8
Diagnosis
Table 2B. Recommendations for the Care of Infants With
SCID Diagnosis
a
Recommendation Frequency Comment
Test cytomegalovirus
(CMV) polymerase chain
reaction (PCR) in urine
and in blood
Baseline and
every 3 to 4 mo
If present, treat CMV infection
(valganciclovir, 16 mg/kg/dose, orally
twice a day or ganciclovir, 6 mg/
kg/dose, intravenously twice a day).
Alternatives are cidofovir and foscarnet.
Test serum anti-CMV
IgG in patient's mother
Baseline If suspected or confirmed maternal
CMV infection, avoid breastfeeding.
Test EBV PCR in blood Baseline and
every 3 to 4 mo
If present, treat EBV infection
(valganciclovir or ganciclovir, dose
similar to CMV).
Test HIV PCR or antigen
tests in blood
Baseline Treat HIV infection
Test PCR-based
respiratory viral pathogen
panel (e.g., influenza A
and B, parainfluenza
1, 2, and 3, adenovirus,
rhinovirus, human
metapneumovirus).
When there is
an increase of
nasal secretions
or respiratory
symptoms such as
cough or shortness
of breath
Treat respiratory viral infection:
oxygen support, beta-agonists, antiviral
drugs (e.g., oseltamivir) if indicated
Environment with
reduced exposure to
infections
At all times Inpatient (with reverse isolation) or
outpatient (close distance to a medical
center)
Prophylaxis for
Pneumocystis jirovecii
pneumonia (PJP)
Starting at 1 mo
of age
Trimethoprim/sulfamethoxazole
(TMP/SMX)
5 mg (of trimethoprim component)/
kg/d oral 2 or 3 times a week
Prophylaxis for candidiasis Daily Fluconazole 3 mg/kg/d oral
Prophylaxis for herpes
infection
Daily Acyclovir 12.5 mg/kg/d oral
Prophylaxis for
respiratory syncytial virus
(RSV) infection
During RSV
season
Palivizumab or nirsevimab-alip
Immunoglobulin
replacement therapy
Monthly or
weekly
Intravenous or subcutaneous routes
(400 mg/kg/mo)
Avoid live viral vaccines Includes: rotavirus, measles, mumps,
rubella (MMR), bacillus Calmette-
Guerin (BCG), oral polio. Household
members are encouraged to receive all
scheduled vaccines.
a
From Dorsey et al. Not an exhaustive list, alternative recommendations exist.
