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İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ

Year 2022, Volume: 24 Issue: 3, 475 - 481, 31.12.2022
https://doi.org/10.24938/kutfd.1099330

Abstract

Amaç: Enfeksiyonlar febril nöbetin en sık nedenlerinden olup, sık üst solunum yolu enfeksiyonu hikayesi çocuklarda immünglobulin (Ig) düzeylerinin düşüklüğünün bir göstergesidir. Çalışmamız; ilk kez febril nöbet geçiren çocuk hastalarda yıl içinde geçirdikleri enfeksiyon sayısına göre total Ig G, A, M, E değerlerinin ölçülmesinin önemini göstermeyi, ikinci yıl sonundaki takiplerinde Ig düşüklüğünün sıklığını tanımlamayı ve Ig düşüklüğü olanların febril nöbet geçirme riskini belirlemeyi amaçlamaktadır.
Gereç ve Yöntemler: 2010-2018 yılları arasında ilk kez febril nöbet geçirerek acil servise başvuran toplam 320 çocuk hastadan, yıl içinde geçirdikleri enfeksiyon sayıları-na göre toplam 174 çocuk çalışmaya dahil edildi ve Ig düzeyleri 189 sağlıklı çocuk ile karşılaştırıldı. Yirmi dört ay sonra Ig değerleri tüm çocuk-larda tekrarlandı.
Bulgular: Çalışmaya alınan 174 çocuğun 53’ünde (%30.4) yaşa göre Ig (yaş aralığına göre 36 çocuğun IgG düzey-leri, 17 hastanın IgA düzeyleri) düzeylerinde düşüklük mevcuttu. İkiyıllık takipleri sonrasında %16.7’sinde (süt çocuğunun geçici hipogamaglobulinemisi %5.5 ve sel-ektif IgA eksikliği%11.2) takip gerektiren Ig düşüklüğü tespit edildi. İkinci yıl sonunda Ig düşüklüğü ile takip edilen çocukların %55.5’i komplike febril nöbetti.İkinci yıl sonundaki kontrollerinde %7.5selektif IgA eksikliği tanısı aldı. IgA<14.55 mg/dl olanların komplike febril nöbet geçirme riski 1.961 kat daha yüksekti.
Sonuç: Yıl içinde geçirdikleri enfeksiyon sayılarına göre ilk kez febril nöbetle başvuran çocuklarda Ig düzeyleri başvuru anında tetkik edilmelidir. Uzun süreli takip gerekse de özellikle ilk komplike febril nöbettte IgA eksikliği olabileceği klinisyenler tarafından farkında olunmalıdır.

Thanks

Çalışmamıza vermiş olduğunuz destek, çaba ve bilimsel katkı için çok teşekkür ederim. Bu çalışma bizim gözlemsel olarak farkına vardığımız sonrasında ayrıntılı irdelediğimizde ilginç ve sık rastladığımız bir durumu aydınlatmak imkanı bulabileceğimizi düşündüğümüz ayrıca farklı bir bakış açısı için heyecan duyduğumuz bir çalışmadır ve bunun için fırsat verildiğinden dolayı çok mutluyuz. Saygıalrımızla

References

  • Paul SP, Seymour M, Flower D, Rogers E. Febrile convulsions in children. Nurs Child Young People. 2015;27(5):14–5.
  • Swaiman KF, Swaiman KF, Ashwal S, Ferriero DM, Schor NF. Swaiman’s pediatric neurology. 5th ed. Vol. 1. Philadelphia: Elsevier Health Sciences; 2012:790-7 p.
  • Leung AK. Febrile seizures. In: Leung AK, ed. Common Problems in Ambulatory Pediatrics: Specific Clinical Problems, Volume 1. New York, NY: Nova Science Publishers, Inc, 2011:199–206.
  • Patterson JL, Carapetian SA, Hageman JR, Kelley KR. Febrile seizures. Pediatr Ann. 2013;42(12):249-54.
  • V. Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281–6.
  • Tu YF, Lin CL, Lin CH, Huang CC, Sung FC, Kao CH. Febrile convulsions increase risk of Tourette syndrome. Seizure. 2014;23(8):651–6.
  • Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia. 2013;54(12):2101–7.
  • Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia. 2018;59(4):739–44.
  • Roth J, Blatteis CM. Mechanisms of fever production and lysis: lessons from experimental LPS fever. Compr Physiol. 2014;4(4):1563-604.
  • Cansu A, Serdaroğlu A, Yüksel D, Doğan V, Ozkan S, Hirfanoğlu T et al. Prevalence of some risk factors in children with epilepsy compared to their controls. Seizure. 2007;16(4):338-44.
  • Sarnat HB, Scantlebury MH. Novel Inflammatory Neuropathology in Immature Brain: (1) Fetal Tuberous Sclerosis, (2) Febrile Seizures, (3) α-B-crystallin, and (4) Role of Astrocytes. Semin Pediatr Neurol. 2017;24(3):152-60.
  • Yu X, Zhang N, Liu S, Xi Z, Zhang Y. Polymorphisms in the interleukin-1β (IL-1B) and interleukin-1α (IL-1A) genes on risk of febrile seizures: a meta-analysis. Neurol Sci. 2018;39(9):1529-36.
  • Kowalczyk D, Mytar B, Zembala M. Cytokine production in transient hypogammaglobulinemia and isolated IgA deficiency. J Allergy Clin Immunol.1997;100(4):556-62.
  • Gupta D, Thakral D, Kumar P, Kabra SK, Lodha R, Kumari R et al. Primary Immunodeficiency Disorders Among North Indian Children. Indian J Pediatr. 2019;86(10):885-91.
  • Ten warning signs of primary immunodeficiencies. http:// www.info4pi.org.
  • Geha RS. Antibody deficiency syndromes and novel immunodeficiencies. Pediatr. Infect Dis J. 1988;7(5Suppl):57-60.
  • Strober W, Sneller MC; IgA deficiency. Ann Allergy. 1991;66(5);363-76.
  • Plebani A, Ugazio AG, Monafo V, Burgio GR; Clinical heterogeneity and reversibly of selective immunoglobulin A deficiency in 80 children. Lancet. 1986;1(8485):829-34.
  • Wood RA, Sampson HA. The child with frequent infections. Curr Probl Pediatr.1989;19(5):229-84.
  • Aksu G, Genel F, Koturoğlu G, Kurugöl Z, Kütükçüler N. Original Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique. Turkish J Pediatr. 200;48(1):19-24.
  • Caksen H, Oner AF, Arslan S, Kan MC, Cesur Y, Uner A. Immunoglobulin subgroups in children with febrile seizures. Pediatr Int. 2001;43(1):58-60.
  • Eeg-Olofsson O, Wigertz A, Link H. Immunoglobulin abnormalities in cerebrospinal fluid and blood in children with febrile seizures. Neuropediatrics. 1982;13(1):39-41.
  • Tuncer O, Karaman S, Caksen H, Oner AF, Odabas D, Yilmaz C et al. Lymphocytes subsets in children with febrile convulsions. Int J Neurosci. 2007;117(7): 919-25.
  • Zubiel M, Wendorff J, Zeman K, Tosik M. Disorders of specific humoral immunological response in children with febrile seizures. Neurol Neurochir Pol. 2004;38(1 Suppl 1):39-44.
  • Lenti C, Masserini C, Barlocco A, Peruzzi C, Morabito A. IgG2 deficiency in children with febrile convulsions: a familial study. Ital J Neurol Sci. 1993;14(7):561-4.
  • Montelli TC, Soares AM, Parise-Fortes MR, Rezkallah-Iwasso MT, Padula NM, Peraçoli MT. Alterations of cell-mediated immune response in children with febrile seizures. Arq Neuropsiquiatr. 1997;55(2):193-8.
  • Ranua J, Luoma K, Auvinen A, Peltola J, Haapala AM, Raitanen J et al. Serum IgA, IgG, and IgM concentrations in patients with epilepsy and matched controls: a cohort-based cross-sectional study. Epilepsy Behav. 2005;6(2):191-5.
  • Isaacs D, Webster AD, Valman HB. Immunoglobulin levels and function in pre-school children with recurrent respiratory infections. Clin Exp Immunol. 1984;58(2):335-40.
  • Liimatainen S, Fallah M, Kharazmi E, Haapala AM, Isojärvi J, PeltolaJ. High concentration of immunoglobulin A is associated with temporal lobe epilepsy. Epilepsy Res. 2013;103(1):54-61.
  • Hafez M1, Nagaty M, el-Shennawy F, el-Ziny M. Immunogenetic aspects of febrile convulsions. J Neurogenet. 1987;4(5):267-74.
  • Callenbach PM, Jol-Van Der Zijde CM, Geerts AT, Arts WF, Van Donselaar CA, Peters AC et al. Dutch Study of Epilepsy in Childhood. Immunoglobulins in children with epilepsy: the Dutch Study of Epilepsy in Childhood. Clin Exp Immunol. 2003;132(1):144-51.
  • Geng J, Dong J, Li Y, Ni H, Jiang K, Shi LL et al. Intravenous immunoglobulins for epilepsy. Cochrane Database Syst Rev. 2017;7(7): CD008557
  • Bostantjopoulou S, Hatzizisi O, Argyropoulou O, Andreadis S, Deligiannis K, Kantaropoulou M et al. Immunological parameters in patients with epilepsy. Funct Neurol. 1994;9(1):11-5.
  • Gilhus NE, Aarli JA. Immunoglobulin concentrations in patients with a history of febrile convulsions prior to the development of epilepsy. Neuropediatrics. 1981;12:314-8.

The Importance of Evaluating Immunoglobulin Levels in the First Febrile Seizure and Predicting the Risk of Having a Febrile Seizure

Year 2022, Volume: 24 Issue: 3, 475 - 481, 31.12.2022
https://doi.org/10.24938/kutfd.1099330

Abstract

Objective: Infections are one of the most common causes of febrile seizure and a history of frequent upper respiratory tract infections is an indicator of low immunoglobulin (Ig) levels in children. We aimed to evaluate Ig values in children with a history of frequent infection who had febrile seizures for the first time to determine the frequency of Ig deficiency diagnosed in the first febrile seizure after their follow-up, and to determine the risk of febrile seizures in those with low Ig levels.
Material and Methods: Between 2010-2018 a total of 320 children who had febrile seizure for the first time were admitted to the emergency department. A total of 174 children were included in the study according to the number of infections they had per year. Ig levels were compared with 189 healthy children. After 24 months, the Ig values were repeated in all children.
Results: Of the 174 children, 53 (30.4%) patients had Ig deficiency (36 children with IgG deficiency and 17 children with IgA deficiency). After two years of follow-up, Ig deficiency requiring follow-up was detected in 16.7% (temporary hypogamaglobulinemia in 5.5% of infants and selective IgA deficiency in 11.2%). Of the children with Ig deficiency followed up after two years, 55.5% had complicated febrile seizure. At the end of the second year, 7.5% of the children had a diagnosis of selective IgA deficiency. The risk of complicated febrile seizure was 1.961 times higher in those with IgA<14.55 mg/dl.
Conclusion: The Ig levels of children who have febrile seizure for the first time should be examined at the time of admission according to the number of infections they have experienced in a year. Although long-term follow-up is required, clinicians should be aware that IgA deficiency may be present especially in the first complicated febrile seizure.

References

  • Paul SP, Seymour M, Flower D, Rogers E. Febrile convulsions in children. Nurs Child Young People. 2015;27(5):14–5.
  • Swaiman KF, Swaiman KF, Ashwal S, Ferriero DM, Schor NF. Swaiman’s pediatric neurology. 5th ed. Vol. 1. Philadelphia: Elsevier Health Sciences; 2012:790-7 p.
  • Leung AK. Febrile seizures. In: Leung AK, ed. Common Problems in Ambulatory Pediatrics: Specific Clinical Problems, Volume 1. New York, NY: Nova Science Publishers, Inc, 2011:199–206.
  • Patterson JL, Carapetian SA, Hageman JR, Kelley KR. Febrile seizures. Pediatr Ann. 2013;42(12):249-54.
  • V. Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281–6.
  • Tu YF, Lin CL, Lin CH, Huang CC, Sung FC, Kao CH. Febrile convulsions increase risk of Tourette syndrome. Seizure. 2014;23(8):651–6.
  • Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia. 2013;54(12):2101–7.
  • Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia. 2018;59(4):739–44.
  • Roth J, Blatteis CM. Mechanisms of fever production and lysis: lessons from experimental LPS fever. Compr Physiol. 2014;4(4):1563-604.
  • Cansu A, Serdaroğlu A, Yüksel D, Doğan V, Ozkan S, Hirfanoğlu T et al. Prevalence of some risk factors in children with epilepsy compared to their controls. Seizure. 2007;16(4):338-44.
  • Sarnat HB, Scantlebury MH. Novel Inflammatory Neuropathology in Immature Brain: (1) Fetal Tuberous Sclerosis, (2) Febrile Seizures, (3) α-B-crystallin, and (4) Role of Astrocytes. Semin Pediatr Neurol. 2017;24(3):152-60.
  • Yu X, Zhang N, Liu S, Xi Z, Zhang Y. Polymorphisms in the interleukin-1β (IL-1B) and interleukin-1α (IL-1A) genes on risk of febrile seizures: a meta-analysis. Neurol Sci. 2018;39(9):1529-36.
  • Kowalczyk D, Mytar B, Zembala M. Cytokine production in transient hypogammaglobulinemia and isolated IgA deficiency. J Allergy Clin Immunol.1997;100(4):556-62.
  • Gupta D, Thakral D, Kumar P, Kabra SK, Lodha R, Kumari R et al. Primary Immunodeficiency Disorders Among North Indian Children. Indian J Pediatr. 2019;86(10):885-91.
  • Ten warning signs of primary immunodeficiencies. http:// www.info4pi.org.
  • Geha RS. Antibody deficiency syndromes and novel immunodeficiencies. Pediatr. Infect Dis J. 1988;7(5Suppl):57-60.
  • Strober W, Sneller MC; IgA deficiency. Ann Allergy. 1991;66(5);363-76.
  • Plebani A, Ugazio AG, Monafo V, Burgio GR; Clinical heterogeneity and reversibly of selective immunoglobulin A deficiency in 80 children. Lancet. 1986;1(8485):829-34.
  • Wood RA, Sampson HA. The child with frequent infections. Curr Probl Pediatr.1989;19(5):229-84.
  • Aksu G, Genel F, Koturoğlu G, Kurugöl Z, Kütükçüler N. Original Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique. Turkish J Pediatr. 200;48(1):19-24.
  • Caksen H, Oner AF, Arslan S, Kan MC, Cesur Y, Uner A. Immunoglobulin subgroups in children with febrile seizures. Pediatr Int. 2001;43(1):58-60.
  • Eeg-Olofsson O, Wigertz A, Link H. Immunoglobulin abnormalities in cerebrospinal fluid and blood in children with febrile seizures. Neuropediatrics. 1982;13(1):39-41.
  • Tuncer O, Karaman S, Caksen H, Oner AF, Odabas D, Yilmaz C et al. Lymphocytes subsets in children with febrile convulsions. Int J Neurosci. 2007;117(7): 919-25.
  • Zubiel M, Wendorff J, Zeman K, Tosik M. Disorders of specific humoral immunological response in children with febrile seizures. Neurol Neurochir Pol. 2004;38(1 Suppl 1):39-44.
  • Lenti C, Masserini C, Barlocco A, Peruzzi C, Morabito A. IgG2 deficiency in children with febrile convulsions: a familial study. Ital J Neurol Sci. 1993;14(7):561-4.
  • Montelli TC, Soares AM, Parise-Fortes MR, Rezkallah-Iwasso MT, Padula NM, Peraçoli MT. Alterations of cell-mediated immune response in children with febrile seizures. Arq Neuropsiquiatr. 1997;55(2):193-8.
  • Ranua J, Luoma K, Auvinen A, Peltola J, Haapala AM, Raitanen J et al. Serum IgA, IgG, and IgM concentrations in patients with epilepsy and matched controls: a cohort-based cross-sectional study. Epilepsy Behav. 2005;6(2):191-5.
  • Isaacs D, Webster AD, Valman HB. Immunoglobulin levels and function in pre-school children with recurrent respiratory infections. Clin Exp Immunol. 1984;58(2):335-40.
  • Liimatainen S, Fallah M, Kharazmi E, Haapala AM, Isojärvi J, PeltolaJ. High concentration of immunoglobulin A is associated with temporal lobe epilepsy. Epilepsy Res. 2013;103(1):54-61.
  • Hafez M1, Nagaty M, el-Shennawy F, el-Ziny M. Immunogenetic aspects of febrile convulsions. J Neurogenet. 1987;4(5):267-74.
  • Callenbach PM, Jol-Van Der Zijde CM, Geerts AT, Arts WF, Van Donselaar CA, Peters AC et al. Dutch Study of Epilepsy in Childhood. Immunoglobulins in children with epilepsy: the Dutch Study of Epilepsy in Childhood. Clin Exp Immunol. 2003;132(1):144-51.
  • Geng J, Dong J, Li Y, Ni H, Jiang K, Shi LL et al. Intravenous immunoglobulins for epilepsy. Cochrane Database Syst Rev. 2017;7(7): CD008557
  • Bostantjopoulou S, Hatzizisi O, Argyropoulou O, Andreadis S, Deligiannis K, Kantaropoulou M et al. Immunological parameters in patients with epilepsy. Funct Neurol. 1994;9(1):11-5.
  • Gilhus NE, Aarli JA. Immunoglobulin concentrations in patients with a history of febrile convulsions prior to the development of epilepsy. Neuropediatrics. 1981;12:314-8.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Özgün Araştırma
Authors

Beril Dilber 0000-0002-7633-0060

Yeşeren Demirhan 0000-0003-0569-2694

Fazıl Orhan 0000-0002-4850-932X

Ali Cansu 0000-0002-1930-6312

Publication Date December 31, 2022
Submission Date April 6, 2022
Published in Issue Year 2022 Volume: 24 Issue: 3

Cite

APA Dilber, B., Demirhan, Y., Orhan, F., Cansu, A. (2022). İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 24(3), 475-481. https://doi.org/10.24938/kutfd.1099330
AMA Dilber B, Demirhan Y, Orhan F, Cansu A. İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ. Kırıkkale Uni Med J. December 2022;24(3):475-481. doi:10.24938/kutfd.1099330
Chicago Dilber, Beril, Yeşeren Demirhan, Fazıl Orhan, and Ali Cansu. “İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24, no. 3 (December 2022): 475-81. https://doi.org/10.24938/kutfd.1099330.
EndNote Dilber B, Demirhan Y, Orhan F, Cansu A (December 1, 2022) İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24 3 475–481.
IEEE B. Dilber, Y. Demirhan, F. Orhan, and A. Cansu, “İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ”, Kırıkkale Uni Med J, vol. 24, no. 3, pp. 475–481, 2022, doi: 10.24938/kutfd.1099330.
ISNAD Dilber, Beril et al. “İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24/3 (December 2022), 475-481. https://doi.org/10.24938/kutfd.1099330.
JAMA Dilber B, Demirhan Y, Orhan F, Cansu A. İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ. Kırıkkale Uni Med J. 2022;24:475–481.
MLA Dilber, Beril et al. “İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 24, no. 3, 2022, pp. 475-81, doi:10.24938/kutfd.1099330.
Vancouver Dilber B, Demirhan Y, Orhan F, Cansu A. İLK FEBRİL NÖBETTE İMMUNGLOBULİN DÜZEYLERİNİN DEĞERLENDİRİLMESİNİN ÖNEMİ VE FEBRİL NÖBET GEÇİRME RİSKİNİNİN ÖNGÖRÜLMESİ. Kırıkkale Uni Med J. 2022;24(3):475-81.

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