n South African Medical Journal - Investigation of adult immunodeficiency and indications for immunoglobulin replacement therapy : CME - article summary




Underlying immunodeficiency needs to be excluded in adults presenting with recurrent infections. These patients fall into one of three groups: () with recurrent localised infections, it is mandatory to exclude an underlying predisposing, anatomical defect, e.g. base of skull fractures presenting with recurrent pneumococcal meningitis, urinary tract obstruction presenting with recurrent urinary infections, and recurrent sinusitis after previous extensive surgery that results in bacterial colonisation on abnormal mucosal surfaces; () secondary immune deficiency, which can be due to underlying diseases or a complication of immune suppression, e.g. HIV, diabetes, liver cirrhosis and nephrotic syndrome, haematological diseases, autoimmunity and malignancy; () primary immune disorders, which can present for the first time in adulthood, involving defects in antibody production, T-cell function, complement deficiencies, or phagocytic function.


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