What are the clinical features which should raise suspicion for PID syndromes?
Any child with two or more sinopulmonary infections within 1 year, four or more ear infections within 1 year, or two or more deep skin or organ infections including septicemia should be evaluated for a PID disorder. The first test to get is a complete blood count with differential. Physical exam findings in children may include dysmorphic facial features such as low-set ears and stigmata of developmental delay. Adults with recurrent respiratory tract infections, especially any community-acquired pneumonias or unexplained chronic diarrhea, should be screened for low quantitative immunoglobulins of all classes (IgG, IgM, IgA, and IgE). Cytopenias occur in both children and adults with PID syndromes. Adults may have a normal exam, or abnormalities such as absent tonsils (with no history of tonsillectomy), hepatosplenomegaly, synovitis, petechiae, pallor, and/or abnormal breath or bowel sounds.
