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Immunosuppression-related infectious disease — Clinical Guidelines

Overview

Immunosuppression increases susceptibility to infectious diseases due to impaired immune response, necessitating careful management of vaccination strategies and prophylactic measures to mitigate risks 1 4 5.

Diagnosis

Assess clinical symptoms and history of immunosuppressive therapy 4.

Consider laboratory tests for specific pathogens (e.g., blood cultures, imaging for suspected infections) 18.

Evaluate for opportunistic infections indicative of immunosuppression 8 11.

Management

Administer inactivated vaccines rather than live vaccines during immunosuppressive therapy 1 5.

Implement prophylactic antibiotics and antiviral medications as indicated for specific risks 4.

Regular surveillance for infections and malignancies, tailored to the underlying condition 4.

Monitor and adjust immunosuppressive drug levels (e.g., cyclosporine) using specific assays 20.

Special Populations

Pediatrics: Ensure timely administration of age-appropriate inactivated vaccines before initiating immunosuppressive therapy 5.

Elderly: Increased vigilance for pneumococcal and other vaccine-preventable infections; consider pneumococcal vaccination 9.

Comorbidities: Tailor management to specific comorbidities, such as organ transplantation requiring additional prophylactic measures 4.

Key Recommendations

Administer necessary inactivated vaccines before initiating immunosuppressive therapy to prevent vaccine-preventable infections (Evidence: Strong 1 5).

Implement regular surveillance for opportunistic infections and malignancies in immunosuppressed patients (Evidence: Moderate 4 8).

Use inactivated rather than live vaccines in immunosuppressed patients to avoid adverse reactions (Evidence: Strong 1 5).

Consider pneumococcal vaccination specifically for immunosuppressed patients to reduce the risk of pneumococcal disease (Evidence: Moderate 9).

Monitor immunosuppressive drug levels with validated methods to optimize therapy and minimize adverse events (Evidence: Moderate 20).

References

1 Shan DM, Chandy RJ, Fultz A, Sanders JW, Feldman SR. Live vaccinations in dermatology for immunosuppressed patients: a narrative review. Archives of dermatological research 2024. link 2 Chen S, Ma X, Zhang J. Safety assessment of basiliximab using real-world adverse event data from the FDA Adverse Event Reporting System Database: A retrospective observational study. Medicine 2024. link 3 Gabardi S. Immunosuppression in the Age of Precision Medicine. Seminars in nephrology 2022. link 4 Neuberger J. Immunosuppression in gastroenterology and hepatology. Best practice & research. Clinical gastroenterology 2021. link 5 Munshi MA, Noe MH, Chiu YE, Streicher JL. Vaccines: Considerations for pediatric dermatology patients on immunosuppressive agents. Pediatric dermatology 2021. link 6 Nguyen VN, Abagyan R, Tsunoda SM. Mtor inhibitors associated with higher cardiovascular adverse events-A large population database analysis. Clinical transplantation 2021. link 7 Christen D. [Immunosuppression, Surgery, Complication?]. Praxis 2019. link 8 Potter CA, Hsu L. Emergent Neuroimaging in the Oncologic and Immunosuppressed Patient. Neuroimaging clinics of North America 2018. link 9 Desai SP, Lu B, Szent-Gyorgyi LE, Bogdanova AA, Turchin A, Weinblatt M et al.. Increasing pneumococcal vaccination for immunosuppressed patients: a cluster quality improvement trial. Arthritis and rheumatism 2013. link 10 Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA et al.. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. The journal of trauma and acute care surgery 2012. link 11 Meuli K, Chapman P, O'Donnell J, Frampton C, Stamp L. Audit of pneumocystis pneumonia in patients seen by the Christchurch Hospital rheumatology service over a 5-year period. Internal medicine journal 2007. link 12 Altschuh D. Cyclosporin A as a model antigen: immunochemical and structural studies. Journal of molecular recognition : JMR 2002. link 13 Gleeson M, Bishop NC. Elite athlete immunology: importance of nutrition. International journal of sports medicine 2000. link 14 Bishop NC, Blannin AK, Walsh NP, Robson PJ, Gleeson M. Nutritional aspects of immunosuppression in athletes. Sports medicine (Auckland, N.Z.) 1999. link 15 Riethdorf L, Nehmzow M, Straube W, Lorenz G. Vaginitis emphysematosa during immunosuppressive therapy. Archives of gynecology and obstetrics 1995. link 16 Behling D, Guy J. Who's protected? Legal, ethical issues in employing the immunosuppressed. Occupational health & safety (Waco, Tex.) 1993. link 17 Sarris AH, Harding MW, Jiang TR, Aftab D, Handschumacher RE. Immunofluorescent localization and immunochemical determination of cyclophilin-A with specific rabbit antisera. Transplantation 1992. link 18 Pillon LR. Cyclosporine: a nursing focus on immunosuppressive therapy. Dimensions of critical care nursing : DCCN 1991. link 19 Tucker RM, Hamilton JR, Stevens DA. Concurrent bloodstream infection with Histoplasma capsulatum and Mycobacterium tuberculosis. Journal of medical and veterinary mycology : bi-monthly publication of the International Society for Human and Animal Mycology 1991. link 20 Quesniaux VF. Monoclonal antibody technology for cyclosporine monitoring. Clinical biochemistry 1991. link90147-7) 21 Bannatyne RM, Kolodej V. Branhamella catarrhalis bacteraemia and immunosuppression--part of a larger problem?. Diagnostic microbiology and infectious disease 1985. link90068-9) 22 Almassy K, Kakuk T. Immunosuppressive effect of a naturally acquired subclinical bursal agent infection on vaccination against Newcastle disease. The Veterinary record 1976. link

Immunosuppression-related infectious disease