The prevalence of immunodeficiency in a special population: intern doctors

Yıl 2024, Cilt: 5 Sayı: 2, 56 - 65, 31.05.2024

Filiz Sadi Aykan , Fatih Çölkesen , Recep Evcen , Mehmet Kılınç , Eray Yıldız , Ümmügülsüm Yılmaz Ergün , Tuğba Önalan , Fatma Arzu Akkuş , Selim Kahraman , Mehmet Emin Gerek , Şevket Arslan

https://doi.org/10.47482/acmr.1393582

Öz

Background: This study analyzes the immune system parameters of intern doctors working actively during the COVID-19
pandemic. When an intern doctor failed to respond to the treatment during a severe COVID-19 condition, the immune system
panel was examined and as a result, it revealed an underlying immunodeficiency. The death of the intern doctor caused several
concerns among other intern doctors, and for this reason, their immune systems were also considered to be examined. This study
aims to demonstrate that immunodeficiencies might be more common than is known among the general population.
Methods: In this single-center study, the demographic characteristics and European Society for Immunodeficiencies (ESID)
diagnostic criteria of 92 intern doctors have been examined retrospectively. For the study, immune system parameters (complete
blood count, serum immunoglobulins and subgroup levels, specific vaccine responses, isohemagglutinin titers, lymphocyte
subgroups, and class-switched memory B cell (cSMB) levels have been evaluated.
Results: When the demographic characteristics have been analyzed it is seen that the median age is 23.6 (21-28) years, and 64
(70%) of the intern doctors are female. In immune system parameters, one or more are found to be low in 51.08% of the doctors.
Among the immunoglobulin subgroups, low IgG4 has been the most common. Selective IgA deficiency has been detected in 2.17%
and selective IgM deficiency has been detected in also 2.17% of them. Low B cells (CD19+) are detected in 10.9% and low levels of
class-switched memory B cells are found in 35.7% of them.
Conclusion: This study reveals that deficient immunological parameters, especially selective Ig A, selective IgM deficiency, and
low IgG4, might be more frequent than known. Depending on the data, it can be concluded that immunodeficiency might be
more common than it is known among the general population; however, low immunological parameters alone do not lead to
immunodeficiency.

Anahtar Kelimeler

Intern doctor, immune system, immunodeficiency, immunoglobulins, lymphocyte subgroup

Etik Beyan

Approved

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

• Abbas AK, Lichtman AH, Pillai S. Properties and overview of immune responses. In: Abbas AK, editor. Cellular and molecular immunology, 9. ed. Amsterdam: Elsevier; 2017. p. 1-11.
• Zhang Q, Frange P, Blanche S, Casanova JL. Pathogenesis of infections in HIV-infected individuals: insights from primary immunodeficiencies. Curr Opin Immunol. 2017;48:122-33.
• Veramendi-Espinoza LE, Zafra-Tanaka JH, Toribio-Dionicio C, Huaman MR, Perez G, Cordova-Calderon W. Awareness of primary immunodeficiency diseases at a national pediatric reference center in Peru. Einstein (Sao Paulo). 2021;19:eAO6289.
• World Health Organization. Coronavirus disease dashboard. 2020. Available at https://covid19.who.int/Accessed October 20, 2023.
• Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. 2020;16(1):57.
• European Society for Immunodeficiencies Warning Signs for PID in Adults. 2022. Available at https://esid.org/ Working-Parties/ Clinical-Working-Party/Resources/6-Warning-Signsfor-PID-in-Adults. Accessed September 20, 2023
• Bousfiha AA, Jeddane L, Ailal F, Benhsaien I, Mahlaoui N, Casanova JL, et al. Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol. 2013;33(1):1-7.
• Sewell WA, Khan S, Dore PC. Early indicators of immunodeficiency in adults and children: protocols for screening for primary immunological defects. Clin Exp Immunol. 2006;145(2):201-3.
• Tangye SG, Al-Herz W, Bousfiha A, Cunningham-Rundles C, Franco JL, Holland SM, et al. Human inborn errors of immunity: 2022 update on the classification from the international union of immunological societies expert committee. J Clin Immunol. 2022;42(7):1473-1507.
• Waltenburg R, Kobrynski L, Reyes M, Bowen S, Khoury MJ. Primary immunodeficiency diseases: practice among primary care providers and awareness among the general public, United States, 2008. Genet Med. 2010;12(12):792-800.
• Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656- 657.
• Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res. 2020;291:113190.
• Arslan S, Ucar R, Caliskaner AZ, Reisli I, Guner SN, Sayar EH, et al. How effective are the 6 European Society of Immunodeficiency warning signs for primary immunodeficiency disease? Ann Allergy Asthma Immunol. 2016;116(2):151-155.e1.
• Y DI-S, Stepensky P. Social determinants of health and primary immunodeficiency. Ann Allergy Asthma Immunol. 2022;128(1):12-18.
• Oen K, Petty RE, Schroeder ML. Immunoglobulin A deficiency: genetic studies. Tissue Antigens. 1982;19(3):174-82.
• Yazdani R, Azizi G, Abolhassani H, Aghamohammadi A. Selective IgA deficiency: Epidemiology, pathogenesis, clinical phenotype, diagnosis, prognosis and management. Scand J Immunol. 2017;85(1):3-12.
• Baştürk B, Sari S, Aral A, Dalgiç B. Prevalence of selective immunoglobulin A deficiency in healthy Turkish school children. Turk J Pediatr. 2011;53(4):364-8.
• Rawla P, Killeen RB, Joseph NI. Selective IgA Deficiency. 2023. Available at https://www.ncbi.nlm.nih.gov/books/NBK538205/ Accessed September 20, 2023
• Cassidy JT, Nordby GL. Human serum immunoglobulin concentrations: prevalence of immunoglobulin deficiencies. J Allergy Clin Immunol. 1975;55(1):35-48.
• Goldstein MF, Goldstein AL, Dunsky EH, Dvorin DJ, Belecanech GA, Shamir K. Selective IgM immunodeficiency: retrospective analysis of 36 adult patients with review of the literature. Ann Allergy Asthma Immunol. 2006;97(6):717-30.
• Pan Q, Hammarstrom L. Molecular basis of IgG subclass deficiency. Immunol Rev. 2000;178:99-110.
• Ochs HD, Stiehm ER, Winkelstein JA. Antibody deficiencies. In: Ochs HD, Stiehm ER, Winkelstein JA, editors. Immunologic disorders in infants and children, 5th ed. Philadelphia: Elsevier; 2004. p. 356-426
• Recio MJ, Moreno-Pelayo MA, Kilic SS, Guardo AC, Sanal O, Allende LM, et al. Differential biological role of CD3 chains revealed by human immunodeficiencies. J Immunol. 2007;178(4):2556-64.
• Hadrup SR, Strindhall J, Kollgaard T, Seremet T, Johansson B, Pawelec G, et al. Longitudinal studies of clonally expanded CD8 T cells reveal a repertoire shrinkage predicting mortality and an increased number of dysfunctional cytomegalovirus-specific T cells in the very elderly. J Immunol. 2006;176(4):2645-53.
• Macallan DC, Wallace DL, Zhang Y, Ghattas H, Asquith B, de Lara C, et al. B-cell kinetics in humans: rapid turnover of peripheral blood memory cells. Blood. 2005;105(9):3633-40.
• Ciocca M, Zaffina S, Fernandez Salinas A, Bocci C, Palomba P, Conti MG, et al. Evolution of human memory B cells from childhood to old age. Front Immunol. 2021;23;12:690534.
• Ogata K, An E, Shioi Y, Nakamura K, Luo S, Yokose N, et al. Association between natural killer cell activity and infection in immunologically normal elderly people. Clin Exp Immunol. 2001;124(3):392-7.
• Gimsa U, Tuchscherer A, Gimsa J, Tuchscherer M. Assessing immune competence in pigs by immunization with tetanus toxoid. Animal. 2018;12(1):116-121.
• Paris K. Assessing antibody function as part of an immunologic evaluation 2020. 2020. Available at https://www. uptodate.com/ contents/assessing-antibody-function-as-part-of-animmunologicevaluation Accessed September 21, 2023