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

Öz

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.

Anahtar Kelimeler

• Febrile seizure
• Transient hypogammaglobulinemia of infancy
• immunoglobulin A deÿciency
• complex febrile seizure

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

Öz

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.

Anahtar Kelimeler

• Febril nöbet
• Süt çocuğu geçici hipogamaglobulinemisi
• İmmünglobulin A eksikliği
• Komplike febril nöbet

Kaynakça

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