Abstract • 75

This study included 45 children, they were classified into 3 groups: 1) Marasmic group which comprised 21 children, 2) Marasmic-kwashiorkor group which comprised 9 children and 3) Control group which comprised 15 children. All the studied cases were subjected to thorough clinical, anthropometric measurements including weight, length and head circumference. The lab tests included serum total protein, albumin, serum iron, complete blood picture, measurement of serum IL-2, and evaluation of the T-lymphocyte subsets using flow cytometry.

Results: The results of the study showed that the anthropometric measurements were significantly lower in both patient group when compared with the control one. The mean levels of serum total protein and albumin were lower in the marasmic-kwashirkor group than those of the marasmic one, the control group were significantly higher than those in the two malnourished groups. Serum iron was significantly lower in malnourished groups than the control one. In marasmic group, the percentage of lymphocytes CD4+, CD8+ and CD4+/CD8+ ratio showed no significant difference compared to the control, while in marasmic-kwo group the percentage of CD4+ was markedly decreased, CD8+ was increased with low CD4+/CD8+ ratio and significant decrease in the percentage of the total lymphocytes compared to both control and marasmic groups. Serum IL-2 was found to be significantly lower in the marasmic-kwo group when compared with the control group.

Conclusion: This study has shown that there is an altered cell mediated immunity in marasmic-kwo group manifested by decreased percent of both total and CD4+ lymphocytes, increased percent of CD8+ and low CD4+/CD8+ ratio as well as low serum IL-2 levels. Also, the study revealed negative correlation between serum total proteins, albumin and cellular immunity in this group of patients. Thus protein energy malnutrition in such cases can be considered as a cause of acquired immune-deficiency states.