# Immunological dysfunction of children with severe parapneumonic effusion

## TL;DR

This study shows that children with severe parapneumonic effusion may have hidden immune problems, even after vaccination, and highlights the need for immunological screening.

## Contribution

The study identifies immune deficiencies in children with PPE and emphasizes the importance of immunological evaluation despite PCV13 vaccination.

## Key findings

- 12 out of 49 patients had confirmed immune dysfunction, including MBL deficiency and specific antibody deficiency.
- Immunocompromised patients had longer hospital stays compared to non-immunocompromised patients.
- Early diagnosis of immune dysfunction can prevent organ damage and reduce long-term complications.

## Abstract

Despite the worldwide decrease in the incidence of serious pneumococcal infections following the introduction of the 13-valent pneumococcal conjugate vaccines (PCV13), invasive infections still occur. This study aimed to investigate the immunological function of children with severe parapneumonic effusion (PPE) both during their hospitalization and after full recovery.

This was a prospective, single-center study. Children with PPE were admitted to our clinic between 1 January 2011 and 30 June 2023, and participated in the study. Due to the severity of the effusion, all PPE cases required thoracic drainage and some children also underwent fibrinolysis and/or video-assisted thoracoscopic surgery. Demographic and clinical data and laboratory results were collected at admission. Extended immunological testing was performed at the time of clinical admission and again 6–8 weeks after discharge.

A total of 66 episodes of PPE were identified. During hospitalization, one patient was diagnosed with human immunodeficiency virus infection and another with immunoglobulin A deficiency. Extended immunological evaluation was performed during follow-up in 49 patients. Within this cohort, seven patients were diagnosed with mannose-binding lectin deficiency and three with specific antibody deficiency. In total, immune dysfunction was confirmed in 12 patients. When comparing the immunocompromised and non-immunocompromised groups, the duration of hospitalization was longer in the immunocompromised group, with no other differences observed.

Although the incidence of severe PPE has declined since the introduction of PCV13, immunological evaluation remains essential for identifying underlying immunodeficiencies. Despite vaccination, screening patients with PPE for immune dysfunction is crucial. Early diagnosis and timely treatment can help prevent organ damage and reduce long-term morbidity.