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Manuel AR, Vieira J, Figueiredo A, Correia P. Invasive meningococcal disease: Should the first episode prompt further investigation? J Paediatr Child Health 2022; 58:1091-1093. [PMID: 34672415 DOI: 10.1111/jpc.15768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ana R Manuel
- Child and Youth Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - Joana Vieira
- Child and Youth Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - António Figueiredo
- Child and Youth Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - Paula Correia
- Child and Youth Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
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Flatrès C, Roué JM, Picard C, Carausu L, Thomas C, Pellier I, Millot F, Gandemer V, Chantreuil J, Lorton F, Gras Le Guen C, Launay E. Investigation of primary immune deficiency after severe bacterial infection in children: A population-based study in western France. Arch Pediatr 2021; 28:398-404. [PMID: 33903000 DOI: 10.1016/j.arcped.2021.03.009] [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: 04/27/2020] [Revised: 11/30/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitted to a pediatric intensive care unit. We also assessed the frequency and described the typology of diagnosed primary immune deficiency (PID). METHODS We conducted a retrospective observational epidemiological study in six university hospitals in western France. All children from 1 month to 16 years of age admitted to hospital for bacterial meningitis, purpura fulminans, or meningococcal disease between August 2009 and January 2014 were included. We analyzed the frequency, type, and results of the immunological tests performed on children with meningitis, purpura fulminans, or a meningococcemia episode. RESULTS Among the 143 children included (144 episodes), 84 (59%) and 60 (41%) had bacterial meningitis and purpura fulminans or meningococcemia, respectively: 72 (50%) had immunological tests and 8% had a complete immunological investigation as recommended. Among the 72 children examined for PID, 11 (15%) had at least one anomaly in the immunological test results. Two children had a diagnosis of PID (one with C2 deficit and the other with C8 deficit) and seven other children had possible PID. Thus, the prevalence of a definite or possible diagnosis of PID was 12% among the children examined. CONCLUSION PID is rarely investigated after COSBI. We raise awareness of the need for immunological investigations after a severe infection requiring PICU admission.
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Affiliation(s)
- C Flatrès
- Brest University Hospital, Pediatrics Department, Brest, France.
| | - J M Roué
- Brest University Hospital, neonatal Intensive Care Unit, Brest, France
| | - C Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, Inserm UMR 1163, Paris, University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - L Carausu
- Brest University Hospital, Pediatrics Department, Brest, France
| | - C Thomas
- CHU de Nantes, Pediatric Hematology-Oncology Unit, Nantes, France
| | - I Pellier
- University Hospital of Angers, Department of Pediatric Onco-hematology, Angers, France
| | - F Millot
- Department of Pediatric Onco-Hematology, Poitiers University Hospital, Poitiers, France
| | - V Gandemer
- Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes, France
| | - J Chantreuil
- Centre Hospitalo-universitaire de Tours, Service de réanimation pédiatrique, Tours, France
| | - F Lorton
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France
| | - C Gras Le Guen
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France; CHU de Nantes, Department of Pediatrics, Nantes, France
| | - E Launay
- CHU de Nantes, Department of Pediatrics, Nantes, France
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Audemard-Verger A, Descloux E, Ponard D, Deroux A, Fantin B, Fieschi C, John M, Bouldouyre A, Karkowsi L, Moulis G, Auvinet H, Valla F, Lechiche C, Davido B, Martinot M, Biron C, Lucht F, Asseray N, Froissart A, Buzelé R, Perlat A, Boutboul D, Fremeaux-Bacchi V, Isnard S, Bienvenu B. Infections Revealing Complement Deficiency in Adults: A French Nationwide Study Enrolling 41 Patients. Medicine (Baltimore) 2016; 95:e3548. [PMID: 27175654 PMCID: PMC4902496 DOI: 10.1097/md.0000000000003548] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Complement system is a part of innate immunity, its main function is to protect human from bacterial infection. As genetic disorders, complement deficiencies are often diagnosed in pediatric population. However, complement deficiencies can also be revealed in adults but have been poorly investigated. Herein, we describe a case series of infections revealing complement deficiency in adults to study clinical spectrum and management of complement deficiencies.A nationwide retrospective study was conducted in French university and general hospitals in departments of internal medicine, infectious diseases enrolling patients older than 15 years old who had presented at least one infection leading to a complement deficiency diagnosis.Forty-one patients included between 2002 and 2015 in 19 different departments were enrolled in this study. The male-to-female ratio was 1.3 and the mean age at diagnosis was 28 ± 14 (15-67) years. The main clinical feature was Neisseria meningitidis meningitis 75% (n = 31/41) often involving rare serotype: Y (n = 9) and W 135 (n = 7). The main complement deficiency observed was the common final pathway deficiency 83% (n = 34/41). Half of the cohort displayed severe sepsis or septic shock at diagnosis (n = 22/41) but no patient died. No patient had family history of complement deficiency. The mean follow-up was 1.15 ± 1.95 (0.1-10) years. Half of the patients had already suffered from at least one infection before diagnosis of complement deficiency: meningitis (n = 13), pneumonia (n = 4), fulminans purpura (n = 1), or recurrent otitis (n = 1). Near one-third (n = 10/39) had received prophylactic antibiotics (cotrimoxazole or penicillin) after diagnosis of complement deficiency. The vaccination coverage rate, at the end of the follow-up, for N meningitidis, Streptococcus pneumonia, and Haemophilius influenzae were, respectively, 90% (n = 33/37), 47% (n = 17/36), and 35% (n = 14/34).This large study emphasizes that complement deficiencies can be revealed in adults by infectious episodes. Most of them were meningococcal infections revealing common final pathway deficiency. To avoid undiagnosis or late diagnosis, adult displaying first episode of N meningitidis infection should be tested for complement deficiency.
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Affiliation(s)
- A Audemard-Verger
- From the CHU de Caen, Department of Internal Medicine, Caen (AA-V, BB), Department of Infectious Diseases, Nouvelle Calédonie University Hospital, Nouvelle Calédonie (ED, MJ), Laboratory of Immunology, Grenoble University Hospital, Grenoble (DP, AD), Department of Internal Medicine, Grenoble University Hospital, Grenoble, Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (BF), Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (CF, DB), Department of Internal Medicine, Robert Ballanger General Hospital, Aulnay sous Bois (MAB), Department of Internal Medicine, Hôpital d'Instruction des Armées, Metz (LK), Department of Internal Medicine, Toulouse University Hospital, UMR 1027 INSERM University of Toulouse; CIC 1436, Toulouse (GM), Department of Internal Medicine, Brest University Hospital, Brest (HA), Department of Paediatric Intensive Care Unit, Lyon University Hospital, Lyon (FV), Department of Infectious Diseases, Nîmes University Hospital, Nîmes (CL), Department of Infectious Diseases, Raymond Poincaré University Hospital, Garches (BD), Department of Medicine, Colmar General Hospital, Colmar (MM), Department of Infectious Diseases, Nantes University Hospital, Nantes (CB, NA), Department of Infectious Diseases, Saint Etienne University Hospital, Saint Etienne (FL), Department of Internal Medicine, Créteil Hospital, Créteil (AF), Department of Infectious Diseases, Tours University Hospital, Tour (RB), Department of Internal Medicine, Rennes University Hospital, Rennes (AP), Laboratory of Immunology, Team Dentritic Cells Physiology, Cochin Institute (SI); and Laboratory of Immunology, Européen Georges Pompidou University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (VF-B), France
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Daures M, John M, Balter CV, Simon O, Barguil Y, Missotte I, Grangeon JP, Laumond-Barny S, Noel M, Besson-Leaud L, Spasic PE, de Suremain A, Gourinat AC, Descloux E. Relationships Between Clinico-Epidemiological Patterns of Invasive Meningococcal Infections and Complement Deficiencies in French South Pacific Islands (New Caledonia). J Clin Immunol 2014; 35:47-55. [PMID: 25352052 DOI: 10.1007/s10875-014-0104-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/29/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Invasive Meningococcal Disease (IMD) is three fold more common in New Caledonia (NC) than in metropolitan France and many IMD cases (35.7%) are due to Y and W135 serogroups. The purpose of our study was to identify IMD risk factors in NC. METHODS A retrospective study of all IMD cases that occurred in NC between 2005 and 2011 was conducted. Socio-environmental, clinical and biological data were collected. A search for immune deficiency was proposed to all cases. IMD presentation and outcome were compared according to meningoccal serogroups and the complement deficiency status (C-deficiency). RESULTS Sixty-six sporadic IMD cases (29 B serogroup, 20 Y or W135, 6 C, 1 A, 10 unknown) occurred in 64 patients often <24 years-old and of Melanesian origin. Five patients died (7.8%). No socio-environmental risk factors were identified. No asplenia, HIV infection or immunoglobulin deficiencies were found. Two patients had diabetes and 28 of 53 (52.8%) patients had C-deficiency including 20 (71.4%) cases of late complement component deficiency. Patients with C-deficiency were mainly Melanesian (92.8%) originating from the Loyalty Islands (62.1%). They were mostly infected with Y/W135 (42.9%) or B serogroups (32.1%). They often developed later and more severe disease than patients without C-deficiency (need for intensive cares in 60% versus 28.0% of cases, p = 0.01). CONCLUSIONS A high prevalence of C-deficiency in the Melanesian population may explain epidemiological and clinical features of IMD in NC. Our results imply an adaptation of meningococcal vaccine strategies in NC.
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Affiliation(s)
- Maguy Daures
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia.
| | - Michele John
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | | | - Olivier Simon
- Neurology Department, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Yann Barguil
- Biochemistry and Haemostasis Laboratory, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Isabelle Missotte
- Paediatrics Department, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Jean-Paul Grangeon
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | - Sylvie Laumond-Barny
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | - Martine Noel
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | | | | | | | - Ann-Claire Gourinat
- Laboratory of Serology and Molecular Diagnosis, Pasteur Institute, Noumea, New Caledonia
| | - Elodie Descloux
- Department of Internal Medicine, Noumea Territorial Hospital, Noumea, New Caledonia
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Bussone G, Mouthon L. [Late onset of primary immune deficiencies]. Presse Med 2009; 39:196-207. [PMID: 19481902 DOI: 10.1016/j.lpm.2009.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/30/2009] [Accepted: 04/07/2009] [Indexed: 01/20/2023] Open
Abstract
Primary immune deficiencies (PID) are characterized by a failure of the immune system that is not explained by any infectious, neoplastic, or iatrogenic cause. The diagnosis of PID should be considered in cases of severe or recurrent infections but also in cases with granulomatosis, autoimmune diseases, hemophagocytic syndrome, lymphoproliferative disorders, or even some solid tumors. The onset of PID may be late, most often in adulthood. Nonetheless, late onset may also mean in the first years rather than months of life or in adolescence rather than early childhood. In adults, the diagnosis of PID cannot be considered before acquired immunodeficiencies--far more frequent--are ruled out. Factors affecting the late onset of PID are not known.
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Affiliation(s)
- Guillaume Bussone
- Université Paris Descartes, Faculté de médecine, Pôle de médecine interne, Centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, F-75679 Paris Cedex 14, France
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Abstract
The complement system, composed of several plasma and membrane proteins, is an integral part of the innate immune system and plays a role in inflammatory response, destruction of infectious agents, elimination of immune complexes, and control of the specific (adaptive) immune response. Hereditary deficiencies of complement components are relatively rare and associated with susceptibility to a wide variety of clinical diseases. Complement components may be target of antibodies (anti-C1q, factor H, C3 alternative convertase, or C3NeF autoantibodies or anti-C1 inhibitor antibodies) that lead to acquired deficiencies. Testing the complement system is especially necessary in patients with autoimmune diseases, some kidney diseases, recurrent infections (especially meningococcal), and angioedema. Precise clinical descriptions of the phenotypes associated with these deficiencies and their molecular diagnosis are necessary to improve our understanding of the role that the complement system plays in the physiopathological mechanisms of these diseases and to propose the most specific treatment for them.
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