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Recurrent infectious disease — Clinical Guidelines

Overview

Recurrent infectious diseases often stem from deficiencies or dysfunctions in the immune system, particularly involving immunoglobulins (Ig). These conditions can manifest as hypogammaglobulinemias or specific Ig deficiencies impacting serum and secretory immunity.

Diagnosis

Key Diagnostic Criteria: Elevated or deficient serum immunoglobulin levels (IgG, IgA, IgM) 7 8.

Recommended Tests: Serum immunoglobulin levels, salivary IgA assessment using reliable immunoassays 1 8.

Grading: Quantitative assessment of Ig levels to classify severity (e.g., partial, severe deficiency) 7.

Management

First-Line Treatments: Intravenous or subcutaneous immunoglobulin replacement therapy tailored to the specific Ig deficiency 7.

Adjunctive Treatments: Use of protective measures against infections (e.g., prophylactic antibiotics) in severe cases 7.

Purification Methods: For therapeutic preparations, utilize hydroxylapatite chromatography for efficient immunoglobulin purification 6.

Special Populations

Pediatrics: Early identification and intervention crucial; monitor growth and recurrent infections closely 7.

Elderly: Increased susceptibility to infections; consider underlying comorbidities affecting immune function 7.

Comorbidities: Careful management of coexisting conditions that may exacerbate immune deficiencies 7.

Key Recommendations

Regular monitoring of serum and salivary immunoglobulin levels to guide treatment adjustments (Evidence: Moderate 1 8).

Implement immunoglobulin replacement therapy for confirmed hypogammaglobulinemia to prevent recurrent infections (Evidence: Strong 7).

Utilize advanced chromatographic methods like hydroxylapatite for purification of therapeutic immunoglobulins to ensure efficacy and safety (Evidence: Moderate 6).

References

1 Coad S, Mclellan C, Whitehouse T, Gray B. Validity and reliability of a novel salivary immunoassay for individual profiling in applied sports science. Research in sports medicine (Print) 2015. link 2 Li R, Wu K, Liu C, Huang Y, Wang Y, Fang H et al.. 4-Amino-1-(3-mercapto-propyl)-pyridine hexafluorophosphate ionic liquid functionalized gold nanoparticles for IgG immunosensing enhancement. Analytical chemistry 2014. link 3 Zhou D, Zou H, Ni J, Yang L, Jia L, Zhang Q et al.. Membrane supports as the stationary phase in high-performance immunoaffinity chromatography. Analytical chemistry 1999. link 4 Karlsson R, Jendeberg L, Nilsson B, Nilsson J, Nygren PA. Direct and competitive kinetic analysis of the interaction between human IgG1 and a one domain analogue of protein A. Journal of immunological methods 1995. link00030-e) 5 Hazen KC, Bourgeois LD, Carpenter JF. Cryoprotection of antibody by organic solutes and organic solute/divalent cation mixtures. Archives of biochemistry and biophysics 1988. link90042-2) 6 Smith GJ, McFarland RD, Reisner HM, Hudson GS. Lymphoblastoid cell-produced immunoglobulins: preparative purification from culture medium by hydroxylapatite chromatography. Analytical biochemistry 1984. link90067-8) 7 Rennert OM. The hypogammaglobulinemias. Annals of clinical and laboratory science 1978. link 8 Brandtzaeg P. Human secretory immunoglobulins. II. Salivary secretions from individuals with selectively excessive or defective synthesis of serum immunoglobulins. Clinical and experimental immunology 1971. link 9 Brown WR, Newcomb RW, Ishizaka K. Proteolytic degradation of exocrine and serum immunoglobulins. The Journal of clinical investigation 1970. link 10 Marinkovich VA, Baluda MA. In vitro synthesis of gamma M-like globulin by various chick embryonic cells. Immunology 1966. link 11 Lamm ME, Nussenzweig V, Benacerraf B. Isolation of purified H and L polypeptide chains from guinea-pig gamma-2-immunoglobulin after mild reduction. Immunology 1966. link

Recurrent infectious disease