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The Approach to Children with Recurrent Infections
Asghar Aghamohammadi,Hassan Abolhassani,Payam Mohammadinejad,Nima Rezaei
Iranian Journal Of Allergy, Asthma and Immunology , 2012,
Abstract: Recurrent and chronic infections in children are one of the most common reasons for physicians' visits that make a diagnostic challenge to pediatricians. Although the majority of referred children with recurrent infections are normal, underlying causes of recurrent infection such as atopy, anatomical and functional defects, and primary or secondary immunodeficiency must be considered in evaluation of children with this complaint.Although primary immunodeficiency diseases (PIDs) were originally felt to be rare, it has became clear that they are much more common than routinely appreciated. Early and accurate detection of PIDs in children is essential to institute early lifesaving care and optimized treatments.Therefore in the approach to children with recurrent infections, careful medical history taking and physical examination with more attention to warning PIDs signs and symptoms are essential to distinguish those children with underlying PIDs from those who are normal or having other underlying disorders. If indicated, appropriate laboratory studies including simple screening and advanced tests must be performed.
Analysis of energy demandingness of metallurgical production  [PDF]
K. Janovská,?. Vilamová,P. Besta,A. Samolejová
Metalurgija , 2012,
Abstract: The article suggests the possibility of using methods of structural analysis to calculate the direct and complex consumption and, on the basis of this calculation, are can determine the energy demandingness of the individual metallurgical technologies.
Risk Factors for Recurrent Urinary Tract Infections  [PDF]
Serda Gülsün,Pa?a G?kta?
Dicle Medical Journal , 2004,
Abstract: To evaluate risk factors associated with recurrent urinary tract infections,we conducted a case- control study comparing 400 patients referred to aninfectious diseases outpatient clinic who had a history of recurrent urinary tractinfections (case patients) with 400 age, sex-matched control patients without ahistory of urinary tract infections. The distribution of 400 case patients to thegroups; 200 were women, 100 were men and 100 were children. 100 womenwere from 18 through 40 years of age (premenopausal) and 100 of them wereover 40 years of age (menopausal).Each patient completed a questionnaire providing an earlier history ofurinary tract infections, frequency of repeat episodes of urinary tract infections,having maternal history of urinary tract infections, recent antibiotic use,urogenital surgery history, marriage status and hygienic measures. In addition,physical examination of genitourinary system and laboratory investigation wasdone.In conclusion; our data support the view that some common factorsimportantly influence the incidence of recurrent urinary tract infections amongdifferent groups such as premenopausal, menopausal, men and childrengroups. These factors are; history of urinary tract infections, having urinarytract infections under the age of 15, recent antibiotic use in last one yearsperiod, urogenital surgery history and inappropriate hygienic measures.
Evaluation of the Children with Recurrent Respiratory Tract Infections  [PDF]
MD. Gunseli Bozdogan,MD. Ismail Reisli,MD. Figen Dogu,MD. Aydan Ikinciogullari
Journal of Medical Sciences , 2003,
Abstract: The aim of the present study is to evaluate the main causes underlying recurrent respiratory tract infections during childhood retrospectively. The records of 204 patients out of 6935 subjects who were admitted to our clinic between the years 1994-1999, with complaints of recurrent respiratory tract infections were examined. The patients were divided into three groups depending on their complaints during admission: Children with symptoms of only upper respiratory tract infection (group I), children with symptoms of only lower respiratory tract infection (group II) and children with symptoms of upper and lower respiratory tract infection (group III). The subjects consisted of 204 children, 132 male and 72 female with a median age of 3 years. Asthma and allergic diseases were the most common causes (45%) of recurrent complaints of respiratory tract while primary immunodeficiencies were determined as the second frequent cause (37.2%). Anatomic-obstructive diseases (9.3%) and the nutritional deficiency of micronutrient (8.3%) were determined as the other primary factors causing recurrent complaints of respiratory tract. Asthma and allergic diseases, primary immunodeficiencies and anatomic-obstructive factors, as well as nutritional zinc and iron deficiencies seems to be the major causes underlying recurrent respiratory tract infection in childhood.
A Girl with Autoimmune Cytopenias, Nonmalignant Lymphadenopathy, and Recurrent Infections  [PDF]
Marjolein A. C. Mattheij,Ellen J. H. Schatorjé,Eugenie F. A. Gemen,Lisette van de Corput,Peet T. G. A. Nooijen,Mirjam van der Burg,Esther de Vries
Case Reports in Immunology , 2012, DOI: 10.1155/2012/196417
Abstract: We describe a girl, now 9 years of age, with chronic idiopathic thrombocytopenic purpura, persistent nonmalignant lymphadenopathy, splenomegaly, recurrent infections, and autoimmune hemolytic anemia. Her symptoms partly fit the definitions of both autoimmune lymphoproliferative syndrome (ALPS) and common variable immunodeficiency disorders (CVIDs). Genetic analysis showed no abnormalities in the ALPS-genes FAS, FASLG, and CASP10. The CVID-associated TACI gene showed a homozygous polymorphism (Pro251Leu), which is found also in healthy controls. 1. Introduction Acute idiopathic thrombocytopenic purpura (ITP) is a well-known clinical entity in children. Generally, in children the disease is self-limiting and easily distinguished from a hematological malignancy, even without investigating the bone marrow [1]. However, the case becomes more complicated when the ITP becomes chronic and accompanying profound lymphadenopathy develops. We describe the diagnostic dilemma in a girl with these problems, who with time also developed recurrent respiratory infections, suffered from a prolonged episode of intractable diarrhea, a severe episode of varicella zoster infection and autoimmune hemolytic anemia. 2. Patient The girl, now 9 years of age, is the second child of healthy nonconsanguineous Caucasian parents. She was born after an uncomplicated pregnancy and delivery and showed normal growth and development. Her family history reveals allergy on the paternal side and autoimmune disease and malignancies on the maternal side. At the age of 14 months, she developed ITP and showed a partial slow recovery after 3 days of high-dose intravenous immunoglobulins (IVIGs) followed by prednisolone. One year later, she suffered a relapse during a mild parainfluenza type 3 infection and treatment with 3 days of high-dose IVIG was started again. A few days after receiving this second course of high-dose IVIG she developed cervical, axillary and inguinal lymphadenopathy and enlarged tonsils: this lymphadenopathy never resolved. There was no hepatomegaly, splenomegaly, or mediastinal or abdominal lymph node enlargement at that time. Blood tests showed a mild normocytic anemia (Hb 6.4?mmol/L, MCV 77?fL) and granulocytopenia (0.7–1.0 × 109/L) and large unstained cells in the hematology analyzer ( ; 0.4 × 109/L). A bone marrow aspirate and biopsy showed some atypical lymphocytes and specific maturational disturbances, but no malignancy. Bone marrow immunophenotyping was normal. FAS-mediated apoptosis of T-lymphoblasts was normal (two separate tests in two different laboratories). She
An Evaluation of Cotinine as an Index of Exposure to Tabacco Smoke in Children with Recurrent Respiratory Tract Infections Using HPLC Method  [PDF]
Barbara Kamer, Renata Pasowska, Anna Matczak-Rynkowska, Anna Socha-Banasiak, Joanna Ka?u?na-Czaplińska, Wioletta Grys, Jacek Rynkowski
American Journal of Analytical Chemistry (AJAC) , 2013, DOI: 10.4236/ajac.2013.47A008
Abstract:

The authors evaluated the frequency of exposure to tobacco smoke among children suffering from respiratory tract infections. The investigations comprised 141 children aged from 2 months to 6 years that were treated in the 2nd Department of Pediatric and Allergology of Polish Mother’s Memorial Hospital Research Institute in ?ód? (Poland). 69 of them were exposed to tobacco smoke in their home environment. The remaining 72 children came from non-smoking families. 26 (37.7%) individuals among the passive smokers and 15 (20.83%) among the children from non-smoking families suffered from recurrent respiratory tract infections. Cotinine concentrations were evaluated in the group of 69 children using the HPLC-UV method. The determined average cotinine/creatinine index expressed as median was higher in passive smokers with recurrent respiratory infections than among passive smokers with non-recurrent respiratory infections. Moreover, it was stated that the exposure to cigarette smoke was more often among children of younger and less well educated parents as well as living in poor housing conditions. These studies clearly indicate that there is a need for extensive education on the harmful effects of passive smoking and the recurrence of infections.

Recurrent myositis triggered by infections: a case report
Sui H Wong, Bryan RF Lecky, Ian J Hart, Daniel Crooks, Tom Solomon
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-344
Abstract: We report the case of a 24-year-old Caucasian woman with recurrent myositis triggered by sore throat, respiratory and urinary tract infections, over the past 18 years, up to four times a year. Myositis of this frequency and duration, apparently triggered by infections, has not been reported previously.We believe that this case adds to the understanding of myositis associated with infections being a triggered autoimmune response, and postulate that the pathogenesis in our patient is a non-specific immune response to a range of different precipitants, both bacterial and viral.Myositis can occur in association with infections. However, its pathogenesis is not clearly understood, and may be due to direct pathogenic invasion, for example, bacterial micro abscesses, or an autoimmune antigenic response. There may be serious consequences including rhabdomyolysis and acute renal failure. Recurrent myositis with different infections may suggest an autoimmune response from antigenic triggers. We describe such a case.A 24-year-old woman was referred in 2005 with increasing episodes of debilitating lower limb myalgia, since the age of seven. The attacks occurred every 1–2 years but had increased since 2005 to four per year. They were preceded by sore throats, and more recently, by cough or dysuria. During these episodes, creatine kinase (CK) ranged from 89 to 700 U/litre (normal range <175), normal between episodes. Her muscle pain responded to oral prednisolone within days.Because of the sore throats and an elevated antistreptolysin O titre (ASOT), she underwent a tonsillectomy in 1992. Apart from the tonsillectomy, her past medical history and drug history were unremarkable.We set out to fully investigate one of these attacks. In September 2005, an attack of muscle pains was preceded by cough and green sputum 2 weeks earlier. An examination was normal except for a slightly injected throat and tenderness of the calves and anterior compartment muscles. Biopsy of the right tibial
Urodynamic study in children with recurrent urinary tract infections
Madani A.,Pournasiri Z,Kajbafzadeh A.M.,Attaee N
Tehran University Medical Journal , 2007,
Abstract: Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05). Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.
SPECIFIC ANTIBODY DEFICIENCY IN CHILDREN SUFFERING RECURRENT INFECTIONS
M. Naseri. G.P. Spickett,?AJ. Cant
Acta Medica Iranica , 1999,
Abstract: Specific antibody deficiency lias been recognized as an immunodeficiency. In order to investigate an antipolysaccliaride antibody defect as a cause of rcccttrent infections, 30 children were studied. Patients who had been identified to have a major immunodeficiency or structural abnormality or a disease known to cause infection were excluded."nTliirty patints, aged I to 13.8 years (mean age, 5.8; male; female, 13:17) were chosen; all liad normal IgG and IgGl. Tiic level of IgA, IgG2 and lgG3 were of lower than normal in some cases. All were immunized with Hih conjugate (PRI'-T) vaccine, and 26 with pneumococcal vaccine. Antibody responses were measured 4-6 weeks later. Twelve showed a poor response to immunization: 8 to pneumovax 3 to Hib and 1 to both. No correlation was observed between IgG 2 level anil specific antibody responses to polysacciiaridc antigens. Tlie infections were more severe and more frequent in children who responded poorly to polysacciiaridc antigens. Chikircn who had infections in more than one site were most likely to have deficient antibody responses."nThese results show that assessment of specific antibody responses to challenge immunization is an essential part of the investigation of children suffering from recurrent pyogenic infections. The study confirms that measurement of immunoglobulin isotypes and IgG subclasses atone docs not exclude significant hormonal immune deficiency.
Immunological Evaluation of Children with Recurrent Ear, Nose, and Throat (ENT) Infections
A Karimi,A Isaiyan,A Aghamohammadi,M Moin
Iranian Journal of Pediatrics , 2007,
Abstract: Background: Recurrent and chronic infections of ear, nose, and throat (ENT) such as sinusitis (rhinosinusitis) and otitis media are one of the most common health care problems worldwide and significantly impact quality of life in both children and adults. Antibody deficiencies are the most common type of primary immunodeficiency and also the most likely to present with recurrent ENT infections. Methods: A study was carried out to search for underlying immunodeficiencies in 103 patients with recurrent or chronic ear, nose and throat infections. Serum total IgG, IgA, and IgM levels were measured by kinetic nephelometry, and IgG subclasses by enzyme-linked immunosorbent assay (ELISA). All patients were immunized intramuscularly with polyvalent pneumococcal vaccine (PENEUMO 23). Blood samples were drawn immediately before and 21 days after vaccination and antibodies to pneumococcal antigens were measured using a modified ELISA technique. Finding: Of 103 patients twenty one (20%) were found to have an immunodeficiency. One had a common variable immunodeficiency (CVID), 5 had selective IgA deficiency (one of them was associated with IgG2 deficiency and one with specific antibody deficiency). Eight patients had IgG-subclass deficiency including seven with an IgG2 deficiency and one patient with IgG3 deficiency. In 75 patients antibody titers of whole pneumococcal antigens were determined before and 21 days after immunization. Ten patients were found to have abnormally low antibody titers. Conclusion: The results of this study suggest that in a subpopulation of patients with a long standing history of ENT infections, a low serum immunoglobulin concentration or hypo responsiveness to pneumococcal antigen would be associated with susceptibility to recurrent infections.
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