Recurrent Infections in Children

It can be difficult to know when to investigate further for recurrent infections in children. It is normal for a healthy child to have 4 – 8 respiratory infections per year. When starting nursery or school and during winter months children are likely to pick up recurrent infections.

Most children with recurrent infections have a normal immune system. Other features associated with recurrent infections may make you consider investigating further for immunodeficiency and other pathology. Children with these features should be referred to a specialist for further assessment.

  • Chronic diarrhoea since infancy
  • Failure to thrive
  • Appearing unusually well with quite a severe infection, for example afebrile with a large pneumonia
  • Significantly more infections than expected, particularly bacterial lower respiratory tract infections
  • Unusual or persistent infections such as cytomegalovirus, candida and pneumocystis jiroveci

 

Investigations

The choice of investigations will be guided by a full history and examination.

  • Full blood count: low neutrophils suggest a phagocytic disorder and low lymphocytes suggest a T cell disorder
  • Immunoglobulins: abnormalities suggest a B cell disorders
  • Complement proteins: abnormalities suggest a complement disorder
  • Antibody responses to vaccines, specifically pneumococcal and haemophilus vaccines
  • HIV test if clinically relevant
  • Chest xray for scarring from previous chest infections
  • Sweat test for cystic fibrosis
  • CT chest for bronchiectasis

 

Last updated January 2020
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