KATHMANDU: Do you often suffer from repeated fever, allergies, or infections? These may be signs of an immune disorder. The immune system is the body’s primary defense mechanism, protecting us from bacteria, viruses, fungi, and other harmful agents. When it becomes weak, repeated infections, allergies, fever, and even pneumonia can occur.
Rather than dismissing such symptoms as common and relying only on symptomatic treatment, it is important to evaluate the immune system in depth. Below is an edited excerpt from a conversation with pediatrician Dr. Dharmagat Bhattarai on this issue.
What is the immune system? How does it protect the body?
The immune system is a complex protective mechanism that safeguards our body from both external infections and internal disorders. Just as a country has water, land, and air forces for national security, our body has immune cells, lymph nodes, and specialized organs working together to defend it. These components fight bacteria, viruses, fungi, and environmental allergens.
The immune system not only attacks invading germs but also identifies and destroys abnormal cells within the body, including those that may develop into cancer. It also helps remove damaged or dead cells. Because of this protective role, it is often compared to an “army” guarding the body. The science that studies this system is known as immunology.
What are the main immune cells?
Immunity is broadly divided into two types: innate and acquired. Innate immunity is present from birth and acts immediately when harmful organisms enter the body. Acquired immunity develops over time and involves specialized cells. T-cells and natural killer cells directly attack infected or abnormal cells. B-cells produce antibodies that recognize and neutralize specific proteins on bacteria and viruses. In addition, organs such as the liver, spleen, and lymph nodes contribute collectively to immune defense.
How can someone know if their immune system is weak?
When the immune system is weak, infections occur more frequently and may be more severe than usual. According to the warning signs outlined by the Jeffrey Modell Foundation, immune deficiency may be suspected if a person experiences repeated ear infections, sinusitis, pneumonia, recurrent skin abscesses, or persistent mouth sores more than twice a year.
Other possible signs include a decrease in white blood cells or platelets, swollen glands, pale skin, recurrent or cyclic fever, and enlargement of the liver or spleen. In young children, serious complications such as stroke or kidney problems may also be linked to immune dysfunction.
What should be done to strengthen the immune system?
A balanced diet, adequate sleep, regular exercise, and a stress-free environment are essential for maintaining a healthy immune system. Proper nutrition that includes carbohydrates, proteins, fats, vitamins, minerals, water, and fiber provides the foundation for optimal immune function.
However, lifestyle measures alone cannot correct congenital immune deficiencies. If a child is born without functional B-cells or cannot produce antibodies, treatment such as immunoglobulin replacement therapy may be necessary. Approximately 80 percent of significant immune system disorders are congenital and caused by genetic defects.
Is this condition hereditary?
Around 80 percent of immune deficiency diseases result from genetic errors, while the remaining 20 percent may be caused by malnutrition, viral infections, or the use of certain strong medications. Hereditary does not always mean the disease is visible in the parents. Sometimes new genetic mutations occur spontaneously. In some cases, parents may be carriers without symptoms, and there may be up to a 25 percent chance of passing the condition to their child.
Is childhood diabetes or cancer related to immune disorders?
Yes, in some cases. Diabetes diagnosed in newborns is often autoimmune in origin. When the immune system mistakenly attacks the body’s own organs, such as the pancreas or thyroid, autoimmune diseases develop. Similarly, immune dysfunction is considered a major contributing factor in certain kidney diseases and rheumatologic conditions.
What is the status of treatment and awareness in Nepal?
Awareness has improved compared to the past, but it is still insufficient. There has not yet been strong, coordinated action at the government level. While some medications for rheumatologic diseases are available in Nepal, more than 30 percent of the medicines and diagnostic tests required for severe immune disorders are still unavailable in the country. In many cases, samples must be sent to India for testing.
At present, Dr. Bhattarai reports that he is managing approximately 6,000 patients with rheumatologic conditions and 640 children with immune deficiencies. Patients requiring transplants are referred to countries such as Taiwan, the United Kingdom, and India for advanced treatment.
In your opinion, what should the government do immediately regarding immune diseases and treatment?
The most urgent need, in my view, is to stop the culture of treating only symptoms, especially in the public sector. Many parents repeatedly admit their child to the hospital every month, use antibiotics frequently, and sometimes undergo CT scans or MRIs. If cancer has been ruled out, the possibility of an immune disorder should also be considered. I strongly advise parents in such situations to consult an immunologist.
If we continue to treat a disease without identifying its root cause, it will never be cured. Similarly, immune diseases must be properly included in the national medical education curriculum. At the MBBS and MD levels, there should be structured teaching on immunological disorders. I have also raised this issue at the ministry level.
If we look at global trends, including Nobel Prizes awarded since 2008, many breakthroughs in medicine are related to immunology and genetics. When new drugs and treatment approaches are largely based on these fields, it is not appropriate for the government to ignore such an important and rapidly advancing area.
Just as the government has established specialized centers for heart disease and cancer, there should also be a dedicated center for immunological diseases. In fact, treatment costs for severe immune disorders can be even higher than cancer treatment. Unfortunately, parents of children with immune diseases currently receive little to no government support.
Are there official positions for immunology in government health institutions?
Not yet. Hopefully, there will be in the future. However, creating positions alone is not enough. The real need is proper infrastructure and well-equipped centers.
As we now have transplant services and heart disease centers in the country, immunology too deserves similar institutional development. Immunology is a vast field that includes allergies, immune deficiencies, rheumatologic conditions, and especially genetic diseases. All of these should fall under a comprehensive immunology center.
Many diseases currently labeled as “rare” are not truly rare; they are simply undiagnosed or not actively investigated. If a disease reported in 50 or 60 individuals worldwide is found in 24 people in Nepal, how can we call it rare? The reality is that we have not searched thoroughly. To change this, we need proper diagnostic facilities. In the 21st century, lacking genetic testing services in our country is a matter of concern. Without diagnostic capacity, we cannot move forward.
You work especially with children. What do you suggest to parents of children with weak immune systems?
My first advice to parents is not to rely solely on symptomatic treatment. For example, if a child develops allergies once or twice and improves with ointments, that may be manageable. But if the problem repeatedly returns after stopping the ointment, long-term evaluation and treatment are necessary.
If a child’s platelet count decreases, or the white blood cell count fluctuates significantly—sometimes very high, sometimes very low—and fever occurs frequently with repeated infections, parents should not limit themselves to basic testing. It is important to investigate the deeper cause and address it at its root.
If a child shows problems affecting two or more organs or systems, and cancer has been ruled out, immune deficiency should be strongly considered. Early diagnosis and proper management can significantly improve outcomes and quality of life.
Comment