By Dr Sagar Bhattad
All living organisms are born with an immune system that is designed to protect us against external attacks on the body such as bacterial, viral and protozoan infections among others. The immune system is akin to a smoothly functioning orchestra of players, working in sync with each other to defend the human body at various levels. A child’s immune system is typically weaker than an adult’s and as he/she grows up and is exposed to a variety of micro-organisms, his immunity strengthens and improves.
Most healthy babies are born with a basic defence system in place to fight off minor illnesses. A child’s immune capabilities also depend on several factors such as the parent’s genetic profiles (genetic strengths and weaknesses passed on to the offspring) and the mother’s condition during her pregnancy/environmental factors that she was exposed to during her pregnancy.
Toddlers and school-going children very often develop coughs and cold. These are mild viral infections that are a part and parcel of normal childhood. These children continue to grow well, gain height and weight and do not get hospitalised. Contrary to these healthy kids, some children find it difficult to fight even simple pathogens and may fall ill repeatedly, indicating that they lack this basic immune system or that there is a defect which needs to be addressed. Such children may be affected by what is called ‘Primary Immunodeficiency Disease’ (PIDs), a group of disorders where children are more prone to infections than usual due to a defect in the immune system.
Some forms of primary immunodeficiency are so mild that they go unnoticed, while other types have more pronounced symptoms and can be identified soon after an affected baby is born. Depending on the severity of the disease, such babies may have to go through hospitalisation for a while to strengthen their immune systems before they can be safely introduced to the outside world.
What are the symptoms?
- Chest infection: Children with problems in immunity are prone to chest infections.
- Ear discharge: Episodes of unexplainable ear-discharge.
- Loose motions: Episodes of loose motions/diarrhoea that take an unusually long time to resolve.
- Not gaining weight and height: Healthy children gain weight and height as per age norms. If a child fails to achieve his/her potential, this is a sign that something is amiss.
- More serious symptoms could include blood disorders, internal infections or autoimmune disorders.
Diagnosing a child with PIDs
One of the major red flags to watch out for is repeated, unexplainable illness in a child with no conclusive root cause behind it. If your child remains unwell for long periods of time, you have to visit the paediatrician often or you find yourself hospitalising the child with no conclusive answers, it is advisable to consult an immunologist. For parents, it is essential to note that their baby is growing as per age norms. If a child is failing to attain appropriate height and weight, it is a cause for concern and an immunologist must be contacted. By performing a few blood tests, the doctor will determine if there is any problem in the immune system of the child. Commonly asked immunological tests are serum immunoglobulins (IgG, IgA and IgM), however, the battery of tests would vary based on the problems in a given child.
Treating a child with PIDs
Children who have immunity issues require special care and treatment. Most cases are likely to be mild and can be treated with injections that boost their immunity (called immunoglobulins). In case of a severe onset of PIDs, a bone marrow transplant is one of the solutions to completely cure the issue. If diagnosed and treated in time, these children can lead a healthy and normal life.
Treatments are known to boost the immune system in many types of primary immunodeficiency disorders. In many cases, improved treatments enhance quality of life for children with the condition. Research on these treatments is ongoing and medical practitioners are hopeful that better treatments would emerge soon.
Why do PIDs occur?
Parental genes form the blueprint of the child’s body and determine the quality of the cells produced in the child. As PIDs are genetic diseases, the root cause for these disorders is transference through genes. Genetic counselling is extremely useful to help track and identify these issues beforehand to be prepared for the baby.
Cases of PIDs in India
We do not have comprehensive information available on the number of cases of Primary Immune Deficiency disease although one research conducted worldwide shows that one in 1,200 children suffers from immune deficiency. It is possible that cases are going undiagnosed because the symptoms of this disorder are very generic. It is difficult to correctly diagnose cases of PIDs unless the doctor has had past experience dealing with the disorder. Typically most cases of PIDs are treated for their symptoms – that is, the child is treated for their infections however until the root cause, i.e. the immune system defect is treated, it will be difficult to stop the child from falling ill repeatedly.
(The writer is Consultant, Pediatric Immunology and Rheumatology, ASTER CMI Hospital, Bengaluru, India.)