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