CASE 3
John, a 12-month-old boy with severe gram-positive bacterial pneumonia, has been referred to the local pediatric hospital by the family’s general practitioner. In addition to the fact that this is his fourth such infection in 6 months, he has had recurrent diarrhea (Giardia lamblia) and his tonsils/adenoids are barely detectable. As well, John is below the norm for height and weight. He has received the recommended DTaP (diphtheria, tetanus toxoids, and acellular pertussis) pediatric immunizations (see Fig. 45-1). John has three healthy sisters aged 3, 5, and 7 years. The family lost a boy at 10 months of age to bacterial pneumonia 8 years ago. Blood test results show low total serum immunoglobulin levels, few B cells, but normal numbers and functioning of T cells. All tests for macrophage/neutrophil function and number are normal. Medical and family histories, as well as blood test results, were included in the file that the family physician sent to the hospital. How would you proceed?
