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All Journal The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Indonesian Journal of Cardiology Narra J Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Aryono Hendarto
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia RS Dr. Cipto Mangunkusumo Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Identifying primary immunodeficiency through the evaluation of severe, persistent, unusual, and recurrent infections in Indonesian children Muktiarti, Dina; Hendarto, Aryono; Munasir, Zakiudin; Wulandari, Dewi; Satari, Hindra Irawan; Werdhani, Retno Asti; Kumara Wati, Ketut Dewi
Paediatrica Indonesiana Vol. 66 No. 2 (2026): March 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Primary immunodeficiency (PID) is widely underdiagnosed in countries with high rates of infection and limited diagnostic facilities, such as Indonesia. It remains challenging to distinguish PID from other conditions predisposing children to severe, persistent, unusual, and recurrent (SPUR) infection. Such conditions include secondary immunodeficiency caused by human immunodeficiency virus (HIV) infection, allergic diseases, and chronic diseases with structural or anatomical abnormalities. Objective To evaluate children with SPUR infections for PID and to compare the clinical characteristics of children with PID to those with other underlying conditions. Methods We conducted a cross-sectional, analytic study of children aged 0-18 years presenting with SPUR infections at 10 hospitals in Jakarta, Indonesia, from July 2024 to September 2025. Clinical assessment and laboratory investigations, including immunological tests, were performed to identify the underlying cause of SPUR infections. Children were classified as healthy, PID, secondary immunodeficiency (HIV), allergy, or chronic disease/anatomical abnormalities. Results Two hundred fifty-four subjects (53% male) with a median age of 26 months were included in our study. Most of them had a history of pneumonia (72.1%), diarrhea (31.1%), and pulmonary tuberculosis (27.9%). Thirty-three (13%) subjects were diagnosed with PID, with the majority being male (60.6%). The most common PID found was antibody deficiency (27.3%), followed by immunodeficiencies combined with associated or syndromic features (24.2%), and immunodeficiencies affecting cellular and humoral immunity (21.2%). Median age of onset in the PID group was 12 (3–24) months. Severe malnutrition was most common in children with HIV. Gender, parental consanguinity, and adverse events following live vaccines did not differ significantly across groups. Conclusion The prevalence of PID among children with SPUR infection in this study was 13%, with the most common classification being antibody deficiency.
Co-Authors Abdul Latief Alan R Tumbelaka Ali Khomaini Alhadar Ali Khomaini Alhadar Aman B Pulungan Anggia Widyasari Anjar Setiani Annang Giri Moelyo Antonius H. Pudjiadi Ardi Findyartini, Ardi Aria Kekalih Arwin A. P. Akib Atut Vebriasa Bambang Tridjaja AAP, Bambang Tridjaja Cut Nurul Hafifah Dadi Suyoko Dahlan Ali Musa Dalima Ari Wahono Astrawinata Damayanti Rusli Sjarif Darmawan B Setyanto Dewi Wulandari Dilawar, Ismail Dina Muktiarti, Dina Djajadiman Gatot Endang Windiastuti Fathy Pohan Frieda Handayani Kawanto Hartono Gunardi Henny Adriani Puspitasari Heri Wibowo Herlina Dimiati Hindra Irawan Satari I Dewa Gede Ariputra Irawan Mangunatmadja Irma Annisa Jeanne Vidianty Kemas Firman Ketut Dewi Kumara Wati Lisnawati Rachmadi Ludi Dhyani Rahmartani Luh Karunia Wahyuni, Luh Karunia Marsubrin, Putri Maharani Tristanita Merry Angeline Halim Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murni, Indah K. Muzal Kadim Najib Advani Najib Advani Ni Ketut Prami Rukmini Nia Kurniati Nina Dwi Putri Novie Amelia Chozie Partini P Trihono Piprim B. Yanuarso, Piprim B. Pramita Gayatri Primo Parmato Reni Fahriani Retno Asti Werdhani Rhyno Febriyanto Riki Alkamdani Rinawati Rohsiswatmo Risma K. Kaban RR Putri Zatalini Sabila Rubiana Sukardi, Rubiana Rumaisha Hasnah Ibrahim Santoso, Dara Ninggar Saptawati Bardosono Soedjatmiko Sondang Sidabutar Sri S Nasar Sri Sudaryati Nasar Stanislaus Djokomuljanto Stephen Diah Iskandar Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudung O. Pardede Sukman Tulus Putra Sukman Tulus Putra Supriatna, Novianti Susanti, Dhama S. Tania Paramita Teny Tjitra Sari, Teny Tjitra Tety Nidiawati Velanie Frida Batubara Yessi Yuniarti Yogi Prawira Zakiudin Munasir