Bajo índice de sospecha para deficiencia de anticuerpos en niños sometidos a procedimientos quirúrgicos de Otorrinolaringología.

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Title:	Bajo índice de sospecha para deficiencia de anticuerpos en niños sometidos a procedimientos quirúrgicos de Otorrinolaringología.
Alternate Title:	Low index of suspicion for antibody deficiency in children who underwent otolaryngology surgical procedures.
Authors:	Ramírez-López, A. B.¹, Zúñiga-Lagunes, C. G.², Martínez-Viveros, A.³, Medina-Torres, E. A.¹, Murata, C.⁴, Espinosa-Padilla, S. E.¹, Lugo-Reyes, S. O.¹ dr.lugo.reyes@gmail.com
Source:	Acta Pediatrica de Mexico. jul/ago2016, Vol. 37 Issue 4, p204-214. 11p. 2 Charts, 7 Graphs.
Abstract (English):	INTRODUCTION: Primary immunodeficiencies (PID) are underdi- agnosed all around the world, even at tertiary care centers. Antibody defects make the most prevalent defect group, and usually manifest themselves clinically after 6 months of age with recurrent respiratory infections caused by encapsulated bacteria. A number of ear-nose and throat surgeries are indicated in patients with recurrent or complicated respiratory infections, who have not adequately responded to medical therapy. These children who underwent a surgical procedure after a history of recurrent respiratory infections might constitute a high-risk group for PID. OBJECTIVE: To enquire how frequent antibody defects are among children with a history of respiratory infections who underwent any of three otolaryngology surgeries. METHODS: We reviewed the electronic medical records of children who underwent adenoid-tonsillectomy (ATT), endoscopic paranasal sinus drainage (ESD), and tympanic ventilation tube placement (TVT) at our center during 2011-2012, for serum immunoglobulins (IgE, IgG, IgA, IgM) levels. RESULTS: We found 112 surgical procedures in 87 patients. Of these, the indication for surgery was infectious in 37 (21 male, 1 dead, mean age 7.3 years), more often chronic rhinosinusitis (19/37) and tonsillitis (9/37). The procedures included: 24 ATT, 13 ESD, and 6 TVT, for a total of 43. Eight patients (21.6%) underwent more than one surgery. Serum IgE was found in 27 (72.9%), and "at-least-IgG" in 18 (48.6%). Only 70% of these tests were ordered before surgery. Abnormal results included: High IgE 10/27, high IgG 8/18, low IgG 1/18, high IgM 3/17, and high IgA 5/17. Two children with known Chronic granulomatous disease (CGD) were identified through this electronic search. DISCUSSION: We describe 37 patients who underwent ENT surgery for a history of complicated, recurrent or refractory respiratory infec- tions, of whom at least nine were allergic and at least two had PID (CGD). Only 18 of those 37 had IgG measured as part of their workup; an alarmingly low index of suspicion for antibody defects. Previous studies in adults with refractory CRS have found antibody defects. We intend to complete the immunological evaluation of the 37, includ- ing for specific antibody deficiency (SAD). "Red flags" such as IgE >2,000 IU/mL, complicated pneumonia, or Aspergillus sp. culture growth may prove to be useful to detect patients with previously undiagnosed PID. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	INTRODUCCIÓN: las inmunodeficiencias primarias están subdiagnosticadas en todo el mundo, aun en centros de tercer nivel de atención. Los defectos de anticuerpos constituyen el grupo más prevalente y suelen manifestarse clínicamente después de los 6 meses de edad como infecciones respiratorias recurrentes causadas por bacterias encapsuladas. Algunas cirugías de oído-nariz y garganta se indican en pacientes con infecciones respiratorias recurrentes o complicadas que no han respondido adecuadamente al tratamiento médico. Estos niños sometidos a procedimientos quirúrgicos luego de una historia de infecciones respiratorias recurrentes pueden constituir un grupo de alto riesgo para inmunodeficiencias primarias. OBJETIVO: indagar qué tan frecuentes son los defectos de anticuerpos en niños sometidos a cualquiera de tres cirugías de otorrinolaringología. MATERIALES Y MÉTODOS: revisamos los expedientes electrónicos de niños que hubieran sido sometidos a adenoamigdalectomía (ATT), drenaje endoscópico de senos paranasales (ESD) y colocación de tubos timpánicos de ventilación (TVT) en nuestro instituto durante 2011-2012, en busca de niveles séricos de inmunoglobulinas (IgE, IgG, IgA, IgM). RESULTADOS: encontramos 112 procedimientos quirúrgicos en 87 pacientes, de los cuales la indicación para cirugía fue infecciosa en 37 (21 varones, 1 muerto, edad media 7.3 años), más frecuentemente rinosinusitis (19/37) y amigdalitis (9/37) crónicas. Los procedimientos incluyeron: 24 adenoamigdalectomías, 13 drenajes endoscópicos de senos paranasales y 6 colocaciones de tubos timpánicos de ventilación, para un total de 43; ocho pacientes (21.6%) fueron sometidos a más de una cirugía. La IgE sérica se encontró en el expediente de 27 pacientes (72.9%), y "al menos IgG" en 18 (48.6%). Sólo 70% de las pruebas fueron ordenadas antes de la cirugía. Los resultados anormales incluyeron: IgE elevada en 10/27, IgG elevada en 8/18, IgG baja 1/18, IgM elevada 3/17 e IgA elevada en 5/17. Dos niños con enfermedad granulomatosa crónica fueron identificados a través de esta búsqueda electrónica. CONCLUSIONES: describimos 37 pacientes sometidos a cirugía de otorrinolaringología por una historia de infecciones respiratorias recurrentes, complicadas o refractarias, de los cuales al menos nueve eran alérgicos y al menos dos tenían una inmunodeficiencia primaria. Sólo 18 de esos 37 tenían determinación de IgG como parte de su evaluación preoperatoria; un índice alarmantemente bajo de sospecha para defectos de anticuerpos. Estudios previos en adultos con rinosinusitis crónica han encontrado defectos de anticuerpos. Planeamos completar la evaluación inmunológica de los 37 pacientes, incluyendo para deficiencia específica de anticuerpos (SAD). Banderas rojas como IgE >2,000 IU/mL, neumonía complicada o cultivo de Aspergillus pueden ser útiles para detectar pacientes con inmunodeficiencia primaria no diagnosticada. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	INTRODUCTION: Primary immunodeficiencies (PID) are underdi- agnosed all around the world, even at tertiary care centers. Antibody defects make the most prevalent defect group, and usually manifest themselves clinically after 6 months of age with recurrent respiratory infections caused by encapsulated bacteria. A number of ear-nose and throat surgeries are indicated in patients with recurrent or complicated respiratory infections, who have not adequately responded to medical therapy. These children who underwent a surgical procedure after a history of recurrent respiratory infections might constitute a high-risk group for PID. OBJECTIVE: To enquire how frequent antibody defects are among children with a history of respiratory infections who underwent any of three otolaryngology surgeries. METHODS: We reviewed the electronic medical records of children who underwent adenoid-tonsillectomy (ATT), endoscopic paranasal sinus drainage (ESD), and tympanic ventilation tube placement (TVT) at our center during 2011-2012, for serum immunoglobulins (IgE, IgG, IgA, IgM) levels. RESULTS: We found 112 surgical procedures in 87 patients. Of these, the indication for surgery was infectious in 37 (21 male, 1 dead, mean age 7.3 years), more often chronic rhinosinusitis (19/37) and tonsillitis (9/37). The procedures included: 24 ATT, 13 ESD, and 6 TVT, for a total of 43. Eight patients (21.6%) underwent more than one surgery. Serum IgE was found in 27 (72.9%), and "at-least-IgG" in 18 (48.6%). Only 70% of these tests were ordered before surgery. Abnormal results included: High IgE 10/27, high IgG 8/18, low IgG 1/18, high IgM 3/17, and high IgA 5/17. Two children with known Chronic granulomatous disease (CGD) were identified through this electronic search. DISCUSSION: We describe 37 patients who underwent ENT surgery for a history of complicated, recurrent or refractory respiratory infec- tions, of whom at least nine were allergic and at least two had PID (CGD). Only 18 of those 37 had IgG measured as part of their workup; an alarmingly low index of suspicion for antibody defects. Previous studies in adults with refractory CRS have found antibody defects. We intend to complete the immunological evaluation of the 37, includ- ing for specific antibody deficiency (SAD). "Red flags" such as IgE >2,000 IU/mL, complicated pneumonia, or Aspergillus sp. culture growth may prove to be useful to detect patients with previously undiagnosed PID. [ABSTRACT FROM AUTHOR]
ISSN:	01862391
DOI:	10.18233/apm37no4pp204-214