Table II.
Infections that are general warning signs of PIDD for all clinicians
| Otitis media* |
| • Early onset < 3–4 months of age |
| • Recurrence after antibiotic treatment |
| • Complications: mastoiditis |
| • Association with invasive infections |
| • Recurrence after ear tubes |
| • Change to sinusitis after ear tubes |
| • Repeated ear tube placement |
| * The number of otitis episodes that suggest PIDD varies with age: ≥ 3 episodes/year under 5 years; ≥ 2 episodes/year ≥ 5 years |
| Chronic recurrent rhinosinusitis |
| • Association with persistent asthma |
| • Requirement for sinus surgery due to fungal infections |
| Pneumonia |
| Evaluate after a single pneumonia if the patient has: |
| • A personal history of recurrent upper respiratory infections (URI) including recurrent otitis media |
| • A personal history of other immune problems (autoimmunity, chronic diarrhea, periodic fevers, persistent skin rash, etc.) |
| • Pneumonia that requires hospitalization (any: ICU or regular service) |
| • Persistent pneumonia after adequate therapy with antibiotics |
| • Pneumonia requiring IV antibiotics |
| • Bilateral pneumonias |
| • Necrotizing pneumonia |
| • Interstitial pneumonitis |
| Evaluate patients with 2 or more pneumonias: |
| • All patients (preferred option) |
| Or evaluate only if: |
| • X-ray proven pneumonias in different lung sites |
| • Positive family history for early death or primary immunodeficiency (PIDD) |
| • Pneumonia that is complicated by pneumatocele or bronchiectasis |
| Uncommon infections or uncommon presentations in HIV-negative patients* |
| Atypical mycobacteriosis |
| Tuberculosis resistant infection |
| Histoplasmosis |
| Neurocryptococcosis |
| Aspergilosis |
| Leishmaniasis |
| Blastomycosis |
| * More relevant signs in developed countries or non-endemic countries for these diseases |
| Chronic diarrhea or colitis |
| Evaluate if the patient has: |
| Rotavirus |
| Enteroviruses |
| Campylobacter |
| Cryptosporidium |
| Persistent Salmonella |
| Clostridium difficile |
| Recurrent giardiasis |
| Chronic dermatitis |
| Recurrent staphylococcal infections |
| Recurrent or persistent candidiasis or fungal infections |
| Abscesses (liver, lungs, cutaneous) |
| Staphylococcus aureus |
| Infections of central nervous system (CNS) |
| Meningococcal meningitis |
| Herpes encephalitis |
| Fungal infections |
| Complications due to live attenuated vaccines |
| Disseminated BCG (Mycobacterium bovis Bacillus Calmette-Guérin) |
| Poliomyelitis due to poliovirus vaccine |
| Diarrhea due to rotavirus vaccine |
See text under “Recurrent, Severe, or Unusual Infections”
For all the common infections listed in this table, evaluation starts with a complete blood count to rule out neutropenia and assessment of antibody mediated immunity