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Low Lymphocytes in 5 year old

Hi there. In June my 5 year old had a pea sized lump behind her ear but at the time she was having seizures due to a new Epilepsy diagnosis so it was brushed under the carpet and the lump eventually disappeared. In September My 5 year old had a blood test in hospital in September where her Lymphocytes were quite low 0.65 - they said likely to be caused by a virus.  Yesterday we have just had a abdominal ultra sound and it revealed right iliac foss lymph nodes - most likely caused by Mesenteric Adenitis - in otherwords a virus/infection. The doctors are all pointing towards virus related issues (she gets a virus every 4-6 weeks without fail) or lactose intolerance - just doesnt sit right with me......thoughts? Thank you.
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1081992 tn?1389903637
COMMUNITY LEADER
https://labtestsonline.org/conditions/lactose-intolerance#

"Lactose tolerance tests, including:

    Hydrogen breath test – currently, this is the most reliable test used to diagnose lactose intolerance. Breath samples are taken before and at timed intervals after a patient drinks a fluid containing a standard amount of lactose. With lactose intolerance, undigested lactose is broken down by bacteria in the large intestine, producing excess hydrogen gas. The hydrogen moves to the circulation and is eventually exhaled by the lungs. Increasing levels of hydrogen in the breath samples over time strongly indicates lactose intolerance."

[Though if it's positive, that doesn't necessarily mean something. But if it's negative, that should eliminate lactose intolerance being present.]

----------------------------------

Is it possible that she was getting reinfected with the Dientamoeba, maybe at a daycare or by a pet or some other animal(s)?
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1081992 tn?1389903637
COMMUNITY LEADER
Hi, Nells. If there is no family history of immune system problems then my guess is that the focus should go squarely on the amoeba.

In this study, almost half of infected patients have symptoms:
https://www.ncbi.nlm.nih.gov/pubmed/30328410
"Clinical and Epidemiological Characteristics of Patients with Dientamoeba fragilis Infection."

There seems to be a long history of medical papers saying something like "we need to wake up to the harm caused by this parasite".

You might also now that there are often coinfections (bacteria or other parasites) that can cause problems, too. Dientamoeba Fragilis can even cause lactose intolerance by interfering with lactose absorption. However, from the symptoms, I'd guess that the problem is more likely to be sensitivity to dairy proteins -- because of 'leaky gut' from the amoeba, which is very different. But you've said that she was dairy free for a while anyway, so maybe dairy is not a factor.


Why haven't they done the breath test for lactose intolerance?
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Not sure. We were told to cut out dairy for a few weeks and see how she goes. We have been off dairy for over 2 weeks now and I accidentally gave her some last weekend but she had no bad effects from it. I haven't heard of a breath test before - I will look into that. I think this dreaded parasite causes more troubles then the docs think. I have had one doctor tell me this parasite is the cause of all of these problems and then several others tell me its irrelevant but the more I discuss it with people the more I am hearing it causes issues. The problem is - how to get rid of it?! We spent over $500 last year on medicines to try and get rid of it but no luck. Stubborn little bugger !!
1081992 tn?1389903637
COMMUNITY LEADER
"About 730pm last night while watching TV the pain started again and this time it was sharp in the centre of my chest and was quite uncomfortable. It feels like each time I feel this pain it's getting sharper every time."
Try, if possible, to determine if that pain can be in your esophagus. Or alternatively, if it hurts more when inhaling forcibly.



"gallbladder"
That might be from immune driven 'acalculous cholecystitis' which might not have been picked up on ultrasound, if in early stage. Or was a CT with contrast done for that?

"Although it is unusual for acalculous cholecystitis to occur in patients with a normal gallbladder, on US and cholescintigraphy examinations, the gallbladder may be found to be normal early in the course of the disease."
https://emedicine.medscape.com/article/365553-overview
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Hi again Ken - sorry for the delay in responding. Hectic time of the year.
With my 'issues' mine all came down to some meds that I was on - the side effects were quite substantial. I am otherwise it good shape.
Back to my little one - she was treated a year ago for Dientamoeba Fragilis Infection with Nitazoxanide and Secnidazole with no luck - the little bugger was still there Jan this year.
When she had trouble walking - she would suddenly fall to the floor and refused to walk. Looking back I think her energy levels just decreased as she was very weak and tired. This year she suddenly had right sided weakness that caused her to drag her leg and not be able to put her foot flat on the floor - this happened at the same time her epilepsy was diagnosed.
We just had a  ultrasound on her belly which showed 'multiple para umbilical and right iliac fossa lymph nodes' measuring up to 7mm in short axis - doc said possible lactose intolerant. I don't think so but we are trialing a lactose free diet at the moment.......
1081992 tn?1389903637
COMMUNITY LEADER
Throughout this, Nells, we have to keep in mind that it's difficult to separate symptoms due to a pathogen, from symptoms due to only the immune chemicals (like the flu, in which it's all from immune chemicals). Immune reactions certainly produce tiredness. Again, that's why the CBC is important now, unfortunately. Also, which particular white cells go high is important. Or, if you have any from the past during episodes, that might suffice.


Which antibiotic(s) has she had and since what age?


What did you mean that she had trouble walking?
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1081992 tn?1389903637
COMMUNITY LEADER
Well, by having the same thing I mean that you share genetics which might lead to a predisposition to having unusual immune systems. You also can be subject to the same environmental factors, such as the parasite. You also can be exposed to the same triggers such as food or pets or pollens & molds, and on and on. Meanwhile, your husband doesn't have that genetic susceptibility nor the symptoms - so we can probably rule out any strong chemical toxin (such as mercury) or a pathogen (like the amoeba) that could be responsible all by itself.

But all that won't necessarily mean that you and your daughter have all the same symptoms. That diversity is true in people with CFS, or with eosinophilic or mast cell disorders, even in lupus and other auto immune conditions.

By going back and forth, maybe we can narrow this down somewhat. At least a goal can be to reduce her symptoms.



I'd mentioned CFS mainly in regard to you and your other posts which I'd glanced at. It's a common list for CFS: female, exerciser, British. Even the apnea is associated. (Have you tried sleeping only on your side?)  Did you start out with a bad cold? Extreme stress?
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1081992 tn?1389903637
COMMUNITY LEADER
Has she ever had an EEG that showed seizures? Or was she just diagnosed by symptoms?
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Hi again Ken. yes she has had two EEG's now and both indicated abnormal brain activity which showed absent seizures and now activity in her front temporal lobe. We are actually in Australia however I was born in the UK but my girl was born here.The parasite is called Dientamoeba which is associated with abdominal pain, nausea, vomiting but a lot of doctors think this parasite is 'irrelevant' and don't even take it into account. Our last doctor believed it was the cause of everything and put my daughter on some harsh antibiotics that cost us a fortune but it didnt get rid of the parasite.  It is very common where we live as it is in swimming pools and in rain water tanks. I know a lot of friends that have it and their kids - some react to it others don't have any symptoms. I have not been tested for it - I don't get any abdominal discomfort. Yes I have heard of CFS - never crossed my mind with my girl though, something to consider.....thank you once agian.
1081992 tn?1389903637
COMMUNITY LEADER
Well, there are lots of things to say. Most overriding is that both you and your daughter probably have the same thing. This very much looks immune related. That also fits with  resulting tiredness and any so-called "brain fog".

The principle of Occam's Razor comes into play: look first for a common cause for everything.

It's important to get a CBC done now in order to try and distinguish between an infection and an immune-only condition.

Are you British? You must have heard of CFS/ME, which is one example of a mystery immune condition.

You're almost certainly correct that it's your lungs, not your heart. Probably leukotrienes. Possibly the esophagus is also involved.


Was a parasite positively identified in your little daughter? What is the name of it?


Consider this carefully:
"Preventing misdiagnosis of epilepsy"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065943/
"Hindley et al found that epilepsy was the diagnosis in only 23% of the children [originally thought to have epilepsy]."
and
"Uldall et al found that 39% of those referred to the Danish Epilepsy Centre did not have epilepsy."

Also, "Oct 19, 2006 ... Each year more than 90 000 people in England and Wales are wrongly given a diagnosis of epilepsy, a new study has estimated." in "Epilepsy is misdiagnosed in 90 000 people a year in England and Wales"  https://www.bmj.com/content/333/7573/824.2



"she was allergic to something and to 'go figure it out'"
Unfortunately that is how it can be, and is more difficult if the problem is a component in foods, such as salicylates or oxalates.


There is also "leaky gut" which can make a person seem to be sensitive to almost any food.

------------

That's for starters, Nells. It's not going to be easy. Step one, I think, would be to try to determine if there is some common environmental "trigger" for both you and your daughter that sets off immune activation. (Sorry to be curt in all this, but there is so much to try to get in.)

Have you been tested for the same parasite?




Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Hi, I don't see any reason to think it's lymphoma. That's especially so since the first node (behind the ear) went down all by itself. Lymphoma wouldn't behave that way.

One big thing to keep in mind whenever you research this is that children's immune systems are different than an adults -- specifically being more likely to enlarge more frequently, and sometimes also even getting bigger than seems normal (though pea sized was not very big). You'd think of mesenteric adenitis from cancer being more in older adults.

So what we have would be infection or else inflammation without an infection. Having her symptoms from a virus is not unusual in children. There's probably no reason to worry unless 3 weeks or so go by and the pain/tenderness is still there. (I'm assuming that pain/tenderness is present currently, and that's what caused the ultrasound to be done.)

However, this stands out: "she gets a virus every 4-6 weeks without fail" . There are such things as periodic syndromes, which generally show up in childhood years. Most involve some immune system dysfunction: inflammation without infection. Some are called cyclic instead of periodic. Maybe that's what your intuition is picking up on.

It's a good idea to start keeping a log about when a seeming virus shows up and how long it lasts. That might give a clue as to zeroing in on which specific syndrome might be responsible - if indeed it's not really just from an ordinary virus.

The ultrasound would likely have ruled out appendicitis. You'll want to be wary in future of any epilepsy meds causing adenitis  - especially if she happens to have an over reactive immune system... and having close relatives with odd immune conditions can be a tipoff to that.

Lactose intolerance seems unlikely to be cyclic, unless that's a known thing in children that I'm not aware of. However, a food *sensitivity* to dairy might be sporadic.

Are her current CBC tests showing as normal?
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1 Comments
Hi Ken - Thanks for your feedback. Really appreciate it. I have the blood test paperwork just have to try and convince her to get it done - she is terrified of needles. She also currently has a cold so I am going to wait until next week to have it done when the cold has cleared so we can get a good comparison with the last lot of blood work done in September. My daughter has had stomach pain for a long time now,  it started in 2016 and I went to a GP who told me she was allergic to something and to 'go figure it out' . At that stage her blood work showed she was anemic. Fast forward a year down the track after trying various diets Gluten free, dairy free etc we were still getting tiredness, paleness, dark rings under eyes so tried  a new GP who put her systems down to a gut parasite. We tested her a year later and the bugger was still there but a pediatrician we met said that this particular parasite is 'irrelevant' . Mid last year my girl had troubles walking but the same pediatrician said it was nothing, she is pale because she has fair skin and she is tired because she is a kindy kid. This year she started school and her teacher rang me to say he doesnt think she is her usual self, falling asleep on the classroom floor and dazed and confused a lot. This then lead to seizure activity and the Epilepsy diagnosis and then of course on to my original post with the swollen node behind her ear, the blood work and the ultrasound results......my girl comes home from school sleeps straight away, if she runs around for a bit she pays for it straight after and has to lie down and sleep. It's so hard to work out what is the Epilepsy and could be some other disorder........
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