Verminderde afweer: Risicogroepen en gevolgen voor de huisartsenpraktijk

Abstract

Due to medication use, comorbidities and/or age, an increasing number of patients have an impaired immunity to infection. Impaired immunity may lead to an increased risk of (opportunistic) infection, complications from infections, and difficulties in the diagnosis of infections. Guided by clinical parameters, a general practitioner can classify an impaired immunity as 'clinically irrelevant', 'limitedly relevant' or 'potentially serious'. Tocilizumab impairs the production of CRP, which makes it unreliable as an infection parameter. In case of a suspected infection in patients with severe immunosuppression, it will often be necessary to consult a specialist as quickly as possible about further diagnostic procedures and the need for, type and administration route of antimicrobials. In patients with an impaired immunity, adaptation of the antibiotic policy and prophylactic measures, such as vaccination, may be indicated. Patients with (functional) asplenia should immediately start antibiotic treatment in case of fever, pending clinical evaluation by a physician.