Secondary immunodeficiency needs to be tackled first by addressing the underlying problem like malnutrition, chronic illness, immuno-suppression with chemotherapy drugs. The underlying etiology for secondary immune deficiency needs to be addressed. Patients with human immunodeficiency virus infection need to be started on antiretroviral therapy (ARV) in addition to supportive measures like nutrition, treatment of infectious diseases.
However, patients with primary immune deficiency (PID) need to be seen in a holistic approach of underlying molecular defect. Various PIDs like hypogammaglobulinemia, agammaglobulinemia, common variable immune deficiency need IVIG at regular intervals . Other T cell defects and severe combined immunodeficiency (SCID) patients need to be tackled on emergency basis.
Any early suspicion of these defects may warrant early referral so that they may be evaluated for bone marrow transplant (BMT). Early BMT done in such children prior to 3 months of age has better survival. These infants should be put on antibiotic prophylaxis along with monthly IVIG till a compatible donor for BMT is found. Various conditions like hyper IgE syndrome, IgA deficiency, hyper IgM syndrome need supportive care and antibiotics.
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