1
|
Smith KL, Dai D, Modi BP, Sara R, Garabedian E, Marsh RA, Puck J, Secord E, Sullivan KE, Turvey SE, Biggs CM. Inborn Errors of Immunity Associated With Type 2 Inflammation in the USIDNET Registry. Front Immunol 2022; 13:831279. [PMID: 35273610 PMCID: PMC8902297 DOI: 10.3389/fimmu.2022.831279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 12/27/2022] Open
Abstract
Background Monogenic conditions that disrupt proper development and/or function of the immune system are termed inborn errors of immunity (IEIs), also known as primary immunodeficiencies. Patients with IEIs often suffer from other manifestations in addition to infection, and allergic inflammation is an increasingly recognized feature of these conditions. Methods We performed a retrospective analysis of IEIs presenting with allergic inflammation as reported in the USIDNET registry. Our inclusion criteria comprised of patients with a reported monogenic cause for IEI where reported lab eosinophil and/or IgE values were available for the patient prior to them receiving potentially curative therapy. Patients were excluded if we were unable to determine the defective gene underlying their IEI. Patients were classified as having eosinophilia or elevated IgE when their record included at least 1 eosinophil count or IgE value that was greater than the age stratified upper limit of normal. We compared the proportion of patients with eosinophilia or elevated IgE with the proportion of samples in a reference population that fall above the upper limit of normal (2.5%). Results The query submitted to the USIDNET registry identified 1409 patients meeting inclusion criteria with a monogenic cause for their IEI diagnosis, of which 975 had eosinophil counts and 645 had IgE levels obtained prior to transplantation or gene therapy that were available for analysis. Overall, 18.8% (183/975) of the patients evaluated from the USIDNET registry had eosinophilia and 20.9% (135/645) had an elevated IgE. IEIs caused by defects in 32 genes were found to be significantly associated with eosinophilia and/or an elevated IgE level, spanning 7 of the 10 IEI categories according to the International Union of Immunological Societies classification. Conclusion Type 2 inflammation manifesting as eosinophilia or elevated IgE is found in a broad range of IEIs in the USIDNET registry. Our findings suggest that allergic immune dysregulation may be more widespread in IEIs than previously reported.
Collapse
Affiliation(s)
- Kelsey L Smith
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada
| | - Darlene Dai
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada
| | - Bhavi P Modi
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada
| | - Rahnuma Sara
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada
| | - Elizabeth Garabedian
- National Human Genome Research Institute, Bethesda, MD, United States.,National Institutes of Health, Bethesda, MD, United States
| | - Rebecca A Marsh
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Puck
- Division of Allergy/Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | | | - Kathleen E Sullivan
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada
| | - Catherine M Biggs
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia (BC) Children's Hospital, Vancouver, BC, Canada.,St Paul's Hospital, Vancouver, BC, Canada
| | | |
Collapse
|
2
|
Wang D, Cong Y, Deng Q, Han X, Zhang S, Zhao L, Luo Y, Zhang X. Physiological and Disease Models of Respiratory System Based on Organ-on-a-Chip Technology. MICROMACHINES 2021; 12:mi12091106. [PMID: 34577749 PMCID: PMC8467891 DOI: 10.3390/mi12091106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022]
Abstract
The pathogenesis of respiratory diseases is complex, and its occurrence and development also involve a series of pathological processes. The present research methods are have difficulty simulating the natural developing state of the disease in the body, and the results cannot reflect the real growth state and function in vivo. The development of microfluidic chip technology provides a technical platform for better research on respiratory diseases. The size of its microchannel can be similar to the space for cell growth in vivo. In addition, organ-on-a-chip can achieve long-term co-cultivation of multiple cells and produce precisely controllable fluid shear force, periodically changing mechanical force, and perfusate with varying solute concentration gradient. To sum up, the chip can be used to analyze the specific pathophysiological changes of organs meticulously, and it is widely used in scientific research on respiratory diseases. The focus of this review is to describe and discuss current studies of artificial respiratory systems based on organ-on-a-chip technology and to summarize their applications in the real world.
Collapse
Affiliation(s)
- Di Wang
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China; (D.W.); (Q.D.); (X.H.)
- Department of Pulmonary and Critical Care Medicine, Second Medical School, China Medical University, Shenyang 110004, China
| | - Ye Cong
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences, School of Chemical Engineering, Dalian University of Technology, Dalian 116023, China; (Y.C.); (S.Z.)
| | - Quanfeng Deng
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China; (D.W.); (Q.D.); (X.H.)
| | - Xiahe Han
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China; (D.W.); (Q.D.); (X.H.)
| | - Suonan Zhang
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences, School of Chemical Engineering, Dalian University of Technology, Dalian 116023, China; (Y.C.); (S.Z.)
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Second Medical School, China Medical University, Shenyang 110004, China
- Correspondence: (L.Z.); (Y.L.); (X.Z.); Tel.: +86-138-4116-9035 (X.Z.)
| | - Yong Luo
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences, School of Chemical Engineering, Dalian University of Technology, Dalian 116023, China; (Y.C.); (S.Z.)
- Correspondence: (L.Z.); (Y.L.); (X.Z.); Tel.: +86-138-4116-9035 (X.Z.)
| | - Xiuli Zhang
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China; (D.W.); (Q.D.); (X.H.)
- Correspondence: (L.Z.); (Y.L.); (X.Z.); Tel.: +86-138-4116-9035 (X.Z.)
| |
Collapse
|
3
|
White PL, Price JS, Backx M. Pneumocystis jirovecii Pneumonia: Epidemiology, Clinical Manifestation and Diagnosis. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00349-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Nawroth JC, Barrile R, Conegliano D, van Riet S, Hiemstra PS, Villenave R. Stem cell-based Lung-on-Chips: The best of both worlds? Adv Drug Deliv Rev 2019; 140:12-32. [PMID: 30009883 PMCID: PMC7172977 DOI: 10.1016/j.addr.2018.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/06/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023]
Abstract
Pathologies of the respiratory system such as lung infections, chronic inflammatory lung diseases, and lung cancer are among the leading causes of morbidity and mortality, killing one in six people worldwide. Development of more effective treatments is hindered by the lack of preclinical models of the human lung that can capture the disease complexity, highly heterogeneous disease phenotypes, and pharmacokinetics and pharmacodynamics observed in patients. The merger of two novel technologies, Organs-on-Chips and human stem cell engineering, has the potential to deliver such urgently needed models. Organs-on-Chips, which are microengineered bioinspired tissue systems, recapitulate the mechanochemical environment and physiological functions of human organs while concurrent advances in generating and differentiating human stem cells promise a renewable supply of patient-specific cells for personalized and precision medicine. Here, we discuss the challenges of modeling human lung pathophysiology in vitro, evaluate past and current models including Organs-on-Chips, review the current status of lung tissue modeling using human pluripotent stem cells, explore in depth how stem-cell based Lung-on-Chips may advance disease modeling and drug testing, and summarize practical consideration for the design of Lung-on-Chips for academic and industry applications.
Collapse
Affiliation(s)
| | | | | | - Sander van Riet
- Department of Pulmonology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | | |
Collapse
|
5
|
Mahdaviani SA, Rezaei N. Pulmonary Manifestations of Predominantly Antibody Deficiencies. PULMONARY MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES 2019. [PMCID: PMC7123456 DOI: 10.1007/978-3-030-00880-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Predominantly antibody deficiencies (PADs) are the most frequent forms of primary immunodeficiency diseases (PIDs). Commonly accompanied with complications involving several body systems, immunoglobulin substitution therapy along with prophylactic antibiotics remained the cornerstone of treatment for PADs and related complications. Patients with respiratory complications should be prescribed an appropriate therapy as soon as possible and have to be adhering to more and longer medical therapies. Recent studies identified a gap for screening protocols to monitor respiratory manifestations in patients with PADs. In the present chapter, the pulmonary manifestations of different PADs for each have been discussed. The chapter is mainly focused on X-linked agammaglobulinemia, common variable immunodeficiency, activated PI3K-δ syndrome, LRBA deficiency, CD19 complex deficiencies, CD20 deficiency, other monogenic defects associated with hypogammaglobulinemia, immunoglobulin class switch recombination deficiencies affecting B-cells, transient hypogammaglobulinemia of infancy, and selective IgA deficiency.
Collapse
Affiliation(s)
- Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies Children’s Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| |
Collapse
|
6
|
Therapy and Management of Pneumocystis jirovecii Infection. J Fungi (Basel) 2018; 4:jof4040127. [PMID: 30469526 PMCID: PMC6313306 DOI: 10.3390/jof4040127] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 12/21/2022] Open
Abstract
The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP.
Collapse
|
7
|
Mooney D, Edgar D, Einarsson G, Downey D, Elborn S, Tunney M. Chronic lung disease in common variable immune deficiency (CVID): A pathophysiological role for microbial and non-B cell immune factors. Crit Rev Microbiol 2017; 43:508-519. [PMID: 28068853 DOI: 10.1080/1040841x.2016.1268568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
One of the most common and most severe forms of primary antibody deficiency encountered in the clinical setting is a heterogeneous group of syndromes termed common variable immune deficiency (CVID). This disorder is characterized by reduced immunoglobulin production and increased susceptibility to infection, particularly of the respiratory tract. Infection and subsequent immunological/inflammatory processes may contribute to the development of pulmonary complications such as bronchiectasis and interstitial lung disease. Immunoglobulin replacement and/or antibiotic therapy, to prevent infection, are routinely prescribed treatments. However, chronic lung disease, the major cause of morbidity and mortality in this patient cohort, may still progress. This clinical progression suggests that pathogens recalcitrant to currently prescribed treatments and other immunological defects may be contributing to the development of pulmonary disease. This review describes the potential role of microbiological and non-B cell immunological factors, including T-cells, neutrophils, complement, toll like receptors, and antimicrobial peptides, in the pathogenicity of chronic lung disease in patients with CVID.
Collapse
Affiliation(s)
- Denver Mooney
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - David Edgar
- c T he Royal Hospitals, Belfast Health and Social Care Trust , Regional Immunology Service , Belfast , United Kingdom
| | - Gisli Einarsson
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - Damian Downey
- d Belfast City Hospital, Belfast Health and Social Care Trust , Regional Respiratory Centre , Belfast , United Kingdom
| | - Stuart Elborn
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - Michael Tunney
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- e School of Pharmacy , Queen's University Belfast , Belfast , United Kingdom
| |
Collapse
|
8
|
|
9
|
Kyriakidis I, Tragiannidis A, Zündorf I, Groll AH. Invasive fungal infections in paediatric patients treated with macromolecular immunomodulators other than tumour necrosis alpha inhibitors. Mycoses 2017; 60:493-507. [DOI: 10.1111/myc.12621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Ioannis Kyriakidis
- 2nd Department of Pediatrics; Aristotle University of Thessaloniki; AHEPA University General Hospital; Thessaloniki Greece
| | - Athanasios Tragiannidis
- 2nd Department of Pediatrics; Aristotle University of Thessaloniki; AHEPA University General Hospital; Thessaloniki Greece
| | - Ilse Zündorf
- Institute of Pharmaceutical Biology; Goethe-University of Frankfurt; Frankfurt am Main Germany
| | - Andreas H. Groll
- Infectious Disease Research Program; Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology; University Childrens Hospital; Muenster Germany
| |
Collapse
|
10
|
White PL, Backx M, Barnes RA. Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther 2017; 15:435-447. [PMID: 28287010 DOI: 10.1080/14787210.2017.1305887] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pneumocystis jirovecii is a ubiquitous fungus, which causes pneumonia in humans. Diagnosis was hampered by the inability to culture the organism, and based on microscopic examination of respiratory samples or clinical presentation. New assays can assist in the diagnosis and even aid with the emergence of resistant infections. Areas covered: This manuscript will provide background information on Pneumocystis pneumonia (PcP). Diagnosis, from radiological to non-microbiological (e.g. Lactate dehydrogenase) and microbiological investigations (Microscopy, PCR, β-D-Glucan) will be discussed. Recommendations on prophylactic and therapeutic management will be covered. Expert commentary: PcP diagnosis using microscopy is far from optimal and false negatives will occur. With an incidence of 1% or less, the pre-test probability of not having PcP is 99% and testing is suited to excluding disease. Microscopy provides a high degree of diagnostic confidence but it is not infallible, and its lower sensitivity limits its application. Newer diagnostics (PCR, β-D-Glucan) can aid management and improve performance when testing less invasive specimens, such as upper respiratory samples or blood, alleviating clinical pressure. Combination testing may allow PcP to be both diagnosed and excluded, and molecular testing can assist in the detection of emerging resistant PcP.
Collapse
Affiliation(s)
- P Lewis White
- a Public Health Wales Microbiology Cardiff, UHW , Cardiff , UK
| | - Matthijs Backx
- a Public Health Wales Microbiology Cardiff, UHW , Cardiff , UK
| | - Rosemary A Barnes
- a Public Health Wales Microbiology Cardiff, UHW , Cardiff , UK.,b Infection, Immunity and Biochemistry , Cardiff University, School of Medicine, UHW , Cardiff , UK
| |
Collapse
|
11
|
Tizioto PC, Kim J, Seabury CM, Schnabel RD, Gershwin LJ, Van Eenennaam AL, Toaff-Rosenstein R, Neibergs HL, Taylor JF. Immunological Response to Single Pathogen Challenge with Agents of the Bovine Respiratory Disease Complex: An RNA-Sequence Analysis of the Bronchial Lymph Node Transcriptome. PLoS One 2015; 10:e0131459. [PMID: 26121276 PMCID: PMC4484807 DOI: 10.1371/journal.pone.0131459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/02/2015] [Indexed: 01/31/2023] Open
Abstract
Susceptibility to bovine respiratory disease (BRD) is multi-factorial and is influenced by stress in conjunction with infection by both bacterial and viral pathogens. While vaccination is broadly used in an effort to prevent BRD, it is far from being fully protective and cases diagnosed from a combination of observed clinical signs without any attempt at identifying the causal pathogens are usually treated with antibiotics. Dairy and beef cattle losses from BRD are profound worldwide and genetic studies have now been initiated to elucidate host loci which underlie susceptibility with the objective of enabling molecular breeding to reduce disease prevalence. In this study, we employed RNA sequencing to examine the bronchial lymph node transcriptomes of controls and beef cattle which had individually been experimentally challenged with bovine respiratory syncytial virus, infectious bovine rhinotracheitis, bovine viral diarrhea virus, Pasteurella multocida, Mannheimia haemolytica or Mycoplasma bovis to identify the genes that are involved in the bovine immune response to infection. We found that 142 differentially expressed genes were located in previously described quantitative trait locus regions associated with risk of BRD. Mutations affecting the expression or amino acid composition of these genes may affect disease susceptibility and could be incorporated into molecular breeding programs. Genes involved in innate immunity were generally found to be differentially expressed between the control and pathogen-challenged animals suggesting that variation in these genes may lead to a heritability of susceptibility that is pathogen independent. However, we also found pathogen-specific expression profiles which suggest that host genetic variation for BRD susceptibility is pathogen dependent.
Collapse
Affiliation(s)
- Polyana C. Tizioto
- Embrapa Southeast Livestock, São Carlos, São Paulo, Brazil
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, United States of America
| | - JaeWoo Kim
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, United States of America
| | - Christopher M. Seabury
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, Texas, United States of America
| | - Robert D. Schnabel
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, United States of America
| | - Laurel J. Gershwin
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Alison L. Van Eenennaam
- Department of Animal Science, College of Agriculture, University of California Davis, Davis, California, United States of America
| | - Rachel Toaff-Rosenstein
- Department of Animal Science, College of Agriculture, University of California Davis, Davis, California, United States of America
| | - Holly L. Neibergs
- Department of Animal Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | | | - Jeremy F. Taylor
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, United States of America
- * E-mail:
| |
Collapse
|
12
|
José RJ, Dickey BF, Brown JS. Infectious respiratory disease in non-HIV immunocompromised patients. Br J Hosp Med (Lond) 2014; 75:685-90. [DOI: 10.12968/hmed.2014.75.12.685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ricardo J José
- Wellcome Trust Clinical Research Fellow in the Centre for Inflammation and Tissue Repair, University College London and Honorary Specialist Registrar, Department of Thoracic Medicine, University College London Hospital, London WC1E 6JF
| | - Burton F Dickey
- Professor and Chair in the Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Centre, Houston
| | - Jeremy S Brown
- Professor of Respiratory Infection, Centre for Inflammation and Tissue Repair, University College London and Consultant Respiratory Physician, Department of Thoracic Medicine, University College London Hospital, London
| |
Collapse
|
13
|
Mincarini M, Bagnasco D, Ferrantino MG, Balbi F, Passalacqua G. Multiple pulmonary nodules and unexplained fever: when the pulmonologist fails. Int J Immunopathol Pharmacol 2014; 27:309-11. [PMID: 25004845 DOI: 10.1177/039463201402700221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe herein a difficult case of persistent and refractory fever, associated with multiple lung nodules, progressive respiratory failure and general deterioration. Our patient was carefully investigated for the possible causes of his symptoms, using current and advanced diagnostic procedures, either serological or by imaging. The confirmatory diagnosis of anaplastic T-cell lymphoma, was obtained only after an invasive procedure (with severe pneumothorax), although it was too late. This suggests that also very rare diseases should be considered in the presence of unexplained signs/symptoms, and that in such cases, aggressive diagnostic procedures should be applied as early as possible.
Collapse
Affiliation(s)
- M Mincarini
- Respiratory Diseases, IRCCS S.Martino Hospital-IST, University of Genoa, Italy
| | - D Bagnasco
- Respiratory Diseases, IRCCS S.Martino Hospital-IST, University of Genoa, Italy
| | - M G Ferrantino
- Respiratory Diseases, IRCCS S.Martino Hospital-IST, University of Genoa, Italy
| | - F Balbi
- Respiratory Diseases, IRCCS S.Martino Hospital-IST, University of Genoa, Italy
| | - G Passalacqua
- Respiratory Diseases, IRCCS S.Martino Hospital-IST, University of Genoa, Italy
| |
Collapse
|
14
|
Atzeni F, Benucci M, Sarzi-Puttini P. Infections during treatment with biological agents and possible treatment in clinical practice. Expert Rev Clin Immunol 2014; 9:193-5. [DOI: 10.1586/eci.13.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
15
|
Abstract
Opportunistic infections are a major cause of morbidity and mortality in severely immunocompromised patients, such as those receiving chemotherapy or with haematological malignancy, aplastic anaemia or HIV infection, or recipients of solid-organ or stem cell transplants. In addition, the increasing use of biological therapies will result in more patients at risk of opportunistic infections, albeit to a lesser degree than classic causes of immunocompromise. The type and degree of immune defect dictates the profile of potential opportunistic pathogens; T-cell mediated defects increase the risk of viral (cytomegalovirus and respiratory viruses) and Pneumocystis jirovecii infections, whereas neutrophil defects are associated with bacterial pneumonia and invasive aspergillosis. However, patients often have combinations of immune defects and a wide range of other opportunistic infections can cause pneumonia. The radiological pattern of disease (best assessed by CT scan) and speed of onset also help identify the likely pathogen(s), which can then be supported by targeted investigation including early use of bronchoscopy in selected patients. Rapid and expert clinical assessment can identify the most likely pathogens, which can then be treated aggressively and so provide the best opportunity for a positive outcome.
Collapse
Affiliation(s)
- Ricardo J José
- is an Academic Clinical Fellow in Respiratory Medicine, UK. His interests include all aspects of respiratory medicine, particularly respiratory infection, diffuse parenchymal lung disease and acute lung injury. Conflicts of interest: none declared.,is a Clinician Scientist and a Reader in Respiratory Infection in the Centre for Respiratory Research at University College London, UK, where he runs a research group investigating the molecular pathogenesis of lung infections. He is a consultant at University College London Hospitals Trust, where his main clinical interests are pneumonia, infections in the immunocompromised host, and bronchiectasis. Conflicts of interest: none declared
| | - Jeremy S Brown
- is an Academic Clinical Fellow in Respiratory Medicine, UK. His interests include all aspects of respiratory medicine, particularly respiratory infection, diffuse parenchymal lung disease and acute lung injury. Conflicts of interest: none declared.,is a Clinician Scientist and a Reader in Respiratory Infection in the Centre for Respiratory Research at University College London, UK, where he runs a research group investigating the molecular pathogenesis of lung infections. He is a consultant at University College London Hospitals Trust, where his main clinical interests are pneumonia, infections in the immunocompromised host, and bronchiectasis. Conflicts of interest: none declared
| |
Collapse
|