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Ricci S, Guarnieri V, Capitanini F, Pelosi C, Astorino V, Boscia S, Calistri E, Canessa C, Cortimiglia M, Lippi F, Lodi L, Malvagia S, Moriondo M, La Marca G, Azzari C. EXPANDED NEWBORN SCREENING FOR INBORN ERRORS OF IMMUNITY: THE EXPERIENCE OF TUSCANY. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00395-7. [PMID: 38636590 DOI: 10.1016/j.jaip.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Inborn errors of immunity (IEIs) include 485 inherited disorders characterized by an increased susceptibility to life threatening infectious diseases, autoimmunity and malignant diseases with a high mortality rate in the first years of life. Severe Combined Immunodeficiency is the most severe of the IEIs and its detection should be a primary goal in a newborn screening (NBS) program. The term "actionable" has recently been used for all IEIs with outcomes that can be demonstrably improved through early specialized intervention. OBJECTIVE to evaluate the results of the expanded NBS strategy for IEIs in Tuscany Region (Italy), based on TREC (T-cell Receptor Excision Circles), KREC (Kappa Recombining Excision Circles) and Tandem Mass-based assays. METHODS This is a retrospective study collecting data from all infants born in Tuscany from October 10, 2018, to October 10, 2022. Tandem mass assay to identify Adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) deficiency, together with TREC and KREC molecular analysis were conducted on dried blood spot (DBS) from the newborns' Guthrie Cards. A new DBS and evaluation by an immunologist were carried out when the results of the first test were outside the diagnostic cut-offs. RESULTS 94,319 newborns were evaluated. Referral rates for TREC (0.031%) and KREC (0.074%) in this study are in line with the data available in literature. The results from the expanded NBS strategy revealed an incidence rate of 1/9,431 affected newborns. CONCLUSION This work represents the first description of a sustainable and real-life based expanded NBS program for IEIs with a high diagnostic incidence facilitating prompt management of identified patients.
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Affiliation(s)
- Silvia Ricci
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Valentina Guarnieri
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | | | - Caterina Pelosi
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - Valeria Astorino
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Silvia Boscia
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - Elisa Calistri
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - Clementina Canessa
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Martina Cortimiglia
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Francesca Lippi
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Lorenzo Lodi
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Sabrina Malvagia
- Newborn Screening, Clinical Chemistry and Pharmacology Laboratory, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
| | - Maria Moriondo
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Giancarlo La Marca
- Newborn Screening, Clinical Chemistry and Pharmacology Laboratory, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
| | - Chiara Azzari
- Immunology Division, Section of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
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Caporizzi A, Ravidà F, Barneschi S, Moriondo M, Nieddu F, Boscia S, Stinco M, Ricci S, Trapani S. Analysis of a Cohort of 165 Pediatric Patients with Human Bocavirus Infection and Comparison between Mono-Infection and Respiratory Co-Infections: A Retrospective Study. Pathogens 2024; 13:55. [PMID: 38251362 PMCID: PMC10821073 DOI: 10.3390/pathogens13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Human Bocavirus (HBoV) is mainly associated with respiratory tract infections. However, its role as respiratory pathogen is not fully understood for a high co-infection rate in symptomatic patients and a significant HBoV detection rate in asymptomatic subjects. This study aimed to describe a large cohort of children with HBoV infection and to compare HBoV mono-infection and co-infections. METHODS We retrospectively reviewed data from 165 children admitted to Meyer Children's Hospital IRCCS from March 2022 to March 2023 with the diagnosis of HBoV infection, detected using Reverse Transcription qPCR from nasal swabs. Thereafter, we compared patients with HBoV mono-infection (Group A) and those with HBoV co-infections (Group B) in terms of disease severity, established by the length of stay (LOS), the requirement of Pediatric Intensive Care Unit (PICU), and advanced respiratory support (ARS). RESULTS The median age was 1.5 years; 80% of patients presented with respiratory symptoms. The discharge rate from the emergency department (ED) within 24 h was 42.4%. Most cases (57.6%) were hospitalized, and 7.3% were admitted to PICU due to respiratory failure. Group A comprised 69 patients, and Group B 96 children (95% viral co-infections, 2% bacterial, 3% viral and bacterial). Group A and Group B were similar in hospitalization rate but differed significantly in LOS (median 3 vs. 5 days) and requirement of PICU admission (0 vs. 12 patients, p < 0.001). Patients with a respiratory disease history (17.5%) showed significantly longer LOS and more necessity of inhaled bronchodilator therapy. CONCLUSIONS HBoV should be considered a relevant respiratory pathogen especially in viral co-infections. Patients with HBoV co-infections have a higher risk of necessitating advanced respiratory support with more PICU admission and longer LOS; a previous respiratory disease puts them at a higher risk of longer hospitalization.
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Affiliation(s)
- Alice Caporizzi
- Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (F.R.); (S.B.)
| | - Federica Ravidà
- Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (F.R.); (S.B.)
| | - Sara Barneschi
- Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (F.R.); (S.B.)
| | - Maria Moriondo
- Division of Immunology, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.M.); (F.N.); (S.B.); (S.R.)
| | - Francesco Nieddu
- Division of Immunology, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.M.); (F.N.); (S.B.); (S.R.)
| | - Silvia Boscia
- Division of Immunology, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.M.); (F.N.); (S.B.); (S.R.)
| | - Mariangela Stinco
- Pediatric Unit, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.S.); (S.T.)
| | - Silvia Ricci
- Division of Immunology, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.M.); (F.N.); (S.B.); (S.R.)
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children’s Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy; (M.S.); (S.T.)
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
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Barni S, Vazquez-Ortiz M, Giovannini M, Liccioli G, Sarti L, Lascialfari G, Pisano L, Boscia S, Mori F. Food Protein-induced Enterocolitis Syndrome Due to Cuttlefish in a Child with Anaphylaxis to Crustaceans. Iran J Allergy Asthma Immunol 2023; 22:208-211. [PMID: 37496414 DOI: 10.18502/ijaai.v22i2.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/13/2023] [Indexed: 07/28/2023]
Abstract
Shellfish is defined as any edible marine invertebrate and refers to crustaceans and mollusks. Crustaceans belong to the phylum Arthropods. Mollusks belong to the phylum Mollusca. This report illustrates a rare case of a 6-year-old girl with challenge-proven acute food protein-induced enterocolitis syndrome (FPIES) to cuttlefish (phylum Mollusca, class Cephalopoda), anaphylaxis to crustaceans (phylum Arthropoda), and tolerance to other mollusks, including clams and mussels (phylum Mollusca, class Bivalvia). The association of IgE-mediated food allergy and acute FPIES seen in this case is rare. To our knowledge, this is the first case of FPIES to cuttlefish reported in a child. This challenge highlights the need for further research into the allergens and mechanisms underpinning FPIES at a molecular level, enabling a better understanding of cross-reactivity patterns and the development of diagnostic and predictive tests to assist in clinical practice.
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Affiliation(s)
- Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Marta Vazquez-Ortiz
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy AND Department of healt Science, University of Florence, Florence, Italy.
| | - Giulia Liccioli
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | | | - Laura Pisano
- Immunology and Molecular Microbiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Silvia Boscia
- Immunology and Molecular Microbiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
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Mastrolia MV, Boscia S, Galli L, Lodi L, Pisano L, Maccora I, Ricci S, Pagnini I, Marrani E, Azzari C, Simonini G. CD38 high/HLA-DR + CD8 + T cells as potential biomarker of hemophagocytic lymphohistiocytosis secondary to visceral Leishmania infection. Eur J Pediatr 2023; 182:1429-1432. [PMID: 36631689 DOI: 10.1007/s00431-022-04789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
Leishmaniasis is a cause of infection associated with hemophagocytic lymphohistiocytosis (HLH). The measurement of the CD8+ CD38high/HLA-DR+ T cells in children presenting with acute onset of shock and multisystem organ failure represents an important parameter to distinguish HLH from sepsis or healthy control. CONCLUSION We report a case series of 4 Italian children suffering from HLH secondary to visceral Leishmaniasis in which the lymphocyte subset assay suggests a potential role of CD38high/HLA-DR+ CD8+ T cells as HLH diagnostic biomarkers. WHAT IS KNOWN • Visceral Leishmaniasis is a well-known cause of infection associated with hemophagocytic lymphohistiocytosis (HLH). • The measurement of the CD8+ CD38high/HLA-DR+ T cells in children presenting with acute onset of shock and multisystem organ failure represents an important diagnostically useful parameter to readily distinguish HLH from sepsis or healthy controls. WHAT IS NEW • We report a case series of 4 Italian children suffering from HLH secondary to visceral Leishmaniasis in which the lymphocyte subset assay suggests a potential role of CD38high/HLA-DR+ CD8+ T cells as HLH diagnostic biomarker. • The flow cytometry assay, performed at the disease onset before starting treatment, revealed a mean percentage value of CD38 cells of 36.95% among CD8+ T cells.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, Florence, 50139, Italy.
| | - Silvia Boscia
- Immunology and Molecular Microbiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Pediatric Infectious Diseases Unit, University of Florence, Meyer Children's University Hospital, Florence, Italy
| | - Lorenzo Lodi
- Immunology and Molecular Microbiology Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence , Florence, Italy
| | - Laura Pisano
- Immunology and Molecular Microbiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, Florence, 50139, Italy
| | - Silvia Ricci
- Immunology and Molecular Microbiology Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence , Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, Florence, 50139, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, Florence, 50139, Italy
| | - Chiara Azzari
- Immunology and Molecular Microbiology Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence , Florence, Italy
| | - Gabriele Simonini
- NEUROFARBA Department, Rheumatology Unit, Meyer Children's University Hospital, University of Florence, Florence, Italy
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