Severe combined immunodeficiency: otolaryngological presentation and management

Organ-based clues for diagnosis of inborn errors of immunity: A practical guide for clinicians

Inborn errors of immunity (IEI) comprise a group of about 490 genetic disorders that lead to aberrant functioning or the development of distinct immune system components. So far, a broad spectrum of IEI-related manifestations has been noted in the literature. Due to overlapping signs and symptoms of IEI, physicians face challenges in appropriately diagnosing and managing affected individuals. The last decade has witnesses improving in the molecular diagnosis of IEI patients. As a result, it can be the mainstay of diagnostic algorithms, prognosis, and possibly therapeutic interventions in patients with IEI. Furthermore, reviewing IEI clinical complications demonstrates that the manifestations and severity of the symptoms depend on the involved gene that causes the disease and its penetrance. Although several diagnostic criteria have been used for IEI, not every patient can be explored in the same way. As a result of the failure to consider IEI diagnosis and the variety of diagnostic capabilities and laboratory facilities in different regions, undiagnosed patients are increasing. On the other hand, early diagnosis is an almost essential element in improving the quality of life in IEI patients. Since there is no appropriate guideline for IEI diagnosis in different organs, focusing on the clues in the patient's chief complaint and physical exams can help physicians narrow their differential diagnosis. This article aims to provide a practical guide for IEI diagnosis based on the involved organ. We hope to assist clinicians in keeping IEI diagnosis in mind and minimizing possible related complications due to delayed diagnosis.

Periodontal and other oral manifestations of immunodeficiency diseases

The list of immunodeficiency diseases grows each year as novel disorders are discovered, classified, and sometimes reclassified due to our ever-increasing knowledge of immune system function. Although the number of patients with secondary immunodeficiencies (SIDs) greatly exceeds those with primary immunodeficiencies (PIDs), the prevalence of both appears to be on the rise probably because of scientific breakthroughs that facilitate earlier and more accurate diagnosis. Primary immunodeficiencies in adults are not as rare as once thought. Globally, the main causes of secondary immunodeficiency are HIV infection and nutritional insufficiencies. Persons with acquired immune disorders such as AIDS caused by the human immunodeficiency virus (HIV) are now living long and fulfilling lives as a result of highly active antiretroviral therapy (HAART). Irrespective of whether the patient's immune-deficient state is a consequence of a genetic defect or is secondary in nature, dental and medical practitioners must be aware of the constant potential for infections and/or expressions of autoimmunity in these individuals. The purpose of this review was to study the most common conditions resulting from primary and secondary immunodeficiency states, how they are classified, and the detrimental manifestations of these disorders on the periodontal and oral tissues.

Bilateral choanal atresia and paranasal sinus hypoplasia in an adult patient with hypogammaglobulinaemia

We present an unusual case of a young female patient presenting with bilateral choanal atresia, which was probably acquired, associated with nasal and paranasal sinus hypoplasia and hypogammaglobulinaemia.

Otolaryngologic manifestations of immunodeficiency

Otolaryngologists are frequently consulted to manage infectious and noninfectious complications of immune deficiency. Although defects of host defense and recurrent or severe infections are the most obvious manifestations of immune deficiency, patients are often at increased risk for autoimmune and malignant disease as well. Knowledge of primary and acquired immune deficiencies will facilitate appropriate identification, treatment, and referral of patients with these defects. When immunodeficiency is known or suspected, it is particularly important to have a high index of suspicion for unusual or severe manifestations of infection, to have a low threshold for obtaining imaging to aid in diagnosis, and to treat infections for longer periods of time with higher doses of antibiotic. Surgery may be required for definitive treatment of infections that do not respond to medical therapy and for management of complications of infectious disease

Dysfunction of peripheral blood granulocyte oxidative metabolism in children with recurrent upper respiratory tract infections

Granulocytes play a key role in the defence against bacterial infections. Their dysfunction may both predispose to and result from infections. The oxidative metabolism of peripheral blood granulocytes was studied in 50 children aged from 1 to 10 years, with recurrent upper respiratory tract infections and/or tonsillar hypertrophy. Four groups of patients were recruited: 15 healthy controls, seven patients with idiopathic tonsillar hypertrophy, 12 patients with upper respiratory tract infections and 16 patients with upper respiratory tract infections with concurrent tonsillar hypertrophy. The ability of granulocytes to produce reactive oxygen species was assessed by nFMLP-induced chemiluminescence. Both increased and depressed granulocyte activity was observed in all studied groups, with the exception of controls. Altered granulocyte function was observed in 30% of patients in the idiopathic tonsillar hypertrophy group. In children with recurrent infections abnormal chemiluminescence results were found in from 75% to nearly 90% of patients. This preliminary study demonstrates the possible relationship between recurrent upper respiratory tract infections, tonsillar hypertrophy and impaired peripheral blood granulocyte chemiluminescence.

Signal-transduction defects in T cells

In conclusion, multiple receptors and signal transduction cascades influence T-cell function and fate. During the past few years many of these important aspects of T-cell biology were identified. The complexity of the various signaling pathways has made appreciation of their clinical significance difficult. One way of studying the function of these molecules is to create mice deficient of these components. However, frequently the murine phenotype is far from reflecting the homologous human deficiency. It is therefore beneficial to define the human immunodeficiencies in order to understand the role of a certain signaling molecule in humans. Further, mutations that result in partial deficiencies may result in a different phenotype from null mutations. This information may aid in improving structure/function analysis of these signaling components.

Infection in patients with primary immunodeficiency disorders

Recent advances in the understanding of the molecular basis of primary immunodeficiency disorders are reviewed, with particular emphasis on how these provide insights to the normal host's handling of particular microbes. Also reviewed are a number of reports on series of patients with these disorders, documenting the incidence and nature of the infective complications that occur and the effectiveness of treatment strategies.