What does it mean to be immunocompromised?

Dr. Anurag Shahi (AIIMS)MBBS,MD

July 16, 2020

July 16, 2020

What does it mean to be immunocompromised?
What does it mean to be immunocompromised?

The words immunodeficiency, immunosuppression and immunocompromised are being used more than ever in these times, especially due to the steadily rising cases of the COVID-19 infection around the world.

Immunodeficiency could be an immune response or an immune system that is deficient or weak. Immunosuppression refers to a watering down or suppression of the immune system. This may be done intentionally with the use of drugs. For example, this is done after an organ transplant to reduce the chances of the immune system attacking the transplanted organ as something foreign (from outside the body). Immunosuppression may also be a side-effect of some medicines and therapies like cancer therapies.

Immunocompromised, however, refers to the body's reduced ability to fight illnesses and infections. In most cases, the condition of being immunocompromised is brought on by an underlying or pre-existing condition such as human immunodeficiency virus or HIV infection, various types of cancer, diabetesobesityheart disease, autoimmune diseases and some genetic disorders. That said, the elderly, as well as smokers, are also usually immunocompromised. The state of being immunocompromised may be permanent or it could become better in some time.

Each of the three above mentioned words indicate the body’s inability or reduced ability to fend off disease.

Read more: Primary immunodeficiency

The immune system of the body is made up of several cells that prepare the body to fight off various kinds of pathogens, such as bacteria to viruses. But when this system isn’t functioning properly in the body, the chances of coming down with an infection or illness are high.

Those who are immunosuppressed or immunodeficient have a higher likelihood of catching an infection and falling sick as a result. But being immunocompromised is a little different, as there are varying degrees of this imbalance in the system.

More than 13 million people have been affected by the new coronavirus infection since it was first reported in Wuhan, China, while the death toll has been steadily climbing with more than 573,000 reported to have lost their lives to the disease globally. In recent weeks, India became the third-worst-hit country in the world due to the respiratory infection, with over 900,000 cases and more than 23,000 deaths reported so far.

Immunocompromised types

While there aren’t distinct ways that people can be immunocompromised, there are differing degrees of the condition—this has a bearing on how susceptible these people are to catching an infection, and how sick they eventually become because of it.

In the case of a patient who is mildly immunocompromised, they may be at greater risk of catching an infection and becoming sick, such as catching a cold or flu. However, those who are on this spectrum of the condition would recover eventually.

But when it comes to someone who is severely immunocompromised, even the most innocuous of infections can prove to be life-threatening, as not only is the person more at risk of catching the infection, but is at a higher risk of suffering from severe complications as a result. An example of this is people living with HIV but without ART therapy.

One can be immunocompromised for a short time, like when they are undergoing treatment for certain diseases. Others may have a more permanent experience of this condition—those with chronic illnesses or genetic disorders often have this problem. For example, people with diabetes are more likely to get severe symptoms if they catch an infection and they take longer than healthy people to heal.

Our immune system is made up of various cells, including T cells, B cells, macrophages and many others that are affected or disrupted due to various conditions affecting the body.

Read more: Immunity to COVID-19 may be higher than previously thought

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Symptoms of being immunocompromised

According to the US Centers for Disease Control and Prevention (CDC), as many as half of all COVID-19 patients with diabetes have needed to be hospitalised, while 78% of the patients who received intensive care were suffering from at least one pre-existing condition. However, in some cases, an overactive immune system is also said to have caused severe complications among COVID-19 patients.

Read more: Cytokine Storm

Some common signs that can show a person may be immunocompromised are as follows:

What causes a person to become immunocompromised

One of the reasons why those who may be immunocompromised have been asked to strictly follow preventive measures including physical distancing, avoiding large gatherings and eating healthy foods is because those with a weakened immune system have been known to suffer from the more severe complications of COVID-19. 

Read more: COVID-19 fatality rate in patients with diabetes

There are several factors that are responsible for a weakened immune system or being immunocompromised, some of which are as follows:

Any of the above-mentioned conditions or a combination of any of them can be the reason behind someone being immunocompromised.

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How to know if someone is immunocompromised

Whether it is a primary immunodeficiency such as type 1 diabetes that is affecting a patient, or a weakened immune system has occurred due to an illness or treatment, visiting a doctor to find out the root cause of your symptoms is important. The doctor may ask questions about your medical history and the symptoms that you have been experiencing, before proceeding to perform a physical examination.

Some common tests that are used to diagnose an immune disorder are blood tests, which look at the IgL (immunoglobulin) levels in the blood. These are the proteins that help in fighting off infections and diseases. If the numbers are abnormal, it can signal a weakened immune system. Antibody tests, which have become popular during the COVID-19 pandemic, are also a way to find out if the body is producing antibodies against the pathogen that is causing infection.

Treatment for patients who are immunocompromised

Those who are immunocompromised are not only at higher risk of suffering from severe symptoms of an infection but sometimes they do not even respond to vaccinations as well, making it difficult to protect them from future illnesses.

In most cases, preventing the onset of an illness is the best-case scenario for those who are immunocompromised. Besides that, ensuring that the body is getting adequate nourishment and nutrition to boost the immune system is another effective strategy towards preventing future harm.

Treating any infection in people who are immunocompromised has to be done immediately, with the appropriate usage of antibiotics or antivirals as the treatment may take longer than for an average person with a relatively strong immune system.

Those with primary immunodeficiency conditions may be required to take antibiotics for a long time. In the case of patients who show frequent symptoms of pain, fever, cough and cold, over the counter medications may be used to get relief from the symptoms before they become worse.

More complex treatments to boost the immune system include injecting antibodies into a patient's body, or even using growth factor therapy, a treatment that helps increase the level of specific white blood cells that are essential towards building immunity in the body.

A healthy diet and regular exercise are important for ensuring the body is strengthened not only from the outside, but has a strong immune system that can fight off future infections and diseases.

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Complications of being immunocompromised

People with weakened immune systems or those who are immunocompromised have a higher likelihood of developing the more severe symptoms of a disease, if and when they become infected.

In the case of COVID-19, various studies have indicated that those with underlying conditions are at a greater risk of suffering from the severe complications of the disease.

Read more: COVID-19 prevention tips for the elderly and people living with lifestyle diseases