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Frommherz L, Akçetin L, Hauck F, Giehl K. [Relevant cutaneous manifestations as indications for inborn errors of immunity]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:577-586. [PMID: 38856791 DOI: 10.1007/s00105-024-05331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 06/11/2024]
Abstract
Inborn errors of immunity (IEI) can affect different parts of the immune system and manifest especially through pathological infection susceptibility and immune dysregulation. Cutaneous manifestations of IEI can hint at the underlying immunodeficiency and the tendency for infection and inflammation. These manifestations can present as recurring eczema, erythema, abscesses, and hair loss with poor response to therapy. Cutaneous manifestations can be specific for certain IEI, or rather unspecific. Together with clinical course and severity, they can indicate the diagnosis. Early and accurate recognition, diagnosis, and treatment are crucial for optimizing patient outcomes. The diagnosis can be determined through a detailed patient history, clinical examination, and immunological diagnostics. Collaboration between immunologists and dermatologists is vital for comprehensive care and improvement of life quality.
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Affiliation(s)
- Leonie Frommherz
- Zentrum für seltene und genetische Hautkrankheiten, Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt | Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Larissa Akçetin
- Zentrum für seltene und genetische Hautkrankheiten, Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt | Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Fabian Hauck
- Immundefektambulanz, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU Klinikum, München, Deutschland
| | - Kathrin Giehl
- Zentrum für seltene und genetische Hautkrankheiten, Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt | Frauenlobstr. 9-11, 80337, München, Deutschland.
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2
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Paganelli R. A Tribute to Two Master Teachers of Immunology. Biomedicines 2023; 11:2178. [PMID: 37626675 PMCID: PMC10452448 DOI: 10.3390/biomedicines11082178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
A Special Issue dedicated in memory of Prof. Fernando Aiuti is a special tribute to a clinician who led the field of Clinical Immunology in Italy and introduced the entire Italian medical and academic scene to it. [...].
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Affiliation(s)
- Roberto Paganelli
- Internal Medicine, Saint Camillus International University of Medical and Health Sciences, 00131 Rome, Italy
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3
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Reilly L, Emonts M. Recurrent or unusual infections in children - when to worry about inborn errors of immunity. Ther Adv Infect Dis 2023; 10:20499361231162978. [PMID: 37089444 PMCID: PMC10116010 DOI: 10.1177/20499361231162978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
Recurrent infections are a common presenting feature in paediatrics and, while most times considered part of normal growing up, they are also a classical hallmark of inborn errors of immunity (IEI). We aimed to outline the value of currently used signs for IEI and the influence of the changing epidemiology of infectious diseases due to implementation of new vaccines and the effect of the COVID-19 pandemic on the assessment of children with recurrent infections. Warning signs for IEI have been developed, but the supporting evidence for their effectiveness is limited, and immune dysregulation is more commonly recognised as a feature for IEI, making reliable identification of children who should be screened for IEI on clinical grounds difficult. In addition, the epidemiology of infectious diseases is changing due to restrictions related to Covid-19 as well as immunisations, which may change the threshold to screen children for IEI. Treatments for IEI are evolving and are often more effective and less complicated when started early. Screening for IEI can be initiated by the non-immunologist and should be considered early to ensure optimal treatment outcomes.
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Affiliation(s)
- Liam Reilly
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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4
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Janssen LMA, van den Akker K, Boussihmad MA, de Vries E. Which triggers could support timely identification of primary antibody deficiency? A qualitative study using the patient perspective. Orphanet J Rare Dis 2021; 16:289. [PMID: 34187500 PMCID: PMC8243743 DOI: 10.1186/s13023-021-01918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients with predominantly (primary) antibody deficiencies (PADs) commonly develop recurrent respiratory infections which can lead to bronchiectasis, long-term morbidity and increased mortality. Recognizing symptoms and making a diagnosis is vital to enable timely treatment. Studies on disease presentation have mainly been conducted using medical files rather than direct contact with PAD patients. Our study aims to analyze how patients appraised their symptoms and which factors were involved in a decision to seek medical care. Methods 14 PAD-patients (11 women; median 44, range 16-68 years) were analyzed using semi-structured interviews until saturation of key emergent themes was achieved. Results Being always ill featured in all participant stories. Often from childhood onwards periods of illness were felt to be too numerous, too bad, too long-lasting, or antibiotics were always needed to get better. Recurrent or persistent respiratory infections were the main triggers for patients to seek care. All participants developed an extreme fatigue, described as a feeling of physical and mental exhaustion and thus an extreme burden on daily life that was not solved by taking rest. Despite this, participants tended to normalize their symptoms and carry on with usual activities. Non-immunologists, as well as patients, misattributed the presenting signs and symptoms to common, self-limiting illnesses or other ‘innocent’ explanations. Participants in a way understood the long diagnostic delay. They know that the disease is rare and that doctors have to cover a broad medical area. But they were more critical about the way the doctors communicate with them. They feel that doctors often don’t listen very well to their patients. The participants’ symptoms as well as the interpretation of these symptoms by their social environment and doctors had a major emotional impact on the participants and a negative influence on their future perspectives. Conclusions To timely identify PAD, ‘pattern recognition’ should not only focus on the medical ‘red flags’, but also on less differentiating symptoms, such as ‘being always ill’ and ‘worn out’ and the way patients cope with these problems. And, most important, making time to really listen to the patient remains the key. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01918-x.
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Affiliation(s)
- Lisanne M A Janssen
- Department of Tranzo, TSB, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Pediatrics, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | | | - Esther de Vries
- Department of Tranzo, TSB, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Jeroen Bosch Academy Research, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
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5
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Tavakol M, Jamee M, Azizi G, Sadri H, Bagheri Y, Zaki-Dizaji M, Mahdavi FS, Jadidi-Niaragh F, Tajfirooz S, Kamali AN, Aghamahdi F, Noorian S, Kojidi HT, Mosavian M, Matani R, Dolatshahi E, Porrostami K, Elahimehr N, Fatemi-Abhari M, Sharifi L, Arjmand R, Haghi S, Zainaldain H, Yazdani R, Shaghaghi M, Abolhassani H, Aghamohammadi A. Diagnostic Approach to the Patients with Suspected Primary Immunodeficiency. Endocr Metab Immune Disord Drug Targets 2020; 20:157-171. [PMID: 31456526 DOI: 10.2174/1871530319666190828125316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/16/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary immunodeficiency diseases (PIDs) are a group of more than 350 disorders affecting distinct components of the innate and adaptive immune systems. In this review, the classic and advanced stepwise approach towards the diagnosis of PIDs are simplified and explained in detail. RESULTS Susceptibility to recurrent infections is the main hallmark of almost all PIDs. However, noninfectious complications attributable to immune dysregulation presenting with lymphoproliferative and/or autoimmune disorders are not uncommon. Moreover, PIDs could be associated with misleading presentations including allergic manifestations, enteropathies, and malignancies. CONCLUSION Timely diagnosis is the most essential element in improving outcome and reducing the morbidity and mortality in PIDs. This wouldn't be possible unless the physicians keep the diagnosis of PID in mind and be sufficiently aware of the approach to these patients.
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Affiliation(s)
- Marzieh Tavakol
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Allergy and Clinical Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Jamee
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Gholamreza Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Sadri
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Allergy and Clinical Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Yasser Bagheri
- Clinical Research Development Unit (CRDU), 5 azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Majid Zaki-Dizaji
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Sanaz Tajfirooz
- Department of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali N Kamali
- CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Aghamahdi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Pediatric Endocrinology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahab Noorian
- Department of Pediatric Endocrinology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Habibeh Taghavi Kojidi
- Department of Pediatric Endocrinology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Mosavian
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Gastroenterology and Hepatology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Rahman Matani
- Department of Gastroenterology and Hepatology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Elahe Dolatshahi
- Department of Rheumatology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kumars Porrostami
- Department of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Nasrin Elahimehr
- Department of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Marzie Fatemi-Abhari
- Department of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Laleh Sharifi
- Uro- Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Arjmand
- Department of Infectious Disease, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sabahat Haghi
- Department of Hematology & Oncology, School of Medicine, Alborz university of medical sciences, Karaj, Iran
| | - Hamed Zainaldain
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hassan Abolhassani
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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6
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Bandari AK, Muthusamy B, Bhat S, Govindaraj P, Rajagopalan P, Dalvi A, Shankar S, Raja R, Reddy KS, Madkaikar M, Pandey A. A Novel Splice Site Mutation in IFNGR2 in Patients With Primary Immunodeficiency Exhibiting Susceptibility to Mycobacterial Diseases. Front Immunol 2019; 10:1964. [PMID: 31497017 PMCID: PMC6712061 DOI: 10.3389/fimmu.2019.01964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023] Open
Abstract
Primary immunodeficiency (PID) refers to a group of heterogeneous genetic disorders with a weakened immune system. Mendelian susceptibility to mycobacterial disease (MSMD) is a subset of PID in which patients exhibit defects in intrinsic and innate immunity. It is a rare congenital disorder characterized by severe and recurrent infections caused by weakly virulent mycobacteria or other environmental mycobacteria. Any delay in definitive diagnosis poses a major concern due to the confounding nature of infections and immune deficiencies. Here, we report the clinical, immunological, and genetic characteristics of two siblings (infants) with recurrent infections. There was a history of death of two other siblings in the family after BCG vaccination. Whole exome sequencing of the two affected surviving infants along with their consanguineous parents identified a novel, homozygous single nucleotide splice acceptor site variant in intron 2 of the interferon gamma receptor 2 (IFNGR2) gene. Sanger sequencing of DNA obtained from blood and fibroblasts confirmed the variant. The patients underwent bone marrow transplantation from their father as a donor. RT-PCR and Sanger sequencing of the cDNA of patients from blood samples after transplantation showed the expression of both wild type and mutant transcript expression of IFNGR2. To assess partial or complete expression of IFNGR2 mutant transcripts, fibroblasts were cultured from skin biopsies. RT-PCR and Sanger sequencing of cDNA obtained from patient fibroblasts revealed complete expression of mutant allele and acquisition of a cryptic splice acceptor site in exon 3 that resulted in deletion of 9 nucleotides in exon 3. This led to an in-frame deletion of three amino acids p.(Thr70-Ser72) located in a fibronectin type III (FN3) domain in the extracellular region of IFNGR2. This illustrates individualized medicine enabled by next generation sequencing as identification of this mutation helped in the clinical diagnosis of MSMD in the infants as well as in choosing the most appropriate therapeutic option.
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Affiliation(s)
- Aravind K Bandari
- Institute of Bioinformatics, International Technology Park, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Babylakshmi Muthusamy
- Institute of Bioinformatics, International Technology Park, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunil Bhat
- Pediatric Haematology, Oncology and Blood & Bone Marrow Transplantation, Mazumdar-Shaw Cancer Center, Narayana Health City, Bangalore, India
| | - Periyasamy Govindaraj
- Neuromuscular Laboratory, Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Aparna Dalvi
- National Institute of Immunohaematology, KEM Hospital Campus, Mumbai, India
| | - Siddharth Shankar
- Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Remya Raja
- Institute of Bioinformatics, International Technology Park, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kavita S Reddy
- Institute of Bioinformatics, International Technology Park, Bangalore, India
| | - Manisha Madkaikar
- National Institute of Immunohaematology, KEM Hospital Campus, Mumbai, India
| | - Akhilesh Pandey
- Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States
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7
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Janssen LMA, van Hout RWNM, de Vries E. Challenges in investigating patients with isolated decreased serum IgM: The SIMcal study. Scand J Immunol 2019; 89:e12763. [PMID: 30887554 PMCID: PMC6850338 DOI: 10.1111/sji.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
Abstract
The clinical consequences of isolated decreased serum immunoglobulin (Ig)M are not sufficiently known. Therefore, it is difficult to determine the clinical policy following such a finding. Only few reported IgM‐deficient patients fulfil the European Society for Immunodeficiencies (ESID) diagnostic criteria for selective IgM deficiency (true sIgMdef), or their diagnosis is uncertain due to insufficient laboratory data (possible sIgMdef). Decreased serum IgM is often incidentally found in asymptomatic adults. The objective of our study was to further characterize true sIgMdef and to compare the European data collected through the ESID Registry community (tertiary centres) to our previously published Dutch cohort (secondary centre). Fifteen centres (12 countries) participated with 98 patients. Patients were excluded if serum IgM was only determined once (n = 14), had normalized (n = 8), or if they also had other immunological abnormalities (n = 15). Ten patients (5 adults) completely fulfilled the ESID criteria for true sIgMdef. Age‐matched cut‐off values varied widely between centres; when using the ESID diagnostic protocol reference values, only six patients (five adults) had true sIgMdef. Because of these small numbers, further analyses were performed in patients with true or possible sIgMdef (13 adults, 48 children). Respiratory infections were commonly reported at presentation (adults 54%, children 60%). Symptomatic adults had lower serum IgM levels (mean 0.27 g/L, 95% CI 0.22‐0.31) than those without symptoms (mean 0.33 g/L, 95% CI 0.30‐0.36; P = 0.02). To be able to explore the clinical consequences of true sIgMdef, we should fully analyse and accurately describe those patients in whom a decreased serum IgM is found.
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Affiliation(s)
- Lisanne M A Janssen
- Department of Tranzo, Tilburg University, Tilburg, the Netherlands.,Department of Pediatrics, Amalia Children's Hospital, Nijmegen, the Netherlands
| | | | - Esther de Vries
- Department of Tranzo, Tilburg University, Tilburg, the Netherlands.,Laboratory for Medical Microbiology and Immunology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
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8
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Papadopoulou C, Omoyinmi E, Standing A, Pain CE, Booth C, D’Arco F, Gilmour K, Buckland M, Eleftheriou D, Brogan PA. Monogenic mimics of Behçet’s disease in the young. Rheumatology (Oxford) 2019; 58:1227-1238. [DOI: 10.1093/rheumatology/key445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/13/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- C Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - E Omoyinmi
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - A Standing
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - C E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Booth
- Infection, Immunity, Inflammation, Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - F D’Arco
- Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - K Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - M Buckland
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - D Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UCLH and GOSH, London, UK
| | - P A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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9
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Lymphocyte subgroups and recurrent infections in children with Down syndrome - a prospective case control study. Cent Eur J Immunol 2018; 43:248-254. [PMID: 30588168 PMCID: PMC6305610 DOI: 10.5114/ceji.2018.80042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
Down syndrome (DS) is the commonest genetic disorder and more liable for recurrent infections. We aimed to determine the differences in lymphocyte subgroups between DS children and the healthy population and to study the pattern and likelihood for recurrent infections and hospital admission due to infection. Our study was carried out in the Genetic Unit of Mansoura University Children’s Hospital, Egypt. The study enrolled 150 DS (DS group) and 100 controls (CG group). They were assessed for recurrent infections (including tonsillitis, otitis media [OM], pneumonia, upper respiratory tract infections [URTI], sinusitis, and gastroenteritis [GE]) and hospital admission due to infections. All patients were subjected to complete blood count and flow cytometric analysis for expression markers of B lymphocytes (CD19), natural killer (NK) cells (CD56), and T lymphocytes (CD3, CD4 and CD8). We found a statistically significant increase in the frequency of URTIs and sinusitis, OM, pneumonia, and hospital admission in the DS group. As regards the type of recurrent infection in DS, it was highest for URTIs and sinusitis. For age groups below 13 years, a statistically significant decrease in all studied CD markers was found in the DS group, while for the 13-18-year-olds, a statistically significant decrease was found in CD4, CD19, and CD56 in the DS group. Non-significant correlations were found between CD markers and recurrent infection and hospital admission. We concluded that lymphocyte subgroups that carry CD3, CD4, CD8, CD19, and CD56 were decreased in DS. Recurrent infections and hospital admission are still striking feature for DS but are not significantly correlated with lymphocyte subgroups.
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10
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Janssen LMA, Bassett P, Macken T, van Esch J, Pruijt H, Knoops A, Sköld M, Parker A, de Vries J, de Vries E. Mild Hypogammaglobulinemia Can Be a Serious Condition. Front Immunol 2018; 9:2384. [PMID: 30374358 PMCID: PMC6196282 DOI: 10.3389/fimmu.2018.02384] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Most patients with primary antibody deficiency (PAD) suffer from less well-described and understood forms of hypogammaglobulinemia (unclassified primary antibody deficiency, unPAD). Because of the moderately decreased immunoglobulin levels compared to CVID, unPAD is generally considered to be clinically mild and not very relevant. Objective: To describe our cohort of—mainly—unPAD patients, and to analyze whether subgroups can be identified. Methods: Data were prospectively collected (February-2012 to June-2016) as part of a standardized, 1-day Care Pathway for suspected primary immunodeficiency. The TNO-AZL Questionnaire for Health-Related Quality of Life (HRQoL) was part of the pre-first-visit intake procedure. Results: Three hundred and twenty patients were referred to the Care Pathway. Data from 23/27 children and 99/113 adults who were diagnosed with PAD and gave informed consent were available for analysis. 89/99 adults had unPAD, the majority (74%) were female and 44% already showed bronchiectasis. HRQoL was significantly decreased in all domains, meaning that a lot of unPAD patients had to cope simultaneously with pain, negative feelings and impairments in cognition, home management tasks, sleep, social interaction, and work. The most prominently impaired HRQoL domain was vitality, indicating these patients feel extremely tired and worn out. Conclusion: These results highlight the need for more attention to the potential patient burden of unPADs. A larger cohort is needed to increase our understanding of unPADs and to analyze whether distinct subgroups can be identified. For now, it is important for the clinician to acknowledge the existence of unPAD and be aware of its potential consequences, in order to timely and appropriately manage its effects and complications.
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Affiliation(s)
| | | | - Thomas Macken
- Department of Pulmonology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Jolanda van Esch
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Hans Pruijt
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Arnoud Knoops
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Markus Sköld
- The Binding Site Group Limited, Birmingham, United Kingdom
| | - Antony Parker
- The Binding Site Group Limited, Birmingham, United Kingdom
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University and Elisabeth TweeSteden Hospital, Tilburg, Netherlands
| | - Esther de Vries
- Department of Tranzo, Tilburg University, Tilburg, Netherlands.,Laboratory for Medical Microbiology and Immunology, Elisabeth Tweesteden Hospital, Tilburg, Netherlands
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11
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Parker AR, Skold M, Ramsden DB, Ocejo-Vinyals JG, López-Hoyos M, Harding S. The Clinical Utility of Measuring IgG Subclass Immunoglobulins During Immunological Investigation for Suspected Primary Antibody Deficiencies. Lab Med 2018; 48:314-325. [PMID: 29126302 PMCID: PMC5907904 DOI: 10.1093/labmed/lmx058] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Measurement of IgG subclass concentrations is a standard laboratory test run as part of a panel to investigate the suspicion of antibody deficiency. The assessment is clinically important when total IgG is within the normal age-specific reference range. The measurement is useful for diagnosis of IgG subclass deficiency, to aid the diagnosis of specific antibody deficiency, as a supporting test for the diagnosis of common variable immunodeficiency, as well as for risk stratification of patients with low IgA. The measurement of IgG subclasses may also help determine a revaccination strategy for patients and support patient management. In certain circumstances, the measurement of IgG subclasses may be used to monitor a patient’s humoral immune system. In this review, we discuss the utility of measuring IgG subclass concentrations.
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Affiliation(s)
| | - Markus Skold
- The Binding Site Group Limited, Edgbaston, Birmingham
| | - David B Ramsden
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Birmingham, UK
| | - J Gonzalo Ocejo-Vinyals
- Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
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12
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Garcia-Prat M, Vila-Pijoan G, Martos Gutierrez S, Gala Yerga G, García Guantes E, Martínez-Gallo M, Martín-Nalda A, Soler-Palacín P, Hernández-González M. Age-specific pediatric reference ranges for immunoglobulins and complement proteins on the Optilite ™ automated turbidimetric analyzer. J Clin Lab Anal 2018; 32:e22420. [PMID: 29603375 DOI: 10.1002/jcla.22420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Measurement of immunoglobulins and complement proteins are frontline tests used in the assessment of immune system integrity, and reference values can vary with age. Their measurement provides an insight into the function of the innate and adaptive immune systems. METHODS We generated pediatric reference ranges for IgG, IgA, IgM, IgD, the IgG and IgA subclasses, and C3 and C4 using the Optilite™ turbidimetric analyzer. RESULTS The concentrations of IgG, IgA, and IgD showed an increase with age, as expected, while IgM remained stable between the age groups. For the IgG subclasses, no significant differences were observed in IgG1 or IgG3, while IgG2 and IgG4 concentrations increased steadily with age. The concentration of IgG2 plateaued at 15-18 years, while IgG4 plateaued at 10-14 years. The trend of concentrations across all groups was IgG1 > IgG2 > IgG3 > IgG4. For both IgA1 and IgA2, concentrations increased significantly with age, plateauing at 15-18 years. The median IgA1 concentration was greater than IgA2 across all groups. There was a good correlation between the total IgG or IgA concentration and summation of their subclasses (R2 = 0.89, P < .0001, slope y = 0.98x + 14.51 mg/dL and R2 = 0.91, P < .0001, slope y = 1.35x-3.28 mg/dL, respectively). The concentration of C3 and C4 remained stable across the groups, with no significant differences observed. CONCLUSION We have generated age-specific reference ranges in healthy children for C3, C4, IgG, IgA, IgM, IgD and the IgG and IgA subclasses using the Optilite™ turbidimetric analyzer. These ranges will help identify individuals with abnormal concentrations, thus will aid in the diagnosis of both primary and secondary immunological disorders.
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Affiliation(s)
- Marina Garcia-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Gemma Vila-Pijoan
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Susana Martos Gutierrez
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Guadalupe Gala Yerga
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Esther García Guantes
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Mónica Martínez-Gallo
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Manuel Hernández-González
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
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13
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van Kessel D, Hoffman T, van Velzen-Blad H, Meek B, van Mens S, Grutters J, Rijkers G. Case report on a defective antibody response against pneumococcal serotype 9V in a patient with a single episode of pneumonia. Pneumonia (Nathan) 2017; 9:16. [PMID: 29119074 PMCID: PMC5671648 DOI: 10.1186/s41479-017-0040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/13/2017] [Indexed: 12/25/2022] Open
Abstract
Background Patients with recurrent respiratory tract infections and an impaired response to pneumococcal polysaccharide vaccination are diagnosed with a specific antibody deficiency. In adult patients with pneumococcal pneumonia an impaired antibody response to the infecting pneumococcal serotype can sometimes be found. It is unknown whether these patients are unable to produce an adequate anti-polysaccharide antibody response to pneumococcal vaccination after recovery. Case presentation The authors describe a case of invasive pneumonia caused by Streptococcus pneumoniae serotype 9V in a previously healthy 35-year-old female. This patient did not produce serotype-specific antibodies against the infecting serotype during disease. After pneumococcal polysaccharide vaccination 3 months after recovery, she responded adequately to most other pneumococcal serotypes, but still had no response to the infecting serotype 9V. However, after 9 years (and prior to pneumococcal-conjugate vaccination) normal antibody levels against 9V were found. These antibody levels further increased after pneumococcal-conjugate vaccination. Conclusion The authors believe that this case is the first description of a temporary deficient response to the infecting pneumococcal serotype in adults, while other reports with similar observations all involved children.
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Affiliation(s)
- Diana van Kessel
- Department of Pulmonology and Respiratory Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Thijs Hoffman
- Department of Pulmonology and Respiratory Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Heleen van Velzen-Blad
- Laboratory of Medical Microbiology and Immunology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Bob Meek
- Laboratory of Medical Microbiology and Immunology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Suzan van Mens
- Laboratory of Medical Microbiology and Immunology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Jan Grutters
- Department of Pulmonology and Respiratory Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ger Rijkers
- Laboratory of Medical Microbiology and Immunology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.,Department of Science, University College Roosevelt, Lange Noordstraat 1, 4330 AB Middelburg, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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14
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Kumarage J, Seneviratne SL, Senaratne V, Fernando A, Gunasekera K, Gunasena B, Gurugama P, Peiris S, Parker AR, Harding S, de Silva NR. The response to Typhi Vi vaccination is compromised in individuals with primary immunodeficiency. Heliyon 2017; 3:e00333. [PMID: 28721392 PMCID: PMC5486435 DOI: 10.1016/j.heliyon.2017.e00333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 01/19/2023] Open
Abstract
Measurement of an individuals ability to respond to polysaccharide antigens is a crucial test to determine adaptive immunity. Currently the response to Pneumovax® is utilized but with the success of Prevnar®, measurement of the response to Pneumovax may be challenging. The aim of the study was to assess the response to Typhi Vi vaccination in both children and adult control groups and patients with primary immunodeficiency (PID). In the control groups, >95% of the individuals had pre Typhi Vi vaccination concentrations <100 U/mL and there was significant increase in concentration post Typhi Vi vaccination (p<0.0001) with>94% achieving ≥3 fold increase in concentration (FI). The response to Typhi Vi vaccination was significantly lower in both children (p = 0.006) and adult (p = 0.002) PID groups when compared to their control groups. 11% and 55% of the children and adult PID groups respectively did not obtain a response >3FI. There were no significant differences between the responses obtained in the children and adult PID groups. When all individuals with PID were separated into those with either hypogammaglobulinemia (HYPO) or common variable immunodeficiency (CVID), both groups had a significantly lower median FI than the control group (19, 95%CI 5–56 vs 59, 95%CI 7–237; p = 0.01 and 1, 95%CI 1–56 vs 32, 95%CI 5–136; p = 0.005). Further, a >3FI differentiated the antibody responses between both the CVID and HYPO groups and their control groups (AUC: 0.83, 95%CI: 0.65–1.00, p = 0.005 and 0.81, 95% CI: 0.65–0.97, p = 0.01). The data suggests that measurement of the response to Typhi Vi vaccination could represent a complementary assay for the assessment of the response to a polysaccharide vaccine.
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Affiliation(s)
- Jeevani Kumarage
- Department of Immunology, Medical Research Institute, Colombo 8, Sri Lanka
| | - Suranjith L Seneviratne
- Institute of Immunity and Transplantation, Royal Free Hospital, London, UK.,Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Amitha Fernando
- National Hospital of Sri Lanka/Central Chest Clinic, Colombo, Sri Lanka
| | - Kirthi Gunasekera
- National Hospital of Sri Lanka/Central Chest Clinic, Colombo, Sri Lanka
| | - Bandu Gunasena
- National Hospital for Respiratory Diseases, Walisara, Sri Lanka
| | - Padmalal Gurugama
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals NHS Foundation Trust, Hills road, Cambridge, UK
| | | | - Antony R Parker
- The Binding Site Group Limited, 8 Calthorpe Road, Edgbaston, Birmingham, B15 1QT, UK
| | - Stephen Harding
- The Binding Site Group Limited, 8 Calthorpe Road, Edgbaston, Birmingham, B15 1QT, UK
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15
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Hadizadeh H, Salehi M, Khoramnejad S, Vosoughi K, Rezaei N. The association between parental consanguinity and primary immunodeficiency diseases: A systematic review and meta-analysis. Pediatr Allergy Immunol 2017; 28:280-287. [PMID: 27893166 DOI: 10.1111/pai.12685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND We aimed to establish the prevalence of parental consanguinity among patients with primary immunodeficiency diseases (PID) and compare the prevalence with the general population. METHOD We searched PubMed, EMBASE, and Scopus for studies mentioning parental consanguinity prevalence in patients with PID and calculated the prevalence odds ratio (POR) of parental consanguinity in each study, compared to a matched healthy population. RESULTS We identified 21 eligible studies with a total population of 18091 accounting for sample overlap. The POR among studies on a sample of mixed patients with PID ranged from 0.6 to 21.9 with the pooled POR of 3.0 (p < 0.001; I2 = 89%, 95% CI: 2.5-3.7). CONCLUSION PIDs with an autosomal recessive pattern of inheritance had significant odds of parental consanguinity compared to the healthy population, a phenomenon not observed in other inheritance patterns. Determining the extent of the impact that consanguinity imposes upon the progeny paves the way for convincing healthcare policymakers in highly consanguineous communities to act more diligently in informing the masses about the consequences of practicing inbreeding.
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Affiliation(s)
- Hasti Hadizadeh
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Masoud Salehi
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Shabnam Khoramnejad
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kia Vosoughi
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Guaní-Guerra E, Jiménez-Romero AI, García-Ramírez UN, Velázquez-Ávalos JM, Martínez-Guzmán E, Sandoval-Ramírez E, Camacho-Meza I. Disease burden for patients with primary immunodeficiency diseases identified at reference hospitals in Guanajuato, Mexico. PLoS One 2017; 12:e0175867. [PMID: 28448570 PMCID: PMC5407621 DOI: 10.1371/journal.pone.0175867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
Background In addition to the deleterious effect on health, there is considerable economic and psychosocial morbidity associated with primary immunodeficiency diseases (PID). Also, the cost of a late diagnosis frequently results in a heavy disease burden on the patient. The objective of this study was to collect and analyze data on patients with PID in the state of Guanajuato in Mexico, to indirectly estimate the burden of the disease. Methods An observational, longitudinal, and comparative study was conducted. A total of 44 patients were included and grouped according to the updated classification of PID. Results The median time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 2.17 (IQR = 6.44) years. Before diagnosis, the number of hospitalizations/year per patient was 0.86 (IQR = 2.28), the number of visit to emergency room/year per patient was 0.92 (IQR = 1.77), the number of doctor’s visits/year per patient was 15 (IQR = 11.25), whereas the school/work absence days per patient were reported in 52.72 (IQR = 56.35) days per year. After diagnosis, 20 patients (45.45%) received IVIG replacement therapy, and all of them presented a significant improvement (p <0.05) in all the mentioned variables. Characteristically, even when patients with PID received IVIG, there was still an important disease burden when comparing them against healthy controls. Complications secondary to PID were detected in 19 patients (43.18%). The reported overall mortality rate was 6.82% (n = 3). Conclusions We were able to indirectly estimate an important disease burden in patients with PID; which is considered to be preventable, at least in part, with effective interventions like health planning, research, collaboration with primary care providers, and generation of policies and practices, in order to improve the quality of life and care of families with PID.
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Affiliation(s)
- Eduardo Guaní-Guerra
- Department of Immunology, Hospital Regional de Alta Especialidad del Bajío, León Guanajuato, México
- Department of Immuno-Alergology, Hospital Aranda de la Parra, León Guanajuato, México
- * E-mail:
| | | | | | | | - Edgar Martínez-Guzmán
- Department of Immunology, Hospital Regional de Alta Especialidad del Bajío, León Guanajuato, México
| | - Eunice Sandoval-Ramírez
- Department of Immuno-Allergology Pediatrics, Hospital Pediátrico de León, León Guanajuato, México
| | - Ignacio Camacho-Meza
- Department of Immuno-Allergology Pediatrics, Hospital Pediátrico de León, León Guanajuato, México
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17
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van Kessel DA, Hoffman TW, van Velzen-Blad H, Zanen P, Grutters JC, Rijkers GT. Long-term Clinical Outcome of Antibody Replacement Therapy in Humoral Immunodeficient Adults With Respiratory Tract Infections. EBioMedicine 2017; 18:254-260. [PMID: 28347655 PMCID: PMC5405168 DOI: 10.1016/j.ebiom.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/12/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022] Open
Abstract
In severe humoral immunodeficiency the indication for antibody replacement therapy (ART) is clear, and supported by several large studies. However, for milder forms of humoral immunodeficiency, the indication for ART is less clear. This is a retrospective cohort study of 87 adults with recurrent respiratory tract infections who received ART. The patients had severe or mild humoral immunodeficiency, and were followed up for a median of 62months. Infection frequency, pharmacy-registered antibiotics use and hospital admissions significantly decreased under ART compared to the year prior to starting ART (median 5.50 (anamnestically)-0.82 (physician-confirmed) infections/year, p<0.001; median 4.00-2.05antibioticscourses/year, p<0.001; mean 0.75-0.44hospitaladmissions/year, p=0.009). These beneficial effects of ART were seen in both severe and mild immunodeficiency. Bronchiectasis was present in 27 patients when ART was started, but was not associated with clinical outcomes. An increase in hospital admissions under ART, observed in some patients, was significantly associated with pulmonary emphysema and current smoking. In conclusion, this study shows that ART is a long-term effective therapy in adults with recurrent respiratory tract infections with severe as well as with milder forms of humoral immunodeficiency.
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Affiliation(s)
- Diana A van Kessel
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands.
| | - Thijs W Hoffman
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Heleen van Velzen-Blad
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Pieter Zanen
- Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
| | - Ger T Rijkers
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Science, University College Roosevelt, Middelburg, The Netherlands
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18
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van Kessel DA, Hoffman TW, van Velzen-Blad H, van de Graaf EA, Grutters JC, Rijkers GT. Immune status assessment in adult lung transplant candidates. Transpl Immunol 2017; 40:31-34. [DOI: 10.1016/j.trim.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/27/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
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19
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Ismail IH, Jamli FM, Othman IS, Noh LM, Abdul Latiff AH. Malaysia's First Transplanted Case of Chronic Granulomatous Disease: The Journey of Overcoming Obstacles. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E9. [PMID: 27417247 PMCID: PMC4934564 DOI: 10.3390/children3020009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/06/2016] [Accepted: 05/12/2016] [Indexed: 11/22/2022]
Abstract
The awareness of primary immunodeficiency (PID) in Malaysia is still not forthcoming. Certain practical issues such as lack of clinical immunologists and specialized laboratory diagnostic facilities remain to be addressed. However, great efforts taken by passionate clinicians and scientists in the immunology networking have ascertained some prevalence. Despite the limitation, all suspected cases of PID are being properly investigated and competently managed. In this case report we highlighted the obstacles we faced in managing PID patients, particularly preparing for bone marrow transplant. This is the first transplanted case of chronic granulomatous disease in Malaysia, which emphasizes the importance of collaborative work to ensure further morbidities or mortalities are prevented.
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Affiliation(s)
- Intan Hakimah Ismail
- Department of Paediatrics, Clinical Immunology University, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400 Selangor, Malaysia.
| | | | - Ida Shahnaz Othman
- Paediatric Haematology, Oncology and Stem Cell Transplant Unit, Institute of Paediatrics, Kuala Lumpur Hospital, 50586 Kuala Lumpur, Malaysia.
| | - Lokman Mohd Noh
- Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia.
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20
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Orange JS, Seeborg FO, Boyle M, Scalchunes C, Hernandez-Trujillo V. Family Physician Perspectives on Primary Immunodeficiency Diseases. Front Med (Lausanne) 2016; 3:12. [PMID: 27066486 PMCID: PMC4811961 DOI: 10.3389/fmed.2016.00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/14/2016] [Indexed: 12/24/2022] Open
Abstract
Primary immunodeficiency diseases (PIDs) include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed) family practice physicians, of whom 44% reported following ≥1 patient with PID. Selective immunoglobulin A deficiency (21%) and chronic granulomatous disease (11%) were most common and were followed by significantly more subspecialist immunologists (P < 0.05). Use of intravenously administered immunoglobulin and live viral vaccinations across PID was significantly different (P < 0.05). Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4 vs. 79% of subspecialist immunologists, P < 0.05). Family practice physicians will likely encounter patients with PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.
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Affiliation(s)
- Jordan S. Orange
- Section of Immunology, Allergy and Rheumatology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Filiz O. Seeborg
- Section of Immunology, Allergy and Rheumatology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Division of Allergy and Immunology, Miami Children’s Hospital, Miami, FL, USA
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21
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Parker AR, Allen S, Harding S. Concentration of anti-pneumococcal capsular polysaccharide IgM, IgG and IgA specific antibodies in adult blood donors. Pract Lab Med 2016; 5:1-5. [PMID: 28856197 PMCID: PMC5574502 DOI: 10.1016/j.plabm.2016.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 12/02/2022] Open
Abstract
Objectives Anti-pneumococcal capsular polysaccharide (PCP) IgM, IgG and IgA ELISAs have been developed to aid assessment of the adaptive immune system. The relationship between the concentrations of PCP IgM, IgG, and IgA was investigated. Design and methods The concentrations of PCP IgM, IgG, and IgA were measured in sera obtained from 231 adult blood donors. Results Concentrations of each isotype were not normally distributed. The median concentration for PCP IgM was 54 U/mL (range 37–75 U/mL), IgG 40 mg/L (range 26–79 mg/L) and IgA 21 U/mL (range 13–44 U/mL). The median PCP IgM titres decreased with age and were significantly lower in patients aged 81–90 years compared to those aged 18–80 years. By contrast, there was a significantly higher median serum PCP IgG titre in the 61–90 years group compared to those aged 18–60 years and a significantly higher median serum PCP IgA titre in the 51–90 years group compared to those aged 18–50 years. The correlation between PCP IgG and IgA was more significant than between IgM and IgA and between IgM and IgG. Correlation of PCP IgA and IgM concentrations identified four phenotypes: high PCP IgM and IgA; high PCP IgM only; high PCP IgA only; and low PCP IgM and IgA. A significant number of individuals with a PCP IgG concentration >50 mg/L had low PCP IgA and IgM concentrations. Conclusion The additional measurement of PCP IgA and PCP IgM, alongside PCP IgG, in individuals investigated for a compromised immune system may provide a more detailed antibody profile.
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22
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Lugo Reyes SO, Ramirez-Vazquez G, Cruz Hernández A, Medina-Torres EA, Ramirez-Lopez AB, España-Cabrera C, Hernandez-Lopez CA, Yamazaki-Nakashimada MA, Espinosa-Rosales FJ, Espinosa-Padilla SE, Murata C. Clinical Features, Non-Infectious Manifestations and Survival Analysis of 161 Children with Primary Immunodeficiency in Mexico: A Single Center Experience Over two Decades. J Clin Immunol 2015; 36:56-65. [PMID: 26707787 DOI: 10.1007/s10875-015-0226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The hallmark of Primary immunodeficiencies (PID) is unusual infection, although other immunological non-infectious manifestations such as autoimmunity, allergy and cancer are often present. Most published reports focus on one disease or defect groups, so that a global prevalence of non-infectious manifestations of PID is hard to find. We aimed to describe the clinical features of our pediatric patients with PID, as well as the frequency and evolution of allergy, cancer and autoimmunity. METHODS We reviewed all the available charts of patients being followed for PID from 1991 to the spring of 2012 at the National Institute of Pediatrics, Mexico City, to describe their demographic, clinical and laboratory features. Their diagnoses were established by pediatric immunologists in accordance to ESID criteria, including routine immunological workup and specialized diagnostic assays. We divided patients by decade of diagnosis to analyze their survival curves. RESULTS There were 168 charts available, from which we excluded one duplicate and six equivocal diagnoses. We studied the charts of 161 PID patients (68% male, 86% alive), mostly from the center of the country, with a positive family history in 27% and known consanguinity in 11%. Eighty percent of the patients were diagnosed during the last decade. Current median age was 124 months; median age at onset of infections, 12 months; median age at diagnosis, 52 months; median age at death, 67.5 months. Severe infection and bleeding were the cause of 22 deaths. Eighty-six percent of all patients had at least one infection, while non-infectious manifestations had a global prevalence of 36%, namely: autoimmunity 19%, allergies 17%, and cancer 2.4%. Survival curves were not significantly different when compared by decade of diagnosis. CONCLUSIONS Compared to other registry reports, we found a lower prevalence of antibody defects, and of associated allergy and cancer. We could only locate two isolated IgA deficiencies and four cases of cancer among our PID patients. Although antibody defects are the most prevalent group (30%), the distribution we found is similar to that reported in Iran, Kuwait, Egypt and Taiwan, with a close 27% share for phagocyte defects, and 26% for the formerly called "well-defined" syndromes. Of note, autoimmune and inflammatory complications are high among our patients with chronic granulomatous disease, as has been reported in both the United States and Japan, but not in Europe.
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Affiliation(s)
| | | | - Alonso Cruz Hernández
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - Edgar A Medina-Torres
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Corín España-Cabrera
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | | | - Francisco J Espinosa-Rosales
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Chiharu Murata
- Research Methodology Department, National Institute of Pediatrics, Mexico City, Mexico.
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Immune Dysfunction in Children with CHARGE Syndrome: A Cross-Sectional Study. PLoS One 2015; 10:e0142350. [PMID: 26544072 PMCID: PMC4636349 DOI: 10.1371/journal.pone.0142350] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022] Open
Abstract
CHARGE syndrome is a variable, multiple congenital malformation syndrome. Patients with CHARGE syndrome have frequent infections that are presumed to be due to anatomical anomalies of the craniofacial region and upper airway, and cranial nerve problems resulting in swallowing difficulties and aspiration. The possible contribution of immunological abnormalities to these infections has not been systematically studied even though immune deficiencies have been described in patients with 22q11.2 deletion syndrome, a condition which shares remarkable clinical overlap with CHARGE syndrome. We assessed the frequency and nature of immune dysfunction in 24 children with genetically proven CHARGE syndrome. All patients, or their parents, completed a questionnaire on infectious history. Their immune system was extensively assessed through full blood counts, immunoglobulin levels, lymphocyte subpopulations, peripheral B- and T-cell differentiation, T-receptor excision circle (TREC) analysis, T-cell function, and vaccination responses. All CHARGE patients had a history of infections (often frequent), mainly otitis media and pneumonia, leading to frequent use of antibiotics and to hospital admissions. Decreased T-cell numbers were found in 12 (50%) patients, presumably caused by insufficient thymic output since TREC amounts were also diminished in CHARGE patients. Despite normal peripheral B-cell differentiation and immunoglobulin production in all patients, 83% of patients had insufficient antibody titers to one or more early childhood vaccinations. Based on our results, we recommend immunological evaluation of CHARGE patients with recurrent infections.
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Duraisingham SS, Manson A, Grigoriadou S, Buckland M, Tong CYW, Longhurst HJ. Immune deficiency: changing spectrum of pathogens. Clin Exp Immunol 2015; 181:267-74. [PMID: 25677249 PMCID: PMC4516442 DOI: 10.1111/cei.12600] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022] Open
Abstract
Current UK national standards recommend routine bacteriology surveillance in severe antibody-deficient patients, but less guidance exists on virology screening and viral infections in these patients. In this retrospective audit, we assessed the proportion of positive virology or bacteriology respiratory and stool samples from patients with severe, partial or no immune deficiency during a 2-year period. Medical notes were reviewed to identify symptomatic viral infections and to describe the course of persistent viral infections. During the 2-year period, 31 of 78 (39·7%) severe immune-deficient patients tested had a positive virology result and 89 of 160 (55.6%) had a positive bacteriology result. The most commonly detected pathogens were rhinovirus (12 patients), norovirus (6), Haemophilus influenzae (24), Pseudomonas spp. (22) and Staphylococcus aureus (21). Ninety-seven per cent of positive viral detection samples were from patients who were symptomatic. Low serum immunoglobulin IgA levels were more prevalent in patients with a positive virology sample compared to the total cohort (P = 0·0078). Three patients had persistent norovirus infection with sequential positive isolates for 9, 30 and 16 months. Virology screening of symptomatic antibody-deficient patients may be useful as a guide to anti-microbial treatment. A proportion of these patients may experience persistent viral infections with significant morbidity.
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Affiliation(s)
| | - A Manson
- Immunology Department, Barts Health NHS Trust, London, UK
| | - S Grigoriadou
- Immunology Department, Barts Health NHS Trust, London, UK
| | - M Buckland
- Immunology Department, Barts Health NHS Trust, London, UK
| | - C Y W Tong
- Department of Infection, Barts Health NHS Trust, London, UK
| | - H J Longhurst
- Immunology Department, Barts Health NHS Trust, London, UK
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25
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Sullivan KE, Boyle M, Nauman E, Carton T. Health care utilization by patients with common variable immune deficiency defined by International Classification of Diseases, Ninth Revision code 279.06. Ann Allergy Asthma Immunol 2015; 115:248-50. [PMID: 26162568 DOI: 10.1016/j.anai.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/27/2015] [Accepted: 06/17/2015] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, Louisiana
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26
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Doctors' awareness concerning primary immunodeficiencies in Brazil. Allergol Immunopathol (Madr) 2015; 43:272-8. [PMID: 25796303 DOI: 10.1016/j.aller.2014.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.
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Abstract
T cell immunodeficiency can occur as one of a group of primary disorders or develop secondary to chronic infection, illness or drug therapy. Primary T cell disorders are rare, accounting for approximately 11% of reported primary immunodeficiencies, and generally present in infancy or early childhood. Early recognition is very important as many of these patients will require bone marrow transplantation prior to the onset of severe infection or other complications. Because of their rarity, these infants usually present to clinicians who have little or no prior experience of these conditions, and therefore laboratory-based clinicians with knowledge of the key laboratory/pathological abnormalities and clinical features have a valuable role in identifying the possibility of immunodeficiency. Secondary T cell deficiency is a cardinal feature of HIV infection and the specific susceptibility to infectious micro-organisms is highlighted. The possibility of T cell immunodeficiency should be considered in any patient presenting with unusual or severe viral, fungal or protozoal infection.
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Affiliation(s)
- J D M Edgar
- David M Edgar, Royal Hospitals, The Belfast Trust, Grosvenor Road, Belfast BT12 6BN, UK.
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28
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Rijkers GT, Damoiseaux JG, Hooijkaas H. Medical immunology: Two-way bridge connecting bench and bedside. Immunol Lett 2014; 162:127-33. [DOI: 10.1016/j.imlet.2014.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Dantas EDO, Aranda CS, Nobre FA, Fahl K, Mazzucchelli JTL, Felix E, Friedlander-Del Nero DL, Nudelman V, Sano F, Condino-Neto A, Damasceno E, Costa-Carvalho BT. Medical awareness concerning primary immunodeficiency diseases in the city of São Paulo, Brazil. EINSTEIN-SAO PAULO 2014; 11:479-85. [PMID: 24488388 PMCID: PMC4880386 DOI: 10.1590/s1679-45082013000400013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 11/07/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate medical knowledge of primary immunodeficiency in the city of São Paulo (SP). METHODS A 14-item questionnaire about primary immunodeficiency was applied to physicians who worked at general hospitals. One of the questions presented 25 clinical situations that could be associated or not with primary immunodeficiency, and the percentage of appropriate answers generated a knowledge indicator. RESULTS Seven hundred and forty-six participated in the study, among them 215 pediatricians (28.8%), 244 surgeons (32.7%), and 287 clinicians (38.5%). About 70% of the physicians responded that they had learned about primary immunodeficiency in graduate school or in residency training. Treatment of patients that use antibiotics frequently was reported by 75% dos physicians, but only 34.1% had already investigated a patient and 77.8% said they did not know the ten warning signs for primary immunodeficiency. The knowledge indicator obtained showed a mean of 45.72% (±17.87). Only 26.6% if the pediatricians and 6.6% of clinicians and surgeons showed a knowledge indicator of at least 67% (equivalent to an appropriate answer in two thirds of the clinical situations). CONCLUSION There is a deficit in medical knowledge of primary immunodeficiency in the city of São Paulo, even among pediatricians, despite having greater contact with the theme over the last few years. The improvement of information on primary immunodeficiency in the medical community is an important step towards the diagnosis and treatment process of these diseases.
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Tosato F, Bucciol G, Pantano G, Putti MC, Sanzari MC, Basso G, Plebani M. Lymphocytes subsets reference values in childhood. Cytometry A 2014; 87:81-5. [PMID: 25132325 DOI: 10.1002/cyto.a.22520] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/02/2014] [Accepted: 07/28/2014] [Indexed: 11/07/2022]
Abstract
Immunophenotyping of blood lymphocyte subsets and activation markers is a basic tool in the diagnostic process of primary immunodeficiency diseases, its use becoming more and more widespread as the knowledge about these illnesses increases. However, the availability of reliable reference values, which need to be age-matched for the pediatric population, is a pre-requisite for the reliable interpretation of immunophenotyping data. Aim of this study is to analyze the lymphocyte subsets and activation markers distribution in children aged 0-18 years referring to the University Hospital of Padova and to create age-matched reference values expressed by percentiles, thus providing a valuable guideline for the interpretation of the immunophenotype.
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Affiliation(s)
- F Tosato
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
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31
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van Kessel DA, Hoffman TW, van Velzen-Blad H, Zanen P, Rijkers GT, Grutters JC. Response to pneumococcal vaccination in mannose-binding lectin-deficient adults with recurrent respiratory tract infections. Clin Exp Immunol 2014; 177:272-9. [PMID: 24547957 DOI: 10.1111/cei.12299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 12/11/2022] Open
Abstract
Mannose-binding lectin (MBL)-deficiency is associated with an increased susceptibility to pneumococcal infections and other forms of disease. Pneumococcal vaccination is recommended in MBL-deficient patients with recurrent respiratory tract infections (RRTI). The response to pneumococcal vaccination in MBL-deficient individuals has not yet been studied in detail. An impaired response to pneumococcal polysaccharides in MBL-deficient patients might explain the association between MBL deficiency and pneumococcal infections. This study investigates the antibody response to pneumococcal vaccination in MBL-deficient adult patients with RRTI. Furthermore, we investigated whether there was a difference in clinical presentation between MBL-deficient and -sufficient patients with RRTI. Eighteen MBL-deficient and 63 MBL-sufficient adult patients with RRTI were all vaccinated with the 23-valent pneumococcal polysaccharide vaccine and antibodies to 14 pneumococcal serotypes were measured on a Luminex platform. There were no differences observed in the response to pneumococcal vaccination between MBL-sufficient and -deficient patients. Forty-three MBL-sufficient patients could be classified as responders to pneumococcal vaccination and 20 as low responders, compared to 15 responders and three low responders in the MBL-deficient patients. We found no clear difference in clinical, radiological, lung function and medication parameters between MBL-sufficient and -deficient patients. In conclusion, our study suggests that MBL-deficient adults with RRTI have a response to a pneumococcal capsular polysaccharide vaccine comparable with MBL-sufficient patients. Moreover, we did not find a clear clinical role of MBL deficiency in adults with RRTI. As MBL deficiency is associated with an increased susceptibility to pneumococcal infections, pneumococcal vaccination might be protective in MBL-deficient patients with RRTI.
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Affiliation(s)
- D A van Kessel
- Department of Pulmonology, Sint Antonius Hospital, Nieuwegein, the Netherlands; Division of Heart and Lungs, University Medical Center, Utrecht, the Netherlands
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Holding S, Khan S, Sewell WAC, Jolles S, Dore PC. Using calculated globulin fraction to reduce diagnostic delay in primary and secondary hypogammaglobulinaemias: results of a demonstration project. Ann Clin Biochem 2014; 52:319-26. [PMID: 25024432 DOI: 10.1177/0004563214545791] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 12/11/2022]
Abstract
Background Median diagnostic delay of five to six years seen in primary hypogammaglobulinaemia results in morbidity including bronchiectasis. Patients typically have multiple health care encounters and blood tests before the diagnosis is considered. We report outcomes from using the difference between total protein and albumin (globulin fraction) to reduce diagnostic delay in unsuspected hypogammaglobulinaemia. Methods A prospective >5 year programme in the setting of a National Health Services Hospital Blood Sciences pathology service processing serum samples from primary and secondary care. Patients with globulin fraction below the first percentile were reviewed in the context of supplied clinical details. Immunoglobulin measurements were performed in selected patients. Results Of 2,910,850 globulin fractions 27,304 (0.9%) were below the 1st percentile globulin fraction (<18 g/L). After exclusions, 933 (3% of these) had immunoglobulins measured. Of these, 292 had IgG < 5 g/L, 186 < 4 g/L and 80 < 3 g/L, giving respective positive predictive values of 31%, 20% and 8.6%. Positive predictive value for common variable immunodeficiency was 1.3%. We identified 12 new cases of common variable immunodeficiency, 10 new haematological disorders and 20 hypogammaglobulinaemias secondary to medication. Locally derived cut-offs are required as small differences between analysers have a significant effect on screen-positive rates. Conclusions Use of a 1st percentile globulin fraction improved early detection of hypogammaglobulinaemia. This is a useful adjunct to alert clinicians to unsuspected hypogammaglobulinaemia but should not replace immunoglobulin measurement. Patients with globulin fraction below the first percentile should be reviewed for possible hypogammaglobulinaemia.
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Affiliation(s)
- Stephen Holding
- Immunology Department, Hull Royal Infirmary, Hull, UK
- Postgraduate Medical Institute, University of Hull, Hull, UK
| | - Sujoy Khan
- Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - William AC Sewell
- PathLinks Immunology, Scunthorpe, UK
- Hull York Medical School, Hull, UK
| | | | - Philip C Dore
- Immunology Department, Hull Royal Infirmary, Hull, UK
- Hull York Medical School, Hull, UK
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Parker AR, Carr‐Smith HD. Calibration Differences and the Prozone Phenomenon in IgG4‐Related Disease: Comment on the Article by Khosroshahi et al. Arthritis Rheumatol 2014; 66:1964-5. [DOI: 10.1002/art.38668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Feleszko W, Ruszczyński M, Zalewski BM. Non-specific immune stimulation in respiratory tract infections. Separating the wheat from the chaff. Paediatr Respir Rev 2014; 15:200-6. [PMID: 24275566 DOI: 10.1016/j.prrv.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 10/18/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022]
Abstract
Parents of children suffering from recurrent respiratory infections can be persuaded by advertisements to pressure their family physicians and pediatricians for "immune-stimulating enhancements". However, the evidence base behind these immune stimulants is usually lacking. Often there is no peer-reviewed studies available that support claims made by "immune-booster" supplements. In this review, we critically analyze most of the marketed immuno-active drugs (including vitamin preparations, dietary supplements, homeopathic remedies, Ecchinacea, bacterial lysates, and probiotics) and identify the necessity to exclude an immunodeficiency in every child suffering from recurrent respiratory tract infections.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Pneumology and Allergy, The Medical University Children's Hospital, Działdowska 1, 01-184 Warsaw, Poland.
| | - Marek Ruszczyński
- Department of Paediatrics, Medical University of Warsaw, Działdowska 1, 01-184 Warsaw, Poland
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35
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Clinical characteristics and outcomes of primary antibody deficiency: A 20-year follow-up study. J Formos Med Assoc 2014; 113:340-8. [DOI: 10.1016/j.jfma.2012.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022] Open
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Abstract
Children with frequent or recurrent infections commonly present to medical practitioners in both primary and secondary care. Here we provide a structured approach to the consultation of the infant under 2 years of age with frequent infections. The key is a focused history and examination to elicit red flags to an underlying diagnosis, while at the same time seeking benign explanations for the frequency of infections, which account for the majority of children, thereby avoiding unnecessary investigations.
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Affiliation(s)
- Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Australia
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37
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Guilhem A, Malcus C, Clarivet B, Plauchu H, Dupuis-Girod S. Immunological abnormalities associated with hereditary haemorrhagic telangiectasia. J Intern Med 2013; 274:351-62. [PMID: 23772771 DOI: 10.1111/joim.12098] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder related to mutations in one of the coreceptors to the transforming growth factor-β superfamily (ALK1 or endoglin). Besides the obvious vascular symptoms (epistaxis and arteriovenous malformations), patients have an unexplained high risk of severe bacterial infections. The aim of the study was to assess the main immunological functions of patients with HHT using the standard biological tests for primary immunodeficiencies. DESIGN, SETTING AND SUBJECTS A prospective single-centre study of 42 consecutive adult patients with an established diagnosis of HHT was conducted at the National French HHT Reference Center (Lyon). Lymphocyte subpopulations and proliferation capacity, immunoglobulin levels and neutrophil and monocyte phagocytosis, oxidative burst and chemotaxis were assessed. RESULTS Innate immunity was not altered in patients with HHT. With regard to adaptive immunity, significant changes were seen in immunological parameters: primarily, a lymphopenia in patients with HHT compared with healthy control subjects affecting mean CD4 (642 cells μL(-1) vs. 832 cells μL(-1) , P < 0.001), CD8 (295 cells μL(-1) vs. 501 cells μL(-1) , P < 0.0001) and natural killer (NK) cells (169 cells μL(-1) vs. 221 cells μL(-1) , P < 0.01), associated with increased levels of immunoglobulins G and A. This lymphopenia mainly concerned naïve T cells. Proliferation capacities of lymphocytes were normal. Lymphopenic patients had a higher frequency of iron supplementation but no increase in infection rate. Lower levels of immunoglobulin M and a higher rate of pulmonary arteriovenous malformations were found amongst patients with a history of severe infection. CONCLUSIONS Patients with HHT exhibit immunological abnormalities including T CD4, T CD8 and NK cell lymphopenia and increased levels of immunoglobulins G and A. The observed low level of immunoglobulin M requires further investigation to determine whether it is a specific risk factor for infection in HHT.
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Affiliation(s)
- A Guilhem
- CHU de Montpellier, Service de Médecine Interne A, Hôpital Saint Eloi, Montpellier, France
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38
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Primary immunodeficiency diseases at reference and high-specialty hospitals in the state of Guanajuato, Mexico. BIOMED RESEARCH INTERNATIONAL 2013; 2013:187254. [PMID: 24073395 PMCID: PMC3773974 DOI: 10.1155/2013/187254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/19/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND In general, primary immunodeficiency diseases (PIDs) are underdiagnosed in most countries. The objective of this study was to describe the frequency and clinical spectrum of PID in the most important tertiary hospitals in our region. METHODS An observational, cross-sectional, with retrospective chart, review study was conducted. A total of 26 patients were included and grouped according to the updated classification of PIDs. RESULTS PIDs spectra were as follows: predominantly antibody deficiency diseases were the most common category (65.38%), followed by other well-defined immunodeficiency syndromes (11.55%), congenital defects of phagocyte number and/or function (7.69%), complement deficiencies (3.85%), combined T- and B-cell immunodeficiencies (3.85%), and defects in innate immunity (3.85%). The mean time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 4.65 ± 6.95 years. CONCLUSIONS Predominant antibody deficiency disease was the most common group of PIDs, agreeing with international reports. Awareness of underdiagnosis by physicians is crucial for a prompt diagnosis and treatment, which in turn should improve the quality of life among patients with PIDs.
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Abstract
PURPOSE OF REVIEW It is 20 years since the 10 Warning Signs of primary immunodeficiency (PID) were first published and with over 180 PIDs now identified it is timely to evaluate their effectiveness, given the broadening clinical spectrum of PID. RECENT FINDINGS Two recent studies have sought to define the features that best identify patients with PID and compare these with the 10 Warning Signs. They suggest the 10 Warning Signs discriminate poorly between those with and without PID, and that other features identify about one-third of patients with PID in whom none of the 10 Warning Signs was present. Recent literature describes the diverse presenting features that may assist in more accurately identifying those with PID. SUMMARY Further development and refinement of early warning signs in light of the growing knowledge of how PIDs manifest clinically may allow relatively simple yet effective guidelines targeted at different groups to better detect PID.
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Affiliation(s)
- Michael D OʼSullivan
- Immunology Department, PathWest Laboratory Medicine, Perth, Western Australia, Australia
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40
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Bender AM, Levy ML. The child with recalcitrant dermatitis: when to worry? Dermatol Clin 2013; 31:223-8. [PMID: 23557651 DOI: 10.1016/j.det.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dermatitis is a frequent cause for referral to the pediatric dermatologist. In this article, a brief overview is given of common childhood dermatoses as well as some rarer dermatoses that may give the clinician cause for concern. Widespread scaling and erythema, described as erythroderma, are a cause of frustration for patients, families, and their physician(s). Both unusual and common skin disorders can present in this fashion. Just as recognizing common dermatoses is important, it is also important to recognize when a dermatitis fails to fit the common pattern and may prompt further investigation.
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Affiliation(s)
- Anna M Bender
- Division of Pediatric Dermatology, Department of Dermatology, Johns Hopkins University, 200 North Wolfe Street, Suite 2107, Baltimore, MD 21287, USA
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Rose MA, Buess J, Ventur Y, Zielen S, Herrmann E, Schulze J, Schubert R. Reference ranges and cutoff levels of pneumococcal antibody global serum assays (IgG and IgG2) and specific antibodies in healthy children and adults. Med Microbiol Immunol 2013; 202:285-94. [PMID: 23529214 DOI: 10.1007/s00430-013-0292-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
Pneumococcal antibodies represent the acquisition of natural immunity. Determination of pneumococcal antibodies is an important screening tool for immunodeficiencies. Our study generated reference ranges and cutoff levels for pneumococcal antibody global serum assays correlated to a specific pneumococcal antibody ELISA. Specific pneumococcal antibody levels were measured from 457 children undergoing elective surgery and 46 healthy adult volunteers (88 with previous pneumococcal immunization from both groups), 22 severe immunodeficient subjects with ataxia telangiectasia (A-T, negative controls), and age-matched 36 healthy allergic asthmatics. We determined a representative panel of serotype-specific pneumococcal antibodies (serotype 4, 5, 6B, 7F, 14, 18C, 19F, 23F) by ELISA and global pneumococcal IgG and IgG2 antibodies by EIA. In vaccine-naïve healthy subjects, initial pneumococcal IgG geometric mean concentrations of 13.1 μg/ml were low in the first year of life and increased over the time, reaching adult levels (70.5 μg/ml) at age 8-12 years. In parallel, IgG2 antibodies increased from 20.7 % (0.5-1 year old) to adult proportions (>30 %) in preschoolers. Correlation between the pneumococcal IgG screening assay and specific pneumococcal antibody levels was acceptable (Pearson's coefficient r = 0.4455; p = 0.001). Cutoff levels showed high sensitivity, whereas specificity was high to moderate calculated from correlations with the specific ELISA. We provide reference ranges and cutoff levels for the interpretation of specific antibody determinations in the clinical setting. The global pneumococcal IgG/IgG2 assay is a suitable screening tool and correlates with the ELISA serotype-specific pneumococcal antibodies. However, results below our cutoff values should be re-evaluated by serotype-specific ELISA testing.
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Affiliation(s)
- M A Rose
- Department of Pulmonology, Children`S Hospital, Allergy, and Cystic Fibrosis, Goethe-University, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
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Picard C. [When should immunologic explorations be carried out in children with suspicion of primary immunodeficiency?]. Arch Pediatr 2013; 20:412-7. [PMID: 23480855 DOI: 10.1016/j.arcped.2013.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/07/2013] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
Abstract
The identification of primary immunodeficiency is important in the prognosis and treatment of patients with these rare genetic diseases. For their diagnosis, simple screening explorations need to be carried out in case of severe, recurrent, and/or unusual infections. These include the whole blood cell count, plasmatic immunoglobulin levels, and postimmunization and/or post-infectious serologies. These examinations are used to guide the diagnosis with the joint analysis of patient's medical history, the clinical examination, and screening of biological results. They will then guide the prescription of more specific second-line explorations depending on the type of primary immunodeficiency suspected.
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Affiliation(s)
- C Picard
- Centre d'étude des déficits immunitaires (CEDI), pavillon Kirmisson, hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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Zasada AA, Rastawicki W, Śmietańska K, Rokosz N, Jagielski M. Comparison of seven commercial enzyme-linked immunosorbent assays for the detection of anti-diphtheria toxin antibodies. Eur J Clin Microbiol Infect Dis 2013; 32:891-7. [PMID: 23354678 DOI: 10.1007/s10096-013-1823-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/09/2013] [Indexed: 11/24/2022]
Abstract
Determination of immune status of patients to diphtheria toxin is based mainly on the results of commercially available ELISA kits. The aim of the present study was to compare the results obtained by ELISAs from seven different manufacturers: Mikrogen, Immunolab, Sekisui Virotech, NovaTec, Virion\Serion, IBL International and Euroimmun. All assays were performed according to the manufacturers' instructions. The concentrations of the anti-diphtheria toxin antibodies in 72 serum samples were calculated on the basis of curves constructed from standards supplied by manufacturers and the new reference material-International Standard for Diphtheria Antitoxin (10/262). The repeatability and reproducibility of all the ELISA kits tested were good. Number of sera with concentrations of the anti-diphtheria toxin antibodies below the WHO-recommended level of protection (0.1 IU/ml) were dependent on the ELISA used: Mikrogen, 20/72 samples (27.7%); Immunolab, 11/72 samples (15.3%); Sekisui Virotech, 0/72 samples (0%); NovaTec 18/72 samples (25.0%); Serion 12/72 samples (16.7%); IBL International, 7/72 samples (9.7 %); and Euroimmun, 17/72 samples (23.6%). However, the results obtained in particular ELISAs, with the exception of Sekisui Virotech, were much more consistent when the concentrations of the anti-diphtheria toxin antibodies in 72 sera measured by using curves constructed from the International Standard 10/262. The data obtained clearly demonstrated that manufacturer-dependent differences between anti-diphtheria IgG ELISA kits exist. The differences in recommendations accepted by the individual manufacturers together with differences shown in our studies in sensitivity greatly affect the clinical interpretation of results.
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Affiliation(s)
- A A Zasada
- Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
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Reda SM, El-Ghoneimy DH, Afifi HM. Clinical predictors of primary immunodeficiency diseases in children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 5:88-95. [PMID: 23450209 PMCID: PMC3579097 DOI: 10.4168/aair.2013.5.2.88] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/23/2012] [Indexed: 12/22/2022]
Abstract
Purpose To promote awareness of primary immunodeficiency (PID), the "10 warning signs" of PID and an immunodeficiency-related (IDR) score were developed. However, their efficiency in identifying PID cases was not sufficiently evaluated in clinical practice. The objective of this study was to test the validity of the 10 warning signs and IDR score in identifying PID among children with recurrent infections at a tertiary pediatric hospital in Egypt. Methods A retrospective analysis of the medical records of 204 patients was performed. Of these patients, 92 had defined PID diseases and 112 were considered non-PID cases because investigations were inconclusive. Results Demonstrating two warning signs and an IDR score of 6 led to sensitivities of 94 and 66%, respectively, and specificities of 64 and 75%, respectively, in identifying PID cases. The strongest predictor of PID was family history that, if combined with the need for intravenous antibiotics, recurrent deep-seated infections, and failure to thrive, could identify 81% of PID patients. A family history of PID, sibling death, and/or parental consanguinity would predict 92% of combined immunodeficiencies, 92% of phagocyte defects, 87% of well-identified immunodeficiency syndromes, and 84% of antibody deficiency if the need for intravenous antibiotics is considered in the latter. Conclusions The 10 warning signs and IDR score do not aid in an early diagnosis of severe PID. Educational campaigns should target pediatricians aiming to increase PID awareness and to address family history of PID, parental consanguinity, and previous sibling death as key predictors of PID in communities with a high prevalence of consanguineous marriages.
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Affiliation(s)
- Shereen M Reda
- Department of Pediatric Allergy and Immunology, Children's Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kilpatrick DC. Birds, babies and blood. Mol Immunol 2012; 55:35-47. [PMID: 22998851 DOI: 10.1016/j.molimm.2012.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 10/27/2022]
Abstract
This is an autobiographical review describing the author's career in immunology research and summarizing his current understanding of the areas involved. Contributions to autoimmunity, immune deficiency, transfusion immunology, HLA-disease associations, reproductive immunology, cellular therapies, and innate immunity are included; also discussion of medical research ethics and various research-related activities.
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Affiliation(s)
- David C Kilpatrick
- Scottish National Blood Transfusion Service, National Science Laboratory, Edinburgh, United Kingdom.
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Hernandez-Trujillo HS, Chapel H, Lo Re V, Notarangelo LD, Gathmann B, Grimbacher B, Boyle JM, Hernandez-Trujillo VP, Scalchunes C, Boyle ML, Orange JS. Comparison of American and European practices in the management of patients with primary immunodeficiencies. Clin Exp Immunol 2012; 169:57-69. [PMID: 22670779 PMCID: PMC3390474 DOI: 10.1111/j.1365-2249.2012.04588.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2012] [Indexed: 11/29/2022] Open
Abstract
Primary immunodeficiency diseases (PIDs) comprise a heterogeneous group of rare disorders. This study was devised in order to compare management of these diseases in the northern hemisphere, given the variability of practice among clinicians in North America. The members of two international societies for clinical immunologists were asked about their management protocols in relation to their PID practice. An anonymous internet questionnaire, used previously for a survey of the American Academy of Allergy, Asthma and Immunology (AAAAI), was offered to all full members of the European Society for Immunodeficiency (ESID). The replies were analysed in three groups, according to the proportion of PID patients in the practice of each respondent; this resulted in two groups from North America and one from Europe. The 123 responses from ESID members (23·7%) were, in the majority, very similar to those of AAAAI respondents, with > 10% of their practice devoted to primary immunodeficiency. There were major differences between the responses of these two groups and those of the general AAAAI respondents whose clinical practice was composed of < 10% of PID patients. These differences included the routine use of intravenous immunoglobulin therapy (IVIg) for particular types of PIDs, initial levels of IVIg doses, dosing intervals, routine use of prophylactic antibiotics, perceptions of the usefulness of subcutaneous immunoglobulin therapy (SCIg) and of the risk to patients' health of policies adopted by health-care funders. Differences in practice were identified and are discussed in terms of methods of health-care provision, which suggest future studies for ensuring continuation of appropriate levels of immunoglobulin replacement therapies.
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Low LCM, Manson AL, Hardman C, Carton J, Seneviratne SL, Ninis N. Autosomal recessive chronic granulomatous disease presenting with cutaneous dermatoses and ocular infection. Clin Exp Dermatol 2012; 38:270-3. [PMID: 22606957 DOI: 10.1111/j.1365-2230.2012.04392.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatoses such as eczematous dermatitis and cutaneous infection are recognized presentations of primary immunodeficiency (PID). However, atopic dermatitis affects approximately 10% of infants, and cutaneous infections are not uncommon in children, therefore the challenge for the dermatologist is to distinguish the few patients that have PID from the many that do not. We report on a 6-year-old girl who was ultimately diagnosed with autosomal recessive chronic granulomatous disease (AR-CGD) after presenting to various hospitals with dermatitis, scalp plaques recalcitrant to treatment, and recurrent infections over a 3-year period, and describe some aspects of her diagnosis and management. This report highlights the importance of considering rare disorders such as AR-CGD in the differential diagnosis of recurrent or recalcitrant dermatological infections in children.
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Affiliation(s)
- L C M Low
- Department of Dermatology, St Mary's Hospital, London, UK.
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Errante PR, Franco JL, Espinosa-Rosales FJ, Sorensen R, Condino-Neto A. Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives. Ann N Y Acad Sci 2012; 1250:62-72. [PMID: 22364447 DOI: 10.1111/j.1749-6632.2011.06289.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary immunodeficiencies (PIDs) are genetic disorders of the immune system comprising many different phenotypes. Although previously considered rare, recent advances in their clinical, epidemiological, and molecular definitions are revealing how much we still need to learn about them. For example, geographical and ethnic variations as well as the impact of certain practices influence their frequency and presentation, making it necessary to consider their study in terms of regions. The Latin American Society for Immunodeficiencies was established as an organization dedicated to provide scientific support for basic and clinical research and to develop tools and educational resources to promote awareness in the medical community. Initiatives such as these are positively influencing the way PIDs are tackled in these countries, as shown by recent reports and publications. This paper provides a historical compilation and a current view of the many issues faced by scientists studying these diseases in these countries, highlighting the diverse scientific contributions and offering a promising perspective for the further developments in this field in Latin America.
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Affiliation(s)
- Paolo Ruggero Errante
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Brazil
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Whitelegg AME, Birtwistle J, Richter A, Campbell JP, Turner JE, Ahmed TM, Giles LJ, Fellows M, Plant T, Ferraro AJ, Cobbold M, Drayson MT, MacLennan CA. Measurement of antibodies to pneumococcal, meningococcal and haemophilus polysaccharides, and tetanus and diphtheria toxoids using a 19-plexed assay. J Immunol Methods 2012; 377:37-46. [PMID: 22293629 DOI: 10.1016/j.jim.2012.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/14/2012] [Accepted: 01/17/2012] [Indexed: 11/19/2022]
Abstract
The measurement of antibody responses to vaccination is useful in the assessment of immune status in suspected immune deficiency. Previous reliance on enzyme-linked immunoabsorbent assays (ELISA) has been cumbersome, time-consuming and expensive. The availability of flow cytometry systems has led to the development of multiplexed assays enabling simultaneous measurement of antibodies to several antigens. We optimized a flow cytometric bead-based assay to measure IgG and IgM concentrations in serum to 19 antigens contained in groups of bacterial subunit vaccines: pneumococcal vaccines, meningococcal vaccines, Haemophilus influenzae b (Hib), and tetanus and diphtheria toxoid vaccines. 89-SF was employed as the standard serum. The assay was used to determine specific antibody levels in serum from 193 healthy adult donors. IgG and pneumococcal IgM antibody concentrations were measurable across 3 log10 ranges encompassing the threshold protective IgG antibody levels for each antigen. There was little interference between antibody measurements by the 19-plexed assay compared with monoplexed assays, and a lack of cross-reactive IgG antibody, but evidence for cross-reacting IgM antibody for 3/19 pneumococcal antigens. 90th centile values for 15/19 IgG concentrations and 12/12 IgM concentrations of the 193 adult sera were within these ranges and percentages of sera containing protective IgG antibody levels varied from 4% to 95% depending on antigen. This multiplexed assay can simultaneously measure antibody levels to 19 bacterial vaccine antigens. It is suitable for use in standard clinical practice to assess the in vivo immune response to test vaccinations and measure absolute antibody levels to these antigens.
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Affiliation(s)
- Alison M E Whitelegg
- Medical Research Council Centre for Immune Regulation and Clinical Immunology Service, Institute of Biomedical Research, School of Immunity and Infection, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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de Vries E. Patient-centred screening for primary immunodeficiency, a multi-stage diagnostic protocol designed for non-immunologists: 2011 update. Clin Exp Immunol 2012; 167:108-19. [PMID: 22132890 DOI: 10.1111/j.1365-2249.2011.04461.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Members of the European Society for Immunodeficiencies (ESID) and other colleagues have updated the multi-stage expert-opinion-based diagnostic protocol for non-immunologists incorporating newly defined primary immunodeficiency diseases (PIDs). The protocol presented here aims to increase the awareness of PIDs among doctors working in different fields. Prompt identification of PID is important for prognosis, but this may not be an easy task. The protocol therefore starts from the clinical presentation of the patient. Because PIDs may present at all ages, this protocol is aimed at both adult and paediatric physicians. The multi-stage design allows cost-effective screening for PID of the large number of potential cases in the early phases, with more expensive tests reserved for definitive classification in collaboration with a specialist in the field of immunodeficiency at a later stage.
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Affiliation(s)
- E de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
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