Study of Neutrophil functions in infants and children with Recurrent Infections

Abstract

Summary atients with neutrophil dysfunction must be suspected on clinical grounds, bearing in mind that they present with chronic, deep tissue infections rather than overt sepsis, which are more likely to occur after a deep infection has gone unrecognized or improperly treated for a few days or weeks. The aim of this study was to evaluate neutrophil function in groups of Egyptian children with proved PID and those with unexplained recurrent bacterial and/or fungal infections. This study included 100 patients, of these patients, 19 patients had documented PID and were recruited from the Pediatric Allergy and Immunololgy Clinic, Children’s Hospital, Ain-Shams University. Besides, 81 patients with recurrent infections were recruited from the inpatients wards of Children’s Hospital, Ain Shams University, Al-Abbasia Fever and Al-Abbasia Chest Hospital. A 50 age and sex matched healthy subjects served as control group. Our patients were subjected to clinical evaluation with special emphasis on assessment of frequency and severity of infections employing the Jeffrey Modell Foundation 10 warning signs for suspected PID and the immune deficiency related (IDR) score. The following investigations were done for the studied patients: Complete blood count (CBC) with differential, C-reactive protein, phagocytic and canidicidal lytic index, DHR test. Serum IgA level was measured for those with recurrent infections and have normal DHR test and normal CBC with P Summary  115 differential, serum IgG and IgM were measured for those with low serum IgA. DHR test was defective in 31% of patients, where it was 24% in one patient with a picture consistent with X-linked CGD, the remaining 5 patients (26%) had DHR test ranged between 2.1% and 82.5 %, they were 3 patients (15%) with AT and one patient (5%) with T–B–NK+ SCID, and the only one patient with Hermansky Pudlak Syndrome. Among patients with recurrent infections, 11 patients (14%) were found to have defective DHR test. Of these patients, 6 patients (7.4%) had clinical features and DHR test consistent with the diagnosis of CGD. Their DHR test ranged between 2.98% and 82.5%. In the remaining 5 (6.6%) patients, the DHR test ranged between 66.7% and 85%, the type of infections identified in these patients were bronchopneumonia and meningitis. These patients had otherwise normal preliminary immunological profile. Moreover, they had normal response to BCG vaccine and free of chronic infections. DHR test was repeated after clearance of infections and found to be normalized in these patients. In PID patients, 3 patients (15%) with AT had isolated IgA defeciency. Panhypogammaglobulinemia was found only in one patient (5%) with T¯B¯NK+ SCID. Among patients with recurrent infections, IgA was found below normal level for age in 6 patients (7.4%) whose ages ranged between 2 and 4 years, these low levels were still above the critical level for the diagnosis of selective IgA deficiency.