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Frequent antibiotic use may mask immunodeficiency

NEW ORLEANS — Frequent antibiotic treatment can mask underlying immunodeficiencies, so clinicians are urged to ask about how often a child has been prescribed an antibiotic when treating a child with repeat bouts of otitis or sinusitis.

Ricardo Sorensen, MD, professor of pediatrics at LSU and director of the Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies of New Orleans, discussed immunodeficiency diagnosis here at the 2012 AAP National Conference and Exhibition.

 

Ricardo Sorensen

He said the Modell Center has identified 10 general warning signs of a primary immunodeficiency, which can assist pediatricians in making a diagnosis. They are:

• Four or more new ear infections within 1 year.
• Two or more serious sinus infections within 1 year.
• Two or more months on antibiotics with little effect.
• Two or more pneumonia infections within 1 year.
• Failure of an infant to gain weight or grow normally.
• Recurrent, deep skin or organ swelling.
• Persistent infection of the mouth and throat caused by a yeast-like fungus, resulting in whitish patches in the mouth or elsewhere on the skin.
• Need for IV antibiotics to clear infections.
• Two or more deep-seated infections, including bacterial blood poisoning.
• A family history of primary immunodeficiency disease.

Sorensen said there are several other predisposing causes for recurrent infections, including anatomic abnormalities and environmental factors such as smoke exposure, and it is important to ask about these during the checkup before considering an immune evaluation.

When a primary immunodeficiency is suspected, Sorensen stressed the importance of a thorough medical and family history. He said blood tests, including a complete blood count, quantitative immunoglobulins and the measurement of specific antibodies to pneumococcal polysaccharides, can detect most immunodeficiencies.

Sorensen said identifying a pathogen and whether it is antibiotic-susceptible is key because early diagnosis and treatment of illness can prevent chronic sinus problems and bronchiectasis. He emphasized that, just as important as identifying a pathogen is to “consider why a given pathogen is causing disease in a specific patient.”

For more information:

Sorensen R. Session 3053. Presented at: AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.

Disclosure: Sorensen reports no relevant financial disclosures.