Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- 83 Evaluation of Suspected Immunodeficiency
- 84 Infections in the Neutropenic Patient
- 85 Infections in Patients with Neoplastic Disease
- 86 Corticosteroids, Cytotoxic Agents, and Infection
- 87 Infections in Transplant Patients
- 88 Diabetes and Infection
- 89 Infectious Complications in the Injection Drug User
- 90 Infections in the Alcoholic
- 91 Infections in the Elderly
- 92 Neonatal Infection
- 93 Pregnancy and the Puerperium: Infectious Risks
- 94 Dialysis-Related Infection
- 95 Overwhelming Postsplenectomy Infection
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
83 - Evaluation of Suspected Immunodeficiency
from Part XI - The Susceptible Host
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- 83 Evaluation of Suspected Immunodeficiency
- 84 Infections in the Neutropenic Patient
- 85 Infections in Patients with Neoplastic Disease
- 86 Corticosteroids, Cytotoxic Agents, and Infection
- 87 Infections in Transplant Patients
- 88 Diabetes and Infection
- 89 Infectious Complications in the Injection Drug User
- 90 Infections in the Alcoholic
- 91 Infections in the Elderly
- 92 Neonatal Infection
- 93 Pregnancy and the Puerperium: Infectious Risks
- 94 Dialysis-Related Infection
- 95 Overwhelming Postsplenectomy Infection
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
The need to evaluate immunologic function has become a part of the standard practice of clinical medicine, resulting at least in part from the secondary immunodeficiency produced by human immunodeficiency virus (HIV) infection. In addition, since the early 1990s the molecular basis of primary immunodeficiency disorders has evolved, with now more than 120 genetic defects identified and an expanded range of clinical phenotypes associated with immune dysfunction. This chapter presents the general methods available to assess immune function linking these to the clinical infection scenaria that suggest specific types of immunodeficiency.
The primary clinical problem that sets the stage for initiating an immunologic evaluation is a history of increased susceptibility to infection. In general, the specific characteristics of the recurrent and/or chronic infections, including organism(s), sites, and response to therapy, provide critical insights into the most likely source of the immunodeficiency.
Defects in adaptive immunity involving antibody production (humoral immunity) lead to recurrent infections with high-grade encapsulated extracellular bacteria such as Haemophilus influenzae and Streptococcus pneumoniae usually affecting the sinopulmonary tract. The protective immune response depends on the production of antibodies against the capsular carbohydrate antigens present on these organisms. In contrast, the clinical picture of patients with defective T-cell (cellular) immunity typically consists of recurrent infections with opportunistic organisms, including Pneumocystis jiroveci (formerly Pneumocystis carinii), Candida species, and cytomegalovirus. This demonstrates that functional T cells are required to prevent or clear infection with these opportunistic intracellular micro organisms.
- Type
- Chapter
- Information
- Clinical Infectious Disease , pp. 587 - 592Publisher: Cambridge University PressPrint publication year: 2008