LAUSR

Background and aims Abnormal antibody response to polysaccharide proteins found in various bacteria (Haemophilus Influenzae type b, Pneumococcus, Klebsiella Pneumoniae, Salmonella Typhi, Escherichia Coli) can be observed in Immunoglobulin A (IgA) deficiencies. Though the majority of the individuals with IgA deficiency are asymptomatic, some of them may develop recurrent respiratory, gastrointestinal or urinary tract infections, asthma, autoimmune diseases or allergic disorders. Aim To establish the importance of the appropriate laboratory tests for diagnosing recurrent infections in patients with IgA deficit. Methods We performed a retrospective study on 232 patients selected from 51 266 children who were hospitalised in ‘Grigore Alexandrescu’ Emergency Hospital for Children between 1st of January 2010 to 1st of January 2017. Included patients were aged between 1 to 16 years old and had low serum levels of IgA. We analysed their medical history and their investigations. We excluded: 45 patients aged less than 1 year, 109 patients without recurrent infections, 7 cases of celiac disease, 13 cases of asthma and 11 cases of food allergies. Results The recurrent infections identified were – 11 cases of respiratory tract infections, 10 cases of low respiratory tract infections, 10 patients with urinary tract infections, 8 patients with gastrointestinal tract infections and 8 cases of association of different infections. 20 patients were tested positively for specific microbial cultures. The most frequently germs found in our study were: Klebsiella Pneumoniae (35%), Escherichia Coli (35%), Pneumococcus (10%), Proteus (10%), Salmonella Typhi (5%) and Pseudomonas Aeruginosa (5%). Conclusions Assessment of IgA should be performed on each child with recurrent respiratory, gastrointestinal or urinary tract infections. Polysaccharide encapsulated bacteria can be identified in biological products, so investigations like pharyngeal or nasal exudate, urine or stool cultures should always be performed before beginning the antibiotherapy. The association between a respiratory, gastrointestinal and urinary tract infection could raise suspicion for a primary immunodeficiency. Screening for primary immunodeficiency at children aged>1 year old might be helpful. Prevention by limiting the patient from exposure to infectious diseases is important since recurrent infections might determine long term school or work absence with high economic impact.