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Infection and immunoglobulin levels in Sudanese children with severe protein-energy malnutrition
Omer S M Suliman1, Mustafa A M Salih1, Zein A Karrar1
11. Department of Paediatrics and Child Health , Faculty of Medicine, University of Khartoum , Sudan.
Insights
Severe protein energy malnutrition (PEM) in Sudanese children is linked to high infection rates, particularly urinary tract infections. Immunoglobulin levels (IgG, IgA, IgM) were elevated in malnourished children but showed minimal change after rehabilitation.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Severe protein energy malnutrition (PEM) is a significant health issue in children.
- PEM is associated with impaired immune function and increased susceptibility to infections.
- Understanding infection patterns and immunoglobulin profiles in malnourished children is crucial for effective management.
Purpose of the Study:
- To investigate the types of infections and immunoglobulin levels in Sudanese children with severe PEM.
- To compare immunoglobulin levels between malnourished children, those with tuberculosis, and healthy controls.
- To assess changes in immunoglobulin levels after dietary rehabilitation.
Main Methods:
- A hospital-based case-control study involving 81 Sudanese children.
- Categorization of children into severe PEM (marasmus, marasmic-kwashiorkor, kwashiorkor), tuberculosis, and healthy control groups.
- Measurement of pre- and post-rehabilitation plasma immunoglobulin (IgG, IgA, IgM) levels and assessment of infection patterns.
Main Results:
- High incidence of pneumonia, gastrointestinal, and urinary tract infections (UTIs) in malnourished children, with *Escherichia coli* being a common UTI pathogen.
- Elevated plasma levels of IgG, IgA, and IgM were observed in malnourished children compared to controls.
- Pulmonary tuberculosis was present in 8 malnourished children; ESR and Mantoux tests were unreliable for diagnosis.
- IgA levels decreased, and IgM levels increased in some groups after rehabilitation, but overall changes were not significant.
Conclusions:
- Severe PEM in Sudanese children is associated with a high burden of infections, including significant rates of UTIs.
- Malnourished children exhibit altered immunoglobulin profiles, with elevated levels of IgG, IgA, and IgM.
- Short-term dietary rehabilitation did not lead to substantial normalization of immunoglobulin levels, highlighting the complexity of immune recovery in severe malnutrition.
Abstract:
A hospital-based case control study was carried out to determine the pattern of infections and immunoblobulin levels in Sudanese children with severe protein energy malnutrition (PEM). The pre-dietary rehabilitation levels of the three major immunoglobulins (IgG, IgA and IgM) were compared with those of normal controls, and with the levels after dietary rehabilitation. Eighty one children were included in the study: 49 with severe PEM (23 with marasmus, 17 with marasmic - kwashiorkor and 9 with kwashiorkor), 13 with tuberculosis and 19 healthy children as controls. The study showed high incidence of infections, especially pneumonia and gastrointestinal infections in the malnourished children. Of special concern was the high incidence of urinary tract infection: 13 (26.5%) had significant pyuria and 9 of them had positive urine cultures, mainly Escherichia coli. Eight of the malnourished children also had pulmonary TB, and the ESR and Mantoux tests were not helpful in the diagnosis. The Mantoux test was negative in 88.8% of the malnourished group compared to 62.5% in those malnourished with TB. The malnourished groups had significantly higher plasma levels of the 3 immunoglobulins. While the maramic group attained significantly higher levels of IgG and IgA compared to the marasmic -kwashiorkor and kwashiorkor groups, the 3 groups of PEM showed a uniformly higher level of the IgM. After 2 weeks of rehabilitation, the levels of the 3 immunoglobulins showed no significant changes, except for the IgA which significantly decreased in all malnourished and the oedematous groups, and the IgM which increased significantly in the oedematous group.
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