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Checklist may provide clue to underlying immune conditions

AAP 2011 National Conference

BOSTON — Making the diagnosis of underlying immunodeficiency can be a challenge, particularly in those patients who may be too young to actually describe their symptoms.

But, there are 10 signs that clinicians can watch for that can facilitate diagnosis of an underlying immunodeficiency, according to a speaker at the American Academy of Pediatrics 2011 National Conference and Exhibition.

Margaret C. Fisher, MD, who is Medical Director of The Children's Hospital at Monmouth Medical Center in Long Branch, N.J., discussed the issue of recurring infections. She said pediatricians should discuss recurring infections with parents, and warn them that those children aged younger than 2 years could see as many as 13 respiratory infections per year, particularly if that child happens to be in child care. Children older than 2 years could expect between four and 10 respiratory infections per year, and between one and four gastrointestinal infections per year.

Other conditions that are commonly seen in children include urinary tract infections — although these are more common in girls than in boys— and skin and soft-tissue infections.

On the bacterial side, Fisher said that pediatricians should expect “the usual suspects, including pneumococcus, otitis media, and occasionally a child will have invasive disease such as meningococcemia.”

Fisher said that there are a few reasons to be concerned about recurrent infections, not the least of which are conditions like cystic fibrosis, inherited diseases, anatomic abnormalities, or underlying immune disorders. She said there are a few red flags that should push pediatricians to investigate further, including, for example, a neonate whose cord does not fall off, or a child with growth failure or a strong family history of a particular disease.

She noted 10 warning signs that may signal an underlying immunodeficiency:

• Eight or more infections in a year;
• Two or more serious sinus infections;
• Two or more months on antibiotics;
• Two or more pneumonias;
• Failure of an infant to grow;
• Recurrent deep skin or organ abscesses;
• Persistent thrush, after age 1;
• A need for intravenous antibiotics;
• Two or more deep-seated infections;
• Family history of immunodeficiency.

Discussing the physical examination, Fisher urged pediatricians to pay careful attention to growth parameters, skin and mucous membranes and joints. She also urged blood counts if an immunodeficiency is suspected, as well as serology and genetic testing.

“Using those 10 warning signs can provide a helpful screening tool for those patients with an underlying immunodeficiency,” Fisher said. – by Colleen Zacharyczuk

Disclosure: Dr. Fisher reported no relevant financial disclosures.

For more information:

• Fisher M. #F1096. Evaluating and Managing the Child with Recurring Infections. Presented at: AAP 2011 National Conference and Exhibition; Oct. 15-18, 2011; Boston.

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