Recurrent Infections

History

Past Medical History

Probe, in depth, to the type, number, and severity of infections - bacterial, viral, and fungal.

• ear infections
• pneumonias (confirmed by X-ray? hospitalized?)
• chicken pox
• oral thrush

response to antibiotics

Atypical organisms at atypical sites are

immunizations

allergy

Medical history

• CF
• asthma
• born normal

Birth history

• BPD
• cleft lip

Family History

• status of other siblings
• allergy

Social history

• daycare
• smoking at home (doubles length of infection, from 7 up to 14 days)
• other allergens
• travel history

Warning Signs

• Eight or more infections within 1 year
• two or more serious sinus infections within 1 year
• two or more months in one year on antiobiotics...
• ....
• ....
• Lymphopenia in newborn or infancy with persistent...
• recurrent, deep skin or organ abscesses with or without the expected host local/systemic repsonse.
• persistent candidiasis, oral or elsewhere (skin, nails, esophagus, etc) beyond 4 months of age with poor response to topical therapy
• adverse response to live vaccines
• two ore more invasive...
• ....

Physical Exam

Growth history

HEENT

• sinuses (frontals present from age 6 onwards)
• tonsils, lymph nodes (absence is suspicious in children)

Clubbing

Lab Investigations

CBC/diff

smear

total Ig: unreliable, with many false negatives

• IgG, IgM, IgG 1,2,3,4

titres against vaccinated antigens

CH50 (complement)

blood, urine culture

Mycoplasmal pneumonia.

Diagnostic Imaging