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Structured Immune Workup in Healthy Children With a First Episode of Severe Bacterial Infection: A 7-year
Sophie Strasser1, Christa Relly1, Christoph Berger1
1Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
Insights
Routine immunological testing for children with severe bacterial infections (SBIs) can identify immune impairments in 6%-17% of cases. This helps in family counseling and preventive strategies like vaccinations to avoid future infections.
Area of Science:
- Pediatric Immunology
- Infectious Diseases
- Clinical Research
Background:
- Severe bacterial infections (SBIs) in healthy children are rare.
- SBIs may indicate underlying immune system impairments, such as primary immunodeficiency.
- Current assessment protocols for these children are unclear.
Purpose of the Study:
- To investigate the utility of immunological testing in children diagnosed with severe bacterial infections.
- To determine the prevalence of immune system abnormalities in this pediatric population.
Main Methods:
- Retrospective analysis of hospital records for children aged 3 days to 18 years with SBIs (pleuropneumonia, meningitis, sepsis).
- Data collected between January 2013 and March 2020.
- Immunological follow-up and testing were performed on a subset of patients.
Main Results:
- Out of 360 analyzed children with SBIs, 244 underwent immunological testing.
- Laboratory abnormalities were detected in 21% of tested children.
- Clinically relevant immunodeficiency was found in 6% (e.g., complement deficiencies, autoimmune neutropenia, humoral immunodeficiencies), and 11% showed milder abnormalities.
Conclusions:
- Routine immunological testing is beneficial for a significant proportion of children with SBIs.
- Testing identifies impaired immune function in 6%-17% of cases.
- Early identification enables targeted family counseling and optimized preventive measures, including vaccinations, to prevent recurrent SBIs.
Background:
Severe bacterial infections (SBIs) in otherwise healthy children are rare and may represent an underlying impairment of the immune system, including primary immunodeficiency. However, it is unclear whether and how children should be assessed.
Methods:
We retrospectively analyzed data from hospital records of previously healthy children aged 3 days to 18 years with SBI, including pleuropneumonia, meningitis, and/or sepsis. Patients were diagnosed or immunologically followed up between 1 January 2013 and 31 March 2020.
Results:
Among 432 children with SBI, findings could be analyzed in 360. Follow-up data were available for 265 children (74%), of whom 244 (92%) underwent immunological testing. Laboratory abnormalities were found in 51 of 244 patients (21%), with 3 deaths (1%). Fourteen children (6%) had immunodeficiency considered clinically relevant (3 complement deficiencies, 1 autoimmune neutropenia, 10 humoral immunodeficiencies), and 27 (11%) had milder humoral abnormalities or findings suggestive of delayed adaptive immune maturation.
Conclusions:
A substantial proportion of children with SBI may benefit from routine immunological testing, revealing (potentially) clinically relevant impaired immune function in 6%-17% of children. The identification of immune abnormalities allows for specific counseling of families and optimization of preventive measures, such as booster vaccinations, to avoid future SBI episodes.
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