{"id":285,"date":"2016-08-29T10:15:00","date_gmt":"2016-08-29T07:15:00","guid":{"rendered":"https:\/\/beglaryan.net\/en\/?p=285"},"modified":"2025-07-17T20:23:35","modified_gmt":"2025-07-17T17:23:35","slug":"10-questions-about-immune-system","status":"publish","type":"post","link":"https:\/\/beglaryan.net\/en\/10-questions-about-immune-system","title":{"rendered":"10 questions about immune system"},"content":{"rendered":"\n

In the past, every physician personally embraced the entirety of medicine as a single, unified science. It was also common for doctors to be scholars, writers, and philosophers at the same time. This remained true up until the late 19th and early 20th centuries. As medicine advanced, the sheer volume of knowledge and skills became too great for any one person to master, leading to the emergence of increasingly narrow specialties. Pediatric immunology is one such specialty, and it is still a relatively young field.<\/p>\n\n\n\n\n\n\n\n

\"\"<\/figure>\n\n\n\n

In May 2016, a medical symposium with international participation took place under the title \u201cDiagnosis of Primary Immunodeficiencies at Different Levels of Pediatric Healthcare\u201d as part of the Central and Eastern European J Project initiative. This annual event is organized by the Department of Pediatric Infectious Diseases and Pediatric Immunology at the Shupyk National Medical Academy of Postgraduate Education together with the Ukrainian Association of Pediatric Immunology. Each year, the conference is held in different cities across Ukraine, aiming to raise awareness about primary immunodeficiencies among pediatricians, family doctors, and neonatologists. That year, the symposium, which was the 12th of its kind in Ukraine, was held in Chernivtsi.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Back in Kyiv, the organizing doctors were carefully planning the conference program. We decided to open the event by asking the attending physicians 10 questions about primary immunodeficiencies and basic immunology. A few months later, after creating this website, I came across the analysis of those questions on my laptop and thought it would be worth sharing.<\/p>\n\n\n\n

Over 100 physicians participated in the survey. Responses from pediatric immunologists were intentionally excluded, as we wanted to see how well non-immunologist doctors who work with children understood key immunology concepts. We also wanted to assess whether the conference itself had value as an educational initiative. To minimize guessing, each question included an option for \u201cI don\u2019t know.\u201d<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Sample size: 62 completed questionnaires. About 50% were pediatricians, around 30% were family physicians, along with several pediatric infectious disease specialists, a pediatric cardiologist, and a pediatric surgeon.<\/p>\n\n\n\n

1. Which of the following organs of the immune system is considered a central (primary) organ?<\/strong>
Bone marrow
Lymph node
Spleen
Peyer\u2019s patches<\/p>\n\n\n\n

    \n
  1. <\/li>\n<\/ol>\n\n\n\n
    \"\"<\/figure>\n\n\n\n

    The correct answer was marked in green, incorrect answers in various shades of red, and \u201cunable to answer\u201d was shown in gray.<\/p>\n\n\n\n

    The first question was answered quite well.<\/p>\n\n\n\n

    2. Which class of immunoglobulins indicates an acute infectious process?
    <\/strong>IgA
    IgG
    IgM
    IgD<\/p>\n\n\n\n

      \n
    1. <\/li>\n<\/ol>\n\n\n\n
      \"\"<\/figure>\n\n\n\n

      Nearly half of the physicians did not know the correct answer regarding immunoglobulins. Doctors in Chernivtsi were no different from their colleagues in Chernihiv, Kyiv, or other cities. It is reasonable to assume that the same situation exists across the country, and likely in neighboring countries as well.<\/p>\n\n\n\n

      This helps explain why diagnoses of \u201cchronic Epstein-Barr infection\u201d or \u201cchronic cytomegalovirus infection\u201d are still being made based solely on positive IgG results, leading to the treatment of a non-existent illness for months or even years.<\/p>\n\n\n\n

      3. What is a primary immunodeficiency?<\/strong>
      A condition that develops due to poor nutrition
      Genetically determined abnormalities of the immune system
      An immune condition resulting from frequent acute respiratory infections
      A condition caused by thymomegaly<\/p>\n\n\n\n

      \"\"<\/figure>\n\n\n\n

      This question was no longer general but specifically about primary immunodeficiencies. It was encouraging to see that many pediatric doctors correctly identified these as genetic abnormalities. However, there was still a downside: among the three incorrect answers, the most common choice was \u201cfrequent respiratory infections.\u201d In other words, many physicians mistakenly believe that frequent colds and bronchitis mean \u201cimmunity has dropped.\u201d Dropped and shattered, apparently. So now the question becomes, \u201cHow do we boost immunity?\u201d And then we wonder why every grandmother in the courtyard insists that her grandchild\u2019s runny nose means their immunity needs to be \u201cboosted\u201d again.<\/p>\n\n\n\n

      In reality, the immune system is trained by respiratory infections. If a child catches a cold ten times and recovers within a week each time, is that really an immunodeficiency?<\/p>\n\n\n\n

      4. Which primary immunodeficiencies are the most common?<\/strong>
      Antibody deficiencies
      Combined immunodeficiencies
      Autoinflammatory diseases
      Phagocytic defects<\/p>\n\n\n\n

        \n
      1. <\/li>\n<\/ol>\n\n\n\n
        \"\"<\/figure>\n\n\n\n

        This was an even more challenging question, one that typically only immunologists can answer accurately. The responses were as expected, so nothing surprising here. Let\u2019s continue.<\/p>\n\n\n\n

        Is an enlarged thymus (thymomegaly) a sign of immunodeficiency?
        <\/strong>Yes, it is associated with congenital immunodeficiency
        No<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        Only about half answered this one correctly. I\u2019ve often seen medical records from different cities where \u201cthymomegaly of such-and-such degree\u201d is casually added as a comorbidity to the primary diagnosis.<\/p>\n\n\n\n

        A large thymus is normal for children, especially infants. The thymus naturally decreases in size with age. While true thymomegaly is possible, it is extremely rare. Yet many pediatricians in infant wards end up diagnosing \u201cthymomegaly\u201d in nearly every baby they see.<\/p>\n\n\n\n

        6. Which immunodeficiency is associated with the so-called \u201cSlavic mutation\u201d?
        DiGeorge syndrome
        Netherton syndrome
        Nijmegen breakage syndrome
        Bruton’s disease<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        The physicians surveyed honestly admitted they did not know the answer. These were exactly the kinds of questions discussed at the conference. Children with such conditions could very well be among their patients.<\/p>\n\n\n\n

        7. Which of the following microorganisms causes disease only in immunocompromised patients?
        <\/strong>Pneumococcus
        Enterovirus
        Influenza virus
        Pneumocystis<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        Well, that\u2019s all correct. Maybe all this criticism is unnecessary. But the idea of \u201cimmunity that periodically drops\u201d and the confusion around immunoglobulins\u2014that\u2019s a bit troubling. On the bright side, knowledge about pneumocystis pneumonia is solid, and that\u2019s good news for children.<\/p>\n\n\n\n

        8. In which of the following conditions should immunodeficiency be suspected?
        <\/strong>Cerebral aspergillosis
        Acute intestinal infection
        Kawasaki syndrome
        Frequent obstructive bronchitis<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        The next question was quite specific. The correct answer wasn\u2019t expected to be among the top choices. Yet again, frequent bronchitis was the most popular response. There seems to be a common misconception that frequent bronchitis and colds mean immunity is \u201cdropping.\u201d This is simply not true.<\/p>\n\n\n\n

        9. Which of the following treatments is not<\/em> used in patients with immunodeficiency?
        <\/strong>Bone marrow transplantation
        Intravenous immunoglobulin infusion
        Immunostimulatory therapy
        Antibiotic therapy<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        This is a highly specialized, professional question, reinforcing the need for ongoing educational efforts.<\/p>\n\n\n\n

        10. Which of these symptoms most likely indicate immunodeficiency?
        <\/strong>Diaper dermatitis
        Thrush during breastfeeding in the first months of life
        Repeated presence of Candida albicans<\/em> in stool samples
        Recurrent thrush in infants<\/p>\n\n\n\n

        \"\"<\/figure>\n\n\n\n

        The response rates to this question were quite good.<\/p>\n\n\n\n

        This was the final question. Thanks to all the doctors who attended the conference. Unfortunately, it wasn\u2019t possible to conduct the same survey after the presentations and lectures, which would likely have shown improved results. The conclusions are yours to draw.<\/p>\n\n\n\n

        Questions prepared by: Maria Teslenko.
        Edited under the guidance of Prof. Lyudmyla Chernyshova: Fedir Lapiy, Anastasia Bondarenko, Yurii Stepanovsky, Anna Gilfanova.
        Analysis by: Stepan Beglaryan.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

        In the past, every physician personally embraced the entirety of medicine as a single, unified science. It was also common for doctors to be scholars, writers, and philosophers at the same time. This remained true up until the late 19th and early 20th centuries. As medicine advanced, the sheer volume of knowledge and skills became … <\/p>\n

        Continue reading “10 questions about immune system”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":287,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[27,28,30,26,29],"class_list":["post-285","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-posts","tag-immunity","tag-immunology","tag-myths","tag-pediatric-immunology","tag-physicians","entry"],"yoast_head":"\n10 questions about immune system - Stepan Beglaryan<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/beglaryan.net\/en\/10-questions-about-immune-system\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"10 questions about immune system - Stepan Beglaryan\" \/>\n<meta property=\"og:description\" content=\"In the past, every physician personally embraced the entirety of medicine as a single, unified science. 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It was also common for doctors to be scholars, writers, and philosophers at the same time. This remained true up until the late 19th and early 20th centuries. 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