Is your body's ability to fight disease reduced? (Immunocompromised) Let's talk about this!

Do you often catch a cold but it doesn't go away in a few days? Or do you feel like you catch diseases more easily than others? Maybe your body's ability to fight diseases, that is, your immunity, is reduced. We call this `(Immunocompromised)` condition. Don't worry, let's talk about this in detail.

Simply put, what is this condition called `(Immunocompromised)`?

Imagine that we have a defense army inside our body, like a country. This army keeps us healthy by fighting off germs that cause diseases from outside. We call this the immune system . So, being ``Immunocompromised'' means that your immune system is not working properly, that is, it is weakened. Then it cannot fight diseases as it should.

You may be born with this condition. Or your immune system may be weakened by certain infections, medications, conditions like cancer, or other health problems throughout your life. You may also hear this called ``Immunosuppression.'' It is not specifically something you were born with, but rather a later treatment or illness that lowers your immune system.

How do you know if you have this condition?

The main symptoms of this are getting sick frequently and taking an unusually long time to recover when you do get sick. However, not everyone who gets sick frequently has a weak immune system. The type of illness you get is also important. For example, it is common for young children to get colds frequently.

However, if you are getting frequent bacterial infections, illnesses like pneumonia, or other specific illnesses, it could be a sign that your immune system is not working properly. In an immunocompromised state, things like this can happen:

• You get sick from germs that normally keep others away without getting sick.
• A disease that is mild and curable for most people can be very serious for you.
• It takes a long time to recover from illness.
• You are more likely than others to develop complications from illness (e.g., developing pneumonia after a respiratory virus).
• Some viral infections that have previously cleared up, for example Epstein-Barr virus or varicella-zoster virus (the virus that causes chickenpox), can recur.
• Even if you receive vaccinations, your body may not produce antibodies.

You may not experience any specific symptoms because you are immunocompromised. However, if you have a disease that causes this condition (such as certain types of cancer), you may experience symptoms such as:

• Feeling very tired (Fatigue)
• Night sweats
• Recurring fevers
• Unintended weight loss
• Swollen lymph nodes

Special infections that occur in people with weakened immune systems

There are some infections that a healthy person can easily fight off and defeat. But if you develop such infections, a doctor may suspect that your immune system is weakened. Such infections include:

• Pneumocystis pneumonia (PCP) is a type of pneumonia.
• Symptomatic cytomegalovirus (CMV) infection
• Fungal infections that spread from the lungs to other parts of the body (e.g. coccidioidomycosis, cryptococcosis, histoplasmosis)
• Frequent bacterial infections
• Frequent or long-term infections such as pneumonia, herpes simplex, campylobacter, or cyclosporiasis.

What are the causes of this decreased immunity?

Many times, the main causes of a weakened immune system are certain medical conditions, side effects of certain medications, and things like an organ or stem cell transplant. All of these can weaken your immune system in different ways.

Diseases and conditions that weaken the immune system

Some diseases destroy our immune cells or affect their ability to repair themselves properly. Such diseases include:

• Primary immunodeficiency: This is any condition that weakens your immune system, whether you're born with it or if your immune system naturally weakens later in life.
• HIV (human immunodeficiency virus) infection: This directly attacks the immune system.
• Cancer: Blood-related cancers, especially leukemia, lymphoma, and multiple myeloma, are the most common cancers that affect the immune system. However, other types of cancer can also affect the immune system.
• Diabetes `(Diabetes Mellitus)`
• Autoimmune diseases: This is when the immune system attacks the body's own cells.
• Sickle cell disease
• Liver cirrhosis
• Viral hepatitis (inflammation of the liver)

Similarly, those who lack a thymus (where our T cells, a type of immune cell, mature) or a spleen (an organ that contains and controls white blood cells) also have low immunity.

Immune-suppressing medications and treatments

Some treatments, such as radiation therapy and chemotherapy for cancer, can weaken the immune system as a side effect. There are other treatments that suppress the immune system as part of their function. For example, a bone marrow transplant usually destroys your entire immune system and replaces it with a better one.

Many medications for autoimmune diseases work by weakening the immune system, stopping it from attacking healthy cells. We call these immunosuppressive medications (which reduce the activity of the immune system) or immunomodulatory medications (which change the way the immune system works).

Some medications and medical treatments that suppress immunity include:

• Bone marrow or solid organ transplant
• Chemotherapy
• Radiation therapy
• Corticosteroids (e.g. prednisone, prednisolone, dexamethasone)
• `Azathioprine (Imuran®)`
• ``Cyclosporine (Gengraf®, Neoral®)''
• `Hydroxychloroquine (Plaquenil®)`
• `Leflunomide (Arava®)`
• `Methotrexate (Rheumatrex®, Trexall®)`
• ``Sulfasalazine (Azulfidine®)''

What are the possible side effects of this?

When your immune system is weakened, you are at greater risk of developing life-threatening complications from infections. Because your body is unable to fight off illness, infections can spread throughout your body. This can lead to organ damage, sepsis (a condition similar to blood poisoning), and septic shock (a severe drop in blood pressure). All of these can be fatal. If you are in serious trouble, go to the nearest emergency room.

How does a doctor recognize this?

Doctors diagnose immunodeficiency and the diseases that cause it by examining your blood and body tissues. Some specific tests are used to do this:

• Complete blood count (CBC)
• Antibody testing
• Flow cytometry (counting immune cells)
• Genetic testing to look for genetic changes that affect immunity
• Urinalysis
• HIV testing
• Lymph node biopsy
• Bone marrow biopsy
• Liver biopsy
• CT scan or other radiological tests

How do you treat someone with a low immune system?

The treatment for a weakened immune system depends on the cause. Doctors can treat some underlying conditions and help boost your immune system. Such treatments include:

• Antiretroviral therapy: These treatments can greatly reduce the amount of HIV in your body. When it is reduced enough, it does not affect your immune system.
• Cancer treatment: Cancers that affect the immune system are treated with chemotherapy, radiation therapy, and immunotherapy.
• Pegfilgrastim injection (Fulphila®, Neulasta®): If your white blood cell count is very low (neutropenia), this injection helps your body make more white blood cells and strengthens your immune system.
• Granulocyte transfusion: This is a rare blood transfusion for severe neutropenia.
• Stem cell transplant: A stem cell transplant can be done to cure or control some diseases that weaken the immune system.

There are other treatments that can help prevent or fight infections.

Treating infections when immunity is low

If your immune system is weak, you may not be able to get better with over-the-counter medications when you get sick. Your doctor will often start antibiotic, antifungal, antiviral, or antiparasitic treatment right away, depending on the type of infection.

You may also be admitted to the hospital to help fight the infection. There, you may be given treatments such as:

• Monoclonal antibodies
• Convalescent plasma
• Interferon gamma injections
• Intravenous immune globulin (IVIG)

What should you expect when living with this condition?

Not everyone with a weakened immune system is the same. For some, it may be a small change, but for others it can change their entire lifestyle.

Also, some people's immunity is only reduced for a short time. Others may need lifelong immune-modulating medications or diseases. Talk to your healthcare team about what to expect based on your condition.

In general, the outlook for someone with a weakened immune system depends on the underlying cause. Many diseases that weaken the immune system can be controlled. However, it is often necessary to be very vigilant throughout life to prevent infections or seek treatment when they occur.

Can this be prevented?

Most immunosuppressive illnesses cannot be prevented. However, avoiding infections from other people is the best way to avoid serious complications. It can also help protect against some immunosuppressive illnesses.

You can do these things to reduce the risk of infection:

• Safer methods: Wash your hands frequently, practice safe sex, and follow food safety practices.
• Vaccinations: Get all the vaccines that are recommended for you. Some vaccines can make people with weakened immune systems sick. So ask your doctor about which vaccines are right for you.
• Pre- and post-exposure prophylaxis: If you are at high risk of exposure to HIV, you can take Preexposure prophylaxis (PrEP). If you have been exposed to HIV, you can take Post-exposure prophylaxis (PEP). There are also post-exposure prophylaxis options for Hepatitis B.
• Limit exposure: Avoid people who are sick or have been exposed to someone who is sick. Go to the store and buy groceries when there are fewer people. This is especially important during cold and flu season and when COVID-19 infections are high.
• Start treatment early: Your doctor may prescribe antibiotics or antifungals to prevent infection.
• Testing for infections: Before starting immunosuppressive therapy, your doctor may test you for things like HIV, hepatitis, tuberculosis, fungal infections, and parasitic infections.

How do you take care of yourself?

If your immune system is weak, you need to be very careful about your health. Even a common cold can make you very sick. In addition to taking special precautions to protect yourself from illness, there are a few other ways you can take care of yourself:

• Monitor your health: Ask your doctor what signs of infection you should watch for and what to do if you have them. For example, a fever above a certain temperature, symptoms that persist, etc.
• Plan ahead: Keep a mask and hand sanitizer handy. When traveling, know where to get medical help wherever you go. Some people carry a card stating that they have a low immune system.
• Inform your loved ones: Talk to your family and friends about taking precautions. They need to understand that they can help keep you healthy. If they feel sick, they need to tell you before they see you.
• Make a plan with your school/workplace: Talk to your company's human resources department or school (if your child's school) about any changes you need to make to stay healthy and safe. You may need to work with your doctor to come up with a plan that details other accommodations for when you or your child cannot go to work/school.
• Talk openly with your doctor: Some people avoid medical appointments for fear of being around other people. Talk to your doctor about the best way to get medical care without risk. See if you can schedule virtual visits (like video calls) or appointments during off-peak hours.
• See if lifestyle changes can help: Ask your doctor if exercise or diet can make a difference to your immune health.
• Prioritize your mental health: Taking care of your physical health can also have an impact on your mental health. Talking to a mental health counselor , taking a daily walk, and other self-care methods can help reduce your stress levels. This can also help your immune system.

What time do I need to see a doctor/go to the hospital?

Talk to your doctor about when you should see them again if you have a weakened immune system, and what to do if you think you have an infection. They may tell you to go straight to the emergency room if you have certain symptoms. A lot depends on your specific situation, but it's best to get checked out if you're concerned about something.

When should you go to the Emergency Treatment Unit (ETU) ?

Ask your doctor what symptoms to watch for and when to go to the emergency room. Always go to the ER if you have signs of a serious infection:

• Fever (usually any temperature above 100.4 Fahrenheit/38 Celsius)
• Confusion or altered consciousness
• Severe headache
• Neck stiffness
• Frequent vomiting or diarrhea
• If the wound is red, swollen, painful, oozing pus, or warm to the touch

What questions should you ask the doctor?

It may be helpful to ask your doctor questions like these:

• How long will I be ``immunocompromised''? Is this temporary or permanent?
• What steps can I take to protect myself from infections?
• What signs of infection should I look out for?
• When should I go to the emergency room?
• When should I see you again?

People can become ``immunocompromised`` for a variety of reasons. Your experience may be different from someone else's. Maybe you're reading this before starting immunosuppressive medication, hoping it won't stop you from doing the things you love. Maybe you're in the hospital, with another infection, wondering what the future holds. Or maybe your child is ``immunocompromised``, and you're trying to convince the world that your family never "just" gets a cold.

One thing that everyone with a weakened immune system has in common is that they have to make changes and take precautions that others may not want to make. It can be overwhelming to explain your health management to others. Lean on your medical team. They may have suggestions for support groups and other ways to keep you safe and healthy.

If someone you know is immunocompromised, listen to their needs. Do what they ask you to do to help protect their mental and physical health.

Things you need to know (Take-Home Message)

Having a low immune system is not something to be afraid of, but it is very important to be aware of it and take the necessary steps.

• If you are frequently sick or if your illness takes a long time to heal, seek medical advice.
• There are various reasons why immunity can decrease; understand that.
• Follow the doctor's treatment and instructions exactly.
• Do everything you can to protect yourself from infections. Make it a habit to wash your hands and avoid crowded places.
• Your mental health is also very important. Don't hesitate to get help if you need it.
• You are not alone. There are doctors, family, and friends to help you.

Remember, this information is for informational purposes only. If you have any health concerns, please consult a doctor.

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