Criteria for a Suspected Case of Primary Immunodeficiency in Children (Indications for Mandatory Referral to a Pediatric Immunologist):
- Frequent, Severe, or Unusual Infections:
- More than four new ear infections within one year.
- More than two serious sinus infections within one year.
- More than two episodes of pneumonia within one year.
- Recurrent deep-seated infections, such as abscesses in organs or skin.
- Persistent fungal infections (e.g., thrush) after the first year of life.
- Infections caused by opportunistic pathogens (e.g., Pneumocystis jiroveci).
- Prolonged or Poor Response to Standard Treatment:
- Infections that do not respond to standard antibiotic therapy for at least two months.
- Need for prolonged intravenous antibiotic treatment to clear infections.
- Failure to Thrive or Growth Delay:
- Unexplained weight loss, poor weight gain, or growth failure.
- Chronic diarrhea with malabsorption.
- Family History of Primary Immunodeficiency or Early Childhood Deaths Due to Infections:
- Siblings or close relatives diagnosed with primary immunodeficiency.
- Unexplained deaths of infants or young children due to infections.
- Hematologic and Autoimmune Manifestations:
- Unexplained persistent low white blood cell count (neutropenia).
- Autoimmune disorders, such as chronic arthritis, thrombocytopenia (low platelet count), hemolytic anemia, or thyroid disease.
- Enlarged Lymphoid Organs or Splenomegaly:
- Persistent or unexplained enlargement of lymph nodes, liver, or spleen.
- Adverse Reactions to Live Vaccines:
- Severe reactions to live vaccines (e.g., BCG, MMR, oral polio vaccine).
- Unusual Skin Manifestations:
- Persistent warts, eczema, or other chronic skin conditions that do not respond to treatment.
- Severe infections of the skin or mucous membranes.
Any child presenting with one or more of these signs should be referred to a pediatric immunologist for further evaluation of possible primary immunodeficiency.
World Allergy Organization