1
|
Wang Q, Su H, Han J, Yang J, Lin N. Case report: Rubella virus-associated cutaneous granuloma in an adult with TAP1 deficiency. Front Immunol 2024; 15:1366840. [PMID: 38680488 PMCID: PMC11045939 DOI: 10.3389/fimmu.2024.1366840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Rubella virus-associated granulomas commonly occur in immunocompromised individuals, exhibiting a diverse range of clinical presentations. These manifestations can vary from predominantly superficial cutaneous plaques or nonulcerative nodules to more severe deep ulcerative lesions, often accompanied by extensive necrosis and significant tissue destruction. TAP1 deficiency, an exceedingly rare primary immune-deficiency disorder, presents with severe chronic sino-pulmonary infection and cutaneous granulomas. This report highlights the occurrence of rubella virus-associated cutaneous granulomas in patients with TAP1 deficiency. Notably, the pathogenic mutation responsible for TAP1 deficiency stems from a novel genetic alteration that has not been previously reported. This novel observation holds potential significance for the field of diagnosis and investigative efforts in the context of immunodeficiency disorders.
Collapse
Affiliation(s)
- Qiaohui Wang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huilin Su
- Department of Dermatology and Venereology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiande Han
- Department of Dermatology and Venereology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Juhua Yang
- Vision Medicals Co., Ltd., Guangzhou, Guangdong, China
| | - Naiyu Lin
- Department of Dermatology and Venereology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
2
|
Kilich G, Perelygina L, Sullivan KE. Rubella virus chronic inflammatory disease and other unusual viral phenotypes in inborn errors of immunity. Immunol Rev 2024; 322:113-137. [PMID: 38009321 DOI: 10.1111/imr.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Infectious susceptibility is a component of many inborn errors of immunity. Nevertheless, antibiotic use is often used as a surrogate in history taking for infectious susceptibility, thereby disadvantaging patients who present with viral infections as their phenotype. Further complicating clinical evaluations are unusual manifestations of viral infections which may be less familiar that the typical respiratory viral infections. This review covers several unusual viral phenotypes arising in patients with inborn errors of immunity and other settings of immune compromise. In some cases, chronic infections lead to oncogenesis or tumor-like growths and the conditions and mechanisms of viral-induced oncogenesis will be described. This review covers enterovirus, rubella, measles, papillomavirus, and parvovirus B19. It does not cover EBV and hemophagocytic lymphohistiocytosis nor lymphomagenesis related to EBV. EBV susceptibility has been recently reviewed. Our goal is to increase awareness of the unusual manifestations of viral infections in patients with IEI and to describe treatment modalities utilized in this setting. Coincidentally, each of the discussed viral infections can have a cutaneous component and figures will serve as a reminder of the physical features of these viruses. Given the high morbidity and mortality, early recognition can only improve outcomes.
Collapse
Affiliation(s)
- Gonench Kilich
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
3
|
Zhang D, Wanat KA, Perelygina L, Rosenbach M, Haun PL, Drolet BA, Shields BE. Cutaneous granulomas associated with rubella virus: A clinical review. J Am Acad Dermatol 2024; 90:111-121. [PMID: 37271455 DOI: 10.1016/j.jaad.2023.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
Since the initial identification of vaccine-derived rubella virus (RuV) in the cutaneous granulomas of pediatric patients with inborn errors of immunity in 2014, more than 80 cases of RuV granulomas have been reported implicating both vaccine-derived and wild type RuV. Previously thought to arise exclusively in patients with significant immunocompromise, the identification of RuV granulomas in clinically immunocompetent patients adds nuance to our understanding of the interplay between host environment, immune dysregulation, and RuV granuloma formation. This review summarizes the literature on RuV granulomas including clinical and histopathologic features, proposed pathomechanisms supporting granuloma development, and potential therapeutic options. There is no standardized algorithm to guide the workup and diagnosis of suspected RuV granulomas. We highlight the importance of contributing RuV granuloma cases to ongoing Centers for Disease Control and Prevention surveillance efforts to monitor wild type and vaccine-derived RuV transmission. Studies advancing our understanding of RuV granulomas may provide insights into the role of viral infectious agents in granulomatous disease pathogenesis and guide the development of improved therapeutic options.
Collapse
Affiliation(s)
- Donglin Zhang
- Department of Dermatology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Karolyn A Wanat
- Department of Dermatology and Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Misha Rosenbach
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul L Haun
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine, Madison, Wisconsin.
| |
Collapse
|
4
|
Patel S, Russo P, M HR, Maurer K, Hao L, Beard RS, Perelygina L, Sullivan KE. Surveillance for rubella virus in samples obtained from non-immunodeficient individuals. Pediatr Allergy Immunol 2024; 35:e14082. [PMID: 38284923 DOI: 10.1111/pai.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Srushti Patel
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pierre Russo
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Harris Rebecca M
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly Maurer
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - LiJuan Hao
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachell Suzanne Beard
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Fourgeaud J, Lecuit MM, Pérot P, Bruneau J, Regnault B, Da Rocha N, Bessaud M, Picard C, Jeziorski É, Fournier B, Levy R, Marçais A, Blanche S, Frange P, Fischer A, Cavazzana M, Ferroni A, Jamet A, Leruez-Ville M, Eloit M, Neven B. Chronic Aichi Virus Infection As a Cause of Long-Lasting Multiorgan Involvement in Patients With Primary Immune Deficiencies. Clin Infect Dis 2023; 77:620-628. [PMID: 37078608 DOI: 10.1093/cid/ciad237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) was used to assess patients with primary or secondary immune deficiencies (PIDs and SIDs) who presented with immunopathological conditions related to immunodysregulation. METHODS Thirty patients with PIDs or SIDs who presented with symptoms related to immunodysregulation and 59 asymptomatic patients with similar PIDs or SIDs were enrolled. mNGS was performed on organ biopsy. Specific Aichi virus (AiV) reverse-transcription polymerase chain reaction (RT-PCR) was used to confirm AiV infection and screen the other patients. In situ hybridization (ISH) assay was done on AiV-infected organs to identify infected cells. Virus genotype was determined by phylogenetic analysis. RESULTS AiV sequences were detected using mNGS in tissue samples of 5 patients and by RT-PCR in peripheral samples of another patient, all of whom presented with PID and long-lasting multiorgan involvement, including hepatitis, splenomegaly, and nephritis in 4 patients. CD8+ T-cell infiltration was a hallmark of the disease. RT-PCR detected intermittent low viral loads in urine and plasma from infected patients but not from uninfected patients. Viral detection stopped after immune reconstitution obtained by hematopoietic stem cell transplantation. ISH demonstrated the presence of AiV RNA in hepatocytes (n = 1) and spleen tissue (n = 2). AiV belonged to genotype A (n = 2) or B (n = 3). CONCLUSIONS The similarity of the clinical presentation, the detection of AiV in a subgroup of patients suffering from immunodysregulation, the absence of AiV in asymptomatic patients, the detection of viral genome in infected organs by ISH, and the reversibility of symptoms after treatment argue for AiV causality.
Collapse
Affiliation(s)
- Jacques Fourgeaud
- Université Paris Cité, Fédération pour l'Étude et évaluation des Thérapeutiques intra-Utérines, Paris, France
- Microbiology Department, AP-HP, Hôpital Necker Paris, France
- Pathogen Discovery Laboratory, Institut Pasteur, Université Paris Cité, Paris, France
| | - Mathilde M Lecuit
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
| | - Philippe Pérot
- Pathogen Discovery Laboratory, Institut Pasteur, Université Paris Cité, Paris, France
| | - Julie Bruneau
- Laboratory of Molecular Mechanisms of Hematologic Disorders and Therapeutic Implications, Université Paris Cité, Inserm, Institut Imagine Paris, France
- Department of Pathology, AP-HP, Hôpital Necker Paris, France
| | - Beatrice Regnault
- Pathogen Discovery Laboratory, Institut Pasteur, Université Paris Cité, Paris, France
| | - Nicolas Da Rocha
- Pathogen Discovery Laboratory, Institut Pasteur, Université Paris Cité, Paris, France
| | - Mael Bessaud
- Laboratoire signalisation antivirale, Institut Pasteur, Université Paris Cité, Paris, France
| | - Capucine Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, Université Paris Cité, Inserm, Institut Imagine Paris, France
- Study Center for Primary Immunodeficiencies, Necker-Children's hospital, APHP Paris, France
| | - Éric Jeziorski
- Pediatric Hematology Immunology Unit, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Benjamin Fournier
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université Paris Cité, Inserm, Institut Imagine Paris, France
| | - Romain Levy
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Université Paris Cité, Inserm, Institut Imagine Paris, France
| | - Ambroise Marçais
- Laboratory of Molecular Mechanisms of Hematologic Disorders and Therapeutic Implications, Université Paris Cité, Inserm, Institut Imagine Paris, France
- Hepatology Unit, AP-HP, Hôpital Necker Paris, France
| | - Stéphane Blanche
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
| | - Pierre Frange
- Université Paris Cité, Fédération pour l'Étude et évaluation des Thérapeutiques intra-Utérines, Paris, France
- Microbiology Department, AP-HP, Hôpital Necker Paris, France
| | - Alain Fischer
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université Paris Cité, Inserm, Institut Imagine Paris, France
- Médecine expérimentale, Collège de France, Paris, France
| | - Marina Cavazzana
- Laboratory of Human Lympho-Hematopoiesis, Université Paris Cité, Inserm, Institut Imagine Paris, France
- Department of Biotherapy, Hôpital Necker, AP-HP Paris, France
| | - Agnès Ferroni
- Microbiology Department, AP-HP, Hôpital Necker Paris, France
| | - Anne Jamet
- Microbiology Department, AP-HP, Hôpital Necker Paris, France
- Department of Pathogenesis of systemic infections, Université Paris Cité, CNRS, Inserm, Institut Necker-Enfants Malades, Paris, France
| | - Marianne Leruez-Ville
- Université Paris Cité, Fédération pour l'Étude et évaluation des Thérapeutiques intra-Utérines, Paris, France
- Microbiology Department, AP-HP, Hôpital Necker Paris, France
| | - Marc Eloit
- Pathogen Discovery Laboratory, Institut Pasteur, Université Paris Cité, Paris, France
- Département des Sciences biologiques et Pharmaceutiques, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Bénédicte Neven
- Pediatric Hematology Immunology and Rheumatology Unit, AP-HP, Hôpital Necker Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université Paris Cité, Inserm, Institut Imagine Paris, France
| |
Collapse
|
6
|
Starshinova A, Zinchenko Y, Malkova A, Kudlay D, Kudryavtsev I, Yablonskiy P. Sarcoidosis and Autoimmune Inflammatory Syndrome Induced by Adjuvants. Life (Basel) 2023; 13:life13041047. [PMID: 37109576 PMCID: PMC10145559 DOI: 10.3390/life13041047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Currently, sarcoidosis remains one of the diseases with unknown etiology, which significantly complicates its diagnosis and treatment. Various causes of sarcoidosis have been studied for many years. Both organic and inorganic trigger factors, provoking the development of granulomatous inflammation are considered. However, the most promising and evidence-based hypothesis is the development of sarcoidosis as an autoimmune disease, provoked by various adjuvants in genetic predisposed individuals. This concept fits into the structure of the autoimmune/inflammatory syndrome, induced by adjuvants (ASIA) that was proposed in 2011 by Professor Shoenfeld Y. In this paper, the authors reveal the presence of major and minor ASIA criteria for sarcoidosis, propose a new concept of the course of sarcoidosis within the framework of ASIA, and point out the difficulties in creating a model of the disease and the selection of therapy. It is obvious that the data obtained not only bring us closer to understanding the nature of sarcoidosis, but also potentiate new studies confirming this hypothesis by obtaining a model of the disease.
Collapse
Affiliation(s)
- Anna Starshinova
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia
| | - Yulia Zinchenko
- Saint-Petersburg Research Institute of Phthisiopulmonology, 194064 Saint-Petersburg, Russia
| | - Anna Malkova
- Laboratory of the Mosaic of Autoimmunity, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Dmitriy Kudlay
- Medical Department, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
- Institute of Immunology, 115478 Moscow, Russia
| | - Igor Kudryavtsev
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia
- Department of Immunology, Institution of Experimental Medicine, 197022 Saint-Petersburg, Russia
| | - Piotr Yablonskiy
- Saint-Petersburg Research Institute of Phthisiopulmonology, 194064 Saint-Petersburg, Russia
- Laboratory of the Mosaic of Autoimmunity, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia
| |
Collapse
|
7
|
Deng S, Rao S, Wang AR, Shi W. Case report: Rubella virus-induced cutaneous granulomas in a girl with atypical SCID caused by DCLRE1C gene mutations. Front Genet 2023; 14:1115027. [PMID: 37007969 PMCID: PMC10061095 DOI: 10.3389/fgene.2023.1115027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Here, we report a case of rubella virus-induced granulomatous dermatitis in a young girl with immunodeficiency caused by DCLRE1C gene mutations. The patient was a 6-year-old girl who presented with multiple erythematous plaques on the face and limbs. Biopsies of the lesions revealed tuberculoid necrotizing granulomas. No pathogens could be identified on extensive special stains, tissue cultures, or PCR-based microbiology assays. Metagenomic next-generation sequencing analysis revealed the rubella virus. Underlying atypical severe combined immunodeficiency was recognized based on the patient’s history of repetitive infections since birth, low T-cell, B-cell, and NK cell counts, and abnormal immunoglobulins and complements. Whole-exome sequencing revealed the genetic abnormality of the atypical severe combined immunodeficiency (SCID), and compound heterozygous mutations of the DCLRE1C gene were detected. This report highlights the diagnostic values of metagenomic next-generation sequencing in identifying rare pathogens causing cutaneous granulomas in patients with atypical SCID.
Collapse
Affiliation(s)
- Sihan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijia Rao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Alun R. Wang
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Wei Shi,
| |
Collapse
|
8
|
Sacco KA, Gazzin A, Notarangelo LD, Delmonte OM. Granulomatous inflammation in inborn errors of immunity. Front Pediatr 2023; 11:1110115. [PMID: 36891233 PMCID: PMC9986611 DOI: 10.3389/fped.2023.1110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
Granulomas have been defined as inflammatory infiltrates formed by recruitment of macrophages and T cells. The three-dimensional spherical structure typically consists of a central core of tissue resident macrophages which may merge into multinucleated giant cells surrounded by T cells at the periphery. Granulomas may be triggered by infectious and non-infectious antigens. Cutaneous and visceral granulomas are common in inborn errors of immunity (IEI), particularly among patients with chronic granulomatous disease (CGD), combined immunodeficiency (CID), and common variable immunodeficiency (CVID). The estimated prevalence of granulomas in IEI ranges from 1%-4%. Infectious agents causing granulomas such Mycobacteria and Coccidioides presenting atypically may be 'sentinel' presentations for possible underlying immunodeficiency. Deep sequencing of granulomas in IEI has revealed non-classical antigens such as wild-type and RA27/3 vaccine-strain Rubella virus. Granulomas in IEI are associated with significant morbidity and mortality. The heterogeneity of granuloma presentation in IEI presents challenges for mechanistic approaches to treatment. In this review, we discuss the main infectious triggers for granulomas in IEI and the major forms of IEI presenting with 'idiopathic' non-infectious granulomas. We also discuss models to study granulomatous inflammation and the impact of deep-sequencing technology while searching for infectious triggers of granulomatous inflammation. We summarize the overarching goals of management and highlight the therapeutic options reported for specific granuloma presentations in IEI.
Collapse
Affiliation(s)
- Keith A Sacco
- Department of Pulmonology, Section of Allergy-Immunology, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Andrea Gazzin
- Laboratory of Clinical Immunology and Microbiology, Immune Deficiency Genetics Section, National Institutes of Health, Bethesda, MD, United States
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Immune Deficiency Genetics Section, National Institutes of Health, Bethesda, MD, United States
| | - Ottavia M Delmonte
- Laboratory of Clinical Immunology and Microbiology, Immune Deficiency Genetics Section, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
9
|
Bonner KE, Sukerman E, Liko J, Lanzieri TM, Sutton M, DeBess E, Leesman C, Icenogle J, Hao L, Chen MH, Faisthalab R, Leman RF, Cieslak PR, DeRavin SS, Perelygina L. Case report: Persistent shedding of a live vaccine-derived rubella virus in a young man with severe combined immunodeficiency and cutaneous granuloma. Front Immunol 2022; 13:1075351. [PMID: 36569925 PMCID: PMC9773200 DOI: 10.3389/fimmu.2022.1075351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
A young man with X-linked severe combined immunodeficiency developed a persistent vaccine-derived rubella virus (VDRV) infection, with the emergence of cutaneous granulomas more than fifteen years after receipt of two doses of measles-mumps-rubella (MMR) vaccine. Following nasopharyngeal swab (NP) collection, VDRV was detected by real-time polymerase chain reaction (RT-qPCR) and sequencing, and live, replication-competent VDRV was isolated in cell culture. To assess duration and intensity of viral shedding, sequential respiratory samples, one cerebrospinal fluid sample, and two urine samples were collected over 15 months, and VDRV RNA was detected in all samples by RT-qPCR. Live VDRV was cultured from nine of the eleven respiratory specimens and from one urine specimen. To our knowledge, this was the first reported instance of VDRV cultured from respiratory specimens or from urine. To assess potential transmission to close contacts, NP specimens and sera were collected from all household contacts, all of whom were immunocompetent and previously vaccinated with MMR. VDRV RNA was not detected in any NP swabs from the contacts, nor did serologic investigations suggest VDRV transmission to any contacts. This report highlights the need to understand the prevalence and duration of VDRV shedding in granuloma patients and to estimate the risk of VDRV transmission to immune and non-immune contacts.
Collapse
Affiliation(s)
- Kimberly E. Bonner
- Oregon Health Authority, Public Health Division, Portland, OR, United States,Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ellie Sukerman
- Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, United States
| | - Juventila Liko
- Oregon Health Authority, Public Health Division, Portland, OR, United States
| | - Tatiana M. Lanzieri
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Melissa Sutton
- Oregon Health Authority, Public Health Division, Portland, OR, United States
| | - Emilio DeBess
- Oregon Health Authority, Public Health Division, Portland, OR, United States
| | - Christopher Leesman
- Corvallis Family Medicine, Corvallis, OR, United States,Transformative Health and Wellness, Corvallis, OR, United States
| | - Joseph Icenogle
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - LiJuan Hao
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Min-hsin Chen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Raeesa Faisthalab
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Richard F. Leman
- Oregon Health Authority, Public Health Division, Portland, OR, United States
| | - Paul R. Cieslak
- Oregon Health Authority, Public Health Division, Portland, OR, United States
| | - Suk See DeRavin
- Laboratory of Clinical Immunology and Microbiology, The National Institute of Allergy and Infectious Diseases (NIAID), The National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States,*Correspondence: Ludmila Perelygina,
| |
Collapse
|
10
|
High Inborn Errors of Immunity Risk in Patients with Granuloma. J Clin Immunol 2022; 42:1795-1809. [PMID: 35980494 DOI: 10.1007/s10875-022-01342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Granuloma etiology includes infections, vasculitis, chemicals, malignancies, lymphoproliferative disorders, and immunological diseases. We hypothesized that patients with granuloma have an underlying primary immunodeficiency disease (PIDD). PATIENTS AND METHODS We retrospectively enrolled 82 patients with immunological evaluation among 294 biopsy-proven granuloma patients (0- to 20-year-old). At the same time frame, we followed up with 1910 patients in the same age group. RESULTS Out of 82 patients, male/female ratio was 45/37. Median age at symptom onset was 5 years (28 days-17.4 years), age of granuloma at diagnosis was 8.6 years (36 days-19.4 years). Common symptoms at disease onset were fever (23.2%), lymphadenopathy (19.6%), abdominal pain (12.2%), and cough (12.2%). Granuloma was frequent in lymph nodes (26.8%), skin (19.5%), lung (13.4%), and bone (11%). Common infectious agents isolated were Mycobacterium spp. (23.2%) and EBV (4.9%). We document PIDD in 76.8% (63/82) of patients. 49.4% (40/81) of immunologically evaluated granuloma patients had hypogammaglobulinemia. Granuloma rate in pediatric PIDD was 3.3%(63/1910). Patients with multiple granulomas (n = 16) had a PIDD diagnosis. Lung involvement was three times more in PIDD. Brain involvement was only seen in PIDD. Fibroadipose tissue and liver involvement were more frequent in patients without documented PIDD and patients whose evaluation was not completed. The mortality rate in PIDD with granuloma was 15.9%, whereas there was no mortality in patients without PIDD. CONCLUSION As documented here, even in a university hospital, the immunologic evaluation ratio is about one-third. We showed high PIDD frequency in children with granuloma, and higher mortality in PIDD with granuloma. Thus, an immunologic evaluation performed meticulously by immunologists is a must for accurate diagnosis and decision of individualized therapeutic options.
Collapse
|
11
|
Browne R, Cliffe L, Ip W, Brown K, McDermott E. A case of wild-type rubella-associated cutaneous granuloma in ataxia telangiectasia. Pediatr Dermatol 2022; 39:619-621. [PMID: 35644916 DOI: 10.1111/pde.15032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
Granulomatous skin disease is known to be associated with various primary immunodeficiencies, including ataxia telangiectasia (AT). Recent reports of persistence of live vaccine strain rubella within such cutaneous granulomas have raised concern regarding the safety of vaccination. Here we report a case of cutaneous granuloma in association with AT, demonstrating wild type, rather than vaccine strain rubella. This supports the persistence of rubella as a causative mechanism, but suggests it is not vaccine strain-specific, and thus may impact the decision of those considering not vaccinating this subset of children.
Collapse
Affiliation(s)
- Rachel Browne
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lucy Cliffe
- Department of Immunology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Winne Ip
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kevin Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Elizabeth McDermott
- Department of Immunology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
12
|
Baumann U, Schulte JH, Groß JP, Beier R, Ludwig M, Wahn V, Hofmann J, Maecker-Kolhoff B, Sauer M, Kaiser-Labusch P, Karimian N, Blume-Peytavi U, Ghoreschi F, Ott H, Perelygina L, Klemann C, Blankenstein O, von Bernuth H, Krüger R. Case Report: Rubella Virus-Induced Cutaneous Granulomas in Two Pediatric Patients With DNA Double Strand Breakage Repair Disorders - Outcome After Hematopoietic Stem Cell Transplantation. Front Immunol 2022; 13:886540. [PMID: 35720367 PMCID: PMC9201904 DOI: 10.3389/fimmu.2022.886540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
We report two patients with DNA repair disorders (Artemis deficiency, Ataxia telangiectasia) with destructive skin granulomas, presumably triggered by live-attenuated rubella vaccinations. Both patients showed reduced naïve T cells. Rapid resolution of skin lesions was observed following hematopoietic stem cell transplantation. However, the patient with AT died due to complications of severe hepatic veno-occlusive disease 6 month after HSCT. Dried blood spots obtained after birth were available from this patient and showed absent T-cell receptor excision circles (TRECs). Therefore, newborn screening may help to prevent patients with moderate T-cell deficiency from receiving live-attenuated rubella vaccine potentially causing granulomas.
Collapse
Affiliation(s)
- Ulrich Baumann
- Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Jonathan P Groß
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Rita Beier
- Paediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany
| | - Marius Ludwig
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Volker Wahn
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Jörg Hofmann
- Labor Berlin GmbH, Department of Virology, Berlin, Germany.,Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Martin Sauer
- Paediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany
| | | | - Negin Karimian
- Department of Dermatology and Allergology, Charité-Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergology, Charité-Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Franziska Ghoreschi
- Department of Dermatology and Allergology, Charité-Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Hagen Ott
- Department of Paediatric Dermatology and Allergology, Center for Rare Congenital Skin Diseases, Children's Hospital Auf der Bult, Hannover, Germany
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christian Klemann
- Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Oliver Blankenstein
- Institute for Experimental Pediatric Endocrinology, Newborn Screening Laboratory, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Berlin, Germany
| | - Horst von Bernuth
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,Labor Berlin GmbH, Department of Immunology, Berlin, Germany
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| |
Collapse
|
13
|
Notarangelo LD. Rubella Virus-Associated Granulomas in Immunocompetent Adults-Possible Implications. JAMA Dermatol 2022; 158:611-613. [PMID: 35338703 DOI: 10.1001/jamadermatol.2022.0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
14
|
Wanat KA, Perelygina L, Chen MH, Hao L, Abernathy E, Bender NR, Shields BE, Wilson BD, Crosby D, Routes J, Samimi SS, Haun PL, Sokumbi O, Icenogle JP, Sullivan KE, Rosenbach M, Drolet BA. Association of Persistent Rubella Virus With Idiopathic Skin Granulomas in Clinically Immunocompetent Adults. JAMA Dermatol 2022; 158:626-633. [PMID: 35338705 DOI: 10.1001/jamadermatol.2022.0828] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Vaccine-derived and wild-type rubella virus (RuV) has been identified within granulomas in patients with inborn errors of immunity, but has not been described in granulomas of healthy adults. Objective To determine the association between RuV and atypical granulomatous inflammation in immune-competent adults. Design, Setting, and Participants This case series, conducted in US academic dermatology clinics from January 2019 to January 2021, investigated the presence of RuV in skin specimens using RuV immunofluorescent staining of paraffin-embedded tissue sections, real-time reverse-transcription polymerase chain reaction, whole-genome sequencing with phylogenetic analyses, and cell culture by the US Centers for Disease Control and Prevention. Rubella immunoglobulin G, immunoglobulin M enzyme-linked immunoassay, and viral neutralization assays were performed for the sera of immunocompetent individuals with treatment refractory cutaneous granulomas and histopathology demonstrating atypical palisaded and necrotizing granulomas. Clinical immune evaluation was performed. Main Outcomes and Measures Identification, genotyping, and culture of vaccine-derived and wild-type RuV within granulomatous dermatitis of otherwise clinically immune competent adults. Results Of the 4 total immunocompetent participants, 3 (75%) were women, and the mean (range) age was 61.5 (49.0-73.0) years. The RuV capsid protein was detected by immunohistochemistry in cutaneous granulomas. The presence of RuV RNA was confirmed by real-time reverse-transcription polymerase chain reaction in fresh-frozen skin biopsies and whole-genome sequencing. Phylogenetic analysis of the RuV sequences showed vaccine-derived RuV in 3 cases and wild-type RuV in 1. Live RuV was recovered from the affected skin in 2 participants. Immunology workup results demonstrated no primary immune deficiencies. Conclusions and Relevance The case series study results suggest that RuV (vaccine derived and wild type) can persist for years in cutaneous granulomas in clinically immunocompetent adults and is associated with atypical (palisaded and necrotizing type) chronic cutaneous granulomas. These findings represent a potential paradigm shift in the evaluation, workup, and management of atypical granulomatous dermatitis and raises questions regarding the potential transmissibility of persistent live RuV.
Collapse
Affiliation(s)
| | | | - Min-Hsin Chen
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LiJuan Hao
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Abernathy
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Bridget E Shields
- University of Wisconsin, Madison.,Assistant Section Editor, JAMA Dermatology
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Petley E, Yule A, Alexander S, Ojha S, Whitehouse WP. The natural history of ataxia-telangiectasia (A-T): A systematic review. PLoS One 2022; 17:e0264177. [PMID: 35290391 PMCID: PMC9049793 DOI: 10.1371/journal.pone.0264177] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ataxia-telangiectasia is an autosomal recessive, multi-system, and life-shortening disease caused by mutations in the ataxia-telangiectasia mutated gene. Although widely reported, there are no studies that give a comprehensive picture of this intriguing condition. OBJECTIVES Understand the natural history of ataxia-telangiectasia (A-T), as reported in scientific literature. SEARCH METHODS 107 search terms were identified and divided into 17 searches. Each search was performed in PubMed, Ovid SP (MEDLINE) 1946-present, OVID EMBASE 1980 -present, Web of Science core collection, Elsevier Scopus, and Cochrane Library. SELECTION CRITERIA All human studies that report any aspect of A-T. DATA COLLECTION AND ANALYSIS Search results were de-duplicated, data extracted (including author, publication year, country of origin, study design, population, participant characteristics, and clinical features). Quality of case-control and cohort studies was assessed by the Newcastle-Ottawa tool. Findings are reported descriptively and where possible data collated to report median (interquartile range, range) of outcomes of interest. MAIN RESULTS 1314 cases reported 2134 presenting symptoms. The most common presenting symptom was abnormal gait (1160 cases; 188 studies) followed by recurrent infections in classical ataxia-telangiectasia and movement disorders in variant ataxia-telangiectasia. 687 cases reported 752 causes of death among which malignancy was the most frequently reported cause. Median (IQR, range) age of death (n = 294) was 14 years 0 months (10 years 0 months to 23 years 3 months, 1 year 3 months to 76 years 0 months). CONCLUSIONS This review demonstrates the multi-system involvement in A-T, confirms that neurological symptoms are the most frequent presenting features in classical A-T but variants have diverse manifestations. We found that most individuals with A-T have life limited to teenage or early adulthood. Predominance of case reports, and case series demonstrate the lack of robust evidence to determine the natural history of A-T. We recommend population-based studies to fill this evidence gap.
Collapse
Affiliation(s)
- Emily Petley
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Alexander Yule
- United Lincolnshire Hospitals NHS Trust, Lincoln, United
Kingdom
| | - Shaun Alexander
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Shalini Ojha
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Children’s Hospital, University Hospitals of Derby and Burton, NHS
Foundation Trust, Derby, United Kingdom
| | - William P. Whitehouse
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Nottingham Children’s Hospital, Nottingham University Hospital NHS Trust,
Nottingham, United Kingdom
| |
Collapse
|
16
|
Drug Sensitivity of Vaccine-Derived Rubella Viruses and Quasispecies Evolution in Granulomatous Lesions of Two Ataxia-Telangiectasia Patients Treated with Nitazoxanide. Pathogens 2022; 11:pathogens11030338. [PMID: 35335662 PMCID: PMC8955873 DOI: 10.3390/pathogens11030338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
A strong association between rubella virus (RuV) and chronic granulomas, in individuals with inborn errors of immunity, has been recently established. Both the RA27/3 vaccine and wild-type RuV strains were highly sensitive to a broad-spectrum antiviral drug, nitazoxanide (NTZ), in vitro. However, NTZ treatment, used as a salvage therapy, resulted in little or no improvements of RuV-associated cutaneous granulomas in patients. Here, we report investigations of possible causes of treatment failures in two ataxia-telangiectasia patients. Although a reduction in RuV RNA in skin lesions was detected by real-time RT-PCR, live immunodeficiency-related vaccine-derived rubella viruses (iVDRV) were recovered from granulomas, before and after the treatments. Tizoxanide, an active NTZ metabolite, inhibited replications of all iVDRVs in cultured A549 cells, but the 50% and 90% inhibitory concentrations were 10–40 times higher than those for the RA27/3 strain. There were no substantial differences in iVDRV sensitivities, neither before nor after treatments. Analysis of quasispecies in the E1 gene, a suspected NTZ target, showed no effect of NTZ treatments on quasispecies’ complexity in lesions. Thus, failures of NTZ therapies were likely due to low sensitivities of iVDRVs to the drug, and not related to the emergence of resistance, following long-term NTZ treatments.
Collapse
|
17
|
Perelygina L, Faisthalab R, Abernathy E, Chen MH, Hao L, Bercovitch L, Bayer DK, Noroski LM, Lam MT, Cicalese MP, Al-Herz W, Nanda A, Hajjar J, Vanden Driessche K, Schroven S, Leysen J, Rosenbach M, Peters P, Raedler J, Albert MH, Abraham RS, Rangarjan HG, Buchbinder D, Kobrynski L, Pham-Huy A, Dhossche J, Cunningham Rundles C, Meyer AK, Theos A, Atkinson TP, Musiek A, Adeli M, Derichs U, Walz C, Krüger R, von Bernuth H, Klein C, Icenogle J, Hauck F, Sullivan KE. Rubella Virus Infected Macrophages and Neutrophils Define Patterns of Granulomatous Inflammation in Inborn and Acquired Errors of Immunity. Front Immunol 2022; 12:796065. [PMID: 35003119 PMCID: PMC8728873 DOI: 10.3389/fimmu.2021.796065] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Rubella virus (RuV) has recently been found in association with granulomatous inflammation of the skin and several internal organs in patients with inborn errors of immunity (IEI). The cellular tropism and molecular mechanisms of RuV persistence and pathogenesis in select immunocompromised hosts are not clear. We provide clinical, immunological, virological, and histological data on a cohort of 28 patients with a broad spectrum of IEI and RuV-associated granulomas in skin and nine extracutaneous tissues to further delineate this relationship. Combined immunodeficiency was the most frequent diagnosis (67.8%) among patients. Patients with previously undocumented conditions, i.e., humoral immunodeficiencies, a secondary immunodeficiency, and a defect of innate immunity were identified as being susceptible to RuV-associated granulomas. Hematopoietic cell transplantation was the most successful treatment in this case series resulting in granuloma resolution; steroids, and TNF-α and IL-1R inhibitors were moderately effective. In addition to M2 macrophages, neutrophils were identified by immunohistochemical analysis as a novel cell type infected with RuV. Four patterns of RuV-associated granulomatous inflammation were classified based on the structural organization of granulomas and identity and location of cell types harboring RuV antigen. Identification of conditions that increase susceptibility to RuV-associated granulomas combined with structural characterization of the granulomas may lead to a better understanding of the pathogenesis of RuV-associated granulomas and discover new targets for therapeutic interventions.
Collapse
Affiliation(s)
- Ludmila Perelygina
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Raeesa Faisthalab
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Emily Abernathy
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Min-Hsin Chen
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - LiJuan Hao
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Lionel Bercovitch
- Department of Dermatology, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Diana K Bayer
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
| | - Lenora M Noroski
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Michael T Lam
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Istituto di Ricovero e Cura a Carattere Scientifico (National Institute for Research and Treatment) (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Waleed Al-Herz
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Department of Pediatrics, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Arti Nanda
- Pediatric Dermatology Unit, As'ad Al-Hamad Dermatology Center, Al-sabah Hospital, Kuwait City, Kuwait
| | - Joud Hajjar
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Koen Vanden Driessche
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Shari Schroven
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Julie Leysen
- Department of Dermatology, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Philipp Peters
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Raedler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hemalatha G Rangarjan
- Department of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - David Buchbinder
- Department of Hematology, Children's Hospital of Orange County, Orange, CA, United States.,Department of Pediatrics, University of California at Irvine, Orange, CA, United States
| | - Lisa Kobrynski
- Allergy/Immunology Section, Emory University, Atlanta, GA, United States
| | - Anne Pham-Huy
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Julie Dhossche
- Department of Dermatology, Oregon Health and Science University, Portland, OR, United States
| | - Charlotte Cunningham Rundles
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anna K Meyer
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Amy Theos
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mehdi Adeli
- Division of Immunology and Allergy, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | - Ute Derichs
- Center for Pediatric and Adolescent Medicine, University Medical Hospital Mainz, Mainz, Germany
| | - Christoph Walz
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Horst von Bernuth
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin GmbH, Department of Immunology, Berlin, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joseph Icenogle
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| |
Collapse
|
18
|
Grammatikos A, Donati M, Johnston SL, Gompels MM. Peripheral B Cell Deficiency and Predisposition to Viral Infections: The Paradigm of Immune Deficiencies. Front Immunol 2021; 12:731643. [PMID: 34527001 PMCID: PMC8435594 DOI: 10.3389/fimmu.2021.731643] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
In the era of COVID-19, understanding how our immune system responds to viral infections is more pertinent than ever. Immunodeficiencies with very low or absent B cells offer a valuable model to study the role of humoral immunity against these types of infection. This review looks at the available evidence on viral infections in patients with B cell alymphocytosis, in particular those with X-linked agammaglobulinemia (XLA), Good’s syndrome, post monoclonal-antibody therapy and certain patients with Common Variable Immune Deficiency (CVID). Viral infections are not as infrequent as previously thought in these conditions and individuals with very low circulating B cells seem to be predisposed to an adverse outcome. Particularly in the case of SARS-CoV2 infection, mounting evidence suggests that peripheral B cell alymphocytosis is linked to a poor prognosis.
Collapse
Affiliation(s)
- Alexandros Grammatikos
- Department of Immunology, Southmead Hospital, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Matthew Donati
- Severn Infection Sciences and Public Health England National Infection Service South West, Department of Virology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sarah L Johnston
- Department of Immunology, Southmead Hospital, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Mark M Gompels
- Department of Immunology, Southmead Hospital, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| |
Collapse
|
19
|
Shields BE, Perelygina L, Samimi S, Haun P, Leung T, Abernathy E, Chen MH, Hao L, Icenogle J, Drolet B, Wilson B, Bryer JS, England R, Blumberg E, Wanat KA, Sullivan K, Rosenbach M. Granulomatous Dermatitis Associated With Rubella Virus Infection in an Adult With Immunodeficiency. JAMA Dermatol 2021; 157:842-847. [PMID: 34037685 DOI: 10.1001/jamadermatol.2021.1577] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Immunodeficiency-related, vaccine-derived rubella virus (RuV) as an antigenic trigger of cutaneous and visceral granulomas is a rare, recently described phenomenon in children and young adults treated with immunosuppressant agents. Objective To perform a comprehensive clinical, histologic, immunologic, molecular, and genomic evaluation to elucidate the potential cause of an adult patient's atypical cutaneous granulomas. Design, Setting, and Participants A prospective evaluation of skin biopsies, nasopharyngeal swabs, and serum samples submitted to the Centers for Disease Control and Prevention was conducted to assess for RuV using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and viral genomic sequencing. The samples were obtained from a man in his 70s with extensive cutaneous granulomas mimicking both cutaneous sarcoidosis (clinically) and CD8+ granulomatous cutaneous T-cell lymphoma (histopathologically). The study was conducted from September 2019 to February 2021. Main Outcomes and Measures Identification and genotyping of a novel immunodeficiency-related RuV-associated granulomatous dermatitis. Results Immunohistochemistry for RuV capsid protein and RT-PCR testing for RuV RNA revealed RuV in 4 discrete skin biopsies from different body sites. In addition, RuV RNA was detected in the patient's nasopharyngeal swabs by RT-PCR. The full viral genome was sequenced from the patient's skin biopsy (RVs/Philadelphia.PA.USA/46.19/GR, GenBank Accession #MT249313). The patient was ultimately diagnosed with a novel RuV-associated granulomatous dermatitis. Conclusions and Relevance The findings of this study suggest that clinicians and pathologists may consider RuV-associated granulomatous dermatitis during evaluation of a patient because it might have implications for the diagnosis of cutaneous sarcoidosis, with RuV serving as a potential antigenic trigger, and for the diagnosis of granulomatous cutaneous T-cell lymphoma, with histopathologic features that may prompt an evaluation for immunodeficiency and/or RuV.
Collapse
Affiliation(s)
- Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.,Assistant Section Editor, JAMA Dermatology
| | - Ludmila Perelygina
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - Sara Samimi
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Paul Haun
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Thomas Leung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily Abernathy
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - Min-Hsin Chen
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - LiJuan Hao
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - Joseph Icenogle
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara Wilson
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Joshua S Bryer
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ross England
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily Blumberg
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Section Editor, JAMA Dermatology
| | - Kathleen Sullivan
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Allergy and Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| |
Collapse
|
20
|
Abstract
Evaluation of antibodies produced after immunization is central to immune deficiency diagnosis. This includes assessment of responses to routine immunizations as well as to vaccines administered specifically for diagnosis. Here, we present the basic concepts of the humoral immune response and their relevance for vaccine composition and diagnosis of immune deficiency. Current vaccines are discussed, including nonviable protein and glycoprotein vaccines, pure polysaccharide vaccines, polysaccharide-protein conjugate vaccines, and live agent vaccines. Diagnostic and therapeutic applications of vaccine antibody measurement are discussed in depth. Important adverse effects of vaccines are also presented.
Collapse
|
21
|
Monogenic susceptibility to live viral vaccines. Curr Opin Immunol 2021; 72:167-175. [PMID: 34107321 PMCID: PMC9586878 DOI: 10.1016/j.coi.2021.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Live attenuated viral vaccines (LAV) have saved millions of lives globally through their capacity to elicit strong, cross-reactive and enduring adaptive immune responses. However, LAV can also act as a Trojan horse to reveal inborn errors of immunity, thereby highlighting important protective elements of the healthy antiviral immune response. In the following article, we draw out these lessons by reviewing the spectrum of LAV-associated disease reported in a variety of inborn errors of immunity. We note the contrast between adaptive disorders, which predispose to both LAV and their wild type counterparts, and defects of innate immunity in which parenterally delivered LAV behave in a particularly threatening manner. Recognition of the underlying pathomechanisms can inform our approach to disease management and vaccination in a wider group of individuals, including those receiving immunomodulators that impact the relevant pathways.
Collapse
|
22
|
Groß M, Speckmann C, May A, Gajardo-Carrasco T, Wustrau K, Maier SL, Panning M, Huzly D, Agaimy A, Bryceson YT, Choo S, Chow CW, Dückers G, Fasth A, Fraitag S, Gräwe K, Haxelmans S, Holzinger D, Hudowenz O, Hübschen JM, Khurana C, Kienle K, Klifa R, Korn K, Kutzner H, Lämmermann T, Ledig S, Lipsker D, Meeths M, Naumann-Bartsch N, Rascon J, Schänzer A, Seidl M, Tesi B, Vauloup-Fellous C, Vollmer-Kary B, Warnatz K, Wehr C, Neven B, Vargas P, Sepulveda FE, Lehmberg K, Schmitt-Graeff A, Ehl S. Rubella vaccine-induced granulomas are a novel phenotype with incomplete penetrance of genetic defects in cytotoxicity. J Allergy Clin Immunol 2021; 149:388-399.e4. [PMID: 34033843 DOI: 10.1016/j.jaci.2021.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rubella virus-induced granulomas have been described in patients with various inborn errors of immunity. Most defects impair T-cell immunity, suggesting a critical role of T cells in rubella elimination. However, the molecular mechanism of virus control remains elusive. OBJECTIVE This study sought to understand the defective effector mechanism allowing rubella vaccine virus persistence in granulomas. METHODS Starting from an index case with Griscelli syndrome type 2 and rubella skin granulomas, this study combined an international survey with a literature search to identify patients with cytotoxicity defects and granuloma. The investigators performed rubella virus immunohistochemistry and PCR and T-cell migration assays. RESULTS This study identified 21 patients with various genetically confirmed cytotoxicity defects, who presented with skin and visceral granulomas. Rubella virus was demonstrated in all 12 accessible biopsies. Granuloma onset was typically before 2 years of age and lesions persisted from months to years. Granulomas were particularly frequent in MUNC13-4 and RAB27A deficiency, where 50% of patients at risk were affected. Although these proteins have also been implicated in lymphocyte migration, 3-dimensional migration assays revealed no evidence of impaired migration of patient T cells. Notably, patients showed no evidence of reduced control of concomitantly given measles, mumps, or varicella live-attenuated vaccine or severe infections with other viruses. CONCLUSIONS This study identified lymphocyte cytotoxicity as a key effector mechanism for control of rubella vaccine virus, without evidence for its need in control of live measles, mumps, or varicella vaccines. Rubella vaccine-induced granulomas are a novel phenotype with incomplete penetrance of genetic disorders of cytotoxicity.
Collapse
Affiliation(s)
- Miriam Groß
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Annette May
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Tania Gajardo-Carrasco
- Molecular Basis of Altered Immune Homeostasis Laboratory, Institut National de la Santé et de la Recherche Médicale (INSERM), Unite Mixte de Recherche (UMR) 1163, Paris, France; Imagine Institute, Université de Paris, Paris, France
| | - Katharina Wustrau
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Lena Maier
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Panning
- Institute of Virology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Yenan T Bryceson
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden; Broegelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
| | - C W Chow
- Department of Anatomical Pathology, The Royal Children's Hospital, Melbourne, Australia
| | - Gregor Dückers
- Helios Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Krefeld, Germany
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, Paris, France
| | - Katja Gräwe
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | | | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Ole Hudowenz
- Department of Rheumatology, Immunology, Osteology, and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Judith M Hübschen
- World Health Organization European Regional Reference Laboratory for Measles and Rubella, Luxembourg Institute of Health, Department of Infection and Immunity, Esch-sur-Alzette, Luxembourg
| | - Claudia Khurana
- Department of Pediatric Hematology and Oncology, Children's Center Bethel, University Hospital Ostwestfalen-Lippe (OWL)/University Bielefeld, Bielefeld, Germany
| | - Korbinian Kienle
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Roman Klifa
- Immunology and Pediatric Hematology Department, Assistance Publique-Hôpitaux de Paris (AH-PH), Paris, France
| | - Klaus Korn
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Tim Lämmermann
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Svea Ledig
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Clinique Dermatologique, Hôpitaux Universitaires, Strasbourg, France
| | - Marie Meeths
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Theme of Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Nora Naumann-Bartsch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anne Schänzer
- Institute of Neuropathology, Justus Liebig University Gießen, Gießen, Germany
| | - Maximilian Seidl
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Institute of Pathology, Heinrich Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Bianca Tesi
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Christelle Vauloup-Fellous
- AP-HP, Hôpital Paul-Brousse, Department of Virology, World Health Organization Rubella National Reference Laboratory, Groupe de Recherche sur les Infections pendant la Grossesse, University Paris Saclay, INSERM U1193, Villejuif, France
| | - Beate Vollmer-Kary
- Institute for Surgical Pathology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany; Department of Medicine I, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Bénédicte Neven
- Imagine Institute, Université de Paris, Paris, France; Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmunity, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Pablo Vargas
- Institut Curie, Centre National de la Recherche Scientifique (CNRS) UMR 144 and Institut Pierre-Gilles de Gennes, and INSERM U932 Immunité et Cancer, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Fernando E Sepulveda
- Molecular Basis of Altered Immune Homeostasis Laboratory, Institut National de la Santé et de la Recherche Médicale (INSERM), Unite Mixte de Recherche (UMR) 1163, Paris, France; Imagine Institute, Université de Paris, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Schmitt-Graeff
- Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.
| |
Collapse
|
23
|
Cagdas D, Mayr D, Baris S, Worley L, Langley DB, Metin A, Aytekin ES, Atan R, Kasap N, Bal SK, Dmytrus J, Heredia RJ, Karasu G, Torun SH, Toyran M, Karakoc-Aydiner E, Christ D, Kuskonmaz B, Uçkan-Çetinkaya D, Uner A, Oberndorfer F, Schiefer AI, Uzel G, Deenick EK, Keller B, Warnatz K, Neven B, Durandy A, Sanal O, Ma CS, Özen A, Stepensky P, Tezcan I, Boztug K, Tangye SG. Genomic Spectrum and Phenotypic Heterogeneity of Human IL-21 Receptor Deficiency. J Clin Immunol 2021; 41:1272-1290. [PMID: 33929673 PMCID: PMC8086229 DOI: 10.1007/s10875-021-01031-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/29/2021] [Indexed: 01/04/2023]
Abstract
Biallelic inactivating mutations in IL21R causes a combined immunodeficiency that is often complicated by cryptosporidium infections. While eight IL-21R-deficient patients have been reported previously, the natural course, immune characteristics of disease, and response to hematopoietic stem cell transplantation (HSCT) remain to be comprehensively examined. In our study, we have collected clinical histories of 13 patients with IL-21R deficiency from eight families across seven centers worldwide, including five novel patients identified by exome or NGS panel sequencing. Eight unique mutations in IL21R were identified in these patients, including two novel mutations. Median age at disease onset was 2.5 years (0.5–7 years). The main clinical manifestations were recurrent bacterial (84.6%), fungal (46.2%), and viral (38.5%) infections; cryptosporidiosis-associated cholangitis (46.2%); and asthma (23.1%). Inflammatory skin diseases (15.3%) and recurrent anaphylaxis (7.9%) constitute novel phenotypes of this combined immunodeficiency. Most patients exhibited hypogammaglobulinemia and reduced proportions of memory B cells, circulating T follicular helper cells, MAIT cells and terminally differentiated NK cells. However, IgE levels were elevated in 50% of IL-21R-deficient patients. Overall survival following HSCT (6 patients, mean follow-up 1.8 year) was 33.3%, with pre-existing organ damage constituting a negative prognostic factor. Mortality of non-transplanted patients (n = 7) was 57.1%. Our detailed analysis of the largest cohort of IL-21R-deficient patients to date provides in-depth clinical, immunological and immunophenotypic features of these patients, thereby establishing critical non-redundant functions of IL-21/IL-21R signaling in lymphocyte differentiation, humoral immunity and host defense against infection, and mechanisms of disease pathogenesis due to IL-21R deficiency. Outcome following HSCT depends on prior chronic infections and organ damage, which should thus be considered as early as possible following molecular diagnosis.
Collapse
Affiliation(s)
- Deniz Cagdas
- Division of Pediatric Immunology, Department of Pediatrics, İhsan Doğramacı Children's Hospital, Hacettepe University Medical Faculty, Ankara, Turkey.
- Section of Pediatric Immunology, Institutes of Child Health, Health Science Institute, Hacettepe University, Ankara, Turkey.
| | - Daniel Mayr
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Safa Baris
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Lisa Worley
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - David B Langley
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Ayse Metin
- Department of Pediatric Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Elif Soyak Aytekin
- Division of Pediatric Immunology, Department of Pediatrics, İhsan Doğramacı Children's Hospital, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Raziye Atan
- Department of Pediatrics, Hacettepe University Medical Faculty, 1031, Ankara, Turkey
| | - Nurhan Kasap
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Sevgi Köstel Bal
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Jasmin Dmytrus
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Raul Jimenez Heredia
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gulsun Karasu
- School of Medicine, Goztepe Medicalpark Hospital, Pediatric stem Cell Transplantation Unit, İstinye University, İstanbul, Turkey
| | - Selda Hancerli Torun
- İstanbul Medical Faculty, Pediatric Infectious Disease, Istanbul University, İstanbul, Turkey
| | - Muge Toyran
- Department of Pediatric Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Elif Karakoc-Aydiner
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Daniel Christ
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Baris Kuskonmaz
- Department of Pediatrics, Division of Pediatric Hematology, Hacettepe University Medical School, Ankara, Turkey
| | - Duygu Uçkan-Çetinkaya
- Department of Pediatrics, Division of Pediatric Hematology, Hacettepe University Medical School, Ankara, Turkey
| | - Aysegul Uner
- Department of Pathology, Hacettepe University Medical School, Ankara, Turkey
| | | | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Elissa K Deenick
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Baerbel Keller
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bénédicte Neven
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker Children Hospital, Paris, France
| | - Anne Durandy
- Laboratory of Human Lymphohematopoiesis, Imagine Institute, INSERM UMR 1163, Université de Paris, Paris, France
| | - Ozden Sanal
- Division of Pediatric Immunology, Department of Pediatrics, İhsan Doğramacı Children's Hospital, Hacettepe University Medical Faculty, Ankara, Turkey
- Section of Pediatric Immunology, Institutes of Child Health, Health Science Institute, Hacettepe University, Ankara, Turkey
| | - Cindy S Ma
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Ahmet Özen
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Polina Stepensky
- Department of Bone Marrow Transplantation, Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilhan Tezcan
- Division of Pediatric Immunology, Department of Pediatrics, İhsan Doğramacı Children's Hospital, Hacettepe University Medical Faculty, Ankara, Turkey
- Section of Pediatric Immunology, Institutes of Child Health, Health Science Institute, Hacettepe University, Ankara, Turkey
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria.
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
- St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Stuart G Tangye
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.
| |
Collapse
|
24
|
Rubella Vaccine Persistence Within Cutaneous Granulomas in Common Variable Immunodeficiency Disorder. Am J Dermatopathol 2021; 42:455-457. [PMID: 31899704 DOI: 10.1097/dad.0000000000001598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Common variable immunodeficiency disorder is a primary immunodeficiency disorder characterized by reduced levels of serum immunoglobulins and impaired antibody response. This condition may be associated with development of noninfectious granulomatous dermatitis of the skin which may be disfiguring and destructive. There are no published guidelines for the treatment of cutaneous granulomas in this patient population. In recent studies, rubella virus-positive cells in granulomas were localized to M2 macrophages which have an important role in wound healing and the secretion of immunoregulatory cytokines. We present a case of treatment-refractory, disfiguring common variable immunodeficiency disorder-associated granulomatous dermatitis. Immunofluorescence microscopy of the biopsy specimen confirmed the presence of rubella vaccine capsid proteins in M2 macrophages within the granuloma, a newly recognized phenomenon in this patient population. This knowledge may serve to identify future therapeutic targets or preventative strategies for granulomatous dermatitis in patients with primary immunodeficiency disorder.
Collapse
|
25
|
Zanella MC, Cordey S, Laubscher F, Docquier M, Vieille G, Van Delden C, Braunersreuther V, Ta MK, Lobrinus JA, Masouridi-Levrat S, Chalandon Y, Kaiser L, Vu DL. Unmasking viral sequences by metagenomic next-generation sequencing in adult human blood samples during steroid-refractory/dependent graft-versus-host disease. MICROBIOME 2021; 9:28. [PMID: 33487167 PMCID: PMC7831233 DOI: 10.1186/s40168-020-00953-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/06/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Viral infections are common complications following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Allo-HSCT recipients with steroid-refractory/dependent graft-versus-host disease (GvHD) are highly immunosuppressed and are more vulnerable to infections with weakly pathogenic or commensal viruses. Here, twenty-five adult allo-HSCT recipients from 2016 to 2019 with acute or chronic steroid-refractory/dependent GvHD were enrolled in a prospective cohort at Geneva University Hospitals. We performed metagenomics next-generation sequencing (mNGS) analysis using a validated pipeline and de novo analysis on pooled routine plasma samples collected throughout the period of intensive steroid treatment or second-line GvHD therapy to identify weakly pathogenic, commensal, and unexpected viruses. RESULTS Median duration of intensive immunosuppression was 5.1 months (IQR 5.5). GvHD-related mortality rate was 36%. mNGS analysis detected viral nucleotide sequences in 24/25 patients. Sequences of ≥ 3 distinct viruses were detected in 16/25 patients; Anelloviridae (24/25) and human pegivirus-1 (9/25) were the most prevalent. In 7 patients with fatal outcomes, viral sequences not assessed by routine investigations were identified with mNGS and confirmed by RT-PCR. These cases included Usutu virus (1), rubella virus (1 vaccine strain and 1 wild-type), novel human astrovirus (HAstV) MLB2 (1), classic HAstV (1), human polyomavirus 6 and 7 (2), cutavirus (1), and bufavirus (1). CONCLUSIONS Clinically unrecognized viral infections were identified in 28% of highly immunocompromised allo-HSCT recipients with steroid-refractory/dependent GvHD in consecutive samples. These identified viruses have all been previously described in humans, but have poorly understood clinical significance. Rubella virus identification raises the possibility of re-emergence from past infections or vaccinations, or re-infection. Video abstract.
Collapse
Affiliation(s)
- M C Zanella
- Division of Infectious Diseases, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland.
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland.
| | - S Cordey
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- University of Geneva Medical School, Geneva, Switzerland
| | - F Laubscher
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- University of Geneva Medical School, Geneva, Switzerland
| | - M Docquier
- iGE3 Genomics Platform, University of Geneva, Geneva, Switzerland
- Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
| | - G Vieille
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
| | - C Van Delden
- Division of Infectious Diseases, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- University of Geneva Medical School, Geneva, Switzerland
| | - V Braunersreuther
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Mc Kee Ta
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - J A Lobrinus
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - S Masouridi-Levrat
- University of Geneva Medical School, Geneva, Switzerland
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Y Chalandon
- University of Geneva Medical School, Geneva, Switzerland
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - L Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- University of Geneva Medical School, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva, Switzerland
| | - D L Vu
- Division of Infectious Diseases, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14, Geneva, Switzerland
- University of Geneva Medical School, Geneva, Switzerland
| |
Collapse
|
26
|
Rubella virus-associated chronic inflammation in primary immunodeficiency diseases. Curr Opin Allergy Clin Immunol 2020; 20:574-581. [PMID: 33044342 DOI: 10.1097/aci.0000000000000694] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW The aim of this article is to summarize recent data on rubella virus (RuV) vaccine in chronic inflammation focusing on granulomas in individuals with primary immunodeficiencies (PIDs). RECENT FINDINGS The live attenuated RuV vaccine has been recently associated with cutaneous and visceral granulomas in children with various PIDs. RuV vaccine strain can persist for decades subclinically in currently unknown body site(s) before emerging in granulomas. Histologically, RuV is predominately localized in M2 macrophages in the granuloma centers. Multiple mutations accumulate during persistence resulting in emergence of immunodeficiency-related vaccine-derived rubella viruses (iVDRVs) with altered immunological, replication, and persistence properties. Viral RNA was detected in granuloma biopsies and nasopharyngeal secretions and infectious virus were isolated from the granuloma lesions. The risk of iVDRV transmissibility to contacts needs to be evaluated. Several broad-spectrum antiviral drugs have been tested recently but did not provide significant clinical improvement. Hematopoietic stem cell transplantation remains the only reliable option for curing chronic RuV-associated granulomas in PIDs. SUMMARY Persistence of vaccine-derived RuVs appears to be a crucial factor in a significant proportion of granulomatous disease in PIDs. RuV testing of granulomas in PID individuals might help with case management.
Collapse
|
27
|
Perelygina L, Chen MH, Suppiah S, Adebayo A, Abernathy E, Dorsey M, Bercovitch L, Paris K, White KP, Krol A, Dhossche J, Torshin IY, Saini N, Klimczak LJ, Gordenin DA, Zharkikh A, Plotkin S, Sullivan KE, Icenogle J. Infectious vaccine-derived rubella viruses emerge, persist, and evolve in cutaneous granulomas of children with primary immunodeficiencies. PLoS Pathog 2019; 15:e1008080. [PMID: 31658304 PMCID: PMC6837625 DOI: 10.1371/journal.ppat.1008080] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/07/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
Rubella viruses (RV) have been found in an association with granulomas in children with primary immune deficiencies (PID). Here, we report the recovery and characterization of infectious immunodeficiency-related vaccine-derived rubella viruses (iVDRV) from diagnostic skin biopsies of four patients. Sequence evolution within PID hosts was studied by comparison of the complete genomic sequences of the iVDRVs with the genome of the vaccine virus RA27/3. The degree of divergence of each iVDRV correlated with the duration of persistence indicating continuous intrahost evolution. The evolution rates for synonymous and nonsynonymous substitutions were estimated to be 5.7 x 10-3 subs/site/year and 8.9 x 10-4 subs/site/year, respectively. Mutational spectra and signatures indicated a major role for APOBEC cytidine deaminases and a secondary role for ADAR adenosine deaminases in generating diversity of iVDRVs. The distributions of mutations across the genes and 3D hotspots for amino acid substitutions in the E1 glycoprotein identified regions that may be under positive selective pressure. Quasispecies diversity was higher in granulomas than in recovered infectious iVDRVs. Growth properties of iVDRVs were assessed in WI-38 fibroblast cultures. None of the iVDRV isolates showed complete reversion to wild type phenotype but the replicative and persistence characteristics of iVDRVs were different from those of the RA27/3 vaccine strain, making predictions of iVDRV transmissibility and teratogenicity difficult. However, detection of iVDRV RNA in nasopharyngeal specimen and poor neutralization of some iVDRV strains by sera from vaccinated persons suggests possible public health risks associated with iVDRV carriers. Detection of IgM antibody to RV in sera of two out of three patients may be a marker of virus persistence, potentially useful for identifying patients with iVDRV before development of lesions. Studies of the evolutionary dynamics of iVDRV during persistence will contribute to development of infection control strategies and antiviral therapies.
Collapse
Affiliation(s)
- Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Min-hsin Chen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Suganthi Suppiah
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adebola Adebayo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily Abernathy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Morna Dorsey
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lionel Bercovitch
- Department of Dermatology, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Kenneth Paris
- Division of Allergy and Immunology, Children's Hospital New Orleans, New Orleans, Louisiana, United States of America
| | - Kevin P. White
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Alfons Krol
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Julie Dhossche
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ivan Y. Torshin
- Institute of Pharmacoinformatics, Federal Research Center “Computer Science and Control” of Russian Academy of Sciences, Dorodnicyn Computing Center, Moscow, Russian Federation
| | - Natalie Saini
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, US National Institutes of Health, Research Triangle Park, North Carolina, United States of America
| | - Leszek J. Klimczak
- Integrative Bioinformatics Support Group, National Institute of Environmental Health Sciences, US National Institutes of Health, Research Triangle Park, North Carolina, United States of America
| | - Dmitry A. Gordenin
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, US National Institutes of Health, Research Triangle Park, North Carolina, United States of America
| | - Andrey Zharkikh
- Myriad Genetics, Inc., Salt Lake City, Utah, United States of America
| | - Stanley Plotkin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Kathleen E. Sullivan
- Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Joseph Icenogle
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| |
Collapse
|
28
|
Taylor AMR, Rothblum-Oviatt C, Ellis NA, Hickson ID, Meyer S, Crawford TO, Smogorzewska A, Pietrucha B, Weemaes C, Stewart GS. Chromosome instability syndromes. Nat Rev Dis Primers 2019; 5:64. [PMID: 31537806 PMCID: PMC10617425 DOI: 10.1038/s41572-019-0113-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 01/28/2023]
Abstract
Fanconi anaemia (FA), ataxia telangiectasia (A-T), Nijmegen breakage syndrome (NBS) and Bloom syndrome (BS) are clinically distinct, chromosome instability (or breakage) disorders. Each disorder has its own pattern of chromosomal damage, with cells from these patients being hypersensitive to particular genotoxic drugs, indicating that the underlying defect in each case is likely to be different. In addition, each syndrome shows a predisposition to cancer. Study of the molecular and genetic basis of these disorders has revealed mechanisms of recognition and repair of DNA double-strand breaks, DNA interstrand crosslinks and DNA damage during DNA replication. Specialist clinics for each disorder have provided the concentration of expertise needed to tackle their characteristic clinical problems and improve outcomes. Although some treatments of the consequences of a disorder may be possible, for example, haematopoietic stem cell transplantation in FA and NBS, future early intervention to prevent complications of disease will depend on a greater understanding of the roles of the affected DNA repair pathways in development. An important realization has been the predisposition to cancer in carriers of some of these gene mutations.
Collapse
Affiliation(s)
- A Malcolm R Taylor
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | | | - Nathan A Ellis
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ian D Hickson
- Center for Chromosome Stability, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Meyer
- Stem Cell and Leukaemia Proteomics Laboratory, and Paediatric and Adolescent Oncology, Institute of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Royal Manchester Children's Hospital and The Christie NHS Trust, Manchester, UK
| | - Thomas O Crawford
- Department of Neurology and Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Agata Smogorzewska
- Laboratory of Genome Maintenance, Rockefeller University, New York, NY, USA
| | - Barbara Pietrucha
- Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Corry Weemaes
- Department of Pediatrics (Pediatric Immunology), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Grant S Stewart
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
29
|
Dhossche J, Johnson L, White K, Funk T, Leitenberger S, Perelygina L, Krol A. Cutaneous Granulomatous Disease With Presence of Rubella Virus in Lesions. JAMA Dermatol 2019; 155:859-861. [PMID: 31166586 PMCID: PMC10981170 DOI: 10.1001/jamadermatol.2019.0814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Julie Dhossche
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Luke Johnson
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Kevin White
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Tracy Funk
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Sabra Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Ludmila Perelygina
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
30
|
Pöyhönen L, Bustamante J, Casanova JL, Jouanguy E, Zhang Q. Life-Threatening Infections Due to Live-Attenuated Vaccines: Early Manifestations of Inborn Errors of Immunity. J Clin Immunol 2019; 39:376-390. [PMID: 31123910 DOI: 10.1007/s10875-019-00642-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023]
Abstract
Live-attenuated vaccines (LAVs) can protect humans against 12 viral and three bacterial diseases. By definition, any clinical infection caused by a LAV that is sufficiently severe to require medical intervention attests to an inherited or acquired immunodeficiency that must be diagnosed or identified. Self-healing infections can also result from milder forms of immunodeficiency. We review here the inherited forms of immunodeficiency underlying severe infections of LAVs. Inborn errors of immunity (IEIs) underlying bacille Calmette-Guérin (BCG), oral poliovirus (OPV), vaccine measles virus (vMeV), and oral rotavirus vaccine (ORV) disease have been described from 1951, 1963, 1966, and 2009 onward, respectively. For each of these four LAVs, the underlying IEIs show immunological homogeneity despite genetic heterogeneity. Specifically, BCG disease is due to inborn errors of IFN-γ immunity, OPV disease to inborn errors of B cell immunity, vMeV disease to inborn errors of IFN-α/β and IFN-λ immunity, and ORV disease to adaptive immunity. Severe reactions to the other 11 LAVs have been described yet remain "idiopathic," in the absence of known underlying inherited or acquired immunodeficiencies, and are warranted to be the focus of research efforts. The study of IEIs underlying life-threatening LAV infections is clinically important for the affected patients and their families, as well as immunologically, for the study of the molecular and cellular basis of host defense against both attenuated and parental pathogens.
Collapse
Affiliation(s)
- Laura Pöyhönen
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Jacinta Bustamante
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,Center for the Study of Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,Pediatric Hematology-Immunology Unit, Necker Hospital for Sick Children, Paris, France.,Howard Hughes Medical Institute, New York, NY, USA
| | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Qian Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.
| |
Collapse
|
31
|
Murguia-Favela L, Hiebert J, Haber RM. “Noninfectious” Cutaneous Granulomas in Primary Immunodeficiency Patients and Association With Rubella Virus Vaccine Strain. J Cutan Med Surg 2019; 23:341-342. [DOI: 10.1177/1203475419825780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Luis Murguia-Favela
- Section of Hematology/Immunology Department of Pediatrics, University of Calgary, AB, Canada
| | - Joanne Hiebert
- Viral Exanthemata and STDs Section, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Richard M. Haber
- Section of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| |
Collapse
|
32
|
Leclerc-Mercier S, Moshous D, Neven B, Mahlaoui N, Martin L, Pellier I, Blanche S, Picard C, Fischer A, Perot P, Eloit M, Fraitag S, Bodemer C. Cutaneous granulomas with primary immunodeficiency in children: a report of 17 new patients and a review of the literature. J Eur Acad Dermatol Venereol 2019; 33:1412-1420. [PMID: 30869812 DOI: 10.1111/jdv.15568] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric cutaneous granuloma with primary immunodeficiency (PID) is a rare condition. The physiopathology is unclear, and treatment is challenging. We report on 17 paediatric cases and review the literature. OBJECTIVES To make dermatologists and dermatopathologists aware of the diagnostic value of skin granulomas in paediatric PID. METHODS We collected data on 17 patients with cutaneous granulomas and PID registered with us and also reviewed 33 cases from the literature. RESULTS Cutaneous granuloma was the presenting feature of the PID in 15 of the 50 collated cases. The lesions presented as red-brownish nodules and infiltrated ulcerative plaques, predominantly on the face and limbs. Scleroderma-like infiltration on a single limb was observed in 10% of the cases. The associated PID was ataxia-telangiectasia (52%), combined immunodeficiency (24%), cartilage-hair hypoplasia (6%) and other subtypes (18%). The granulomas were mostly sarcoidal, tuberculoid, palisaded or undefined subtypes. In some patients, several different histopathologic granulomatous patterns were found in the same biopsy. Some granulomas were associated with the presence of a vaccine strain of rubella virus. CONCLUSION Cutaneous granulomas associated with a PID have a variable clinical presentation. A PID can be suspected when crusty, brownish lesions are found on the face or limbs. The concomitant presence of several histological subtypes in a single patient is suggestive of a PID.
Collapse
Affiliation(s)
- S Leclerc-Mercier
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Necker-Enfants Malades Hospital, APHP, Paris, France.,Department of Dermatology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - D Moshous
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France
| | - B Neven
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France
| | - N Mahlaoui
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,National Reference Centre for Primary Immune Deficiency (CEREDIH), Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L Martin
- Department of Dermatology, UNAM University, Angers University Hospital, Angers, France
| | - I Pellier
- Departments of Pediatric Hematology, UNAM University, Angers University Hospital, Angers, France
| | - S Blanche
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France.,National Reference Centre for Primary Immune Deficiency (CEREDIH), Necker-Enfants Malades Hospital, APHP, Paris, France
| | - C Picard
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France.,National Reference Centre for Primary Immune Deficiency (CEREDIH), Necker-Enfants Malades Hospital, APHP, Paris, France.,Study center of primary immunodeficiency, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - A Fischer
- Department of Immunohematology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France.,National Reference Centre for Primary Immune Deficiency (CEREDIH), Necker-Enfants Malades Hospital, APHP, Paris, France.,Collège de France, Paris, France
| | - P Perot
- Biology of Infection Unit, Institut Pasteur, Inserm U1117, Laboratory of Pathogen Discovery, Paris, France
| | - M Eloit
- Biology of Infection Unit, Institut Pasteur, Inserm U1117, Laboratory of Pathogen Discovery, Paris, France.,Ecole Nationale Vétérinaire d'Alfort, Virologie, Maisons Alfort, France
| | - S Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Necker-Enfants Malades Hospital, APHP, Paris, France
| | - C Bodemer
- National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Necker-Enfants Malades Hospital, APHP, Paris, France.,Department of Dermatology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Imagine Institute, Inserm U 1163, Descartes University, Paris Sorbonne Cité, Paris, France
| |
Collapse
|
33
|
Minto H, Mensah KA, Reynolds PR, Meffre E, Rubtsova K, Gelfand EW. A novel ATM mutation associated with elevated atypical lymphocyte populations, hyper-IgM, and cutaneous granulomas. Clin Immunol 2019; 200:55-63. [PMID: 30639167 PMCID: PMC7027322 DOI: 10.1016/j.clim.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022]
Abstract
Ataxia-Telangiectasia (AT) is an immunodeficiency most often associated with T cell abnormalities. We describe a patient with a hyper-IgM phenotype and immune cell abnormalities that suggest a distinct clinical phenotype. Significant B cell abnormalities with increased unswitched memory B cells, decreased naive transitional B cells, and an elevated frequency of CD19+CD38loCD27-CD10-CD21-/low B cells expressing high levels of T-bet and Fas were demonstrated. The B cells were hyporesponsive to in vitro stimulation through the B cell receptor, Toll like receptors (TLR) 7 and 9, and CD40. T cell homeostasis was also disturbed with a significant increase in γδ T cells, circulating T follicular helper cells (Tfh), and decreased numbers of T regulatory cells. The ATM mutations in this patient are posited to have resulted in the perturbations in the frequencies and distributions of B and T cell subsets, resulting in the phenotype in this patient. KEY MESSAGES: A novel mutation creating a premature stop codon and a nonsense mutation in the ATM gene are postulated to have resulted in the unique clinical picture characterized by abnormal B and T cell populations, lymphocyte subset dysfunction, granuloma formation, and a hyper-IgM phenotype. CAPSULE SUMMARY: A patient presented with ataxia-telangiectasia, cutaneous granulomas, and a hyper-IgM phenotype; a novel combination of mutations in the ATM gene was associated with abnormal distributions, frequencies, and function of T and B lymphocyte subsets.
Collapse
Affiliation(s)
- Heather Minto
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO 80206, United States
| | - Kofi A Mensah
- Department of Immunobiology and Division of Rheumatology, Yale University School of Medicine, New Haven, CT 06511, United States
| | - Paul R Reynolds
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO 80206, United States
| | - Eric Meffre
- Department of Immunobiology and Division of Rheumatology, Yale University School of Medicine, New Haven, CT 06511, United States
| | - Kira Rubtsova
- Department of Biomedical Research, National Jewish Health, Denver, CO 80206, United States
| | - Erwin W Gelfand
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO 80206, United States.
| |
Collapse
|
34
|
Perelygina L, Buchbinder D, Dorsey MJ, Eloit M, Hauck F, Hautala T, Moshous D, Uriarte I, Deripapa E, Icenogle J, Sullivan KE. Outcomes for Nitazoxanide Treatment in a Case Series of Patients with Primary Immunodeficiencies and Rubella Virus-Associated Granuloma. J Clin Immunol 2019; 39:112-117. [PMID: 30680653 DOI: 10.1007/s10875-019-0589-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Nitazoxanide was recently reported as having in vitro effectiveness against the rubella virus. Immunodeficiency-related vaccine-derived rubella occurs in some patients who have an inherited immunodeficiency and who received the MMR vaccine. This study investigated the in vivo effectiveness of nitazoxanide therapy. METHODS This is a retrospective analysis of seven patients treated with nitazoxanide as salvage therapy for immunodeficiency-related vaccine-derived rubella infection. The patients were recruited from an ongoing rubella detection surveillance project. RESULTS Seven patients with persistent rubella were treated with nitazoxanide and one demonstrated significant clinical improvement. Two additional patients exhibited diminished viral capsid production with one patient having transient slowing of progression. The cohort overall generally had low T cell counts and had a high burden of comorbidities. There were three deaths. Two deaths were from PML and one was related to hematopoietic stem cell transplantation. CONCLUSIONS Nitazoxanide has limited in vivo anti-viral effects for immunodeficiency-related vaccine-derived rubella. Most patients did not exhibit clinical improvement.
Collapse
Affiliation(s)
- Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, CA, USA
| | - Morna J Dorsey
- Department of Pediatrics, Division of Allergy, Immunology, and Blood and Marrow Transplant, Benioff Children's Hospital, University of California, San Francisco, 1975 4th Street, San Francisco, CA, 94158, USA
| | - Marc Eloit
- Institut Pasteur, Laboratory of Pathogen Discovery, Biology of Infection Unit, Inserm U1117, Paris, France
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Timo Hautala
- Research Unit of Internal Medicine, University of Oulu and Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Despina Moshous
- Department of Pediatric Immunology, Hematology and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker Children's Hospital, Paris, France.,Laboratory "Genome Dynamics in The Immune System," INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Ignacio Uriarte
- Immunology Unit, The Child's and Mother Hospital, Vitorio Tetamanti, High School of Medicine, Mar del Plata National University, Castelli 2450 Mar del Plata, 7600, Buenos Aires, Argentina
| | - Elena Deripapa
- Department of Immunology, Center for Pediatric Hematology, Oncology, Immunology, Moscow, Russia
| | - Joseph Icenogle
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| |
Collapse
|
35
|
Haddad-Boubaker S, Joffret ML, Pérot P, Bessaud M, Meddeb Z, Touzi H, Delpeyroux F, Triki H, Eloit M. Metagenomic analysis identifies human adenovirus 31 in children with acute flaccid paralysis in Tunisia. Arch Virol 2019; 164:747-755. [DOI: 10.1007/s00705-018-04141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/29/2018] [Indexed: 01/24/2023]
|
36
|
Buchbinder D, Hauck F, Albert MH, Rack A, Bakhtiar S, Shcherbina A, Deripapa E, Sullivan KE, Perelygina L, Eloit M, Neven B, Pérot P, Moshous D, Suarez F, Bodemer C, Bonilla FA, Vaz LE, Krol AL, Klein C, Seppanen M, Nugent DJ, Singh J, Ochs HD. Rubella Virus-Associated Cutaneous Granulomatous Disease: a Unique Complication in Immune-Deficient Patients, Not Limited to DNA Repair Disorders. J Clin Immunol 2019; 39:81-89. [PMID: 30607663 DOI: 10.1007/s10875-018-0581-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
Abstract
The association of immunodeficiency-related vaccine-derived rubella virus (iVDRV) with cutaneous and visceral granulomatous disease has been reported in patients with primary immunodeficiency disorders (PIDs). The majority of these PID patients with rubella-positive granulomas had DNA repair disorders. To support this line of inquiry, we provide additional descriptive data on seven previously reported patients with Nijmegen breakage syndrome (NBS) (n = 3) and ataxia telangiectasia (AT) (n = 4) as well as eight previously unreported patients with iVDRV-induced cutaneous granulomas and DNA repair disorders including NBS (n = 1), AT (n = 5), DNA ligase 4 deficiency (n = 1), and Artemis deficiency (n = 1). We also provide descriptive data on several previously unreported PID patients with iVDRV-induced cutaneous granulomas including cartilage hair hypoplasia (n = 1), warts, hypogammaglobulinemia, immunodeficiency, myelokathexis (WHIM) syndrome (n = 1), MHC class II deficiency (n = 1), Coronin-1A deficiency (n = 1), X-linked severe combined immunodeficiency (X-SCID) (n = 1), and combined immunodeficiency without a molecular diagnosis (n = 1). At the time of this report, the median age of the patients with skin granulomas and DNA repair disorders was 9 years (range 3-18). Cutaneous granulomas have been documented in all, while visceral granulomas were observed in six cases (40%). All patients had received rubella virus vaccine. The median duration of time elapsed from vaccination to the development of cutaneous granulomas was 48 months (range 2-152). Hematopoietic cell transplantation was reported to result in scarring resolution of cutaneous granulomas in two patients with NBS, one patient with AT, one patient with Artemis deficiency, one patient with DNA Ligase 4 deficiency, one patient with MHC class II deficiency, and one patient with combined immunodeficiency without a known molecular etiology. Of the previously reported and unreported cases, the majority share the diagnosis of a DNA repair disorder. Analysis of additional patients with this complication may clarify determinants of rubella pathogenesis, identify specific immune defects resulting in chronic infection, and may lead to defect-specific therapies.
Collapse
Affiliation(s)
- David Buchbinder
- Department of Pediatric Hematology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
- Department of Pediatrics, University of California at Irvine, Orange, CA, USA.
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Anita Rack
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Shahrzad Bakhtiar
- Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Anna Shcherbina
- Department of Immunology, Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena Deripapa
- Department of Immunology, Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Eloit
- Biology of Infection Unit, Pathogen Discovery Laboratory, Institut Pasteur, Paris, France
| | - Bénédicte Neven
- Unité d'Immunologie-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants-Malades, AP-HP, Paris, France
- INSERM U116 and Institut Imagine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Pérot
- Biology of Infection Unit, Pathogen Discovery Laboratory, Institut Pasteur, Paris, France
- Centre d'innovation et de Recherche Technologique (Citech), Institut Pasteur, Paris, France
| | - Despina Moshous
- Unité d'Immunologie-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants-Malades, AP-HP, Paris, France
- INSERM U116 and Institut Imagine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | - Félipe Suarez
- Unité d'hématologie adulte, Hopital Necker-Enfants-Malades, AP-HP, INSERM U116 & Institut Imagine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Bodemer
- Service de dermatologie pédiatrique, Hopital Necker-Enfants-Malades, AP-HP, INSERM U116 & Institut Imagine, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Louise E Vaz
- Department of Infectious Disease, Doernbecher Children's Hospital, Oregon Health Sciences University, Portland, OR, USA
| | - Alfons L Krol
- Department of Dermatology, Doernbecher Children's Hospital, Oregon Health Sciences University, Portland, OR, USA
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Mikko Seppanen
- Rare Disease Center, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Diane J Nugent
- Department of Pediatric Hematology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
- Department of Pediatrics, University of California at Irvine, Orange, CA, USA
| | - Jasjit Singh
- Department of Pediatrics, University of California at Irvine, Orange, CA, USA
- Department of Infectious Disease, Children's Hospital of Orange County, Orange, CA, USA
| | - Hans D Ochs
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| |
Collapse
|
37
|
Meyer AK, Banks M, Nadasdy T, Clark JJ, Zheng R, Gelfand EW, Abbott JK. Vasculitis in a Child With the Hyper-IgM Variant of Ataxia-Telangiectasia. Front Pediatr 2019; 7:390. [PMID: 31709200 PMCID: PMC6821675 DOI: 10.3389/fped.2019.00390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
A subset of patients with Ataxia-Telangiectasia (A-T) have dramatically reduced levels of IgG, IgA, and IgE with retained or elevated IgM levels. Several reports suggest that these A-T patients with a "hyper-IgM phenotype" (HIgM) suffer more clinical immunologic consequences than other A-T patients. The immunopathologic mechanism driving this phenomenon is unknown, making it difficult to predict response to immunomodulatory therapy. We describe an A-T patient with HIgM who underwent tumor necrosis factor (TNF) receptor blockade for cutaneous granuloma and after several months of successful therapy developed non-malignant lymphoproliferation, cytopenia, and increased serum immunoglobulin levels. This process was subsequently followed by an immune-complex-mediated intrarenal small vessel vasculitis that led to renal failure. The vasculitis was successfully treated with rituximab and corticosteroids. This case underscores the importance of HIgM as an unfavorable prognostic indicator in A-T and highlights the complexity of immunomodulatory treatment in this population, and the potential for a successful approach tailored to the immune defect.
Collapse
Affiliation(s)
- Anna K Meyer
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Mindy Banks
- Rocky Mountain Hospital for Children, Denver, CO, United States
| | - Tibor Nadasdy
- Department of Pathology, Ohio State University, Columbus, OH, United States
| | | | - Rui Zheng
- Rocky Mountain Hospital for Children, Denver, CO, United States
| | - Erwin W Gelfand
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Jordan K Abbott
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, CO, United States
| |
Collapse
|
38
|
Woelke S, Valesky E, Bakhtiar S, Pommerening H, Pfeffermann LM, Schubert R, Zielen S. Treatment of Granulomas in Patients With Ataxia Telangiectasia. Front Immunol 2018; 9:2000. [PMID: 30279689 PMCID: PMC6153364 DOI: 10.3389/fimmu.2018.02000] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Ataxia telangiectasia (A-T) is a devastating multi-system disorder characterized by progressive cerebellar ataxia, growth retardation, immunodeficiency, chronic pulmonary disease and chromosomal instability. Cutaneous granulomas are a known phenomenon in A-T but extra-dermal manifestation of granulomas at bone and synovia has not been reported so far. The clinical presentation, immunological findings, the long-term course and treatment options of eight patients with severe granulomas will be reported. Methods: From our cohort of 44 classical A-T patients, eight patients aged 2–11 years (18.2%) presented with granulomas. Immunological features of patients with and without granulomas were compared. Five patients suffered from cutaneous manifestation, in two patients we detected a bone and in one a joint involvement. Patients with significant extra-dermal involvement as well as one patient with massive skin manifestation were treated with TNF inhibitors. The patient with granulomas at his finger joint and elbow was treated with hematopoietic stem cell transplantation (HSCT). Results: Interestingly, seven of eight patients with granulomas were total IgA deficient, but there were no differences in IgG and IgM levels. All lymphocytes subsets were equally distributed except patients with granuloma had significantly lower naïve CD8 cells. In patients without treatment, four of eight showed a slow but significant enlargement of the granuloma. Treatment success with TNF inhibitors was variable. In one patient, treatment with TNF inhibitors led to a total remission for 3 years up to now. In two patients, treatment with TNF inhibitors led to a partial regression of granulomas. Treatment interruptions caused deterioration again. Conclusions: Granulomas in A-T progress slowly over years and can lead to significant morbidity.Treatment with TNF inhibitors was safe and in part successful in our patients. Interestingly HSCT leads to complete remission, and indicates that aberrant immune function is responsible for granulomas in A-T patients. What This Study Adds to the Field: Granulomas in A-T progress slowly over years and can lead to significant morbidity. Treatment with TNF inhibitors was safe and in part successful in our patients. AT A GLANCE COMMENTARY: Scientific knowledge on the subject: Little is known about the clinical presentation, course and treatment of granulomas in ataxia telangiectasia (A-T). In addition, this is the first report of extra-dermal manifestation of granulomas at bone and synovia in patients with A-T. What This Study Adds to the Field: Granulomas in A-T progress slowly over years and can lead to significant morbidity. Treatment with TNF inhibitors was safe and in part successful in our patients.
Collapse
Affiliation(s)
- Sandra Woelke
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Eva Valesky
- Department of Dermatology, Venereology and Allergology, Goethe University, Frankfurt, Germany
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Helena Pommerening
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - L M Pfeffermann
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Ralf Schubert
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Stefan Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| |
Collapse
|
39
|
Leung J, Sullivan KE, Perelygina L, Icenogle JP, Fuleihan RL, Lanzieri TM. Prevalence of Granulomas in Patients With Primary Immunodeficiency Disorders, United States: Data From National Health Care Claims and the US Immunodeficiency Network Registry. J Clin Immunol 2018; 38:717-726. [PMID: 30043271 DOI: 10.1007/s10875-018-0534-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Granulomas are a potentially severe condition that can last for several years in persons with primary immunodeficiency disorders (PIDD). We assessed the prevalence of granulomas in patients with PIDD. METHODS We used the Truven Health MarketScan® 2005-2015 Commercial Claims and Encounters and 2006-2015 Medicaid databases and the US Immunodeficiency Network (USIDNET) PIDD registry (a program of the Immune Deficiency Foundation). Our study population consisted of persons age < 65 years with PIDD, defined as persons with ≥ 2 claims with a diagnostic code for PIDD in MarketScan databases, or patients enrolled in USIDNET. Granulomas were identified using diagnostic codes in MarketScan or provider report in USIDNET. We calculated annual prevalence of PIDD and of granulomas among PIDD patients. RESULTS We identified 247,474 and 40,395 persons with PIDD among commercially and Medicaid-insured persons, respectively. PIDD prevalence was 6.0/10,000 in 2005 and 11.7/10,000 in 2015 among commercially insured persons and 5.5/10,000 in 2006 and 9.6/10,000 in 2015 among Medicaid-insured persons. The prevalence of granulomas among PIDD patients was 1.2 and 1.5% among commercially and Medicaid-insured persons, respectively. In USIDNET, prevalence of granulomas was 4.4% (177/4021). The proportion with granulomas was similar across age groups in MarketScan, but varied from 2 to 9% in USIDNET. The reported prevalence of granulomas differed depending on PIDD condition: 1-2% in the MarketScan data and 0-13% in USIDNET. CONCLUSION Granuloma prevalence in PIDD patients was 1-4%. Our study provides an estimate of the proportion of PIDD patients and suggests that granulomas are an uncommon occurrence among patients with PIDD.
Collapse
Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA.
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ludmila Perelygina
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
| | - Joseph P Icenogle
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
| | - Ramsay L Fuleihan
- Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, 60611, USA
| | - Tatiana M Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
| |
Collapse
|
40
|
Update: Vaccines in primary immunodeficiency. J Allergy Clin Immunol 2017; 141:474-481. [PMID: 29288077 DOI: 10.1016/j.jaci.2017.12.980] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
Abstract
Vaccines were originally developed to prevent or ameliorate infectious disease. As knowledge of immune function and appreciation of immunodeficiency has developed, researchers have used vaccine responses as a tool to characterize the phenotypes of patients exhibiting various syndromes. Thus it has become possible for a clinician to evaluate individual responses to vaccines to interrogate the immunocompetence of their patients. Although there have been many advances in these areas, we still have much to learn about the quantity and quality of humoral and cellular vaccine responses in healthy and immunodeficient subjects and how that knowledge can then be extrapolated to diagnostic purposes. Adverse effects of vaccines have been recognized for many years, especially the occurrence of infections caused by viable vaccine organisms in immunodeficient hosts. Nevertheless, vaccines are essential for disease prevention in immunodeficient patients, just as they are for healthy subjects. Clinicians must understand the appropriate and safe use of vaccines in patients with immunodeficiency. This review highlights some recent advances and ongoing challenges in application of vaccines for the diagnosis and treatment of immunodeficiencies.
Collapse
|
41
|
Ruppé E, Cherkaoui A, Lazarevic V, Emonet S, Schrenzel J. Establishing Genotype-to-Phenotype Relationships in Bacteria Causing Hospital-Acquired Pneumonia: A Prelude to the Application of Clinical Metagenomics. Antibiotics (Basel) 2017; 6:antibiotics6040030. [PMID: 29186015 PMCID: PMC5745473 DOI: 10.3390/antibiotics6040030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 01/20/2023] Open
Abstract
Clinical metagenomics (CMg), referred to as the application of next-generation sequencing (NGS) to clinical samples, is a promising tool for the diagnosis of hospital-acquired pneumonia (HAP). Indeed, CMg allows identifying pathogens and antibiotic resistance genes (ARGs), thereby providing the information required for the optimization of the antibiotic regimen. Hence, provided that CMg would be faster than conventional culture, the probabilistic regimen used in HAP could be tailored faster, which should lead to an expected decrease of mortality and morbidity. While the inference of the antibiotic susceptibility testing from metagenomic or even genomic data is challenging, a limited number of antibiotics are used in the probabilistic regimen of HAP (namely beta-lactams, aminoglycosides, fluoroquinolones, glycopeptides and oxazolidinones). Accordingly, based on the perspective of applying CMg to the early diagnostic of HAP, we aimed at reviewing the performances of whole genomic sequencing (WGS) of the main HAP-causing bacteria (Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia and Staphylococcus aureus) for the prediction of susceptibility to the antibiotic families advocated in the probabilistic regimen of HAP.
Collapse
Affiliation(s)
- Etienne Ruppé
- Genomic Research Laboratory, Geneva University Hospitals, CMU-9F, Rue Michel Servet 1, CH-1211 Geneva 14, Switzerland.
| | - Abdessalam Cherkaoui
- Laboratory of Bacteriology, University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, CMU-9F, Rue Michel Servet 1, CH-1211 Geneva 14, Switzerland.
| | - Stéphane Emonet
- Service of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
| | - Jacques Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, CMU-9F, Rue Michel Servet 1, CH-1211 Geneva 14, Switzerland.
- Laboratory of Bacteriology, University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
- Service of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
| |
Collapse
|
42
|
Inhibition of rubella virus replication by the broad-spectrum drug nitazoxanide in cell culture and in a patient with a primary immune deficiency. Antiviral Res 2017; 147:58-66. [PMID: 28974385 PMCID: PMC7127570 DOI: 10.1016/j.antiviral.2017.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022]
Abstract
Persistent rubella virus (RV) infection has been associated with various pathologies such as congenital rubella syndrome, Fuchs's uveitis, and cutaneous granulomas in patients with primary immune deficiencies (PID). Currently there are no drugs to treat RV infections. Nitazoxanide (NTZ) is an FDA-approved drug for parasitic infections, and has been recently shown to have broad-spectrum antiviral activities. Here we found that empiric 2-month therapy with oral NTZ was associated in the decline/elimination of RV antigen from lesions in a PID patient with RV positive granulomas, while peginterferon treatment had no effect. In addition, we characterized the effects of NTZ on cell culture models of persistent RV infection. NTZ significantly inhibited RV replication in a primary culture of human umbilical vein endothelial cells (HUVEC) and Vero and A549 epithelial cell lines in a dose dependent manner with an average 50% inhibitory concentration of 0.35 μg/ml (1.1 μM). RV strains representing currently circulating genotypes were inhibited to a similar extent. NTZ affected early and late stages of infection by inhibiting synthesis of cellular and RV RNA and interfering with intracellular trafficking of the RV surface glycoproteins, E1 and E2. These results suggest a potential application of NTZ for the treatment of persistent rubella infections, but more studies are required.
Collapse
|
43
|
Ruppé E, Lazarevic V, Girard M, Mouton W, Ferry T, Laurent F, Schrenzel J. Clinical metagenomics of bone and joint infections: a proof of concept study. Sci Rep 2017; 7:7718. [PMID: 28798333 PMCID: PMC5552814 DOI: 10.1038/s41598-017-07546-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/29/2017] [Indexed: 12/19/2022] Open
Abstract
Bone and joint infections (BJI) are severe infections that require a tailored and protracted antibiotic treatment. Yet, the diagnostic based on culturing samples lacks sensitivity, especially for hardly culturable bacteria. Metagenomic sequencing could potentially address those limitations. Here, we assessed the performances of metagenomic sequencing on 24 BJI samples for the identification of pathogens and the prediction of their antibiotic susceptibility. For monomicrobial samples in culture (n = 8), the presence of the pathogen was confirmed by metagenomics in all cases. For polymicrobial samples (n = 16), 32/55 bacteria (58.2%) were found at the species level (and 41/55 [74.5%] at the genus level). Conversely, 273 bacteria not found in culture were identified, 182 being possible pathogens and 91 contaminants. A correct antibiotic susceptibility could be inferred in 94.1% and 76.5% cases for monomicrobial and polymicrobial samples, respectively. Altogether, we found that clinical metagenomics applied to BJI samples is a potential tool to support conventional culture.
Collapse
Affiliation(s)
- Etienne Ruppé
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - William Mouton
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France
- Infectious Diseases Department, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France
- Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| |
Collapse
|
44
|
Sullivan KE, Bassiri H, Bousfiha AA, Costa-Carvalho BT, Freeman AF, Hagin D, Lau YL, Lionakis MS, Moreira I, Pinto JA, de Moraes-Pinto MI, Rawat A, Reda SM, Reyes SOL, Seppänen M, Tang MLK. Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies. J Clin Immunol 2017; 37:650-692. [PMID: 28786026 PMCID: PMC5693703 DOI: 10.1007/s10875-017-0426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 12/18/2022]
Abstract
In today's global economy and affordable vacation travel, it is increasingly important that visitors to another country and their physician be familiar with emerging infections, infections unique to a specific geographic region, and risks related to the process of travel. This is never more important than for patients with primary immunodeficiency disorders (PIDD). A recent review addressing common causes of fever in travelers provides important information for the general population Thwaites and Day (N Engl J Med 376:548-560, 2017). This review covers critical infectious and management concerns specifically related to travel for patients with PIDD. This review will discuss the context of the changing landscape of infections, highlight specific infections of concern, and profile distinct infection phenotypes in patients who are immune compromised. The organization of this review will address the environment driving emerging infections and several concerns unique to patients with PIDD. The first section addresses general considerations, the second section profiles specific infections organized according to mechanism of transmission, and the third section focuses on unique phenotypes and unique susceptibilities in patients with PIDDs. This review does not address most parasitic diseases. Reference tables provide easily accessible information on a broader range of infections than is described in the text.
Collapse
Affiliation(s)
- Kathleen E Sullivan
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Hamid Bassiri
- Division of Infectious Diseases and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ahmed A Bousfiha
- Clinical Immunology Unit, Infectious Department, Hopital d'Enfant Abderrahim Harouchi, CHU Ibn Rochd, Laboratoire d'Immunologie Clinique, d'Inflammation et d'Allergie LICIA, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Beatriz T Costa-Carvalho
- Department of Pediatrics, Federal University of São Paulo, Rua dos Otonis, 725, São Paulo, SP, 04025-002, Brazil
| | - Alexandra F Freeman
- NIAID, NIH, Building 10 Room 12C103, 9000 Rockville, Pike, Bethesda, MD, 20892, USA
| | - David Hagin
- Division of Allergy and Immunology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yu L Lau
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Rm 106, 1/F New Clinical Building, Pok Fu Lam, Hong Kong.,Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Michail S Lionakis
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10, Room 11C102, Bethesda, MD, 20892, USA
| | - Ileana Moreira
- Immunology Unit, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425, Buenos Aires, Argentina
| | - Jorge A Pinto
- Division of Immunology, Department of Pediatrics, Federal University of Minas Gerais, Av. Alfredo Balena 190, room # 161, Belo Horizonte, MG, 30130-100, Brazil
| | - M Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, Rua Pedro de Toledo, 781/9°andar, São Paulo, SP, 04039-032, Brazil
| | - Amit Rawat
- Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shereen M Reda
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saul Oswaldo Lugo Reyes
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Av Iman 1, Torre de Investigacion, Piso 9, Coyoacan, 04530, Mexico City, Mexico
| | - Mikko Seppänen
- Harvinaissairauksien yksikkö (HAKE), Rare Disease Center, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Mimi L K Tang
- Murdoch Children's Research Institute, The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| |
Collapse
|
45
|
Deripapa E, Balashov D, Rodina Y, Laberko A, Myakova N, Davydova NV, Gordukova MA, Abramov DS, Pay GV, Shelikhova L, Prodeus AP, Maschan MA, Maschan AA, Shcherbina A. Prospective Study of a Cohort of Russian Nijmegen Breakage Syndrome Patients Demonstrating Predictive Value of Low Kappa-Deleting Recombination Excision Circle (KREC) Numbers and Beneficial Effect of Hematopoietic Stem Cell Transplantation (HSCT). Front Immunol 2017; 8:807. [PMID: 28791007 PMCID: PMC5523727 DOI: 10.3389/fimmu.2017.00807] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/26/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nijmegen breakage syndrome (NBS) is a combined primary immunodeficiency with DNA repair defect, microcephaly, and other phenotypical features. It predominantly occurs in Slavic populations that have a high frequency of carriers with the causative NBN gene c.657_661del5 mutation. Due to the rarity of the disease in the rest of the world, studies of NBS patients are few. Here, we report a prospective study of a cohort of Russian NBS patients. METHODS 35 Russian NBS patients of ages 1-19 years, referred to our Center between years 2012 and 2016, were prospectively studied. RESULTS Despite the fact that in 80% of the patients microcephaly was diagnosed at birth or shortly thereafter, the average delay of NBS diagnosis was 6.5 years. Though 80% of the patients had laboratory signs of immunodeficiency, only 51% of the patients experienced significant infections. Autoimmune complications including interstitial lymphocytic lung disease and skin granulomas were noted in 34%, malignancies-in 57% of the patients. T-cell excision circle (TREC)/kappa-deleting recombination excision circle (KREC) levels were low in the majority of patients studied. Lower KREC levels correlated with autoimmune and oncological complications. Fifteen patients underwent hematopoietic stem cell transplantation (HSCT), 10 of them were alive and well, with good graft function. Three patients in the HSCT group and five non-transplanted patients died; tumor progression being the main cause of death. The probability of the overall survival since NBS diagnosis was 0.76 in the HSCT group and 0.3 in the non-transplanted group. CONCLUSION Based on our findings of low TRECs in most NBS patients, independent of their age, TREC detection can be potentially useful for detection of NBS patients during neonatal screening. KREC concentration can be used as a prognostic marker of disease severity. HSCT is a viable treatment option in NBS and should be especially considered in patients with low KREC numbers early on, before development of life-threatening complications.
Collapse
Affiliation(s)
- Elena Deripapa
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dmitry Balashov
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Yulia Rodina
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexandra Laberko
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Natalya Myakova
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Nataliia V. Davydova
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Speransky Children’s Hospital, Moscow, Russia
| | | | - Dmitrii S. Abramov
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Galina V. Pay
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Larisa Shelikhova
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Andrey P. Prodeus
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Speransky Children’s Hospital, Moscow, Russia
| | - Mikhail A. Maschan
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexey A. Maschan
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anna Shcherbina
- Dmitry Rogachev National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| |
Collapse
|
46
|
Ruffner MA, Sullivan KE, Henrickson SE. Recurrent and Sustained Viral Infections in Primary Immunodeficiencies. Front Immunol 2017; 8:665. [PMID: 28674531 PMCID: PMC5474473 DOI: 10.3389/fimmu.2017.00665] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/22/2017] [Indexed: 01/25/2023] Open
Abstract
Viral infections are commonplace and often innocuous. Nevertheless, within the population of patients with primary immunodeficiencies (PIDDs), viral infections can be the feature that drives a diagnostic evaluation or can be the most significant morbidity for the patient. This review is focused on the viral complications of PIDDs. It will focus on respiratory viruses, the most common type of viral infection in the general population. Children and adults with an increased frequency or severity of respiratory viral infections are often referred for an immunologic evaluation. The classic teaching is to investigate humoral function in people with recurrent sinopulmonary infections, but this is often interpreted to mean recurrent bacterial infections. Recurrent or very severe viral infections may also be a harbinger of a primary immunodeficiency as well. This review will also cover persistent cutaneous viral infections, systemic infections, central nervous system infections, and gastrointestinal infections. In each case, the specific viral infections may drive a diagnostic evaluation that is specific for that type of virus. This review also discusses the management of these infections, which can become problematic in patients with PIDDs.
Collapse
Affiliation(s)
- Melanie A Ruffner
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Sarah E Henrickson
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| |
Collapse
|
47
|
Fischer A, Provot J, Jais JP, Alcais A, Mahlaoui N. Autoimmune and inflammatory manifestations occur frequently in patients with primary immunodeficiencies. J Allergy Clin Immunol 2017; 140:1388-1393.e8. [PMID: 28192146 DOI: 10.1016/j.jaci.2016.12.978] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary immunodeficiencies (PIDs) are inherited diseases associated with a considerable increase in susceptibility to infections. It is known that PIDs can also predispose to cancer and immune diseases, including allergy, autoimmunity, and inflammation. OBJECTIVE We aimed at determining the incidence of autoimmunity and inflammation in patients with PIDs. METHODS We have retrospectively screened 2183 consecutive cases of PID in the Centre de Référence Déficits Immunitaires Héréditaires registry (CEREDIH; the French national PID registry) for the occurrence of autoimmunity and inflammation. RESULTS One or more autoimmune and inflammatory complications were noted in 26.2% of patients, with a risk of onset throughout the patient's lifetime. The risk of autoimmune cytopenia was at least 120 times higher than in the general population, the risk of inflammatory bowel disease in children was 80 times higher, and the risk of other autoimmune manifestations was approximately 10 times higher. Remarkably, all types of PIDs were associated with a risk of autoimmune and inflammatory complications, although the greatest risk was associated with T-cell PIDs and common variable immunodeficiency. The occurrence of autoimmune disease is a negative prognostic factor for survival. CONCLUSIONS Our results provide the basis for a detailed prospective evaluation of autoimmunity and inflammation in the context of PIDs, with a view to accurately assessing these risks and describing the possible effect of medical intervention.
Collapse
Affiliation(s)
- Alain Fischer
- Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Unité d'Immuno-Hématologie et Rhumatologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; INSERM UMR 1163, Paris, France; Collège de France, Paris, France.
| | - Johan Provot
- Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Jais
- Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Université Paris Descartes, INSERM UMRS 1138 Team 22, Paris, France AP-HP, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France
| | - Alexandre Alcais
- Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Paris, France
| | - Nizar Mahlaoui
- Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Unité d'Immuno-Hématologie et Rhumatologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France; Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Paris, France
| | | |
Collapse
|
48
|
Perelygina L, Plotkin S, Russo P, Hautala T, Bonilla F, Ochs HD, Joshi A, Routes J, Patel K, Wehr C, Icenogle J, Sullivan KE. Rubella persistence in epidermal keratinocytes and granuloma M2 macrophages in patients with primary immunodeficiencies. J Allergy Clin Immunol 2016; 138:1436-1439.e11. [PMID: 27613149 DOI: 10.1016/j.jaci.2016.06.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/10/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ludmila Perelygina
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Stanley Plotkin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Pierre Russo
- Department of Pathology and Laboratory Medicine, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Timo Hautala
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | | | - Hans D Ochs
- University of Washington and Seattle Children's Hospital, Seattle, Wash
| | - Avni Joshi
- Division of Allergy/Immunology, Mayo Clinic Children's Center, Rochester, Minn
| | - John Routes
- Division of Allergy Immunology, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Kiran Patel
- Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis, and Sleep, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Claudia Wehr
- Centre of Chronic Immunodeficiency, University Medical Center, University of Freiburg, Freiburg, Germany; Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Joseph Icenogle
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Kathleen E Sullivan
- Division of Allergy Immunology, the Children's Hospital of Philadelphia, Philadelphia, Pa.
| |
Collapse
|
49
|
Ebbo M, Gérard L, Carpentier S, Vély F, Cypowyj S, Farnarier C, Vince N, Malphettes M, Fieschi C, Oksenhendler E, Schleinitz N, Vivier E. Low Circulating Natural Killer Cell Counts are Associated With Severe Disease in Patients With Common Variable Immunodeficiency. EBioMedicine 2016; 6:222-230. [PMID: 27211564 PMCID: PMC4856746 DOI: 10.1016/j.ebiom.2016.02.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Natural Killer (NK) cells have been shown to exert antiviral and antitumoural activities. Nevertheless most available data are derived from mouse models and functions of these cells in human remain unclear. To evaluate the impact of low circulating NK cell counts and to provide some clues to the role of NK cells in natural conditions, we studied a large cohort of patients with common variable immunodeficiency (CVID) included in a multicenter cohort of patients with primary hypogammaglobulinaemia. Patients were classified into three groups on the basis of their NK cell counts: severe and mild NK cell lymphopenia (< 50 and 50–99 × 106/L respectively), and normal NK cell counts (> 100 × 106/L). Clinical events were analyzed and compared between these three groups of patients. During study period, 457 CVID patients were included: 99 (21.7%) with severe NK cell lymphopenia, 118 (25.8%) with mild NK cell lymphopenia and 240 (52.5%) with normal NK cell counts. Non-infectious complications (57% vs. 36% and 35%), and, particularly, granulomatous complications (25.3% vs. 13.6% and 8.8%), were more frequent in patients with severe NK cell lymphopenia than in other groups. Invasive infections (68.7% vs. 60.2% and 48.8%), including bacteraemia (22.2% vs. 5.9% and 8.3%) and infectious pneumonia (63.6% vs. 59.3% and 44.2%), were also more frequent in this population. However, no difference was observed for viral infections and neoplasms. Low circulating NK cell counts are associated with more severe phenotypes of CVID, which may indicate a protective role of these immune cells against severe bacterial infections and other complications and non-redundant immune functions when the adaptive immune response is not optimal. CVID patients with low NK cell counts present increased rates of severe bacterial infections and granuloma. Mortality appears to be especially high in CVID patients with both severe CD4+ T cell and NK cell deficiency. NK cells could have non-redundant immune functions in patients with non-optimal adaptive immune response.
Forty years after their discovery, the functions of Natural Killer (NK) cells in natura remain poorly understood. Association studies linking clinical symptoms and defects in NK cell numbers or function are exceptional and poorly described in large cohorts of human patients. Our study analyzes the correlation between NK cell lymphopenia and clinical events in a large cohort of immunocompromised patients. We report the unexpected findings that severe invasive bacterial infections, especially bacteremia episodes, and non-infectious complications, especially granulomatous complications, are more frequent in common variable immunodeficiency patients with severe NK cell deficiency. These findings in natura highlights that NK cells may play a pivotal role in immunity in immunocompromised individuals, when the adaptive immune system is not optimal.
Collapse
Affiliation(s)
- Mikael Ebbo
- Centre d'Immunologie de Marseille-Luminy, Aix-Marseille University UM2, 13288 Marseille, France; Inserm U1104, 13288 Marseille, France; CNRS UMR7280, 13288 Marseille, France; Médecine Interne, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France
| | - Laurence Gérard
- Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75010 Paris, France; EA3518, University Paris 7 Denis Diderot, Paris, France
| | - Sabrina Carpentier
- MI-mAbs Consortium (Aix Marseille University), CIML, 13288 Marseille, France
| | - Frédéric Vély
- Centre d'Immunologie de Marseille-Luminy, Aix-Marseille University UM2, 13288 Marseille, France; Inserm U1104, 13288 Marseille, France; CNRS UMR7280, 13288 Marseille, France; Immunologie, Hôpital de la Conception, Assistance Publique -Hôpitaux de Marseille, 13385 Marseille, France
| | - Sophie Cypowyj
- Centre d'Immunologie de Marseille-Luminy, Aix-Marseille University UM2, 13288 Marseille, France; Inserm U1104, 13288 Marseille, France; CNRS UMR7280, 13288 Marseille, France
| | - Catherine Farnarier
- Immunologie, Hôpital de la Conception, Assistance Publique -Hôpitaux de Marseille, 13385 Marseille, France
| | - Nicolas Vince
- Inserm U1126, University Paris 7 Denis Diderot, Paris, France
| | - Marion Malphettes
- Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75010 Paris, France; Inserm U1126, University Paris 7 Denis Diderot, Paris, France
| | - Claire Fieschi
- Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75010 Paris, France; Inserm U1126, University Paris 7 Denis Diderot, Paris, France
| | - Eric Oksenhendler
- Immunopathologie Clinique, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75010 Paris, France
| | - Nicolas Schleinitz
- Centre d'Immunologie de Marseille-Luminy, Aix-Marseille University UM2, 13288 Marseille, France; Inserm U1104, 13288 Marseille, France; CNRS UMR7280, 13288 Marseille, France; Médecine Interne, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, 13005 Marseille, France
| | - Eric Vivier
- Centre d'Immunologie de Marseille-Luminy, Aix-Marseille University UM2, 13288 Marseille, France; Inserm U1104, 13288 Marseille, France; CNRS UMR7280, 13288 Marseille, France; MI-mAbs Consortium (Aix Marseille University), CIML, 13288 Marseille, France.
| | | |
Collapse
|
50
|
Abstract
The characterization of the human blood-associated viral community (also called blood virome) is essential for epidemiological surveillance and to anticipate new potential threats for blood transfusion safety. Currently, the risk of blood-borne agent transmission of well-known viruses (HBV, HCV, HIV and HTLV) can be considered as under control in high-resource countries. However, other viruses unknown or unsuspected may be transmitted to recipients by blood-derived products. This is particularly relevant considering that a significant proportion of transfused patients are immunocompromised and more frequently subjected to fatal outcomes. Several measures to prevent transfusion transmission of unknown viruses have been implemented including the exclusion of at-risk donors, leukocyte reduction of donor blood, and physicochemical treatment of the different blood components. However, up to now there is no universal method for pathogen inactivation, which would be applicable for all types of blood components and, equally effective for all viral families. In addition, among available inactivation procedures of viral genomes, some of them are recognized to be less effective on non-enveloped viruses, and inadequate to inactivate higher viral titers in plasma pools or derivatives. Given this, there is the need to implement new methodologies for the discovery of unknown viruses that may affect blood transfusion. Viral metagenomics combined with High Throughput Sequencing appears as a promising approach for the identification and global surveillance of new and/or unexpected viruses that could impair blood transfusion safety.
Collapse
Affiliation(s)
- V Sauvage
- Département d'études des agents transmissibles par le sang, Institut national de la transfusion sanguine (INTS), Centre national de référence des hépatites virales B et C et du VIH en transfusion, 75015 Paris, France.
| | - M Eloit
- PathoQuest, bâtiment François-Jacob, 25, rue du Dr-Roux, 75015 Paris, France; Inserm U1117, Biology of Infection Unit, Laboratory of Pathogen Discovery, Institut Pasteur, 28, rue du Docteur-Roux, 75724 Paris, France
| |
Collapse
|