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Justiz-Vaillant AA, Hoyte T, Davis N, Deonarinesingh C, De Silva A, Dhanpaul D, Dookhoo C, Doorpat J, Dopson A, Durgapersad J, Palmer C, Asin-Milan O, Williams-Persad AFA, Arozarena-Fundora R. A Systematic Review of the Clinical Diagnosis of Transient Hypogammaglobulinemia of Infancy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1358. [PMID: 37628357 PMCID: PMC10453633 DOI: 10.3390/children10081358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Transient hypogammaglobulinemia of infancy (THI) is a primary immunodeficiency caused by a temporary decline in serum immunoglobulin G (IgG) levels greater than two standard deviations below the mean age-specific reference values in infants between 5 and 24 months of age. Preterm infants are particularly susceptible to THI, as IgG is only transferred across the placenta from mother to infant during the third trimester of pregnancy. This study aimed to conduct a systematic review of the diagnostic criteria for transient hypogammaglobulinemia of infancy. Systematic review: Three electronic databases (PubMed, MEDLINE, and Google Scholar) were manually searched from September 2021 to April 2022. Abstracts were screened to assess their fit to the inclusion criteria. Data were extracted from the selected studies using an adapted extraction tool (Cochrane). The studies were then assessed for bias using an assessment tool adapted from Cochrane. Of the 215 identified articles, 16 were eligible for examining the diagnostic criteria of THI. These studies were also assessed for bias in the six domains. A total of five studies (31%) had a low risk of bias, while four studies (25%) had a high risk of bias, and bias in the case of seven studies (44%) was unclear. We conclude that THI is only definitively diagnosed after abnormal IgG levels normalise. Hence, THI is not a benign condition, and monitoring for subsequent recurrent infections must be conducted. The diagnostic criteria should also include vaccine and isohaemagglutinin responses to differentiate THI from other immunological disorders in infants.
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Affiliation(s)
- Angel A. Justiz-Vaillant
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Trudee Hoyte
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Nikao Davis
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Candice Deonarinesingh
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Amir De Silva
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Dylan Dhanpaul
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Chloe Dookhoo
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Justin Doorpat
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Alexei Dopson
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Joash Durgapersad
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Clovis Palmer
- Tulane National Primate Research Centre, Tulane University, Covington, LA 70433, USA;
| | | | - Arlene Faye-Ann Williams-Persad
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
| | - Rodolfo Arozarena-Fundora
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine 685509, Trinidad and Tobago; (T.H.); (N.D.); (C.D.); (A.D.S.); (D.D.); (C.D.); (J.D.); (A.D.); (J.D.); (A.F.-A.W.-P.); (R.A.-F.)
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Neurological Involvement in Childhood Evans Syndrome. J Clin Immunol 2019; 39:171-181. [PMID: 30671780 DOI: 10.1007/s10875-019-0594-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) are associated in the definition of Evans syndrome (ES). The occurrence of neurological involvement in this population is poorly described and suggests an underlying primary immunodeficiency (PID). We aimed to describe the clinical manifestations, evolution, and PID profiles of these patients. METHODS OBS'CEREVANCE is a French, nationwide prospective cohort that includes children with chronic ITP, AIHA, and ES. Patients with a neurological involvement were described. Centralized radiological and pathological reviews and genetic analyses were performed. RESULTS On October 2016, eight patients (7/181 ES, 1/371 AIHA, and 0/615 ITP) were identified, all male, with a median age (range) at cytopenia onset of 11.5 years (1.6-15.8). Neurological symptoms appeared with a median delay of 6 years (2.5-18) after cytopenia and were polymorphic: seizures (n = 4), cranial nerve palsy (n = 2), Brown-Sequard syndrome (n = 2), intracranial pressure (n = 2), vertigo (n = 1), and/or sensory neuropathy (n = 1). Magnetic resonance imaging (MRI) showed inflammatory lesions, confirmed by pathology for five patients with macrophagic or lymphoplasmocytic infiltrates. All patients had other relevant immunopathological manifestations: pulmonary nodules (n = 6), lymphoproliferation (n = 4), abnormal immunophenotype (n = 8), and hypogammaglobulinemia (n = 7). Treatment consisted of steroids that improved symptomatology and MRI. Five patients relapsed and three had an asymptomatic radiological progression. A PID was identified in 3/8 patients: 22q11.2 microdeletion (n = 1) and CTLA deficiency (n = 2). CONCLUSION Neurological involvement is a rare and severe late event in the course of childhood ES, which can reveal an underlying PID. Imaging and pathology examination highlight a causative immune dysregulation that may guide targeted therapeutic strategies.
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Evans C, Bateman E, Steven R, Ponsford M, Cullinane A, Shenton C, Duthie G, Conlon C, Jolles S, Huissoon AP, Longhurst HJ, Rahman T, Scott C, Wallis G, Harding S, Parker AR, Ferry BL. Measurement of Typhi Vi antibodies can be used to assess adaptive immunity in patients with immunodeficiency. Clin Exp Immunol 2018; 192:292-301. [PMID: 29377063 PMCID: PMC5980364 DOI: 10.1111/cei.13105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 02/06/2023] Open
Abstract
Vaccine‐specific antibody responses are essential in the diagnosis of antibody deficiencies. Responses to Pneumovax II are used to assess the response to polysaccharide antigens, but interpretation may be complicated. Typhim Vi®, a polysaccharide vaccine for Salmonella typhoid fever, may be an additional option for assessing humoral responses in patients suspected of having an immunodeficiency. Here we report a UK multi‐centre study describing the analytical and clinical performance of a Typhi Vi immunoglobulin (Ig)G enzyme‐linked immunosorbent assay (ELISA) calibrated to an affinity‐purified Typhi Vi IgG preparation. Intra‐ and interassay imprecision was low and the assay was linear, between 7·4 and 574 U/ml (slope = 0·99–1·00; R2 > 0·99); 71% of blood donors had undetectable Typhi Vi IgG antibody concentrations. Of those with antibody concentrations > 7·4 U/ml, the concentration range was 7·7–167 U/ml. In antibody‐deficient patients receiving antibody replacement therapy the median Typhi Vi IgG antibody concentrations were < 25 U/ml. In vaccinated normal healthy volunteers, the median concentration post‐vaccination was 107 U/ml (range 31–542 U/ml). Eight of eight patients (100%) had post‐vaccination concentration increases of at least threefold and six of eight (75%) of at least 10‐fold. In an antibody‐deficient population (n = 23), only 30% had post‐vaccination concentration increases of at least threefold and 10% of at least 10‐fold. The antibody responses to Pneumovax II and Typhim Vi® correlated. We conclude that IgG responses to Typhim Vi® vaccination can be measured using the VaccZyme Salmonella typhi Vi IgG ELISA, and that measurement of these antibodies maybe a useful additional test to accompany Pneumovax II responses for the assessment of antibody deficiencies.
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Affiliation(s)
- C Evans
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - E Bateman
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - R Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - M Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - A Cullinane
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - C Shenton
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - G Duthie
- Infectious Disease Department, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - C Conlon
- Infectious Disease Department, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - A P Huissoon
- West Midlands Primary Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, UK
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - T Rahman
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - C Scott
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - G Wallis
- Binding Site Group Limited, Birmingham, UK
| | - S Harding
- Binding Site Group Limited, Birmingham, UK
| | - A R Parker
- Binding Site Group Limited, Birmingham, UK
| | - B L Ferry
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
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de Melo KM, de Moraes-Pinto MI, Andrade LEC, Salomão R, Brunialti MKC, Ferreira VS, Costa-Carvalho BT. Hypogammaglobulinemia in children: a warning sign to look deeply? APMIS 2017; 125:902-909. [PMID: 28929596 DOI: 10.1111/apm.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/29/2017] [Indexed: 01/14/2023]
Abstract
This study investigated phenotypic and functional characteristics of lymphocytes in children with common variable immunodeficiency (CVID) and unclassified hypogammaglobulinemia (UH), as well as B-cell subsets in non-consanguineous parents. Blood samples of 30 children, CVID (n = 9), UH (n = 9), healthy donors HD (n = 12), and 19 adults (parents and controls) were labeled by a combination of surface markers to identify CD4, CD8 T-cell and B-cell subpopulations. T-cell cytokine production in children was analyzed in vitro after stimulation with phytohemagglutinin (PHA) and tetanus toxoid. We observed low percentages of switched memory B cells in children with CVID, increase in total CD4+ T-cell counts, and high percentages of transitional B cells only in UH group. Analysis of T-cell immunity showed that CVID children had decreased percentages of CD8+ IFN-γ-producing cells after stimulation with PHA and tetanus toxoid. Parent of children with CVID had low percentages of naive B cell and increased percentages of memory B cells in comparison with controls. These results suggest that (i) early combined immune defect in children with CVID and (ii) a possible familial B-cell disturbance in pediatric CVID.
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Affiliation(s)
- Karina Mescouto de Melo
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Maria Isabel de Moraes-Pinto
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Luís E C Andrade
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Reinaldo Salomão
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Milena K C Brunialti
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Vanessa S Ferreira
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Beatriz T Costa-Carvalho
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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Chinen J, Notarangelo LD, Shearer WT. Advances in clinical immunology in 2015. J Allergy Clin Immunol 2016; 138:1531-1540. [PMID: 27931534 PMCID: PMC5157931 DOI: 10.1016/j.jaci.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/02/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022]
Abstract
Advances in clinical immunology in the past year included the report of practice parameters for the diagnosis and management of primary immunodeficiencies to guide the clinician in the approach to these relatively uncommon disorders. We have learned of new gene defects causing immunodeficiency and of new phenotypes expanding the spectrum of conditions caused by genetic mutations such as a specific regulator of telomere elongation (RTEL1) mutation causing isolated natural killer cell deficiency and mutations in ras-associated RAB (RAB27) resulting in immunodeficiency without albinism. Advances in diagnosis included the increasing use of whole-exome sequencing to identify gene defects and the measurement of serum free light chains to identify secondary hypogammaglobulinemias. For several primary immunodeficiencies, improved outcomes have been reported after definitive therapy with hematopoietic stem cell transplantation and gene therapy.
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Affiliation(s)
- Javier Chinen
- Immunology, Allergy and Rheumatology Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
| | - Luigi D Notarangelo
- Division of Immunology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - William T Shearer
- Immunology, Allergy and Rheumatology Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
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