Dawaa Reference

Clinical reference

Immunodeficiency

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD99.00 - condition scope only, no dose · Immunodeficiency Disorders (Primary and Secondary) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK500027/ · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Four or more ear infections in a year, two or more serious sinus infections, or repeated pneumonia are red-flag features
  • The kind of organism causing infection hints at which arm of the immune system is defective
  • Recurrent infection with encapsulated bacteria such as pneumococcus or Haemophilus points to an antibody defect [recurrent infections]
  • Infections with Pneumocystis, Candida, atypical mycobacteria or Aspergillus point to a T-cell or phagocyte defect
  • Consanguinity, an early childhood death from infection, or relatives with immunodeficiency should be asked about
  • Failure to thrive, chronic diarrhoea, autoimmune cytopenias or unexplained lymphoproliferation can appear before the infections do [diarrhoea · failure to thrive]
  • For suspected secondary disease, the timing of infections relative to starting immunosuppressive treatment is a key clue

Signs — what you find (5)

  • Absent or very small tonsils and lymph nodes point to X-linked agammaglobulinemia
  • Petechiae with low platelets together with eczema are characteristic of Wiskott-Aldrich syndrome [petechiae]
  • Delayed separation of the umbilical cord with non-purulent infections suggests leukocyte adhesion deficiency
  • Facial dysmorphism, cleft palate, low calcium and a congenital heart defect together suggest DiGeorge syndrome
  • Ataxia together with visible telangiectasia on exam is characteristic of ataxia-telangiectasia [telangiectasia · unsteadiness]

Tests (7)

  • A low lymphocyte count on the differential, roughly under 2500 per microliter in an infant, points to a T-cell defect
  • Low IgG, IgA and IgM together suggest a humoral immunodeficiency such as X-linked agammaglobulinemia or common variable immunodeficiency
  • A low IgG paired with a raised IgM is suggestive of hyper-IgM syndrome
  • Vaccine responses that fail to reach protective antibody levels point to an antibody-deficiency disorder
  • An abnormal neutrophil oxidative burst test is diagnostic of chronic granulomatous disease
  • Whole exome or genome sequencing gives a diagnosis in roughly a quarter to two-fifths of previously undiagnosed cases
  • The TREC newborn screening assay detects T-cell lymphopenia, including every form of severe combined immunodeficiency

If not this — what else fits (6)

  • HIV must be excluded in anyone with an opportunistic infection, unexplained low lymphocytes, weight loss or recurrent pneumonia
  • Nephrotic syndrome or protein-losing enteropathy can mimic a humoral defect through loss of immunoglobulin
  • Protein-energy malnutrition is the leading secondary cause worldwide, worsened by zinc, selenium, copper or iron deficiency
  • Cystic fibrosis can resemble antibody deficiency through recurrent sinus and lung infection with bronchiectasis
  • Primary ciliary dyskinesia causes recurrent respiratory infection from poor mucus clearance despite a normal immune system
  • A transient drop in IgG between roughly 3 and 6 months of age, resolving by 24 months, shouldn't be mistaken for true deficiency

SourceStatPearls "Immunodeficiency Disorders (Primary and Secondary)" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Suspect an underlying immunodeficiency in any child or adult presenting with recurrent severe bacterial infections (such as recurrent deep-seated abscesses, two or more serious sinus infections or pneumonias in a year), persistent mucosal candidiasis, failure to thrive, or opportunistic infections. In primary care, obtain a complete blood count with differential, quantitative serum immunoglobulins, and screen for secondary causes including HIV, diabetes, protein-losing enteropathy, and immunosuppressive medication exposure. Avoid administering any live vaccines (such as MMR, rotavirus, or BCG) until an inborn error of immunity has been ruled out, and refer promptly to a clinical immunologist or infectious disease specialist. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Suspect an underlying immunodeficiency in any child or adult presenting with recurrent severe bacterial infections (such as recurrent deep-seated abscesses, two or more serious sinus infections or pneumonias in a year), persistent mucosal candidiasis, failure to thrive, or opportunistic infections. In primary care, obtain a complete blood count with differential, quantitative serum immunoglobulins, and screen for secondary causes including HIV, diabetes, protein-losing enteropathy, and immunosuppressive medication exposure. Avoid administering any live vaccines (such as MMR, rotavirus, or BCG) until an inborn error of immunity has been ruled out, and refer promptly to a clinical immunologist or infectious disease specialist.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Recurrent, severe, or unusual infections, failure to thrive in a child, opportunistic infections, or a family history of early childhood deaths from infection.

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