Clinical immunology review series: an approach to the patient with recurrent infections in childhood

Abstract

Recurrent or persistent infection is the major manifestation of primary immunodeficiency, which also results in atypical infection with opportunistic organisms. Young children are also vulnerable to infection and recurrent infection is common. While most children with recurrent infection have a normal immunity, it is important to recognize the child with an underlying primary immunodeficiency and investigate and treat appropriately and yet not over investigate normal children. Prompt, accurate diagnosis directs the most appropriate treatment, and early and judicious use of prophylactic antibiotics and replacement immunoglobulin can prevent significant end organ damage and improve long-term outlook and quality of life. This paper describes important presenting features of primary immunodeficiency and indicates when further investigation is warranted.

Fig. 1

Chest radiograph of a 15-year-old boy with autosomal recessive chronic granulomatous disease, showing bilateral dense infiltrates because of Aspergillus fumigatus and Absidia corymbifera pneumonitis (courtesy of the Paediatric Immunology Unit, Newcastle General Hospital).

Fig. 2

Pyoderma because of Pseudomonas auruginosa infection in a boy with X-linked agammaglobulinaemia (courtesy of the Paediatric Immunology Unit, Newcastle General Hospital).

Fig. 3

Bulbar telangiectasia on the conjunctivae of a girl with ataxia telangiectasia (courtesy of the Paediatric Immunology Unit, Newcastle General Hospital).