Skip to main content

Recurrent Infections

  • 1125 Accesses

Abstract

Recurrent and chronic infections in children are one of the most common reasons for physician visits and present a diagnostic challenge to pediatricians. The majority of referred children with recurrent infections are normal. However, other underlying causes of recurrent infection such as atopy, anatomical and functional defects, and primary and secondary immunodeficiencies must be considered in evaluation of children with this complaint.

Keywords

  • Chronic Lymphocytic Leukemia
  • Correct Answer
  • Total Parenteral Nutrition
  • Recurrent Infection
  • Primary Immunodeficiency Disease

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-642-31785-9_1
  • Chapter length: 75 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   129.00
Price excludes VAT (USA)
  • ISBN: 978-3-642-31785-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   169.99
Price excludes VAT (USA)
Hardcover Book
USD   219.99
Price excludes VAT (USA)

References

  1. Campbell H (1995) Acute respiratory infection: a global challenge. Arch Dis Child 73(4):281–283

    PubMed  CrossRef  CAS  Google Scholar 

  2. Gruber C, Keil T, Kulig M, Roll S, Wahn U, Wahn V (2008) History of respiratory infections in the first 12 yr among children from a birth cohort. Pediatr Allergy Immunol 19(6):505–512

    PubMed  CrossRef  Google Scholar 

  3. Monto AS (1995) Viral respiratory infections in the community: epidemiology, agents, and interventions. Am J Med 99(6B):24S–27S

    PubMed  CrossRef  CAS  Google Scholar 

  4. American Academy of Pediatrics Committee on Environmental Health (1997) Environmental tobacco smoke: a hazard to children. Pediatrics 99(4):639–642

    Google Scholar 

  5. Geha RS, Notarangelo LD, Casanova JL, Chapel H, Conley ME, Fischer A, Hammarstrom L, Nonoyama S, Ochs HD, Puck JM, Roifman C, Seger R, Wedgwood J (2007) Primary immunodeficiency diseases: an update from the International Union of Immunological Societies Primary Immunodeficiency Diseases Classification Committee. J Allergy Clin Immunol 120(4):776–794

    PubMed  CrossRef  Google Scholar 

  6. Bruton OC (1952) Agammaglobulinemia. Pediatrics 9:722–728

    PubMed  CAS  Google Scholar 

  7. Fudenberg HH, Good RA, Hitzig W, Kunkel HG, Roitt IM, Rosen FS, Rowe DS, Seligmann M, Soothill JR (1970) Classification of the primary immune deficiencies: WHO recommendation. N Engl J Med 283(12):656–657

    PubMed  CrossRef  CAS  Google Scholar 

  8. Al-Herz W, Bousfiha A, Casanova JL, Chapel H, Conley ME, Cunningham-Rundles C, Etzioni A, Fischer A, Franco JL, Geha RS, Hammarstrom L, Nonoyama S, Notarangelo LD, Ochs H, Puck JM, Roifman C, Seger R, Tang ML (2011) Primary immunodeficiency diseases: an update on the classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency.. Front Immunol 2(54):1–26

    PubMed  Google Scholar 

  9. Skoda-Smith S, Barrett DJ (2000) When earaches and sore throats become more than a pain in the neck. Contemp Pediatr 17:156

    Google Scholar 

  10. Bush A (2009) Recurrent respiratory infections. Pediatr Clin North Am 56(1):67–100, x

    PubMed  CrossRef  Google Scholar 

  11. Bonilla FA, Bernstein IL, Khan DA, Ballas ZK, Chinen J, Frank MM, Kobrynski LJ, Levinson AI, Mazer B, Nelson RP Jr, Orange JS, Routes JM, Shearer WT, Sorensen RU (2005) Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol 94(5 Suppl 1):S1–S63

    PubMed  CrossRef  Google Scholar 

  12. Stiehm ER, Ochs HD, Winkelstein JA (2004) Immunodeficiency disorders: general considerations. In: Stiehm ER, Ochs HD, Winkelstein JA (eds) Immunologic disorders in infants and children, 5th edn. Elsevier/Saunders, Philadelphia, pp 289–355

    Google Scholar 

  13. Ballow M (2008) Approach to the patient with recurrent infections. Clin Rev Allergy Immunol 34(2):129–140

    PubMed  CrossRef  Google Scholar 

  14. Slatter MA, Gennery AR (2008) Clinical immunology review series: an approach to the patient with recurrent infections in childhood. Clin Exp Immunol 152(3):389–396

    PubMed  CrossRef  CAS  Google Scholar 

  15. McKinney RE Jr, Katz SL, Wilfert CM (1987) Chronic enteroviral meningoencephalitis in agammaglobulinemic patients. Rev Infect Dis 9(2):334–356

    PubMed  CrossRef  Google Scholar 

  16. Wilfert CM, Buckley RH, Mohanakumar T, Griffith JF, Katz SL, Whisnant JK, Eggleston PA, Moore M, Treadwell E, Oxman MN, Rosen FS (1977) Persistent and fatal central-nervous-system ECHOvirus infections in patients with agammaglobulinemia. N Engl J Med 296(26):1485–1489

    PubMed  CrossRef  CAS  Google Scholar 

  17. Winkelstein JA, Marino MC, Johnston RB Jr, Boyle J, Curnutte J, Gallin JI, Malech HL, Holland SM, Ochs H, Quie P, Buckley RH, Foster CB, Chanock SJ, Dickler H (2000) Chronic granulomatous disease. Report on a national registry of 368 patients. Medicine (Baltimore) 79(3):155–169

    CrossRef  CAS  Google Scholar 

  18. Fischer A (2001) Primary T-lymphocyte immunodeficiencies. Clin Rev Allergy Immunol 20(1):3–26

    PubMed  CrossRef  CAS  Google Scholar 

  19. Fischer A (2000) Severe combined immunodeficiencies (SCID). Clin Exp Immunol 122(2):143–149

    PubMed  CrossRef  CAS  Google Scholar 

  20. Ellison RT 3rd, Kohler PF, Curd JG, Judson FN, Reller LB (1983) Prevalence of congenital or acquired complement deficiency in patients with sporadic meningocococcal disease. N Engl J Med 308(16):913–916

    PubMed  CrossRef  Google Scholar 

  21. Lim D, Gewurz A, Lint TF, Ghaze M, Sepheri B, Gewurz H (1976) Absence of the sixth component of complement in a patient with repeated episodes of meningococcal meningitis. J Pediatr 89(1):42–47

    PubMed  CrossRef  CAS  Google Scholar 

  22. Zoppi M, Weiss M, Nydegger UE, Hess T, Spath PJ (1990) Recurrent meningitis in a patient with congenital deficiency of the C9 component of complement. First case of C9 deficiency in Europe. Arch Intern Med 150(11):2395–2399

    PubMed  CrossRef  CAS  Google Scholar 

  23. Potter PC, Frasch CE, van der Sande WJ, Cooper RC, Patel Y, Orren A (1990) Prophylaxis against Neisseria meningitidis infections and antibody responses in patients with deficiency of the sixth component of complement. J Infect Dis 161(5):932–937

    PubMed  CrossRef  CAS  Google Scholar 

  24. de Vries E (2006) Patient-centred screening for primary immunodeficiency: a multi-stage diagnostic protocol designed for non-immunologists. Clin Exp Immunol 145(2):204–214

    PubMed  CrossRef  Google Scholar 

  25. Puck JM (2007) Neonatal screening for severe combined immune deficiency. Curr Opin Allergy Clin Immunol 7(6):522–527

    PubMed  CrossRef  Google Scholar 

  26. Schwartzwald H (2011) Fever in human immunodeficiency virus-infected infants and ­children. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  27. Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H (2009) Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 58(RR-4):1–207, quiz CE201-204

    Google Scholar 

  28. Mueller BU (1999) Cancers in children infected with the human immunodeficiency virus. Oncologist 4(4):309–317

    PubMed  CAS  Google Scholar 

  29. Antinori A, Ammassari A, Torti C, Marconi P, Andreoni M, Angarano G, Bonora S, Castagna A, Cauda R, Clerici M, Monforte A, De Luca A, Di Perri G, Galli M, Girardi E, Gori A, Lazzarin A, Lo Caputo S, Mazzotta F, Montella F, Mussini C, Perno CF, Puoti M, Rizzardini G, Rusconi S, Vullo V, Carosi G (2009) Italian consensus statement on management of HIV-infected individuals with advanced disease naive to antiretroviral therapy. Infection 37(3):270–282

    PubMed  CrossRef  CAS  Google Scholar 

  30. Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2009). Guidelines for the use of antiretroviral agents in pediatric HIV infection. HIV Clinic Trial 33:24–29

    Google Scholar 

  31. Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC Jr, Hamill RJ (2005) Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 19(4):399–406

    PubMed  CrossRef  Google Scholar 

  32. Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ (2006) Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis 42(11):1639–1646

    PubMed  CrossRef  Google Scholar 

  33. Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2009). Guidelines for the use of antiretroviral agents in pediatric HIV infection. HIV Clinic Trial 33:75–78, 96–97

    Google Scholar 

  34. Shelburne SA, Montes M, Hamill RJ (2006) Immune reconstitution inflammatory syndrome: more answers, more questions. J Antimicrob Chemother 57(2):167–170

    PubMed  CrossRef  CAS  Google Scholar 

  35. Murdoch DM, Venter WD, Feldman C, Van Rie A (2008) Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS 22(5):601–610

    PubMed  CrossRef  CAS  Google Scholar 

  36. Lawn SD, Myer L, Bekker LG, Wood R (2007) Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa. AIDS 21(3):335–341

    PubMed  CrossRef  Google Scholar 

  37. Phillips P, Bonner S, Gataric N, Bai T, Wilcox P, Hogg R, O’Shaughnessy M, Montaner J (2005) Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis 41(10):1483–1497

    PubMed  CrossRef  Google Scholar 

  38. Wormser GP, Horowitz H, Dworkin B (1994) Low-dose dexamethasone as adjunctive therapy for disseminated Mycobacterium avium complex infections in AIDS patients. Antimicrob Agents Chemother 38(9):2215–2217

    PubMed  CrossRef  CAS  Google Scholar 

  39. de Vries E (2006) Patient-centred screening for primary immunodeficiency: a multi-stage diagnostic protocol designed for non-immunologists. Clinical Working Party of the European Society for Immunodeficiencies (ESID). Clin Exp Immunol. 145(2):204–14

    Google Scholar 

  40. Feugier P, Tomowiak C, Daguindau N, Perrot A (2007) Secondary deficiencies of humoral immunity in hematology: what management? Rev Med Interne. 28(2):1.

    Google Scholar 

  41. Vignes S, Bellanger J (2008) Primary intestinal lymphangiectasia (Waldmann’s disease). Orphanet J Rare Dis 3:5

    PubMed  CrossRef  Google Scholar 

  42. Hauser B, Moreels T, Urbain D, Van Marck V, Pletincx M, Devreker T, Vandenplas Y (2009) Intestinal lymphangiectasia. J Pediatr Gastroenterol Nutr 48(2):125

    PubMed  CrossRef  Google Scholar 

  43. Camarero C, Tamariz R, Garcia Trujillo JA, Villagra F, Escobar H, Suarez L, Cazzaniga M, Leon F (2001) Protein-losing enteropathy after Fontan’s operation. An Pediatr (Barc) 54(Suppl 3):39–42

    Google Scholar 

  44. Yang DM, Jung DH (2003) Localized intestinal lymphangiectasia: CT findings. AJR Am J Roentgenol 180(1):213–214

    PubMed  Google Scholar 

  45. Strober W, Wochner RD, Carbone PP, Waldmann TA (1967) Intestinal lymphangiectasia: a protein-losing enteropathy with hypogammaglobulinemia, lymphocytopenia and impaired homograft rejection. J Clin Invest 46(10):1643–1656

    PubMed  CrossRef  CAS  Google Scholar 

  46. Weiden PL, Blaese RM, Strober W, Block JB, Waldmann TA (1972) Impaired lymphocyte transformation in intestinal lymphangiectasia: evidence for at least two functionally distinct lymphocyte populations in man. J Clin Invest 51(6):1319–1325

    PubMed  CrossRef  CAS  Google Scholar 

  47. Heresbach D, Raoul JL, Genetet N, Noret P, Siproudhis L, Ramee MP, Bretagne JF, Gosselin M (1994) Immunological study in primary intestinal lymphangiectasia. Digestion 55(1):59–64

    PubMed  CrossRef  CAS  Google Scholar 

  48. Fuss IJ, Strober W, Cuccherini BA, Pearlstein GR, Bossuyt X, Brown M, Fleisher TA, Horgan K (1998) Intestinal lymphangiectasia, a disease characterized by selective loss of naive CD45RA  +  lymphocytes into the gastrointestinal tract. Eur J Immunol 28(12):4275–4285

    PubMed  CrossRef  CAS  Google Scholar 

  49. Alfano V, Tritto G, Alfonsi L, Cella A, Pasanisi F, Contaldo F (2000) Stable reversal of pathologic signs of primitive intestinal lymphangiectasia with a hypolipidic, MCT-enriched diet. Nutrition 16(4):303–304

    PubMed  CrossRef  CAS  Google Scholar 

  50. Chen CP, Chao Y, Li CP, Lo WC, Wu CW, Tsay SH, Lee RC, Chang FY (2003) Surgical resection of duodenal lymphangiectasia: a case report. World J Gastroenterol 9(12):2880–2882

    PubMed  Google Scholar 

  51. Brown RE, Katz M (1966) Failure of antibody production to yellow fever vaccine in children with kwashiorkor. Trop Geogr Med 18(2):125–128

    PubMed  CAS  Google Scholar 

  52. Dionigi R, Zonta A, Dominioni L, Gnes F, Ballabio A (1977) The effects of total parenteral nutrition on immunodepression due to malnutrition. Ann Surg 185(4):467–474

    PubMed  CrossRef  CAS  Google Scholar 

  53. Alper CA, Johnson AM, Birtch AG, Moore FD (1969) Human C’3: evidence for the liver as the primary site of synthesis. Science 163(864):286–288

    PubMed  CrossRef  CAS  Google Scholar 

  54. Lord GM, Matarese G, Howard JK, Baker RJ, Bloom SR, Lechler RI (1998) Leptin modulates the T-cell immune response and reverses starvation-induced immunosuppression. Nature 394(6696):897–901

    PubMed  CrossRef  CAS  Google Scholar 

  55. Altay C, Dogramaci N, Bingol A, Say B (1972) Nitroblue tetrazolium test in children with malnutrition. J Pediatr 81(2):392–393

    PubMed  CrossRef  CAS  Google Scholar 

  56. Baker SS, Lerman RH, Krey SH, Crocker KS, Hirsh EF, Cohen H (1983) Selenium deficiency with total parenteral nutrition: reversal of biochemical and functional abnormalities by selenium supplementation: a case report. Am J Clin Nutr 38(5):769–774

    PubMed  CAS  Google Scholar 

  57. Carton JA, Maradona JA, Nuno FJ, Fernandez-Alvarez R, Perez-Gonzalez F, Asensi V (1992) Diabetes mellitus and bacteraemia: a comparative study between diabetic and non-diabetic patients. Eur J Med 1(5):281–287

    PubMed  CAS  Google Scholar 

  58. Bessman AN, Sapico FL (1992) Infections in the diabetic patient: the role of immune dysfunction and pathogen virulence factors. J Diabetes Complications 6(4):258–262

    PubMed  CrossRef  CAS  Google Scholar 

  59. Li Volti S, Caruso-Nicoletti M, Biazzo F, Sciacca A, Mandara G, Mancuso M, Mollica F (1998) Hyporesponsiveness to intradermal administration of hepatitis B vaccine in insulin dependent diabetes mellitus. Arch Dis Child 78(1):54–57

    PubMed  CrossRef  CAS  Google Scholar 

  60. Alleyne CH Jr, Vishteh AG, Spetzler RF, Detwiler PW (1999) Long-term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: case report. Neurosurgery 45(6):1461–1463; discussion 1463–1464

    PubMed  CrossRef  Google Scholar 

  61. Moutschen MP, Scheen AJ, Lefebvre PJ (1992) Impaired immune responses in diabetes ­mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab 18(3):187–201

    PubMed  CAS  Google Scholar 

  62. Geerlings SE, Hoepelman AI (1999) Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 26(3–4):259–265

    PubMed  CrossRef  CAS  Google Scholar 

  63. Scavella A, Leiva L, Monjure H, Zea AH, Gardner RV (2010) Effect of L-arginine supplementation on immune responsiveness in patients with sickle cell disease. Pediatr Blood Cancer 55(2):318–323

    PubMed  CrossRef  Google Scholar 

  64. Holdsworth RJ, Irving AD, Cuschieri A (1991) Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 78(9):1031–1038

    PubMed  CrossRef  CAS  Google Scholar 

  65. Carsetti R, Pantosti A, Quinti I (2006) Impairment of the antipolysaccharide response in splenectomized patients is due to the lack of immunoglobulin M memory B cells. J Infect Dis 193(8):1189–1190

    PubMed  CrossRef  Google Scholar 

  66. Musher DM, Ceasar H, Kojic EM, Musher BL, Gathe JC Jr, Romero-Steiner S, White AC Jr (2005) Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine. J Infect Dis 191(7):1063–1067

    PubMed  CrossRef  CAS  Google Scholar 

  67. Shatz DV (2002) Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 53(5):950–956

    PubMed  CrossRef  Google Scholar 

  68. de Marie S (1993) Diseases and drug-related interventions affecting host defence. Eur J Clin Microbiol Infect Dis 12(Suppl 1):S36–S41

    PubMed  CrossRef  Google Scholar 

  69. Donati D, Degiannis D, Homer L, Gastaldi L, Raskova J, Raska K Jr (1991) Immune deficiency in uremia: interleukin-2 production and responsiveness and interleukin-2 receptor expression and release. Nephron 58(3):268–275

    PubMed  CrossRef  CAS  Google Scholar 

  70. Harris RC, Ismail N (1994) Extrarenal complications of the nephrotic syndrome. Am J Kidney Dis 23(4):477–497

    PubMed  CAS  Google Scholar 

  71. Krensky AM, Ingelfinger JR, Grupe WE (1982) Peritonitis in childhood nephrotic syndrome: 1970–1980. Am J Dis Child 136(8):732–736

    PubMed  CAS  Google Scholar 

  72. Sakuma Y, Katoh T, Owada K, Suzuki H, Sakurai K, Eiro M, Asahi K, Watanabe T (2005) Initial functional status predicts infections during steroid therapy for renal diseases. Clin Nephrol 63(2):68–73

    PubMed  CAS  Google Scholar 

  73. Auphan N, DiDonato JA, Rosette C, Helmberg A, Karin M (1995) Immunosuppression by glucocorticoids: inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science 270(5234):286–290

    PubMed  CrossRef  CAS  Google Scholar 

  74. Andersson J, Nagy S, Groth CG, Andersson U (1992) Effects of FK506 and cyclosporin A on cytokine production studied in vitro at a single-cell level. Immunology 75(1):136–142

    PubMed  CAS  Google Scholar 

  75. Russell RG, Graveley R, Coxon F, Skjodt H, Del Pozo E, Elford P, Mackenzie A (1992) Cyclosporin A. Mode of action and effects on bone and joint tissues. Scand J Rheumatol Suppl 95:9–18

    PubMed  CrossRef  CAS  Google Scholar 

  76. Rao VK, Dugan F, Dale JK, Davis J, Tretler J, Hurley JK, Fleisher T, Puck J, Straus SE (2005) Use of mycophenolate mofetil for chronic, refractory immune cytopenias in children with autoimmune lymphoproliferative syndrome. Br J Haematol 129(4):534–538

    PubMed  CrossRef  CAS  Google Scholar 

  77. Mele TS, Halloran PF (2000) The use of mycophenolate mofetil in transplant recipients. Immunopharmacology 47(2–3):215–245

    PubMed  CrossRef  CAS  Google Scholar 

  78. Segal BH, Sneller MC (1997) Infectious complications of immunosuppressive therapy in patients with rheumatic diseases. Rheum Dis Clin North Am 23(2):219–237

    PubMed  CrossRef  CAS  Google Scholar 

  79. Ehrke MJ, Mihich E, Berd D, Mastrangelo MJ (1989) Effects of anticancer drugs on the immune system in humans. Semin Oncol 16(3):230–253

    PubMed  CAS  Google Scholar 

  80. Lee AH, Levinson AI, Schumacher HR Jr (1993) Hypogammaglobulinemia and rheumatic disease. Semin Arthritis Rheum 22(4):252–264

    PubMed  CrossRef  CAS  Google Scholar 

  81. Sinisalo M, Aittoniemi J, Koski T, Tobin G, Thunberg U, Sundstrom C, Rosenquist R, Kayhty H, Vilpo J (2004) Similar humoral immunity parameters in chronic lymphocytic leukemia patients independent of VH gene mutation status. Leuk Lymphoma 45(12):2451–2454

    PubMed  CrossRef  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Aghamohammadi, A., Abolhassani, H., Caracseghi, F., Soler-Palacin, P. (2012). Recurrent Infections. In: Aghamohammadi, A., Rezaei, N. (eds) Clinical Cases in Primary Immunodeficiency Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-31785-9_1

Download citation