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962 NUTRITION-INFECTION INTERACTIONS IN THE COMPROMISED HOST

Malnutrition and infection are two of the major factors affecting morbidity and mortality in children throughout the world. To evaluate the interrelation between these two conditions, we assessed the immune status of 17 children with clinical and laboratory evidence of major bacterial, viral or parasitic infections and varying manifestations of malnutrition. Using standard anthropometric measurements (Bull. WHO 46:547, 1972), the average height for age was below the 50th percentile, and the weight for height below the 25th percentile. Quantitative immunoglobulins, diptheria and tetanus antibody titers, and C3 levels were normal to elevated in most cases. NBT dye reduction was at least 90% of controls. In contrast, PMN chemotaxis was markedly depressed in 11 of 17 patients when compared to controls. Skin tests for delayed hypersensitivity (DH) were positive to PPD-S (1), SKSD (6), and C. albicans (1). Thus, both PMN chemotactic responsiveness and DH skin tests were depressed in these children, indicating that malnutrition has a much greater effect on the cellular portion of the inflammatory mechanism. Our findings are in contrast to previous studies in which normal children with active infection have been shown to have markedly enhanced PMN chemotaxis and metabolism (JCI 53:996, 1974; JID 141:14, 1980). This suggests that the host's nutritional status plays a more important role in modulating the cellular portion of the acute inflammatory response than the mere presence of infection.