Emergency Department Management of the Immunosuppressed Host

Children with immunosuppression are a high-risk but relatively infrequent presentation to the emergency department. Clinicians need to systematically and efficiently assess these children, especially when they present with fever or potential infectious complaints. Although most are not imminently septic, as the risk of bacteremia leading to sepsis is high, a standardized approach is important to be timely to cover serious pathogens. This case-based review will discuss underlying immune deficiencies in children one might see in the emergency department setting, review the approach to evaluation and acute management, and discuss key issues to minimize morbidity or mortality.