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High-Yield Facts

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  • Fever in the immunocompromised child is a medical emergency. Prompt evaluation and administration of antibiotics can decrease morbidity and mortality.

  • Patients on chronic corticosteroids may also require stress dose steroids when febrile.

  • Children with B cell immunodeficiencies are at risk for encapsulated pathogens. Children with T cell defects may present with chronic or severe viral infections, Pneumocystis jirovecii pneumonia, and recurrent bacterial infections. Children with phagocyte defects present with recurrent infections caused by pyogenic bacteria. Children with complement deficiencies present with encapsulated and pyogenic pathogens.

  • Acute HIV infection should be suspected in the adolescent with fever, malaise, diffuse lymphadenopathy, pharyngitis, oral ulcers, and a maculopapular rash

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The number of immunocompromised children seen in the emergency department (ED) is increasing due to improved detection of some primary immunodeficiencies (PIs) (Table 59-1) and to increased survival after diagnosis. This chapter will focus on infectious complications in immunocompromised children. See also Section 20 for hematologic and oncologic emergencies.

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TABLE 59-1   The Most Common Immunodeficiencies and Immunocompromising Conditions in the United States 

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