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Ryan S, Forster E, Griffin B. A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever. Australas Emerg Care 2024:S2588-994X(24)00053-8. [PMID: 39327126 DOI: 10.1016/j.auec.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/07/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
AIM To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes. BACKGROUND There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked. METHOD Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool. RESULTS After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement. CONCLUSIONS Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. RELEVANCE TO PRACTICE There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.
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Affiliation(s)
- Samantha Ryan
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Elizabeth Forster
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
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Phuong LK, Cheung A, Agrawal R, Butters C, Buttery J, Clark J, Connell T, Curtis N, Daley AJ, Dobinson HC, Frith C, Hameed NS, Hernstadt H, Krieser DM, Loke P, Ojaimi S, McMullan B, Pinzon-Charry A, Sharp EG, Sinnappurajar P, Templeton T, Wen S, Cole T, Gwee A. Inborn Errors of Immunity in Children With Invasive Pneumococcal Disease: A Multicenter Prospective Study. Pediatr Infect Dis J 2023; 42:908-913. [PMID: 37463351 DOI: 10.1097/inf.0000000000004004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In settings with universal conjugate pneumococcal vaccination, invasive pneumococcal disease (IPD) can be a marker of an underlying inborn error of immunity. The aim of this study was to determine the prevalence and characterize the types of immunodeficiencies in children presenting with IPD. METHODS Multicenter prospective audit following the introduction of routinely recommended immunological screening in children presenting with IPD. The minimum immunological evaluation comprised a full blood examination and film, serum immunoglobulins (IgG, IgA and IgM), complement levels and function. Included participants were children in whom Streptococcus pneumoniae was isolated from a normally sterile site (cerebrospinal fluid, pleura, peritoneum and synovium). If isolated from blood, features of sepsis needed to be present. Children with predisposing factors for IPD (nephrotic syndrome, anatomical defect or malignancy) were excluded. RESULTS Overall, there were 379 episodes of IPD of which 313 (83%) were eligible for inclusion and 143/313 (46%) had an immunologic evaluation. Of these, 17/143 (12%) were diagnosed with a clinically significant abnormality: hypogammaglobulinemia (n = 4), IgA deficiency (n = 3), common variable immunodeficiency (n = 2), asplenia (n = 2), specific antibody deficiency (n = 2), incontinentia pigmenti with immunologic dysfunction (n = 1), alternative complement deficiency (n = 1), complement factor H deficiency (n = 1) and congenital disorder of glycosylation (n = 1). The number needed to investigate to identify 1 child presenting with IPD with an immunologic abnormality was 7 for children under 2 years and 9 for those 2 years old and over. CONCLUSIONS This study supports the routine immune evaluation of children presenting with IPD of any age, with consideration of referral to a pediatric immunologist.
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Affiliation(s)
- Linny Kimly Phuong
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Abigail Cheung
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, South Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Rishi Agrawal
- Department of General Medicine, Women's and Children's Hospital, South Australia
| | - Coen Butters
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Jim Buttery
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Julia Clark
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Tom Connell
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Hazel C Dobinson
- Department of Paediatrics and Child Health, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Catherine Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Hayley Hernstadt
- Department of Paediatrics, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Emergency Medicine, Sunshine Hospital, St Albans, Victoria, Australia
| | - Paxton Loke
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Samar Ojaimi
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | - Alberto Pinzon-Charry
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Immunology & Allergy Service, Queensland Children's Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Ella Grace Sharp
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Tiarni Templeton
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sophie Wen
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Theresa Cole
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Almalky M, Abdelaziz TA, Baz EG. Clinical and laboratory spectrum of inborn errors of immunity in Egypt: Five years of experience at a tertiary care university hospital. J Paediatr Child Health 2022; 58:1151-1158. [PMID: 35218595 DOI: 10.1111/jpc.15924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/01/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIM The recognition and diagnosis of primary immunodeficiency disorders (PIDs) is challenging in developing countries. This study aimed to describe the features of PID patients in a tertiary care setting in Egypt and analyse the distribution, clinical features and outcome of PID among paediatric patients. METHODS This cross-sectional retrospective study was conducted between January 2016 and January 2021, to evaluate all paediatric patients aged below 18 years with PID that were diagnosed according to the International Union of Immunological Societies 2017 classification. We retrospectively studied the clinical features, diagnostic spectrum, laboratory investigations and relevant immunological workup, and treatment options. RESULTS A total of 61 PID patients were enrolled in the current study. The median age at diagnosis was 22 months. The overall consanguinity rate was 49.2%, and the family history of PID was 19.7%. Among all PIDs, the combined immunodeficiency with syndromic features predominates with 17 cases, accounting for 27.9% of all cases of PIDs. The predominant antibody deficiency was the second common PID that was diagnosed in 14 patients (23%). Recurrent pneumonia was the most common initial presentation, occurring in 77% of patients, followed by failure to thrive (63.9%), and recurrent otitis media (55.7%). The total deaths were 18 patients (29.5%). CONCLUSION Paediatric patients with PIDs are not uncommon in Egypt. There is a need to improve PID diagnosis and treatment, for better estimation of PID and to decrease morbidity and mortality.
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Affiliation(s)
- Mohamed Almalky
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Tarek A Abdelaziz
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Eman Gamal Baz
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
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Boton Pereira DH, Primo LS, Pelizari G, Flores E, de Moraes-Vasconcelos D, Condino-Neto A, Prestes-Carneiro LE. Primary Immunodeficiencies in a Mesoregion of São Paulo, Brazil: Epidemiologic, Clinical, and Geospatial Approach. Front Immunol 2020; 11:862. [PMID: 32477349 PMCID: PMC7235164 DOI: 10.3389/fimmu.2020.00862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Primary immunodeficiencies (PIDs) are rare genetic disorders leading to immunologic abnormalities that can affect different organs and systems. We determined the epidemiology, clinical, and geospatial characteristics of PID disorders among patients diagnosed over a 5 year period in a reference hospital covering a mesoregion in São Paulo, Brazil. Methods: A retrospective analysis of 39 patients with recognizable PIDs according to the criteria of the European Society of Primary Immunodeficiencies were enrolled. Thirty-four patients came from outpatient immunodeficiency clinics and five patients from active search. Demographic, clinical, and immunologic data were collected, and maps were constructed using a geographic information system. Results: The ratio of females to males was 1.4:1, and 48.7% of patients were younger than 17 years of age. The mean age at the onset of symptoms in children was 2.0 years [standard error of the mean (SEM), 1.7 years] and the diagnosis lag was 5.1 years (SEM, 3.1 years); the mean age at diagnosis in adults was 16.3 years (SEM, 11.8 years) and the lag was 10.8 years (SEM, 10.9 years). Antibody deficiency and common variable immunodeficiencies were the most common categories and phenotypes, respectively. The need for intravenous antibiotics and respiratory tract infections were the most prevalent warning signs, with an overall mortality rate of 15.3%. Autoimmune diseases were diagnosed in 56.4% and visceral leishmaniasis in 5.1% of patients. In the active search, 29 patients were investigated and 17.2% were diagnosed; early diagnosis, the involvement of multidisciplinary professionals, and dissemination of knowledge achieved milestone benefits. The distribution of PID networks in Brazil shows great asymmetry between regions and at a regional level; it was shown that the patients lived mainly in Presidente Prudente municipality. Conclusions: The implementation of an immunodeficiency outpatient clinic in a referral hospital covering a mesoregion with a large population has led to the generation of policies and practices to improve the diagnosis, quality of life, and care of patients with PIDs and their families. Furthermore, the search for hospitalized patients with warning signs for PIDs showed great benefits. Inequality in the distribution of PID network centers in Brazil was demonstrated.
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Affiliation(s)
| | - Lívia Souza Primo
- Imunnodeficiencies Outpatient Clinic, Regional Hospital of Presidente Prudente, Presidente Prudente, Brazil
| | - Giovana Pelizari
- Department of Pediatrics, Oeste Paulista University, Presidente Prudente, Brazil
| | - Edilson Flores
- Department of Statistics, Paulista State University, Presidente Prudente, Brazil
| | - Dewton de Moraes-Vasconcelos
- Laboratory of Medical Investigation Unit 56, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luiz Euribel Prestes-Carneiro
- Imunnodeficiencies Outpatient Clinic, Regional Hospital of Presidente Prudente, Presidente Prudente, Brazil.,Department of Internal Medicine, Oeste Paulista University, Presidente Prudente, Brazil
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Dias ALA, da Silva RG, Cunha FGP, Morcillo AM, Lorand-Metze I, Vilela MMDS, Riccetto AGL. Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references. APMIS 2019; 127:228-235. [PMID: 30908772 DOI: 10.1111/apm.12932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/09/2019] [Indexed: 01/25/2023]
Abstract
Our aim was to evaluate the cost-effectiveness of a minimal lymphocyte subset quantification (LSQ) by flow cytometry as the first screening in children with clinically suspected primary immunodeficiency (PID). Two hundred sixty-eight Brazilian patients (0-21 years old) were studied. They were divided by clinical and phenotypical features into those fulfilling criteria for PID (PID phenotype) according to the 2017 International Union of Immunological Societies (IUIS) classification and those not fulfilling these criteria (non-PID phenotype). We evaluated how many patients had values below the 10th percentile for five lymphocyte subsets in peripheral blood, (suggestive of PID) according to reference values for Brazil, Italy and USA. Three lymphocyte subsets (T CD3/CD4, B CD19 and NK CD16/CD56) had p-value < 0.05 and Odds Ratio (OR) indicating a risk at least two times higher for the diagnosis of a PID phenotype. The application of Kappa coefficient (k) on Brazilian vs Italian and Brazilian vs US data sets resulted in k compatible with strong or excellent level of agreement between the three classification systems. The authors conclude that a number of CD3+ /CD4+ , CD19+ and CD16+ /CD56+ (NK) cells in peripheral blood <10th percentile represented a significant risk for the diagnosis of PID in this cohort. Natural killer (NK) deficiency is quite rare and has a very specific clinical profile. So, the analysis of these cells could be requested only in some cases, saving even more costs. The minimal immunophenotyping, with quantification of T CD4+ , CD19+ and in some cases CD16+ /CD56+ cells, may be a useful tool for the first screening of PID, saving costs, especially in developing countries.
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Affiliation(s)
- Ana Luisa Abrahão Dias
- Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - Raquel Gomes da Silva
- Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - Fernanda Gonçalves Pereira Cunha
- Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - André Moreno Morcillo
- Pediatric Department, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - Irene Lorand-Metze
- Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - Maria Marluce Dos Santos Vilela
- Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
| | - Adriana Gut Lopes Riccetto
- Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil
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