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Recurrent Infections and Primary Immune Deficiency PID

  • This pre-referral guideline provides information on the evaluation for Primary Immune Deficiency (PID) in children of all ages.

    Initial work-up

    Warning signs for PID include:

    • 8 or more new infections within one year.
    • 2 or more serious sinus infections within one year.
    • 2 or more months on antibiotics with little or no effect.
    • 2 or more pneumonias within one year.
    • Failure of an infant to gain weight or grow normally.
    • Recurrent deep skin or organ diseases.
    • Persistent thrush in the mouth or elsewhere on skin after age one year.
    • Need for intravenous antibiotics to clear infections.
    • 2 or more deep-seated infections.
    • A family history of immune deficiency or suspected immune deficiency.

    Diagnostics

    • Full blood count.
    • Liver function tests.
    • Immunoglobulins: IgG, IgA and IgM.
    • Microbiology e.g. blood/CSF or sputum culture.
    • Virology e.g. Nasopharyngeal Aspirate.
    • Chest x-ray (if history of chest infections).

    Notes

    PID fact sheets for parents can be found at www.allergy.org.au

    Pre-referral assessment/treatment

    • All suspected cases of PID should be referred to the RCH for diagnosis and treatment - this is a PRIORITY REFERRAL.
    • GPs should treat infections in the usual manner, antibiotics being the first line of treatment.

    When to refer

    • All suspected cases of PID should be referred to the RCH for diagnosis and treatment.
    • CLEARLY INDICATE that the child has a suspected IMMUNODEFICIENCY.
    • If the child is < 1 year old, the referral will be triaged as urgent. If unsure, contact the department on 03 9345 5522.

    Referral criteria are 1 or more of the following conditions:

    • 8 or more new infections within one year.
    • 2 or more serious sinus infections within one year.
    • 2 or more months on antibiotics with little or no effect.
    • 2 or more pneumonias within one year.
    • Failure of an infant to gain weight or grow normally.
    • Recurrent deep skin or organ diseases.
    • Persistent thrush in the mouth or elsewhere on skin after age one year.
    • Need for intravenous antibiotics to clear infections.
    • 2 or more deep-seated infections.
    • A family history of immune deficiency or suspected immune deficiency.

    Information needed:

    • History of infections - date, type of infection, severity, treatment trialed and response. 
    • Family history.
    • Diagnostic test results - organisms identified.
    • Current management.

    Contact information

    Clinical advice

     

    Department of Allergy and Immunology:

    (03) 9345 5701

     

     

    RCH Emergency Department:

    (03) 9345 6477


    Outpatients

     

    Clinical Services Directory (Clinic referral information).

     

    Booking enquiries & 
    appointment rescheduling     (Urgent bookings and for parents)

    RCH OPD referral form (word)

    Generic parent handout (about RCH pre-referral guidelines)

    Victorian Statewide Referral Form (VSRF)

     

     

    (03) 9345 6180 

     

     

     

     

    Rural doctors only

    (03) 9345 6789 


    Admission enquiries

     

    General admission enquiries:

    (03) 9345 6172

    ED admission enquiries:

    (03) 9345 6477

    After hours / Switchboard:

    (03) 9345 5522


    Other

     

    Seriously unwell child:

    (03) 9345 7007

    RCH Drug info-line:

    (03) 9345 5208

    Resources

    References

    Paediatric Handbook (2009). Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

    These guidelines were developed by specialists at the Royal Children's Hospital and reviewed by a working group of metropolitan and rural general practitioners in Victoria. Last reviewed in December 2008.

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