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The evolving population of immunocompromised children
1Department of Hematology-Oncology, Children's Hospital National Medical Center, Washington, DC.
Insights
The study defines the immunocompromised host, highlighting infections in children with congenital deficiencies, cancer, autoimmune diseases, and HIV. Management focuses on addressing immunodeficiency and preventing/treating infections.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- The concept of the immunocompromised host originated from congenital immune deficiencies.
- Therapeutic advancements in cancer and autoimmune diseases have increased the population of immunocompromised children.
- Human immunodeficiency virus (HIV) infection is emerging as a predominant cause of immunocompromise in pediatric populations.
Purpose of the Study:
- To define the immunocompromised host in pediatrics.
- To identify the causes and patterns of infections in immunocompromised children.
- To outline management goals for immunocompromised children, focusing on restoring immune function and preventing/treating infections.
Main Methods:
- Review of historical definitions and evolving populations of immunocompromised hosts.
- Analysis of infection patterns relative to immune system targets affected by various causes of immunodeficiency.
- Identification of dual management goals: addressing the immunodeficiency and managing infectious complications.
Main Results:
- Immunocompromised hosts encompass children with congenital deficiencies, iatrogenic immunosuppression (cancer/autoimmune therapy), and HIV infection.
- Infection incidence and patterns in immunocompromised children correlate with the specific components of the immune system affected.
- Management strategies must address both the underlying immunodeficiency and the associated spectrum of infections.
Conclusions:
- The definition and population of immunocompromised children have evolved significantly.
- Understanding the specific immune defects is crucial for predicting and managing infectious risks.
- A dual approach to management, focusing on immune restoration and infection control, is essential for improving outcomes in immunocompromised children.
Abstract:
The immunocompromised host was first defined around the host abnormalities and consequent infections that were associated with congenitally acquired deficiencies. Although the impact of the deficiency on the affected child was considerable, the numbers of such children remained small. With the advent of immunosuppressive therapy and cytotoxic regimens for the effective treatment of cancers and autoimmune diseases, an increasingly larger number of children became immunocompromised and thus subject to serious infectious complications. More recently a new population of immunocompromised children have emerged, those infected with the human immunodeficiency virus; over the next several years this group of patients threatens to become the predominant group of "immunocompromised hosts" in pediatrics. Regardless of whether the immunodeficiency is a genetically transmitted immunodeficiency or results from cytotoxic therapy or from infection with human immunodeficiency virus, the incidence and pattern of the infections that occur parallel the targets of the immune system that are adversely affected or destroyed. In some cases, this may represent only a single component of the immune system whereas in others, multiple aspects of the immune matrix have been altered or perturbed. Two goals apply to the management of the immunocompromised child: (1) to identify the basis for the immunodeficiency and to develop methods to restore or replenish it; (2) to define the spectrum of infectious complications that can occur in association with the immunocompromised state and to develop regimens to treat or prevent them, at least until the underlying defects can be dealt with in a more definitive manner.(ABSTRACT TRUNCATED AT 250 WORDS)