Secondary Immunodeficiency

in children
Defence against infection
Immunodeficiency disorders represent defects in the immune system that result in weakened
or dysregulated immune defense.

• Primary immunodeficiency disorders (PIDs)

• Occur due to a defect in the development and/or function of innate (macrophage,

neutrophil, dendritic cell, and complement system) or adaptive (B and T lymphocytes)
immune system.

• Mostly are inherited and present during the first few years of life.

• Secondary immunodeficiency

• Extrinsic factors affecting intrinsically normal immune system

• Generally resolved with the management of the primary condition

• Two most common cause  malnutrition and HIV infection.

• Other causes  Malignancy, immunosuppressive medications and protein loss, including

protein-losing enteropathy, asplenia, sickle cell disease, diabetes mellitus, severe liver
disease, and renal failure

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Journal of Allergy and Clinical Immunology. 2010 Feb 1;125(2):S195-203.
Edwards H, Lakshman R. Immune deficiency in children. InnovAiT. 2012 May 9.
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Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. Journal of Allergy and
Clinical Immunology. 2010 Feb 1;125(2):S195-203.
Summary of immune parameters affected and not affected by Malnutrition.

Rytter MJH, Kolte L, Briend A, Friis H, Christensen VB (2014) The Immune System in Children with Malnutrition
—A Systematic Review. PLOS ONE 9(8): e105017. https://doi.org/10.1371/journal.pone.0105017
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105017
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Duggal S, Chugh TD, Duggal AK. HIV and malnutrition: effects on immune system. Clinical and developmental
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 Corticosteroid Therapy
• Decrease cytokine production (IL-1, IL-6, and TNF-a) and impair
leukocyte chemotaxis, cell adhesion, phagocytosis, and lymphocyte
anergy.
• Lymphopenia occurs as a result of the proapoptotic activity and
inhibition of IL-2–mediated proliferative responses.
• When used at large doses, antibody responses and delayed-type
hypersensitivity responses are reversibly suppressed.

Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. Journal of Allergy and
Clinical Immunology. 2010 Feb 1;125(2):S195-203.
 Immunosuppressive Drugs
• Include cytotoxic/antiproliferative agents (eg, azathioprine, 6-
mercaptopurine, chlorambucil, cyclophosphamide), calcineurin
inhibitors (eg, cyclosporine, tacrolimus), and antimetabolites (eg,
methotrexate, mycophenolate mofetil).
• Target T-cell activation and cytokine production, clonal expansion, or
both.
• Produce cytotoxicity through their effect on rapidly dividing cells such
as the malignant cells as well as normal cells of the immune system,
primarily T lymphocytes.
• Cytotoxic agents may cause significant bone marrow and immune
suppression, leading to life-threatening infections.

Abraham Gedalia and Avinash K. Shetty. Chronic Steroid and Immunosuppressant Therapy in Children.
Pediatrics in Review 2004;25;425
Abraham Gedalia and Avinash K. Shetty. Chronic Steroid and Immunosuppressant Therapy in Children.
Pediatrics in Review 2004;25;425
Esposito S, Prada E, Lelii M, Castellazzi L. Immunization of children with secondary
immunodeficiency. Human vaccines & immunotherapeutics. 2015 Nov 2;11(11):2564-70.
Terima kasih
Mohon asupan