Immunosuppressed children

Measles, mumps, and rubella vaccine is a live virus vaccine that should be used with caution in immunosuppressed children, such as those with cancer receiving chemotherapy, solid organ or bone marrow transplantation, or receiving other immunosuppressive drugs, such as steroids in a dose... 

Baumal CR, Levin AV, Read S. Cytomegalovirus retinitis in immunosuppressed children. Am J Ophthalmol 1999 106 301-305. 

In immunocompromised patients with herpes zoster, intravenous acyclovir (500 mg/rrP every 8 hours for 7 days) reduces viral shedding, healing time, risks of cutaneous dissemination and visceral complications, and the length of hospitalization. In immunosuppressed children with varicella, intravenous acyclovir decreases healing time and the risk of visceral complications. 

Varicella Varicella-zoster immune globulin Immunosuppressed children in contact with the index case... 

Gross PA, Lee H, Wolff JA, Hall CB, Minnefore AB, Lazicki ME. Influenza immunization in immunosuppressed children. JPediatr (1978) 92, 30-5. 

Clusters or hospital outbreaks of PCP in the United States were initially reported in immunosuppressed children and more recently in patients with AIDS. Several studies have suggested possible nosocomial transmission between AIDS patients and other immuncompromised patients sharing the same waiting rooms in outpatient clinics (100,101). Although these data are incon-... 

Legionella species are an important and common nosocomial pathogen in adults but they are rare as a cause of nosocomial infection in children. Immunosuppressed children are most commonly affected when nosocomial Legionella is identified (37). It is unclear why children are at such a lower risk compared to hospitalized adults because potable water at facilities caring for children frequently contains some level of Legionella contamination. 

Drying lotions should not be used on skin lesions because they may increase scarring. In the child or adult for whom the skin lesions itch or are irritating, an oral antihistamine may help to prevent scratching, which can lead to secondary infection and thereby scarring. Recommended agents include oral chlorpheniramine or diphenhydramine.The use of cimetidine is controversial as an H2 blocker, oral cimetidine has an immunosuppressive action. The effects are not always consistent, however, and use of cimetidine is risky in autoimmune disorders and organ transplant patients. 

Liver transplantation not only removes the continued risk of variceal bleeding, but also eliminates the underlying liver disease causing portal hypertension. However, due to the scarcity of liver donors, limited financial resources and the life-long immunosuppression required, this major surgical intervention can only rarely be considered - perhaps in cases where a previous shunt operation or the creation of a TIPS was not possible. The survival rate for transplantation is higher than when recurrent bleeding is treated by repeated sclerotherapy (73% versus 17% after 4 years). The indication for transplantation (e. g. cirrhosis Child B or C) should be set as early as possible, (s. p. 872)... 

Primary biliary cholangitis The overlap of PBC with AIH reveals positivity of AMA, ANA and ASGPR as well as lower litres of LP and SMA. In approx. 20% of cases, AMA can be found in AIH. The frequency of this overlap syndrome is 5-10% (-15%). It was first detected in a child (12-year-old girl). (34) IgG and IgM fractions are simultaneously elevated. Histological findings can comprise the criteria of both PBC and CAH. Thus two different autoimmune diseases are present, whereby prognosis is determined by the degree of severity of AIH. This provides the indication for immunosuppressive therapy, (s. tab. 33.1) (s. p. 660)... 

Mechanism of action Rh GAM is a human IgG preparation that contains antibodies against red cell RhJD) antigens. Administration of this antibody to Rh (D)-negative. D -negative mothers at time of antigen exposure (ie, birth of an Rh (D)-positive, D -positive child) blocks the primaiy immune response to the foreign cells. The mechanism probably involves feedback immunosuppression. 

Stiehm ER, Ablin A, Kushner JH, Zoger S. Measles vaccination in patients on immunosuppressive drugs. Am JDis Child ( 966) 111, 191-4. 

Whyte and Loke 1978, Rosati and de Santis 1980). Despite good evidence, it is still not certain that the immune barrier between mother and child is achieved solely by sialic acid-rich glycoproteins. Of at least equal importance is the fact that the maternal organism synthesizes immunosuppressive factors in the early phase of pregnancy (Beer and Billingham 1978, Noonan et al. 1979). 

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