Infection Due to Serratia sp. in Chronic Granulomatous Disease-Is the Incidence Low in Tropical Countries?

A Global-Scale Ecological Niche Modeling of the Emerging Pathogen Serratia marcescens to Aid in its Spatial Ecology

Serratia marcescens is a big emerging concern for human health and coral biodiversity. Spatial ecology and the influencing factors on pathogen ecology, however, remain unknown. The study forms the first global risk assessment of S. marcescens. MaxEnt niche modeling was applied using two biotic and sixteen abiotic variables. The world was classified into five risk-level categories based on the pathogen ecology, and the world population exposed to S. marcescens infection was then quantified. The prepared model showed an area under the curve value of 0.918 ± 0.028, implying excellent prediction ability. The highly and moderately suitable areas occupied around 0.52% and 17.9% of the total global land area. The order of probability of having S. marcescens-related infections was Asia > North America > South America > Europe > Africa > Australia. Human population density and temperature were the most influential factors in the distribution. The moderate to high transmission risk zones contained 0.20% (1.61 billion people) of the human population. In brief, these results give novel insights into its spatial ecology and provide the risk maps that can be utilized to plan targeted strategic control measures against future invasions of this emerging pathogen.

Clinical, Immunological, and Molecular Profile of Chronic Granulomatous Disease: A Multi-Centric Study of 236 Patients From India

BACKGROUND

Chronic granulomatous disease (CGD) is an inherited defect in phagocytic respiratory burst that results in severe and life-threatening infections in affected children. Single center studies from India have shown that proportion of autosomal recessive (AR) CGD is more than that reported from the West. Further, affected patients have high mortality rates due to late referrals and difficulties in accessing appropriate treatment. However, there is lack of multicentric collaborative data on CGD from India.

OBJECTIVE

To describe infection patterns, immunological, and molecular features of CGD from multiple centers in India.

METHODS

A detailed proforma that included clinical and laboratory details was prepared and sent to multiple centers in India that are involved in the care and management of patients with inborn errors of immunity. Twelve centers have provided data which were later pooled together and analyzed.

RESULTS

Of the 236 patients analyzed in our study, X-linked and AR-CGD was seen in 77 and 97, respectively. Male female ratio was 172:64. Median age at onset of symptoms and diagnosis was 8 and 24 months, respectively. Common infections documented include pneumonia (71.6%), lymphadenitis (31.6%), skin and subcutaneous abscess (23.7%), blood-stream infection (13.6%), osteomyelitis (8.6%), liver abscess (7.2%), lung abscess (2.9%), meningoencephalitis (2.5%), splenic abscess (1.7%), and brain abscess (0.9%). Forty-four patients (18.6%) had evidence of mycobacterial infection. Results of molecular assay were available for 141 patients (59.7%)-CYBB (44.7%) gene defect was most common, followed by NCF1 (31.9%), NCF2 (14.9%), and CYBA (8.5%). While CYBA variants were documented only in Southern and Western parts of India, a common dinucleotide deletion in NCF2 (c.835_836delAC) was noted only in North Indian population. Of the 174 patients with available outcome data, 67 (38.5%) had expired. Hematopoietic stem cell transplantation was carried out in 23 patients, and 12 are doing well on follow-up.

CONCLUSIONS

In India, proportion of patients with AR-CGD is higher as compared to Western cohorts, though regional differences in types of AR-CGD exist. Clinical profile and mortality rates are similar in both X-linked and AR-CGD. However, this may be a reflection of the fact that milder forms of AR-CGD are probably being missed.