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  • Fever in the immunocompromised child is a medical emergency. Prompt evaluation and administration of antibiotics can decrease morbidity and mortality.

  • Patients on chronic corticosteroids may also require stress dose steroids when febrile.

  • Children with B cell immunodeficiencies are at risk for encapsulated pathogens. Children with T cell defects may present with chronic or severe viral infections, Pneumocystis jirovecii pneumonia, and recurrent bacterial infections.

  • Children with phagocyte defects present with recurrent infections caused by pyogenic bacteria.

  • Children with complement deficiencies present with encapsulated and pyogenic pathogens.

  • Acute HIV infection should be suspected in the adolescent with fever, malaise, diffuse lymphadenopathy, pharyngitis, oral ulcers, and a maculopapular rash.

The number of immunocompromised children seen in the emergency department (ED) is increasing due to improved detection of some primary immunodeficiencies (PIs) (Table 60-1) and to increased survival after diagnosis. This chapter focuses on infectious complications in immunocompromised children. See also Section 20 for hematologic and oncologic emergencies.

TABLE 60-1The Most Common Immunodeficiencies and Immunocompromising Conditions in the United States

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