Children as their immune system and all body functions are not completely developed, are more prone to infections than adults. They get attacked by many types of small and severe infections often. Recurrent infections are infections that are too great in number, too severe, or too long lasting. Recurrent or persistent infection is the major manifestation of primary immunodeficiency. While most children with recurrent infections have a normal immunity, it is important to recognize the child with an underlying immunodeficiency in order to investigate and treat appropriately.
Signs and symptoms
- General symptoms like fussiness, refusing to eat, lethargy, and more
- A runny nose (that can be clear, yellow, or green)
- A sore throat
- Swollen tonsils
- Swollen glands
- A cough
- Shortness of breath
- Rapid breathing
- Wheezing
- Cyanosis
- Chest retraction
Causes
Recurrent infections in children usually occur due to an imbalance between exposure to infectious diseases and the ability of the immune system to ward off the infection.
Pathophysiology
Mostly transient or permanent immune system deficiencies are present. It should be pointed, that a true immunodeficiency is rare. Pathophysiology includes:
- defects of Fcγ receptor IIIa (CD16) on natural killer cells,
- defect of interleukin receptor-associate kinase 4 (IRAK4),
- reduction in IL-12 production,
- polymorphisms in genes CCR2, CCR5 and mannose-binding lectin gene,
- mutations in TLR-4 encoding sequences,
- defective removal of the apoptotic neutrophils by alveolar macrophages,
- pathologic phagocytosis and production of reactive oxygen intermediates from polymorphonuclear cells
- decrease neutrophil chemotaxis,
- mild decrease in the number of CD4+, CD8+, CD19+ and NK-cells,
- alterations in the cytokine production by lymphocytes (↑ IL-4, ↑ IL-10, ↓ IFN-γ, ↓ IL-2),
- decreases IgM, IgA, IgG subclasses, mannose-binding lectin, L-ficolin,
- defects in the production post-infectious specific antibodies.
Diagnosis
Criteria for diagnosis includes:
- Two or more severe infections in one year
- Three or more respiratory infections (e.g., sinusitis, otitis, bronchitis) in one year
- The need for antibiotics for two months/year
- Severe/serious infections include those with persistent evidence of inflammation (e.g., fever) or confinement to bed for a week or more (e.g., missing school or other activities), failure to respond to oral antibiotics and/or the need for intravenous antibiotics or hospitalization.
- Infections with an unusual pathogen
- Unusual complications (e.g., mastoiditis, pleural effusion, abscesses) or persistent laboratory abnormalities (e.g., leucocytosis, elevated erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP], persistent imaging abnormalities).
Physical examination
Blood tests:
- Complete blood count (CBC) and differential blood count
- HIV test
- Serum immunoglobulin levels
- Sweat chloride test
- Ciliary function tests
Imaging techniques:
- X Ray
- CT
- MRI
Treatments
- Avoiding all risk factors
- Immunizations
- Immunoglobulin treatment
- Antibiotics
Prognosis
Most of the children do not have an immunodeficiency, but if they do, this often concerns an antibody deficiency. If they have a positive history for immunodeficiency, detailed immunological investigation is mandatory.
Complications
Bronchiectasis
Antibiotic resistance
Asthma
Deficiency disorders
Disease & Ayurveda
Ayurveda explains children upto sixteen years as asampoornadhaatu or incompletely developed body tissues. As they are in the growing stage and their organs & organ systems are not fully developed, Ayurveda considers as more prone to diseases. At the same time, many strong medications and treatments are contraindicated in children due to underdeveloped muscles and physical & mental strength. Considering these factors, children are considered to more prone to hyper reactivity and allergic response which leads to recurrent infections in kids. Even normal healthy kids are like this, then premature born or malnourished children will suffer such episodes in a higher frequency & severity. All these conditions can be considered as grahabaadha or Baalaarishtatha which elaborates a wide range of allergic & infective conditions in kids.
Nidana
Causative factors for the vitiation of doshas (mainly Kapha & Pitta) by mother(in breast fed child) and child. It can be related with food, daily/seasonal regimen or environment.
Purvaaroopa
Crying without any reason
Restlessness
Excessive sleep & fatigue
Samprapti
Due to causative factors, the doshas get vitiated and travel throughout the body and get lodged in places where the channels are blocked or deformed(srotovaigunya). There, the disease is manifested.
Lakshana
It depends upon the site of infection.
If the GIT is infected,
Vomiting, diarrhoea, distended abdomen, abdominal pain or headache can develop.
If respiratory tract is infected,
Cough, fever, breathing difficulty, chest pain or difficulty to sleep can develop.
If the ear is infected,
Pain, tenderness and stuffed feeling of ear and deafness can develop.
If the skin is infected,
Skin rashes, and fever can develop.
Divisions
Not mentioned
Prognosis
Saadhya in most of the new & uncomplicated treatment
Chikithsa
Ayurvedic treatment for the infection targets upon both improving the immunity of the child & symptomatic management. Any underlying condition like worms should be managed first, if present. Medicines given and dosage depend upon the infected organ/system and age of the child. Light & easily digestible but nutritious food is mandatory. Make sure enough hydration with herbal or boiled water drinking. Good sleep, proper hygiene and enough rest is assured during the time of treatment.
Most infections in kids can be managed with samana therapy itself. Sodhana therapies like vasti or nasya are done with utmost care in essential cases. Virechana & vamana are even more complicated therapies to be done in children when done as a part of panchakarma procedure. Only mild laxatives and emetics for an immediate cleansing are used in emergency conditions.
Commonly used medicines
Vidangakrishnadi kashayam
Indukantham kashayam
Ariyaradi kashayam
Pippallyasavam
Mustarishtam
Aravindasavam
Gopeechandanadi gulika
Ashtachoornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Symptomatic management according to the site of infection & age of the kid.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect the from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Exercies and Yoga are not recommended in child with recurrent infections. Complete rest is advised.
Yoga is not advised even for healthy kids less than 7 years of age. So, a kid with recurrent infections should get professional help & guidance before starting any kind of exercises.
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
- PMID: 30588168
We aimed to determine the differences in lymphocyte subgroups between DS children and the healthy population and to study the pattern and likelihood for recurrent infections and hospital admission due to infection. Our study was carried out in the Genetic Unit of Mansoura University Children’s Hospital, Egypt. The study enrolled 150 DS (DS group) and 100 controls (CG group). They were assessed for recurrent infections (including tonsillitis, otitis media [OM], pneumonia, upper respiratory tract infections [URTI], sinusitis, and gastroenteritis [GE]) and hospital admission due to infections. All patients were subjected to complete blood count and flow cytometric analysis for expression markers of B lymphocytes (CD19), natural killer (NK) cells (CD56), and T lymphocytes (CD3, CD4 and CD8). We found a statistically significant increase in the frequency of URTIs and sinusitis, OM, pneumonia, and hospital admission in the DS group. As regards the type of recurrent infection in DS, it was highest for URTIs and sinusitis. For age groups below 13 years, a statistically significant decrease in all studied CD markers was found in the DS group, while for the 13-18-year-olds, a statistically significant decrease was found in CD4, CD19, and CD56 in the DS group. Non-significant correlations were found between CD markers and recurrent infection and hospital admission. We concluded that lymphocyte subgroups that carry CD3, CD4, CD8, CD19, and CD56 were decreased in DS. Recurrent infections and hospital admission are still striking feature for DS but are not significantly correlated with lymphocyte subgroups
- PMID: 29115961
Immunofluorescence was used to explore the dynamics of anti-VSA IgG responses generated by children to (i) primary malaria episodes and (ii) recurrent P. falciparum infections.
Results
Consistent with previous studies on anti-VSA responses, sera from each child taken at the time of recovery from their respective primary infection tended to recognize their own secondary parasites poorly. Additionally, compared to patients with reinfections by parasites of new merozoite surface protein 2 (MSP2) genotypes, baseline sera sampled from patients with persistent infections (recrudescence) tended to have higher recognition of heterologous parasites. This is consistent with the prediction that anti-VSA IgG responses may play a role in promoting chronic asymptomatic infections.
Conclusions
This pilot study validates the utility of recurrent natural malaria infections as a functional readout for examining the incremental acquisition of immunity to malaria.
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Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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