Gregg Caring for Immunosuppressed

Caring for the Immunosuppressed

Patient in the Primary Care Setting

Kevin Gregg, MD

Associate Professor of Medicine

Division of Infectious Diseases

June 21, 2018

Disclosure

I have no conflicts of interest related to the

information in this presentation

Goals of this talk

1. Illustrate how the mechanisms of immunosuppressant therapies can

affect the differential diagnosis (¡®what should I be worried about in this

patient¡¯)

2. Highlight some important infections in immunocompromised hosts that

may present to an outpatient clinic

3. Provide a framework for how to start an infectious work-up in a primary

care clinic

4. Raise awareness of detecting immunodeficiency in the primary care clinic

The Immune System

Cellular immunity

Humoral immunity

Adaptive

Innate

Adaptive

Innate

- B-cells

- T-cells

- Monocytes

- Macrophages

- Neutrophils

- NK cells

- Mast Cells

Immunoglobulins

- Complement

cascade

- Cytokines

- Skin

- Mucous

membranes

What does it mean to be

immunocompromised?

Primary immune

deficiencies

HIV infection

Solid organ

transplant recipients

Malignancy

Asplenia

Diabetes?

Stem cell

transplantation

recipients

Immune

suppression for

autoimmune

diseases

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