available to find out just how well our neutrophils are working to ingest and destroy unwanted bacteria. Examples: neutrophil counts, Dihydrorhodamine, leukocyte adhesion molecules. (trust me on this one) This is the compartment that creates that “zit” we all love to squeeze (c’mon, I know you do); valiant neutrophils have given their lives to protect our bodies and leave “pus” behind as evidence we’ve had an infection. Many infections in this compartment are located in the skin, where it’s easy to identify this type of inflammation.
  4. #Complement proteins. A much more rare form of immunodeficiency, yet nonetheless, very important to keep our bodies #healthy and functioning well. How did Bruce Willis always know where to place the bomb stuck to the wall in Die Hard? Evidently, he learned his technique from complement proteins that “stick” to bacteria and viruses and blow them up.  (life isn’t complicated if you watch enough movies!) Complement proteins can be measured and simply go by the nomenclature of CH50, C1, C2, etc.
Tired of studying?

Of all the above compartments used by the immune system for keeping you healthy, our biggest opportunity for intervention is antibody replacement therapy or #gamma globulin. This substance is considered a “medicine” that is administered several different ways to give your body a boost in fighting off infections. Some people have extraordinary high levels of antibody and don’t mind sharing with those less fortunate. When antibodies are collected, the purification process takes 5 steps and I’ve been very pleased with results.  That is, we haven’t had infections such as Hepatitis C, HIV, or other ghastly conditions transmitted by gamma globulin infusions. Gamma globulin is given by IV infusions, under the skin (subcutaneous) and schedules vary from once a week to once per month. But that’s for another  time! I do hope you’ve learned something about how the immune system works, and don’t forget to wash your hands!

 

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