Persistent Oral Thrush

Case Summary2 yrs old male child1st by birth orderBorn of nonconsanguinous marriage referred by G.T hospital with h/o postvaccination paralytic polio at 8 mths of age recurrent pneumonias since 15 mths of ageBlood cultures isolated staph aureus and klebsiella in two different episodes of pneumonia Immunised with OPV 8 times alongwith other routine vaccinesFamily History- Unremarkable

Impression Recurrent pneumonias with past h/o vaccine derived paralytic polioQuestions???Why did the patient develop VDPP?Were the recurrent pneumonias secondary to muscle weakness ?Is there some underlying problem??

Post vaccination diseases and Immunodeficiencies Post vaccination paralytic polio : predominant B cell defects

Post vaccination disseminated BCG or varicella: predominant T cell defect msmd

Suspect ImmunodeficiencyPost vaccination paralytic polio seen in : Predominant B cell defects

Immunological EvaluationCBCLymphocyte SubsetImmunoglobulin levelsBtk evaluationInvestigationsInvestigation Jan 2015Hb10.9Total WBC Count13390ANC4485ALC7097AEC375AMC1339Platelets5260002. Lymphocyte SubsetSr. NoLymphocyte SubpopulationResult % LymphocyteAbsolute Lymphocyte Count/mm3NormalCount/mm3Lymphocytes70972300-5400CD19+ B Lymphocytes00390-1400CD3+ T Lymphocytes8862451400-3700CD3+/ CD4+ T Lymphocytes422981700-2200CD3+/ CD8+ T Lymphocytes

412910490-1300CD3-/ CD16+56+ NK Cells

10710130-720Absolute lympocyte count can be normal even if B-Cell defect is present, as 70% of peripheral lymhocytes are CD3+ T- CellsImmunoglobulin levelsSr. No.TestValueNormal Levels1.Ig G < 0.0671 g/L3.50-16.202.Ig A