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Tsujioka Y, Nishimura G, Nishi E, Kono T, Nozaki T, Hashimoto M, Yamada Y, Jinzaki M. Childhood interstitial lung diseases: current understanding of the classification and imaging findings. Jpn J Radiol 2024; 42:937-952. [PMID: 39012450 PMCID: PMC11364587 DOI: 10.1007/s11604-024-01603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/23/2024] [Indexed: 07/17/2024]
Abstract
Childhood interstitial lung diseases (chILDs) encompass a diverse group of disorders with a high mortality rate and severe respiratory morbidities. Recent investigations have revealed that the classification of adult ILDs is not valid for chILDs, particularly for ILDs of early onset. Therefore, Children's Interstitial Lung Disease Research Cooperative of North America proposed a new classification of chILDs for affected children under 2 years of age, and later another classification for affected individuals between 2 and 18 years of age. In this review, we provide an overview of the imaging findings of chILDs by classification. Most infantile ILDs have unique clinical, radiological, and molecular findings, while the manifestation of pediatric ILDs overlaps with that of adult ILDs.
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Affiliation(s)
- Yuko Tsujioka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan.
| | - Gen Nishimura
- Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan
| | - Eugene Nishi
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
- Department of Radiology, Keiyu Hospital, Yokohama, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
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2
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Jana M, Sinha P, Garg P, Naranje P, Kabra SK, Bhalla AS. Imaging Findings in Chronic Granulomatous Disease (CGD). Indian J Pediatr 2024; 91:242-247. [PMID: 36454508 DOI: 10.1007/s12098-022-04350-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To describe prevalence of various imaging findings in chronic granulomatous disease (CGD) patients; and find imaging biomarkers for differentiating chest infections caused by different micro-organisms. METHODS A retrospective study was conducted on 15 patients (49 scans) with proven CGD. Scans which had a correlative microbiological diagnosis for organisms were included in the analysis. The scans were reviewed by 3 radiologists on a predefined proforma, under the lung parenchymal, airway, pleural, mediastinal, and extrathoracic abnormalities. Analysis of various imaging parameters on a semiquantitative scale was performed, followed by a correlation of each imaging findings with causative organisms. RESULT The mean age of presentation was nearly 7 y, with a male preponderance. Definitive proof of causative organisms was obtained in 22 scans. Bacterial infection was found in 7, fungal in 12, tubercular in 2, and viral in 1 scan. Most prevalent thoracic imaging manifestations included lymphadenopathy (commonest), consolidation, nodules, air trapping, and bronchiectasis. Fungal infections showed necrotic conglomerate lymphadenopathy, cavitating nodules, and multilobar consolidation more frequently than bacterial infections (though not statistically significant). Abscesses and lymphadenopathy were the most common extrathoracic manifestations. CONCLUSION In patients with CGD, multifocal or multilobar consolidation, mass-like consolidation, cavitating nodules, and conglomerate necrotic lymphadenopathy should alert the radiologist to a possible fungal cause.
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Affiliation(s)
- Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pallavi Sinha
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Palak Garg
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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3
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Salvator H, Mahlaoui N, Suarez F, Marcais A, Longchampt E, Tcherakian C, Givel C, Chabrol A, Caradec E, Lortholary O, Lanternier F, Goyard C, Couderc LJ, Catherinot E. [Pulmonary complications of Chronic Granulomatous Disease]. Rev Mal Respir 2024; 41:156-170. [PMID: 38272769 DOI: 10.1016/j.rmr.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
Chronic Granulomatosis Disease (CGD) is an inherited immune deficiency due to a mutation in the genes coding for the subunits of the NADPH oxidase enzyme that affects the oxidative capacity of phagocytic cells. It is characterized by increased susceptibility to bacterial and fungal infections, particularly Aspergillus, as well as complications associated with hyperinflammation and granulomatous tissue infiltration. There exist two types of frequently encountered pulmonary manifestations: (1) due to their being initially pauci-symptomatic, possibly life-threatening infectious complications are often discovered at a late stage. Though their incidence has decreased through systematic anti-bacterial and anti-fungal prophylaxis, they remain a major cause of morbidity and mortality; (2) inflammatory complications consist in persistent granulomatous mass or interstitial pneumoniae, eventually requiring immunosuppressive treatment. Pulmonary complications recurring since infancy generate parenchymal and bronchial sequelae that impact functional prognosis. Hematopoietic stem cell allograft is a curative treatment; it is arguably life-sustaining and may limit the morbidity of the disease. As a result of improved pediatric management, life expectancy has increased dramatically. That said, new challenges have appeared with regard to adults: difficulties of compliance, increased inflammatory manifestations, acquired resistance to anti-infectious therapies. These different developments underscore the importance of the transition period and the need for multidisciplinary management.
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Affiliation(s)
- H Salvator
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; UMR0892 VIM-Suresnes Inrae, université Paris-Saclay, Suresnes, France; Faculté de Sciences de la Vie Simone Veil, Université Versailles Saint Quentin, Montigny-le-Bretonneux, France.
| | - N Mahlaoui
- Centre de référence déficits immunitaires héréditaires (CEREDIH), hôpital Necker-Enfants Malades, institut Imagine, université Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France; Service d'hématologie-immunologie et rhumatologie pédiatrique, hôpital Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, Paris, France
| | - F Suarez
- Centre de référence déficits immunitaires héréditaires (CEREDIH), hôpital Necker-Enfants Malades, institut Imagine, université Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France; Service d'hématologie adultes, hôpital Necker-Enfants Malades, université Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Marcais
- Service d'hématologie adultes, hôpital Necker-Enfants Malades, université Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - E Longchampt
- Service d'anatomopathologie, hôpital Foch, Suresnes, France
| | - C Tcherakian
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Givel
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - A Chabrol
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - E Caradec
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - O Lortholary
- Service de maladies infectieuses, hôpital Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, Paris, France; Centre national de référence des mycoses invasives et antifongiques, Centre national de la recherche scientifique, unite mixté de recherche (UMR) 2000, Institut Pasteur, université Paris Cité, Paris, France
| | - F Lanternier
- Service de maladies infectieuses, hôpital Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, Paris, France; Centre national de référence des mycoses invasives et antifongiques, Centre national de la recherche scientifique, unite mixté de recherche (UMR) 2000, Institut Pasteur, université Paris Cité, Paris, France
| | - C Goyard
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L J Couderc
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; UMR0892 VIM-Suresnes Inrae, université Paris-Saclay, Suresnes, France
| | - E Catherinot
- Service de pneumologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
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Mongkonsritragoon W, Srivastava R, Seth D, Navalpakam A, Poowuttikul P. Non-infectious Pulmonary Complications in Children with Primary Immunodeficiency. Clin Med Insights Pediatr 2023; 17:11795565231196431. [PMID: 37692068 PMCID: PMC10492501 DOI: 10.1177/11795565231196431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Primary immune deficiency (PID) is a large group of diseases characterized by defective immune function, leading to recurrent infections, and immune dysregulation. Clinical presentations, severity, and complications differ for each disease, based on the components of the immune system that are impacted. When patients with PID present with respiratory symptoms, infections should be initially suspected, investigated, and promptly managed. However, non-infectious complications of PID also frequently occur and can lead to significant morbidity and mortality. They can involve both the upper and lower respiratory systems, resulting in various presentations that mimic infectious diseases. Thus, clinicians should be able to detect these conditions and make an appropriate referral to an immunologist and a pulmonologist for further management. In this article, we use case-based scenarios to review the differential diagnosis, investigation, and multidisciplinary treatment of non-infectious pulmonary complications in patients with primary immune deficiencies.
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Affiliation(s)
- Wimwipa Mongkonsritragoon
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Ruma Srivastava
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Pulmonary Medicine, Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Divya Seth
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Aishwarya Navalpakam
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Pavadee Poowuttikul
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
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5
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Gutierrez MJ, Nino G, Sun D, Restrepo-Gualteros S, Sadreameli SC, Fiorino EK, Wu E, Vece T, Hagood JS, Maglione PJ, Kurland G, Koumbourlis A, Sullivan KE. The lung in inborn errors of immunity: From clinical disease patterns to molecular pathogenesis. J Allergy Clin Immunol 2022; 150:1314-1324. [PMID: 36244852 PMCID: PMC9826631 DOI: 10.1016/j.jaci.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
In addition to being a vital organ for gas exchange, the lung is a crucial immune organ continuously exposed to the external environment. Genetic defects that impair immune function, called inborn errors of immunity (IEI), often have lung disease as the initial and/or primary manifestation. Common types of lung disease seen in IEI include infectious complications and a diverse group of diffuse interstitial lung diseases. Although lung damage in IEI has been historically ascribed to recurrent infections, contributions from potentially targetable autoimmune and inflammatory pathways are now increasingly recognized. This article provides a practical guide to identifying the diverse pulmonary disease patterns in IEI based on lung imaging and respiratory manifestations, and integrates this clinical information with molecular mechanisms of disease and diagnostic assessments in IEI. We cover the entire IEI spectrum, including immunodeficiencies and immune dysregulation with monogenic autoimmunity and autoinflammation, as well as recently described IEI with pulmonary manifestations. Although the pulmonary manifestations of IEI are highly relevant for all age groups, special emphasis is placed on the pediatric population, because initial presentations often occur during childhood. We also highlight the pivotal role of genetic testing in the diagnosis of IEI involving the lungs and the critical need to develop multidisciplinary teams for the challenging evaluation of these rare but potentially life-threatening disorders.
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Affiliation(s)
- Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, Md.
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Di Sun
- Division of Pediatric Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Sonia Restrepo-Gualteros
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Division of Pediatric Pulmonology, Fundacion Hospital La Misericordia, Bogotá, Colombia
| | - Sarah C Sadreameli
- Division of Pediatric Pulmonology and Sleep Medicine, Johns Hopkins University, Baltimore, Md
| | - Elizabeth K Fiorino
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Eveline Wu
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC
| | - Timothy Vece
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC
| | - James S Hagood
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC
| | - Paul J Maglione
- Division of Allergy and Immunology, Boston University, Boston, Mass
| | - Geoffrey Kurland
- Division of Pediatric Pulmonology and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Anastassios Koumbourlis
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Kathleen E Sullivan
- Division of Pediatric Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa
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6
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Mellouli F, Ksouri H, Lajhouri M, Ben Khaled M, Rekaya S, Ben Fraj E, Ouederni M, Barbouche MR, Bejaoui M. Long-Term Observational Study of Chronic Granulomatous Disease About 41 Patients From Tunisia and Comparison to Other Long-Term Follow-Up Studies. Clin Pediatr (Phila) 2022; 61:629-644. [PMID: 35678026 DOI: 10.1177/00099228221096329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic granulomatous disease (CGD) is an inherited autosomal recessive or X-Linked primitive immunodeficiency (PID), due to a defective nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex impairing anti-infectious and anti-inflammatory role of peripheral blood mononuclear cells. It is characterized by severe bacterial and fungal infections and by excessive inflammation leading to granulomatous complications. This work was made over a period of 34 years on 41 Tunisian patients suffering from CGD. Cumulative follow-up of patients was 2768.5 months, median 31 months. Survival was studied by survival curves according to Kaplan-Meier method. Lymphatic nodes, pulmonary and cutaneous infections predominate as revealing manifestations and as infectious events during patients' monitoring. At study end 12 patients died mainly of invasive pulmonary aspergillosis and septicemia. Median age of death was 30 months. CGD remains compatible with a decent quality of life. Early diagnosis, anti-infectious prophylaxis, and initiation of adequate management, as soon as complication is perceived, promote pretty good evolution.
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Affiliation(s)
- Fethi Mellouli
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Habib Ksouri
- Laboratories Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Maïssa Lajhouri
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Monia Ben Khaled
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Samia Rekaya
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Elhem Ben Fraj
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | - Monia Ouederni
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
| | | | - Mohamed Bejaoui
- Pediatric Immunohematology Service, Bone Marrow Transplant Center, Tunis, Tunisia
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7
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A Child with Massive Pericardial and Pleural Effusion and Chronic Granulomatous Disease. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect-118095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: chronic granulomatous disease (CGD) is a genetic disease characterized by recurrent life-threatening fungal and bacterial infections and granuloma formation. Pericardial effusion is rare in this disease. Case Presentation: The study reports a 13-year-old boy with CGD and a history of recurrent infections such as pneumonia and abscesses. The patient presented with shortness of breath, cough, abdominal pain, and chest pain and was diagnosed with severe pericardial and pleural effusion. The patient was treated with antibiotics, antifungals, and steroids and finally underwent pericardiotomy. Conclusions: Treatment of CGD patients with recurrent infections and inflammatory lesions is challenging and requires individual decision-making for each patient.
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8
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Ekizalioglu DD, Ozek G, Aygun A, Ozturk GK, Koc G. Persistent pulmonary mass-like lung consolidations and chest wall extension in a newborn diagnosed with chronic granulomatous disease. Br J Hosp Med (Lond) 2022; 83:1-4. [DOI: 10.12968/hmed.2021.0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Duygu D Ekizalioglu
- Department of Pediatric Radiology, Division of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Gulcihan Ozek
- Department of Pediatric Bone Marrow Transplantation, Division of Pediatrics, Ege University School of Medicine, Izmir, Turkey
| | - Ayse Aygun
- Department of Pediatric Immunology, Division of Pediatrics, Ege University School of Medicine, Izmir, Turkey
| | - Gokcen K Ozturk
- Department of Pediatric Pulmonology, Division of Pediatrics, Ege University School of Medicine, Izmir, Turkey
| | - Gonca Koc
- Department of Pediatric Radiology, Division of Radiology, Ege University School of Medicine, Izmir, Turkey
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9
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Al Ghadeer HA, Busaleh FN, Al Habeeb JA, Alaithan RM, Almutahhar AE, Bin Abd MM, Aldawood MM. Liver Abscesses as a Sign of Chronic Granulomatous Disease in Adolescent. Cureus 2021; 13:e17467. [PMID: 34589361 PMCID: PMC8464347 DOI: 10.7759/cureus.17467] [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] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
Chronic granulomatous disease (CGD) is an inherited primary immunodeficiency disease caused by a genetic defect in the nicotinamide adenine dinucleotide phosphate oxidase (NADPH) complex that affects phagocytes. This leads to recurrent severe bacterial and fungal infections manifested by recurrent pneumonia, also involving soft tissue, bones, and liver. Usually, CGD is presented and diagnosed in the first five years of life. In this case report, we describe a late presentation in an adolescent with multiple liver abscesses, the approach of diagnosis, and management.
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Affiliation(s)
| | - Fadi N Busaleh
- Pediatrics, Maternity and Children Hospital, AlAhsa, SAU
| | - Jaber A Al Habeeb
- Allergy and Immunology, Maternity and Children Hospital, AlAhsa, SAU
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10
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Franquet T, Franks TJ, Galvin JR, Marchiori E, Giménez A, Mazzini S, Johkoh T, Lee KS. Non-Infectious Granulomatous Lung Disease: Imaging Findings with Pathologic Correlation. Korean J Radiol 2021; 22:1416-1435. [PMID: 34132073 PMCID: PMC8316771 DOI: 10.3348/kjr.2020.1082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022] Open
Abstract
Non-infectious granulomatous lung disease represents a diverse group of disorders characterized by pulmonary opacities associated with granulomatous inflammation, a relatively nonspecific finding commonly encountered by pathologists. Some lesions may present a diagnostic challenge because of nonspecific imaging features; however, recognition of the various imaging manifestations of these disorders in conjunction with patients' clinical history, such as age, symptom onset and duration, immune status, and presence of asthma or cutaneous lesions, is imperative for narrowing the differential diagnosis and determining appropriate management of this rare group of disorders. In this pictorial review, we describe the pathologic findings of various non-infectious granulomatous lung diseases as well as the radiologic features and high-resolution computed tomography imaging features.
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Affiliation(s)
- Tomás Franquet
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Teri J Franks
- Department of Defense, Pulmonary & Mediastinal Pathology, The Joint Pathology Center, Silver Spring, MD, USA
| | - Jeffrey R Galvin
- Department of Diagnostic Radiology, Chest Imaging, & Pulmonary Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edson Marchiori
- Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Giménez
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sandra Mazzini
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
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11
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Bode SFN, Rohr J, Müller Quernheim J, Seidl M, Speckmann C, Heinzmann A. Pulmonary granulomatosis of genetic origin. Eur Respir Rev 2021; 30:30/160/200152. [PMID: 33927005 PMCID: PMC9488645 DOI: 10.1183/16000617.0152-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Granulomatous inflammation of the lung can be a manifestation of different conditions and can be caused by endogenous inflammation or external triggers. A multitude of different genetic mutations can either predispose patients to infections with granuloma-forming pathogens or cause autoinflammatory disorders, both leading to the phenotype of pulmonary granulomatosis. Based on a detailed patient history, physical examination and a diagnostic approach including laboratory workup, pulmonary function tests (PFTs), computed tomography (CT) scans, bronchoscopy with bronchoalveolar lavage (BAL), lung biopsies and specialised microbiological and immunological diagnostics, a correct diagnosis of an underlying cause of pulmonary granulomatosis of genetic origin can be made and appropriate therapy can be initiated. Depending on the underlying disorder, treatment approaches can include antimicrobial therapy, immunosuppression and even haematopoietic stem cell transplantation (HSCT). Patients with immunodeficiencies and autoinflammatory conditions are at the highest risk of developing pulmonary granulomatosis of genetic origin. Here we provide a review on these disorders and discuss pathogenesis, clinical presentation, diagnostic approach and treatment. Pulmonary granulomatosis of genetic origin mostly occurs in immunodeficiency disorders and autoinflammatory conditions. In addition to specific approaches in this regard, the diagnostic workup needs to cover environmental and occupational aspects.https://bit.ly/31SqdHW
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Affiliation(s)
- Sebastian F N Bode
- Dept of General Paediatrics, Adolescent Medicine and Neonatology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Rohr
- Dept of General Paediatrics, Adolescent Medicine and Neonatology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joachim Müller Quernheim
- Dept of Pneumology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilan Seidl
- Institute for Surgical Pathology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Pathology, Heinrich-Heine University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Carsten Speckmann
- Centre for Paediatrics and Adolescent Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Immunodeficiency, Centre for Chronic Immunodeficiency (CCI), Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Heinzmann
- Dept of General Paediatrics, Adolescent Medicine and Neonatology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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Akar HT, Esenboga S, Cagdas D, Halacli SO, Ozbek B, van Leeuwen K, de Boer M, Tan CS, Köker Y, Roos D, Tezcan I. Clinical and Immunological Characteristics of 63 Patients with Chronic Granulomatous Disease: Hacettepe Experience. J Clin Immunol 2021; 41:992-1003. [PMID: 33629196 DOI: 10.1007/s10875-021-01002-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chronic granulomatous disease (CGD), one of the phagocytic system defects, is the primary immunodeficiency caused by dysfunction of the NADPH oxidase complex which generates reactive oxygen species (ROS), which are essential for killing pathogenic microorganisms, especially catalase-positive bacteria and fungi. OBJECTIVE The objective of our study was to assess the clinical and laboratory characteristics, treatment modalities, and prognosis of patients with CGD. METHODS We retrospectively reviewed 63 patients with CGD who have been diagnosed, treated, and/or followed-up between 1984 and 2018 in Hacettepe University, Ankara, in Turkey, as a developing country. RESULTS The number of female and male patients was 26/37. The median age at diagnosis was 3.8 (IQR: 1.0-9.6) years. The rate of consanguinity was 63.5%. The most common physical examination finding was lymphadenopathy (44/63), growth retardation (33/63), and hepatomegaly (27/63). One adult patient had squamous cell carcinoma of the lung. The most common infections were lung infection (53/63), skin abscess (43/63), and lymphadenitis (19/63). Of the 63 patients with CGD, 6 patients had inflammatory bowel disease (IBD). Twelve of the 63 patients died during follow-up. CYBA, NCF1, CYBB, and NCF2 mutations were detected in 35%, 27.5%, 25%, and 12.5% of the patients, respectively. CONCLUSION We identified 63 patients with CGD from a single center in Turkey. Unlike other cohort studies in Turkey, due to the high consanguineous marriage rate in our study group, AR form of CGD was more frequent, and gastrointestinal involvement were found at relatively lower rates. The rate of patients who treated with HSCT was lower in our research than in the literature. A majority of the patients in this study received conventional prophylactic therapies, which highlight on the outcome of individuals who have not undergone HSCT.
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Affiliation(s)
- Halil Tuna Akar
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, 06100, Ankara, Turkey.
| | - Saliha Esenboga
- Faculty of Medicine, Department of Pediatrics, Division of Immunology, Hacettepe University, 06100, Ankara, Turkey
| | - Deniz Cagdas
- Faculty of Medicine, Department of Pediatrics, Division of Immunology, Hacettepe University, 06100, Ankara, Turkey
| | - Sevil Oskay Halacli
- Institute of Children's Health Basic Sciences of Pediatrics Division of Pediatric Immunology, Hacettepe University, 06100, Sihhiye/Ankara, Turkey
| | - Begum Ozbek
- Institute of Children's Health Basic Sciences of Pediatrics Division of Pediatric Immunology, Hacettepe University, 06100, Sihhiye/Ankara, Turkey
| | - Karin van Leeuwen
- Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin de Boer
- Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cagman Sun Tan
- Institute of Children's Health Basic Sciences of Pediatrics Division of Pediatric Immunology, Hacettepe University, 06100, Sihhiye/Ankara, Turkey
| | - Yavuz Köker
- Faculty of Medicine, Department of Immunology, Erciyes University, Kayseri, Turkey
| | - Dirk Roos
- Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilhan Tezcan
- Faculty of Medicine, Department of Pediatrics, Division of Immunology, Hacettepe University, 06100, Ankara, Turkey
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Articulation infection in patient with chronic granulomatous disease. Chin Med J (Engl) 2021; 134:2492-2494. [PMID: 33625032 PMCID: PMC8654436 DOI: 10.1097/cm9.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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14
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Ayoubi S, Farnia P, Farnia P, Aghajani J, Ghanavi J, Velayati A. Prevalence of non-tuberculosis mycobacteria among samples deposited from the National Tuberculous Reference Laboratory of Iran (2011-2018). ASIAN PAC J TROP MED 2021. [DOI: 10.4103/1995-7645.329007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Yao Q, Zhou QH, Shen QL, Qiao ZW, Wang XC, Hu XH. Imaging findings of pulmonary manifestations of chronic granulomatous disease in a large single center from Shanghai, China (1999-2018). Sci Rep 2020; 10:19349. [PMID: 33168948 PMCID: PMC7652842 DOI: 10.1038/s41598-020-76408-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022] Open
Abstract
Chronic granulomatous disease (CGD) is characterized by recurrent infections and granuloma formation in multiple organs, especially the lung. We aimed to investigate pulmonary manifestations by computed tomography (CT). In total, 100 patients with 117 episodes of pulmonary infection were included. Chest CT scans of every episode were analyzed. Random nodules were the most common findings (79.49%), followed by ground-grass opacities (74.36%), focal consolidations (62.39%), and masses (59.83%). Cavities (12.82%) and multiple small abscesses (17.09%) could be found in the consolidations and masses. CT revealed interstitial pneumonia with tree-in-bud opacities (17.09%), interlobular septal thickening (23.08%) and emphysema (35.04%), which were more severe in the bilateral upper lobes. Mediastinal and hilar lymphadenopathy (78.63%) and axillary lymphadenopathy (65.81%) were common. Fungal infection (n = 27) was the most common and presented with multiple nodules and masses. Approximately 1/4 of fungal infections had interstitial pneumonia. In Staphylococcus aureus (n = 6) and Klebsiella pneumoniae (n = 3) infections, large areas of consolidation were common. In tuberculosis infection, the pulmonary infections were more severe and complex. For Bacillus Calmette-Guérin disease, left-sided axillary lymphadenopathy was a characteristic manifestation. CT images of CGD demonstrated variable pulmonary abnormalities. The main infectious organisms have unique imaging features.
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Affiliation(s)
- Qiong Yao
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Qin-Hua Zhou
- Department of Allergy and Clinical Immunology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Quan-Li Shen
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Zhong-Wei Qiao
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiao-Chuan Wang
- Department of Allergy and Clinical Immunology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xi-Hong Hu
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, 201102, China.
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16
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Jofra Hernández R, Calabria A, Sanvito F, De Mattia F, Farinelli G, Scala S, Visigalli I, Carriglio N, De Simone M, Vezzoli M, Cecere F, Migliavacca M, Basso-Ricci L, Omrani M, Benedicenti F, Norata R, Rancoita PMV, Di Serio C, Albertini P, Cristofori P, Naldini L, Gentner B, Montini E, Aiuti A, Mortellaro A. Hematopoietic Tumors in a Mouse Model of X-linked Chronic Granulomatous Disease after Lentiviral Vector-Mediated Gene Therapy. Mol Ther 2020; 29:86-102. [PMID: 33010230 PMCID: PMC7791081 DOI: 10.1016/j.ymthe.2020.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/03/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare inherited disorder due to loss-of-function mutations in genes encoding the NADPH oxidase subunits. Hematopoietic stem and progenitor cell (HSPC) gene therapy (GT) using regulated lentiviral vectors (LVs) has emerged as a promising therapeutic option for CGD patients. We performed non-clinical Good Laboratory Practice (GLP) and laboratory-grade studies to assess the safety and genotoxicity of LV targeting myeloid-specific Gp91phox expression in X-linked chronic granulomatous disease (XCGD) mice. We found persistence of gene-corrected cells for up to 1 year, restoration of Gp91phox expression and NADPH oxidase activity in XCGD phagocytes, and reduced tissue inflammation after LV-mediated HSPC GT. Although most of the mice showed no hematological or biochemical toxicity, a small subset of XCGD GT mice developed T cell lymphoblastic lymphoma (2.94%) and myeloid leukemia (5.88%). No hematological malignancies were identified in C57BL/6 mice transplanted with transduced XCGD HSPCs. Integration pattern analysis revealed an oligoclonal composition with rare dominant clones harboring vector insertions near oncogenes in mice with tumors. Collectively, our data support the long-term efficacy of LV-mediated HSPC GT in XCGD mice and provide a safety warning because the chronic inflammatory XCGD background may contribute to oncogenesis.
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Affiliation(s)
- Raisa Jofra Hernández
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Calabria
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Sanvito
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabiola De Mattia
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Scala
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Visigalli
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Carriglio
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maura De Simone
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Vezzoli
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Cecere
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Basso-Ricci
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maryam Omrani
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Benedicenti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Norata
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Albertini
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Cristofori
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Non-Clinical Safety In Vivo Translation Research, Glaxo Smith Kline, Ware, UK
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Medical School, Vita-Salute San Raffaele University, Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugenio Montini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Medical School, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alessandra Mortellaro
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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New developments in respiratory medicine: a primary immunodeficiency perspective. Curr Opin Allergy Clin Immunol 2020; 20:549-556. [PMID: 32941317 DOI: 10.1097/aci.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To consider recent developments in respiratory medicine that are of relevance to clinicians caring for adults affected by primary immunodeficiency disorders. RECENT FINDINGS We consider impulse oscillometry, new bronchoscopic techniques for sampling, MRI and PET, the concept of the human airway microbiome, and new treatment approaches for bronchiectasis and interstitial lung disease to better understand the future of respiratory care for people with PID. SUMMARY New approaches to the diagnosis and management of respiratory manifestations of PID have been driven by better understanding of the lung in health and disease, progress in imaging and sampling modalities, and new therapeutics.
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18
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Guo C, Chen X, Wang J, Liu F, Liang Y, Yang J, Dai F, Ding N. Clinical manifestations and genetic analysis of 4 children with chronic granulomatous disease. Medicine (Baltimore) 2020; 99:e20599. [PMID: 32502033 PMCID: PMC7306393 DOI: 10.1097/md.0000000000020599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
Pediatricians are unfamiliar with chronic granulomatous disease (CGD) because of its rarity and paucity of available data, potentially leading to misdiagnosis, late treatments, and mortality. The main purpose of this study was to summarize the clinical manifestations and auxiliary examination findings of four children with CGD confirmed by genetic testing.This was a case series study of children hospitalized at the Pediatric Respiratory Department of Shandong Provincial Hospital. The clinical, laboratory, treatment, and prognosis data were analyzed.All 4 children were boys. Two were brothers. The children's age was from 34 days to 3 years and 2 months at disease onset. The manifestations were repeated pulmonary infection, lymphadenitis, skin infection, and granuloma formation. Pulmonary infections were common. Abnormal responses were common after BCG vaccination. Thoracic computed tomography (CT) mainly showed nodules and masses, while the consolidation area in CT images reduced slowly. No abnormalities in cellular immune functions and immunoglobulin were found. The disease in all four children was confirmed by genetic testing. Long-term antibiotics and anti-fungal drugs were needed to prevent bacterial and fungal infections.CGD should be considered in children with repeated severe bacterial and fungal infections. Abnormal responses after BCG vaccination and nodular or mass-shaped consolidation in thoracic CT images should hint toward CGD. Gene sequencing could provide molecular evidence for diagnosis. The treatments of CGD include the prevention and treatment of infections and complications. Immunologic reconstitution treatment is currently the only curative treatment for CGD.
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Affiliation(s)
- Chunyan Guo
- Department of Pediatric Respiratory, Provincial Hospital Affiliated to Shandong University, Jinan, China
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19
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Patrawala M, Cui Y, Peng L, Fuleihan RL, Garabedian EK, Patel K, Guglani L. Pulmonary Disease Burden in Primary Immune Deficiency Disorders: Data from USIDNET Registry. J Clin Immunol 2020; 40:340-349. [PMID: 31919711 DOI: 10.1007/s10875-019-00738-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Pulmonary manifestations are common in patients with primary immunodeficiency disorders (PIDs) but the prevalence, specific diseases, and their patterns are not well characterized. METHODS We conducted a retrospective analysis of pulmonary diseases reported in the database of the United States Immunodeficiency Network (USIDNET), a program of the Immune Deficiency Foundation. PIDs were categorized into 10 groups and their demographics, pulmonary diagnoses and procedures, infections, prophylaxis regimens, and laboratory findings were analyzed. RESULTS A total of 1937 patients with various PIDs (39.3% of total patients, 49.6% male, average age 37.9 years (SD = 22.4 years)) were noted to have a pulmonary disease comorbidity. Pulmonary diseases were categorized into broad categories: airway (86.8%), parenchymal (18.5%), pleural (4.6%), vascular (4.3%), and other (13.9%) disorders. Common variable immune deficiency (CVID) accounted for almost half of PIDs associated with airway, parenchymal, and other pulmonary disorders. Pulmonary procedures performed in 392 patients were mostly diagnostic (77.3%) or therapeutic (16.3%). These patients were receiving a wide variety of treatments, which included immunoglobulin replacement (82.1%), immunosuppressive (32.2%), anti-inflammatory (12.7%), biologic (9.3%), and cytokine (7.6%)-based therapies. Prophylactic therapy was being given with antibiotics (18.1%), antifungal (3.3%), and antiviral (2.2%) medications, and 7.1% of patients were on long-term oxygen therapy due to advanced lung disease. CONCLUSIONS Pulmonary manifestations are common in individuals with PID, but long-term pulmonary outcomes are not well known in this group of patients. Further longitudinal follow-up will help to define long-term prognosis of respiratory comorbidities and optimal treatment modalities.
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Affiliation(s)
- Meera Patrawala
- Department of Pediatrics, Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Ying Cui
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | - Limin Peng
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | - Ramsay L Fuleihan
- Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth K Garabedian
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kiran Patel
- Department of Pediatrics, Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Lokesh Guglani
- Department of Pediatrics, Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
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A novel mutation in CYBB induced X-linked chronic granulomatous disease: A case report. Respir Med Case Rep 2020; 31:101213. [PMID: 32963958 PMCID: PMC7490557 DOI: 10.1016/j.rmcr.2020.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic granulomatous disease (CGD) is caused by gene mutations that affect the phagocyte NADPH oxidase. This results in recurrent infections by catalase-positive bacteria or fungi. Here, we report a case of X-linked CGD presenting a mixed infection with Burkholderia cepacia and Aspergillus. A novel mutation was found by bioinformatics analyses of his genealogy (c.1234delG), which perhaps changed the structure and function of the related proteins.
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21
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Khurana AK, Goyal A, Khurana U, Dhingra B. Recurrent episodes of pneumonia in a toddler: Don't forget chronic granulomatous disease. J Family Med Prim Care 2019; 8:1260-1262. [PMID: 31041287 PMCID: PMC6482805 DOI: 10.4103/jfmpc.jfmpc_29_19] [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] [Indexed: 11/04/2022] Open
Abstract
A 4-year-old boy presented with community acquired pneumonia, hepatosplenomegaly and bilateral cervical lymphadenopathy. The peripheral blood film showed significant monocytosis and bone marrow examination revealed multiple histiocytic granulomas. Presence of CD 68 positive granulomas supported by cytological findings enabled us to make a diagnosis of chronic granulomatous disease.
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Affiliation(s)
| | - Abhishek Goyal
- Department of Pulmonary Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Ujjawal Khurana
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra
- Department of Pediatrics, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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A homozygous loss-of-function mutation leading to CYBC1 deficiency causes chronic granulomatous disease. Nat Commun 2018; 9:4447. [PMID: 30361506 PMCID: PMC6202333 DOI: 10.1038/s41467-018-06964-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Mutations in genes encoding subunits of the phagocyte NADPH oxidase complex are recognized to cause chronic granulomatous disease (CGD), a severe primary immunodeficiency. Here we describe how deficiency of CYBC1, a previously uncharacterized protein in humans (C17orf62), leads to reduced expression of NADPH oxidase’s main subunit (gp91phox) and results in CGD. Analyzing two brothers diagnosed with CGD we identify a homozygous loss-of-function mutation, p.Tyr2Ter, in CYBC1. Imputation of p.Tyr2Ter into 155K chip-genotyped Icelanders reveals six additional homozygotes, all with signs of CGD, manifesting as colitis, rare infections, or a severely impaired PMA-induced neutrophil oxidative burst. Homozygosity for p.Tyr2Ter consequently associates with inflammatory bowel disease (IBD) in Iceland (P = 8.3 × 10−8; OR = 67.6), as well as reduced height (P = 3.3 × 10−4; −8.5 cm). Overall, we find that CYBC1 deficiency results in CGD characterized by colitis and a distinct profile of infections indicative of macrophage dysfunction. Mutations in genes encoding NAPDH oxidase subunits are known to be causative for the primary immunodeficiency chronic granulomatous disease (CGD). Here, the authors identify CYBC1 mutations in patients with CGD and show that CYBC1 is important for formation of the NADPH complex and respiratory burst.
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van der Weyden L, Speak AO, Swiatkowska A, Clare S, Schejtman A, Santilli G, Arends MJ, Adams DJ. Pulmonary metastatic colonisation and granulomas in NOX2-deficient mice. J Pathol 2018; 246:300-310. [PMID: 30062795 PMCID: PMC6221033 DOI: 10.1002/path.5140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/15/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022]
Abstract
Metastasis is the leading cause of death in cancer patients, and successful colonisation of a secondary organ by circulating tumour cells (CTCs) is the rate‐limiting step of this process. We used tail‐vein injection of B16‐F10 melanoma cells into mice to mimic the presence of CTCs and to allow for the assessment of host (microenvironmental) factors that regulate pulmonary metastatic colonisation. We found that mice deficient for the individual subunits of the NADPH oxidase of myeloid cells, NOX2 (encoded by Cyba, Cybb, Ncf1, Ncf2, and Ncf4), all showed decreased pulmonary metastatic colonisation. To understand the role of NOX2 in controlling tumour cell survival in the pulmonary microenvironment, we focused on Cyba‐deficient (Cybatm1a) mice, which showed the most significant decrease in metastatic colonisation. Interestingly, histological assessment of pulmonary metastatic colonisation was not possible in Cybatm1a mice, owing to the presence of large granulomas composed of galectin‐3 (Mac‐2)‐positive macrophages and eosinophilic deposits; granulomas of variable penetrance and severity were also found in Cybatm1a mice that were not injected with melanoma cells, and these contributed to their decreased survival. The decreased pulmonary metastatic colonisation of Cybatm1a mice was not due to any overt defects in vascular permeability, and bone marrow chimaeras confirmed a role for the haematological system in the reduced metastatic colonisation phenotype. Examination of the lymphocyte populations, which are known key regulators of metastatic colonisation, revealed an enhanced proportion of activated T and natural killer cells in the lungs of Cybatm1a mice, relative to controls. The reduced metastatic colonisation, presence of granulomas and altered immune cell populations observed in Cybatm1a lungs were mirrored in Ncf2‐deficient (Ncf2tm1a) mice. Thus, we show that NOX2 deficiency results in both granulomas and the accumulation of antitumoural immune cells in the lungs that probably mediate the decreased pulmonary metastatic colonisation. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
| | - Anneliese O Speak
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | | | - Simon Clare
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Andrea Schejtman
- Molecular and Cellular Immunology (III), UCL Great Ormond Street Institute of Child Health, London, UK
| | - Giorgia Santilli
- Molecular and Cellular Immunology (III), UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mark J Arends
- University of Edinburgh, Division of Pathology, Centre for Comparative Pathology, Cancer Research UK Edinburgh Centre, Institute of Genetics & Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - David J Adams
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
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Thomas DC. How the phagocyte NADPH oxidase regulates innate immunity. Free Radic Biol Med 2018; 125:44-52. [PMID: 29953922 DOI: 10.1016/j.freeradbiomed.2018.06.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 11/16/2022]
Abstract
The phagocyte NADPH oxidase is a multi subunit protein complex that generates reactive oxygen species at cell membranes and within phagosomes. It is essential for host defence as evidenced by the severe immunodeficiency syndrome caused by a loss of one of the subunits. This is known as chronic granulomatous disease (CGD). However, the phagocyte NADPH oxidase also has a key role to play in regulating immunity and it is notable that chronic granulomatous disease is also characterised by autoimmune and autoinflammatory manifestations. This is because reactive oxygen species play a role in regulating signalling through their ability to post-translationally modify amino acid residues such as cysteine and methionine. In this review, I will outline the major aspects of innate immunity that are regulated by the phagocyte NADPH oxidase, including control of transcription, autophagy, the inflammasome and type 1 interferon signalling.
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Affiliation(s)
- David C Thomas
- Department of Medicine, University of Cambridge School of Clinical Medicine, Box 157 Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
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Warren M, Shimada H. Cytologic and Ultrastructural Findings of Bronchoalveolar Lavage in Patients With Chronic Granulomatous Disease. Pediatr Dev Pathol 2018; 21:347-354. [PMID: 29050515 DOI: 10.1177/1093526617736188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Chronic granulomatous disease (CGD) is a hereditary immunodeficiency caused by mutations in genes encoding nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, which lead to the inability to kill intracellular pathogens. Patients with CGD are susceptible to recurrent bacterial and fungal infections in their early lives. Although the recent survival rate has been significantly improved, early diagnosis is critical to prevent multiple organ impairment. In 1950s, CGD was first described as a disease with recurrent infections and visceral infiltration of granulomas and pigmented histiocytes. Bronchoalveolar lavage (BAL) is commonly performed for patients with CGD; however, no study has described the cytologic features of alveolar macrophages. Methods Cytology of 20 BALs from 11 CGD patients was examined. The greatest diameters of randomly selected 100 alveolar macrophages in each BAL were measured using image analysis and compared with 20 disease control BALs from non-CGD patients. Macrophages from 2 groups were compared with repeated measures mixed-model analysis. Ultrastructural analysis was performed on a representative CGD BAL. Results BALs from CGD patients showed variable numbers of neutrophils and lipid-laden macrophages. Macrophages in CGD BALs were significantly larger than disease control BALs ( P < .0001) and showed "foamy" vacuolated cytoplasm. Ultrastructural analysis revealed the macrophages filled with enlarged lysosomes containing lipofuscin-like materials, which made their appearance "foamy." Conclusion In this study, we demonstrate novel BAL findings in CGD patients. The presence of enlarged "foamy" alveolar macrophages is not specific for CGD, but CGD should be considered as a differential diagnosis when foamy macrophages are present.
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Affiliation(s)
- Mikako Warren
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hiroyuki Shimada
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
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26
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Rider NL, Jameson MB, Creech CB. Chronic Granulomatous Disease: Epidemiology, Pathophysiology, and Genetic Basis of Disease. J Pediatric Infect Dis Soc 2018; 7:S2-S5. [PMID: 29746675 PMCID: PMC5946813 DOI: 10.1093/jpids/piy008] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic Granulomatous Disease is one of the classic primary immunodeficiencies of childhood. While the incidence and severity of bacterial and fungal infections have been greatly reduced in this patient population, much remains to be learned about the pathophysiology of the disease, particularly for autoinflammatory manifestations. In this review, we examine the epidemiology, pathophysiology, and genetic basis for CGD.
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Affiliation(s)
- N L Rider
- Section of Immunology, Allergy and Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - M B Jameson
- Vanderbilt Vaccine Research Program and Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine and Medical Center, Nashville, Tennessee
| | - C B Creech
- Vanderbilt Vaccine Research Program and Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine and Medical Center, Nashville, Tennessee,Correspondence: C. Buddy Creech, MD, MPH, FPIDS, Associate Professor of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center and Children’s Hospital, Nashville, TN ()
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27
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Henrickson SE, Jongco AM, Thomsen KF, Garabedian EK, Thomsen IP. Noninfectious Manifestations and Complications of Chronic Granulomatous Disease. J Pediatric Infect Dis Soc 2018; 7:S18-S24. [PMID: 29746679 PMCID: PMC5946858 DOI: 10.1093/jpids/piy014] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic granulomatous disease (CGD), a primary immunodeficiency characterized by a deficient neutrophil oxidative burst and the inadequate killing of microbes, is well known to cause a significantly increased risk of invasive infection. However, infectious complications are not the sole manifestations of CGD; substantial additional morbidity is driven by noninfectious complications also. These complications can include, for example, a wide range of inflammatory diseases that affect the gastrointestinal tract, lung, skin, and genitourinary tract and overt autoimmune disease. These diseases can occur at any age and are especially problematic in adolescents and adults with CGD. Many of these noninfectious complications present a highly challenging therapeutic conundrum, wherein immunosuppression must be balanced against an already markedly increased risk of invasive fungal and bacterial infections. In this review, the myriad noninfectious complications of CGD are discussed, as are important gaps in our understanding of these processes, which warrant further investigation.
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Affiliation(s)
- Sarah E Henrickson
- Division of Allergy and Immunology, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Artemio M Jongco
- Institute for Immunology, University of Pennsylvania, Philadelphia,Departments of Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Kelly F Thomsen
- Division of Gastroenterology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elizabeth K Garabedian
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Isaac P Thomsen
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee,Correspondence: I. P. Thomsen, MD, MSCI, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, D-7235 MCN1161 21st Avenue South, Nashville, TN 37232-2581 ()
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28
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Bennett N, Maglione PJ, Wright BL, Zerbe C. Infectious Complications in Patients With Chronic Granulomatous Disease. J Pediatric Infect Dis Soc 2018; 7:S12-S17. [PMID: 29746678 PMCID: PMC5985728 DOI: 10.1093/jpids/piy013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nicholas Bennett
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford
| | - Paul J Maglione
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin L Wright
- Mayo Clinic Arizona, Scottsdale,Phoenix Children’s Hospital, Phoenix, Arizona
| | - Christa Zerbe
- The National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland,Correspondence: Christa S. Zerbe, MD, The National Institute of Allergy and Infectious Diseases, The National Institutes of Health, 10 Center Drive Rm 12C110, Bethesda, MD 20892 ()
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29
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Sun J, Wen M, Wang Y, Liu D, Ying W, Wang X. The three CYBA variants (rs4673, rs1049254 and rs1049255) are benign: new evidence from a patient with CGD. BMC MEDICAL GENETICS 2017; 18:127. [PMID: 29132304 PMCID: PMC5683331 DOI: 10.1186/s12881-017-0492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023]
Abstract
Background Chronic granulomatous disease (CGD) is an inherited immunodeficiency disease caused by the defect of NADPH oxidase. Mutations in CYBB or CYBA gene may result in membrane subunits, gp91phox or p22phox, expression failure respectively and NADPH oxidase deficiency. Previous study showed that three variants, c.214 T > C (rs4673), c.521 T > C (rs1049254) and c.*24G > A (rs1049255), in CYBA gene form a haplotype, which are associated with decreased reactive oxygen species generation. The study aims to confirm the three above mentioned variants are benign and report a novel mutation in CYBB gene. Methods A patient with CGD and his family members were enrolled in the study. NADPH oxidase activity and gp91phox protein expression of neutrophils were analyzed by flow cytometry. Direct sequencing was used to detect CYBB and CYBA gene mutations. Results The patient was diagnosed with CGD according to clinical and immune phenotype. The case has a novel homozygous mutation in CYBB gene and the above mentioned three variants in CYBA gene. The mutation in CYBB gene was confirmed to be pathogenic, and the three variants in CYBA gene to be benign. Conclusions The study not only reported a novel mutation in CYBB, which results in CGD, but also confirmed the above mentioned three variants in CYBA are benign.
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Affiliation(s)
- Jinqiao Sun
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Min Wen
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Ying Wang
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Danru Liu
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Wenjing Ying
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xiaochuan Wang
- Department of Clinical Immunology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
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30
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Labrosse R, Abou-Diab J, Blincoe A, Cros G, Luu TM, Deslandres C, Dirks M, Fazilleau L, Ovetchkine P, Teira P, LeDeist F, Fernandez I, Touzot F, Decaluwe H, Halac U, Haddad E. Very Early-Onset Inflammatory Manifestations of X-Linked Chronic Granulomatous Disease. Front Immunol 2017; 8:1167. [PMID: 29018441 PMCID: PMC5622950 DOI: 10.3389/fimmu.2017.01167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare primary immune deficiency caused by mutations in genes coding for components of the nicotinamide adenine dinucleotide phosphate oxidase, characterized by severe and recurrent bacterial and fungal infections, together with inflammatory complications. Dysregulation of inflammatory responses are often present in this disease and may lead to granulomatous lesions, most often affecting the gastrointestinal (GI) and urinary tracts. Treatment of inflammatory complications usually includes corticosteroids, whereas antimicrobial prophylaxis is used for infection prevention. Curative treatment of both infectious susceptibility and inflammatory disease can be achieved by hematopoietic stem cell transplantation. We report herein three patients with the same mutation of the CYBB gene who presented with very early-onset and severe GI manifestations of X-linked CGD. The most severely affected patient had evidence of antenatal inflammatory involvement of the GI and urinary tracts. Extreme hyperleukocytosis with eosinophilia and high inflammatory markers were observed in all three patients. A Mycobacterium avium lung infection and an unidentified fungal lung infection occurred in two patients both during their first year of life, which is indicative of the severity of the disease. All three patients underwent bone marrow transplantation and recovered fully from their initial symptoms. To our knowledge, these are the first reports of patients with such an early-onset and severe inflammatory manifestations of CGD.
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Affiliation(s)
- Roxane Labrosse
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Jane Abou-Diab
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Annaliesse Blincoe
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Guilhem Cros
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Colette Deslandres
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Martha Dirks
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Laura Fazilleau
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Philippe Ovetchkine
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Pierre Teira
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Françoise LeDeist
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.,Department of Microbiology, Infectiology and Immunology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Isabel Fernandez
- Department of Microbiology, Infectiology and Immunology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Fabien Touzot
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Helene Decaluwe
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Ugur Halac
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Elie Haddad
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.,Department of Microbiology, Infectiology and Immunology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
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31
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Pulmonary Aspergillosis in a Previously Healthy 13-Year-Old Boy. Can Respir J 2017; 2016:4575942. [PMID: 27445540 PMCID: PMC4904554 DOI: 10.1155/2016/4575942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare, polygenic primary immunodeficiency. In this case report, we describe a previously healthy 13-year-old boy who presented with multifocal pulmonary aspergillosis and was subsequently diagnosed with an autosomal recessive form of chronic granulomatous disease. CGD has a variable natural history and age of presentation and should be considered when investigating a patient with recurrent or severe infections with catalase-positive organisms.
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32
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Diagnosis of Interstitial Lung Disease Caused by Possible Hypersensitivity Pneumonitis in a Child: Think CGD. J Clin Immunol 2017; 37:269-272. [PMID: 28224353 DOI: 10.1007/s10875-017-0376-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
Interstitial lung disease (ILD) is a rare and heterogeneous group of disorder affecting the lung parenchyma and has a detrimental effect on gas exchange. Chronic granulomatous disease (CGD), when it affects primarily lungs, may cause ILD. We report a 16-year-old patient with CGD caused by homozygous deletion of NCF1 who atypically presented with ILD. The patient had many pigeons and was a pigeon breeder. Exacerbated clinical symptoms were linked to hypersensitivity pneumonitis (HP), and the patient was suggested to keep away from pigeons. In addition to allergen avoidance and prophylactic antibacterial therapy, treatment with corticosteroids and hydroxychloroquine was started for mainly obstructive and persistant symptoms of ILD. CGD is known to cause a hyperinflammatory state and the patients present with excessive granuloma formation and HP. Control of inflammation either by avoidance of allergen exposure and by anti-inflammatory drugs is necessary for the relief of symptoms.
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33
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Necrotizing Liver Granuloma/Abscess and Constrictive Aspergillosis Pericarditis with Central Nervous System Involvement: Different Remarkable Phenotypes in Different Chronic Granulomatous Disease Genotypes. Case Reports Immunol 2017; 2017:2676403. [PMID: 28168067 PMCID: PMC5259602 DOI: 10.1155/2017/2676403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a primary immune deficiency causing predisposition to infections with specific microorganisms, Aspergillus species and Staphylococcus aureus being the most common ones. A 16-year-old boy with a mutation in CYBB gene coding gp91phox protein (X-linked disease) developed a liver abscess due to Staphylococcus aureus. In addition to medical therapy, surgical treatment was necessary for the management of the disease. A 30-month-old girl with an autosomal recessive form of chronic granulomatous disease (CYBA gene mutation affecting p22phox protein) had invasive aspergillosis causing pericarditis, pulmonary abscess, and central nervous system involvement. The devastating course of disease regardless of the mutation emphasizes the importance of early diagnosis and intervention of hematopoietic stem cell transplantation as soon as possible in children with CGD.
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34
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Bondioni MP, Lougaris V, Di Gaetano G, Lorenzini T, Soresina A, Laffranchi F, Gatta D, Plebani A. Early Identification of Lung Fungal Infections in Chronic Granulomatous Disease (CGD) Using Multidetector Computer Tomography. J Clin Immunol 2016; 37:36-41. [DOI: 10.1007/s10875-016-0342-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
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35
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Magnani A, Mahlaoui N. Managing Inflammatory Manifestations in Patients with Chronic Granulomatous Disease. Paediatr Drugs 2016; 18:335-45. [PMID: 27299584 DOI: 10.1007/s40272-016-0182-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by lack of phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, which results in inflammatory dysregulation and increased susceptibility to infections. Patients with CGD may develop severe obstructive disorders of the digestive tract as a result of their dysregulated inflammatory response. Despite a growing focus on inflammatory manifestations in CGD, the literature data on obstructive complications are far less extensive than those on infectious complications. Diagnosis and management of patients with concomitant predispositions to infections and hyperinflammation are particularly challenging. Although the inflammatory and granulomatous manifestations of CGD usually respond rapidly to steroid treatment, second-line therapies (immunosuppressants and biologics) may be required in refractory cases. Indeed, immunosuppressants (such as anti-tumor necrosis factor agents, thalidomide, and anakinra) have shown some efficacy, but the value of this approach is controversial, given the questionable risk-to-benefit ratio and the small numbers of patients treated to date. Significant progress in allogeneic hematopoietic stem cell transplantation (the only curative treatment for CGD) has been made through better supportive care and implementation of improved, reduced-intensity conditioning regimens. Gene therapy may eventually be an option for patients lacking a suitable donor; clinical trials with new, safer vectors are ongoing at a few centers.
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Affiliation(s)
- Alessandra Magnani
- Biotherapy Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France.
| | - Nizar Mahlaoui
- Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France. .,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. .,INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France. .,Pediatric Immunohematology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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36
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37
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El-Azami-El-Idrissi M, Lakhdar-Idrissi M, Chaouki S, Atmani S, Bouharrou A, Hida M. Pediatric recurrent respiratory tract infections: when and how to explore the immune system? (About 53 cases). Pan Afr Med J 2016; 24:53. [PMID: 27642394 PMCID: PMC5012823 DOI: 10.11604/pamj.2016.24.53.3481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/18/2014] [Indexed: 11/11/2022] Open
Abstract
Recurrent respiratory tract infections are one of the most frequent reasons for pediatric visits and hospitalization. Causes of this pathology are multiple ranging from congenital to acquired and local to general. Immune deficiencies are considered as underlying conditions predisposing to this pathology. Our work is about to determine when and how to explore the immune system when facing recurrent respiratory infections. This was based on the records of 53 children hospitalized at the pediatrics unit of Hassan II University Hospital, Fez Morocco. Thirty boys and 23 girls with age ranging from 5 months to 12 years with an average age of 2 years were involved in this study. Bronchial foreign body was the main etiology in children of 3 to 6 year old. Gastro-esophageal reflux, which in some cases is a consequence of chronic cough, as well as asthma were most frequent in infants (17 and 15% respectively). Immune deficiency was described in 7.5% of patients and the only death we deplored in our series belongs to this group. Recurrent respiratory tract infections have multiple causes. In our series they are dominated by foreign body inhalation and gastroesophageal reflux, which in some cases is a consequence of a chronic cough. Immune deficiency is not frequent but could influence the prognosis. Therefore immune explorations should be well codified.
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Affiliation(s)
- Mohammed El-Azami-El-Idrissi
- Laboratory of Immunology, Faculty of Medicine and Pharmacy at Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
| | - Mounia Lakhdar-Idrissi
- Department of Pediatrics, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
| | - Sanae Chaouki
- Department of Pediatrics, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
| | - Samir Atmani
- Department of Pediatrics, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
| | - Abdelhak Bouharrou
- Department of Pediatrics, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
| | - Moustapha Hida
- Department of Pediatrics, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Hassan II University Hospital of Fez, Morocco
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Yamagishi T, Ochi N, Yamane H, Kuribayashi F, Takigawa N. A 60-year-old asymptomatic woman with pulmonary lesions and cervical lymphadenopathy. Chest 2015; 147:e48-e51. [PMID: 25644916 DOI: 10.1378/chest.14-1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 60-year-old asymptomatic woman was referred to our hospital because of an abnormal chest roentgenogram during a routine medical checkup. The patient had no history of memorable infectious diseases, except a liver abscess caused by Serratia marcescens at age 46 years. Her son was diagnosed with chronic granulomatous disease at the age of 1 year. She had never smoked cigarettes and drank only occasionally.
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Affiliation(s)
- Tomoko Yamagishi
- Department of General Internal Medicine 4, Kawasaki Medical School, Kurashiki, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Kurashiki, Japan
| | - Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, Kurashiki, Japan
| | | | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Kurashiki, Japan.
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39
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Abstract
Determining the role of NADPH oxidases in the context of virus infection is an emerging area of research and our knowledge is still sparse. The expression of various isoforms of NOX/DUOX (NADPH oxidase/dual oxidase) in the epithelial cells (ECs) lining the respiratory tract renders them primary sites from which to orchestrate the host defence against respiratory viruses. Accumulating evidence reveals distinct facets of the involvement of NOX/DUOX in host antiviral and pro-inflammatory responses and in the control of the epithelial barrier integrity, with individual isoforms mediating co-operative, but surprisingly also opposing, functions. Although in vivo studies in mice are in line with some of these observations, a complete understanding of the specific functions of epithelial NOX/DUOX awaits lung epithelial-specific conditional knockout mice. The goal of the present review is to summarize our current knowledge of the role of individual NOX/DUOX isoforms expressed in the lung epithelium in the context of respiratory virus infections so as to highlight potential opportunities for therapeutic intervention.
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40
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Salvator H, Mahlaoui N, Catherinot E, Rivaud E, Pilmis B, Borie R, Crestani B, Tcherakian C, Suarez F, Dunogue B, Gougerot-Pocidalo MA, Hurtado-Nedelec M, Dreyfus JF, Durieu I, Fouyssac F, Hermine O, Lortholary O, Fischer A, Couderc LJ. Pulmonary manifestations in adult patients with chronic granulomatous disease. Eur Respir J 2015; 45:1613-23. [PMID: 25614174 DOI: 10.1183/09031936.00118414] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/26/2014] [Indexed: 12/17/2022]
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by failure of superoxide production in phagocytic cells. The disease is characterised by recurrent infections and inflammatory events, frequently affecting the lungs. Improvement of life expectancy now allows most patients to reach adulthood. We aimed to describe the pattern of pulmonary manifestations occurring during adulthood in CGD patients. This was a retrospective study of the French national cohort of adult patients (≥16 years old) with CGD. Medical data were obtained for 67 adult patients. Pulmonary manifestations affected two-thirds of adult patients. Their incidence was significantly higher than in childhood (mean annual rate 0.22 versus 0.07, p=0.01). Infectious risk persisted despite anti-infectious prophylaxis. Invasive fungal infections were frequent (0.11 per year per patient) and asymptomatic in 37% of the cases. They often required lung biopsy for diagnosis (10 out of 30). Noninfectious respiratory events concerned 28% of adult patients, frequently associated with a concomitant fungal infection (40%). They were more frequent in patients with the X-linked form of CGD. Immune-modulator therapies were required in most cases (70%). Respiratory manifestations are major complications of CGD in adulthood. Noninfectious pulmonary manifestations are as deleterious as infectious pneumonia. A specific respiratory monitoring is necessary.
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Affiliation(s)
- Hélène Salvator
- Service de Pneumologie, Hôpital Foch, Suresnes, France UPRES EA 220, Suresnes, France Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Nizar Mahlaoui
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Service d'Immunologie-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France INSERM UMR 1163, Paris, France
| | | | | | - Benoit Pilmis
- Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Borie
- Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, DHU FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France INSERM UMR 1152, Paris, France
| | - Bruno Crestani
- Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, DHU FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France INSERM UMR 1152, Paris, France
| | - Colas Tcherakian
- Service de Pneumologie, Hôpital Foch, Suresnes, France UPRES EA 220, Suresnes, France Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Felipe Suarez
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France INSERM UMR 1163, Paris, France Service d'Hématologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Dunogue
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Anne Gougerot-Pocidalo
- UF Dysfonctionnements Immunitaires, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM UMR 1149, Paris, France
| | - Margarita Hurtado-Nedelec
- UF Dysfonctionnements Immunitaires, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM UMR 1149, Paris, France
| | - Jean-François Dreyfus
- Délégation pour la Recherche Clinique et l'Innovation, Hôpital Foch, Suresnes, France
| | - Isabelle Durieu
- Service de Médecine Interne, Hospices Civils de Lyon, Groupe Hospitalier Sud, Université de Lyon, Lyon, France
| | - Fanny Fouyssac
- Service d'Hématologie et Oncologie pédiatrique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Olivier Hermine
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France INSERM UMR 1163, Paris, France Service d'Hématologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Lortholary
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France INSERM UMR 1163, Paris, France Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Fischer
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Service d'Immunologie-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France INSERM UMR 1163, Paris, France Collège de France, Paris, France
| | - Louis-Jean Couderc
- Service de Pneumologie, Hôpital Foch, Suresnes, France UPRES EA 220, Suresnes, France Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Trocme C, Deffert C, Cachat J, Donati Y, Tissot C, Papacatzis S, Braunersreuther V, Pache JC, Krause KH, Holmdahl R, Barazzone-Argiroffo C, Carnesecchi S. Macrophage-specific NOX2 contributes to the development of lung emphysema through modulation of SIRT1/MMP-9 pathways. J Pathol 2014; 235:65-78. [PMID: 25116588 PMCID: PMC4280678 DOI: 10.1002/path.4423] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 12/19/2022]
Abstract
Reactive oxygen species (ROS) participate in the pathogenesis of emphysema. Among ROS-producing enzymes, NOX NADPH oxidases are thought to be responsible for tissue injury associated with several lung pathologies. To determine whether NOX2 and/or NOX1 participate in the development of emphysema, their expression patterns were first studied by immunohistochemistry in the lungs of emphysematous patients. Subsequently, we investigated their contribution to elastase-induced emphysema using NOX2- and NOX1-deficient mice. In human lung, NOX2 was mainly detected in macrophages of control and emphysematous lungs, while NOX1 was expressed in alveolar epithelium and bronchial cells. We observed an elevated number of NOX2-positive cells in human emphysematous lungs, as well as increased NOX2 and NOX1 mRNA expression in mouse lungs following elastase exposure. Elastase-induced alveolar airspace enlargement and elastin degradation were prevented in NOX2-deficient mice, but not in NOX1-deficient mice. This protection was independent of inflammation and correlated with reduced ROS production. Concomitantly, an elevation of sirtuin 1 (SIRT1) level and a decrease of matrix metalloproteinase-9 (MMP-9) expression and activity were observed in alveolar macrophages and neutrophils. We addressed the specific role of macrophage-restricted functional NOX2 in elastase-induced lung emphysema using Ncf1 mutant mice and Ncf1 macrophage rescue mice (Ncf1 mutant mice with transgenic expression of Ncf1 only in CD68-positive mononuclear phagocytes; the MN mouse). Compared to WT mice, the lack of functional NOX2 led to decreased elastase-induced ROS production and protected against emphysema. In contrast, ROS production was restored specifically in macrophages from Ncf1 rescue mice and contributes to emphysema. Taken together, our results demonstrate that NOX2 is involved in the pathogenesis of human emphysema and macrophage-specific NOX2 participates in elastase-induced emphysema through the involvement of SIRT1/MMP-9 pathways in mice.
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Affiliation(s)
- Candice Trocme
- Laboratory of Protein and Enzyme Biochemistry, University Hospital, Grenoble, France
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Mahdaviani SA, Mehrian P, Najafi A, Khalilzadeh S, Eslampanah S, Nasri A, Karam MB, Rezaei N, Velayati AA. Pulmonary computed tomography scan findings in chronic granulomatous disease. Allergol Immunopathol (Madr) 2014; 42:444-8. [PMID: 23850120 DOI: 10.1016/j.aller.2013.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/15/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic granulomatous disease is a phagocyte defect, characterised by recurrent infections in different organs due to a defect in NADPH oxidase complex. This study was performed to investigate pulmonary problems of CGD in a group of patients who underwent computed tomography (CT) scan. METHODS Computed tomography scan was performed in 24 patients with CGD. The findings of the CT scan were documented in all of these patients. RESULTS Areas of consolidation and scan formation were the most common findings, which were detected in 79% of the patients. Other abnormalities in order of frequencies were as follows: small pulmonary nodules (58%); mediastinal lymphadenopathy (38%); pleural thickening (25%); unilateral hilar lymphadenopathy (25%); axillary lymphadenopathy (21%); bronchiectasis (17%); abscess formation (17%); pulmonary large nodules or masses (8%); and free pleural effusion (8%). CONCLUSION The pulmonary CT scans of the patients with CGD demonstrated a variety of respiratory abnormalities in the majority of the patients. While recurrent respiratory infections and abscesses are considered as prominent features of CGD, early diagnosis and precise check-up of the respiratory systems are needed to prevent further pulmonary complications.
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Affiliation(s)
- S A Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P Mehrian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases(NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - A Najafi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases(NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Khalilzadeh
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Eslampanah
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Nasri
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases(NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Bakhshayesh Karam
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - A A Velayati
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Magnani A, Brosselin P, Beauté J, de Vergnes N, Mouy R, Debré M, Suarez F, Hermine O, Lortholary O, Blanche S, Fischer A, Mahlaoui N. Inflammatory manifestations in a single-center cohort of patients with chronic granulomatous disease. J Allergy Clin Immunol 2014; 134:655-662.e8. [PMID: 24985400 DOI: 10.1016/j.jaci.2014.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/04/2014] [Accepted: 04/17/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is a rare phagocytic disorder that results in not only infections but also potentially severe inflammatory manifestations that can be difficult to diagnose and treat. OBJECTIVE To describe inflammatory manifestations in a single-center cohort of patients with CGD. METHODS Medical records of patients treated at Necker-Enfants Malades Hospital (Paris, France) between 1968 and 2009 and registered at the French National Reference Center for Primary Immunodeficiencies (CEREDIH) were retrospectively reviewed. RESULTS In a study population of 98 patients, a total of 221 inflammatory episodes were recorded in 68 individuals (69.4%). The incidence rate of inflammatory episodes was 0.15 per person-year (0.18 in patients with X-linked [XL] CGD and 0.08 in patients with autosomal-recessive [AR] CGD). The most commonly affected organs were the gastrointestinal tract (in 88.2% of the patients), lungs (26.4%), the urogenital tract (17.6%), and eyes (8.8%). Inflammation at other sites (the skin, central nervous system, and tympanum) and autoimmune manifestations (lupus, arthritis, etc) were recorded in 19.1% and 10.3% of the patients, respectively. Granuloma was found in 50% of the 44 histological analyses reviewed. The risk of inflammatory episodes was 2-fold higher in patients with XL-CGD than in patients with AR-CGD (relative risk, 2.22; 95% CI, 1.43-3.46). CONCLUSIONS Patients with XL-CGD have a higher risk of developing inflammatory episodes than do patients with AR-CGD. Although the most commonly affected organ is the gastrointestinal tract, other sites can be involved, making the management of patients with CGD a complex, multidisciplinary task.
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Affiliation(s)
- Alessandra Magnani
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Pauline Brosselin
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Julien Beauté
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Nathalie de Vergnes
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Richard Mouy
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Marianne Debré
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Felipe Suarez
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France; Assistance Publique-Hôpitaux de Paris, Service d'Hématologie Adultes, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Olivier Hermine
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France; Assistance Publique-Hôpitaux de Paris, Service d'Hématologie Adultes, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Olivier Lortholary
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France; Assistance Publique-Hôpitaux de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Stéphane Blanche
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Alain Fischer
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France; Collège de France, France
| | - Nizar Mahlaoui
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence des Déficits Immunitaires Héréditaires (CEREDIH), Hôpital Universitaire Necker-Enfants Malades, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Hopital Universitaire Necker-Enfants Malades, Inserm U1163, Paris, France.
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Clinical and Molecular Features of 38 Children with Chronic Granulomatous Disease in Mainland China. J Clin Immunol 2014; 34:633-41. [DOI: 10.1007/s10875-014-0061-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 05/15/2014] [Indexed: 12/29/2022]
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Holland DV, Paul Guillerman R, Brody AS. Thoracic Manifestations of Systemic Diseases. PEDIATRIC CHEST IMAGING 2014. [DOI: 10.1007/174_2014_965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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