688 CELL MEDIATED IMMUNE DEFECTS IN MALNOURISHED HOSPITALIZED U.S. CHILDREN

Abstract

Severe protein calorie malnutrition is characterized by profound depression of cell mediated immunity. We studied 28 hospitalized U.S. children with various degrees of malnutrition to determine if similar defects existed. Ages ranged from 6 wks to 20 yrs. All had weights less than the fifth percentile for age. Chief diagnoses were chronic diarrhea(7), gastroesophageal reflux (4), Crohn's disease(4), and anorexia nervosa(3). Thirteen/28 eventually required hyperalimentation. 10/28 (36%) had marked depression (<50%) of T lymphocytes(E-Rosette Forming Cells - E-RFC). 5/10 had depressed PHA transformation (Index <40). 8/10 were <2 years. 3 pts had albumin <3gm/dl, 5 had hgb <10gm%. One 2 month old boy had decreased lymphoid tissue, decreased granulocytes and severe infection. 5/28 (18%) had mild decrease of E-RFC(50-60%). PHA index was low in 3 of these pts. 2 had hgb <10gm%, and 1 had alb <3gm/dl. No severe infections were seen. 13/18 (46%) had initially normal E-RFCs. All these had normal albumins; 3 had low hgb. E-RFC decreased to <50% in 3 pts, including one who had candida sepsis. We conclude that depressed T cell function occurs in malnourished U.S. children, may precede clinical infection, and is associated with young age, chronic diarrhea, and wts less than the fifth percentile. Hyperalimentation may be of value in correcting this defect.