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Original Research Open Access

A Single-Centre Pilot Study in Bulgaria Unravelling the Immunological and Genetic Landscape of Children with Recurrent Infections

  • 1Pediatric Department, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
  • 2Pediatric Clinic, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
  • 3Genetic Medico-Diagnostic Laboratory “Genica”, 1000 Sofia, Bulgaria
  • 4Department of Clinical Immunology, Medical University Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
  • 5Clinic of Clinical Immunology with Stem Cell Bank, UMHAT Alexandrovska, 1 Georgi Sofiyski Str., 1431 Sofia, Bulgaria
  • 6Borola Clinic, 1202 Sofia, Bulgaria
  • 7Paediatric Benign Haematology Department, National Hematology Hospital Sofia, Bul. Kliment Ohridski 1A, 1000 Sofia, Bulgaria
  • 8Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
+ Affiliations - Affiliations

Corresponding Author

Polina Kostova, p.kostova-shahid@medfac.mu-sofia.bg; Guergana Petrova, gstoyanova@medfac.mu-sofia.bg

Received Date: November 03, 2025

Accepted Date: December 31, 2025

Abstract

Background: Recurrent infections in children may indicate underlying inborn errors of immunity. Early detection by combined immunologic and genetic testing is essential for accurate diagnosis and targeted intervention.

Methods: This prospective study included 60 pediatric patients aged ≤18 years with recurrent infections, evaluated between 2022 and 2024. The median age at enrollment was 6.2 years ([IQR] 3.6–11.3). Immunological assessment included flow cytometric immunophenotyping of lymphocyte subsets, serum immunoglobulin profiling (IgG, IgA, IgM, IgE and IgG subclasses), complement (C3, C4), and vitamin D measurement. Microbiological cultures of sputum or pharyngeal swabs were collected. Whole Exome Sequencing (WES) was performed for genetic evaluation and results verified by Sanger sequencing.

Results: A subset of patients had reduced CD4+ T cells, memory B cells or NK cells. Hypogammaglobulinemia, particularly of IgG2 and IgA subclasses, was common. Pathogenic bacteria, mainly Haemophilus influenzae and Staphylococcus aureus, were isolated in 45% of cases. WES identified pathogenic or likely pathogenic variants in TNFRSF13B, CFTR, IL10RA, MEFV and other genes. A possible association between MBL2 c.161 G>A and altered CD4+ T cell percentages, lower NK cell numbers and reduced CD8+ effector T cells could indicate immunomodulatory effects.

Conclusion: Comprehensive immunogenetic profiling reveals distinct patterns of immune dysregulation and genetic susceptibility, supporting personalized diagnostic and therapeutic strategies, including immunoglobulin substitution, immunomodulation, and genetic counseling.

Keywords

Recurrent Infections, Inborn errors of Immunity, Immunophenotyping, Whole-Exome sequencing, SNP Analysis, Infections

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