How should I manage a patient with recurrent infections that may suggest an underlying immunodeficiency?

Management of a patient with recurrent infections suggestive of an underlying immunodeficiency should begin with a thorough clinical assessment, including detailed history of infection types, frequency, severity, and family history of immunodeficiency or autoimmune conditions ¹. Initial investigations should include baseline blood tests such as full blood count, immunoglobulin levels (IgG, IgA, IgM), and specific antibody responses to previous vaccinations to assess humoral immunity ¹. If these initial tests indicate possible immunodeficiency, referral to an immunologist for further specialized testing, including lymphocyte subset analysis and functional assays, is recommended ¹.

Empirical management involves prompt treatment of infections with appropriate antimicrobials and consideration of prophylactic antibiotics in cases of frequent or severe infections ¹. Immunoglobulin replacement therapy may be indicated in patients with confirmed antibody deficiencies, such as common variable immunodeficiency, to reduce infection frequency and improve quality of life (Mullen and Felippe, 2024). Additionally, patient education on infection prevention and regular monitoring for complications is essential ¹.

Recent literature emphasizes the importance of a multidisciplinary approach and the potential role of novel immunologic testing to better characterize immune defects, which can guide personalized management strategies (Mullen and Felippe, 2024). This approach aligns with UK guidelines but highlights advances in diagnostic precision and tailored therapy.