Multiple leukocyte abnormalities in chronic granulomatous disease: a familial study

Association of glucose-6-phosphate dehydrogenase deficiency and X-linked chronic granulomatous disease in a child with anemia and recurrent infections

Patients with severe leukocyte G6PD deficiency may present with impairment of NADPH oxidase activity and a history of recurrent infections, mimicking the phenotype of chronic granulomatous disease. We report herein a child with recurrent infections who initially received the diagnosis of G6PD deficiency. His erythrocyte G6PD activity was reduced: 1.8 U/g Hb (normal: 12.1 +/- 2.1 U/g Hb). Further studies revealed that G6PD activity in neutrophils, mononuclear leukocytes, and Epstein-Barr virus-transformed B-lymphocytes from the proband was similar to healthy controls. Molecular studies showed that the G6PD deficiency was due a 202 G-->A mutation, the A- variant common in African ethnic groups. The proband also exhibited severely impaired respiratory burst activity, as observed in X-linked CGD. Sequence analysis of genomic DNA showed a 264 G-->A substitution at the 3' splice junction of gp91-phox exon 3. The cDNA sequence showed a deletion of gp91-phox exon 3, giving rise to an unstable or nonfunctional mutant gp91-phox and to the phenotype of X-linked CGD. We propose that clinicians treating a patient with G6PD deficiency during a severe infection episode consider the possibility of temporary or permanent impairment of the phagocytes' microbicidal activity and the eventual association of G6PD deficiency and chronic granulomatous disease.

Antioxidant defense mechanisms in human neutrophils

Neutrophils have a short half-life and high tendency to undergo apoptosis. One feature that may influence these characteristics is the antioxidant/oxidant balance of these cells. There are few studies on the levels of antioxidant enzymes in human neutrophils. We have analyzed by immunohistochemistry of paraffin-embedded cells and from cytospin preparations the most important antioxidant proteins in human neutrophils, and compared their levels with those in blood monocytes. Neutrophils showed moderate to high catalase, weak to moderate extracellular superoxide dismutase, and weak copper zinc superoxide dismutase and gamma-glutamylcysteine synthetase immunoreactivities. There were no detectable levels of manganese superoxide dismutase, thioredoxin, and heme oxygenase 1. Some differences were observed between the samples prepared by embedding in paraffin or by cytospin. These results, in combination with a recent study from this laboratory, suggest that a prominent feature in neutrophils is their high catalase activity but lower level of glutathione-dependent antioxidant enzymes. The differences in antioxidant profiles in neutrophils and monocytes may have important effects on the life span of human neutrophils, in both healthy and diseased tissues.

Hepatic abscesses in the immunocompromised patient: role of CT in detection, diagnosis, management, and follow-up

Newer cytotoxic and immunosuppressive agents and more aggressive oncologic treatment protocols have resulted in an increased incidence of opportunistic infections in the immunocompromised host. Clinical symptoms and laboratory data are often nonspecific and definitive diagnosis may be difficult to establish. The role of CT in the detection, diagnosis, management, and follow-up of various hepatic opportunistic infections in 9 immunocompromised hosts is presented. In 5 of 6 patients, CT-guided needle aspiration resulted in definitive diagnosis. In 3 patients, surgical intervention was obviated by abscess drainage using CT guidance. There is clearly a role for CT not only in the detection but also in the definitive diagnosis, treatment, and follow-up of abscesses in the immunocompromised host.

Chronic granulomatous disease: value of the newer imaging modalities

The contribution of computed tomography (CT), ultrasound (US), and nuclear medicine studies in the evaluation and management of seven patients with chronic granulomatous disease was retrospectively reviewed. These modalities proved valuable in detecting sites of infection, particularly in the abdomen. Three patients had liver abscesses, two had suppurative retroperitoneal lymphadenopathy, one had empyema, and one had a scrotal abscess. Furthermore, CT or US-guided percutaneous aspiration and/or drainage of infected material was successfully performed on three separate occasions in a single patient, obviating the need for surgery. The newer imaging modalities are useful in the prompt diagnosis and in some instances non-operative therapy of complications of chronic granulomatous disease.

Chronic granulomatous disease associated with peculiar Aspergillus lesions. Patho-anatomical report based on two autopsy cases and a brief review of all autopsy cases reported in Japan

Chronic granulomatous disease (CGD) is based on the dysfunction of phagocytes and characterized by a comparatively uniform granulomatous lesion caused by organisms which do not produce hydrogen peroxide and which are catalase-positive. This report describes two autopsy cases in children, a nine year-two month-old boy and a ten month-old girl, with the clinical manifestations and autopsy findings of CGD and a brief review of all autopsy cases consistent with CGD reported in Japan. In these cases, in addition to the usual CGD lesions, there was a markedly different type of granuloma due to Aspergillus sp., which consisted of multinuclear giant cells alone, or a caseous center surrounded by giant cells. This peculiar type of aspergillosis may correspond to a primary infection, described as pseudotuberculosis aspergillina. It appears that in some CGD patients, macrophages may function normally and sometimes be more activated by these infections than in the normal body. The histochemical and electron microscopic examination of the present cases and a review of the previous cases suggest that the yellowish brown pigment found seems to resemble a ceroid. It is a product of the degradation of leukocytes and tissue elements with subsequent accumulation in phagocytic histiocytes and is not necessarily peculiar to CGD.