DS is also the most frequent genetic cause of mental retardation and is associated with a high incidence of congenital cardiac and gastrointestinal tract anomalies [3]. Autoimmune phenomena, including hypothyroidism [3] and coeliac disease [4,5], and haematological abnormalities such as acute lymphoblastic leukaemia and transient myeloproliferative disease, occur at much higher frequency compared to non-DS individuals [6]. Infections of the respiratory tract, particularly otitis media, have been identified as one of the most significant health problems in DS children of school age by their parents, with a higher frequency than in the general

population MAPK Inhibitor Library manufacturer [7,8]. This increased susceptibility to infections have been selleck chemicals llc linked to abnormal parameters of the immune system for more than 30 years [9,10], and DS is the most common recognizable genetic syndrome associated with immune defects [11]. Although multiple differences between the immune system of DS children and that of the general population have been described, the clinical relevance of these differences is less clear. Various medical and anatomical co-morbidities commonly associated with DS increase the susceptibility to infections and might also affect the immune responses. We reviewed the infectious disease burden in DS children and the mechanisms of innate and adaptive immunity defective in this condition (Fig. 1).

It is widely accepted that DS children suffer from more frequent infections than normal children, and most studies agree that these are affecting mainly the respiratory tract. Selikowicz [8] used a parent questionnaire and reported that the prevalence

of significant lower respiratory illnesses among DS children was 8%. Hilton et al. [12] comprehensively reviewed 232 hospital admissions among DS children over a 6·5-year period, and found that lower respiratory tract pathology was the most common cause for acute hospital admission. This was in contrast to non-DS children, who were most commonly admitted for asthma, chemotherapy administration, fractures, gastroenteritis, bronchiolitis and adeno-tonsillectomy. Based on age groups, the highest percentage of admissions in this study were among 1–5-year-old children (45%), followed by those less than 1 year of age (27%). Both Mirabegron those aged 5–10 years and 10–17 years had the same rate of hospital admissions (each group 14%). Fifty-four per cent of all hospital admissions were for respiratory tract pathology, including infections such as pneumonia (18%), bronchiolitis (7%) and croup (6·5%). The predominant diagnosis of admission to the intensive care unit (ICU) was pneumonia. Interestingly, the co-morbid diagnoses of congenital heart disease and asthma did not influence admission rates to the hospital. Other studies have shown that DS itself is an independent risk factor for the development of bronchiolitis due to respiratory syncitial virus (RSV) infection. Bloemers et al.