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Punj M, Neshat SS, Mateus AYL, Cheung J, Squire JD. Assessment of Sleep Disorders in Patients with CVID. J Clin Immunol 2024; 44:109. [PMID: 38676767 DOI: 10.1007/s10875-024-01711-y] [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: 12/27/2023] [Accepted: 04/14/2024] [Indexed: 04/29/2024]
Abstract
Inborn errors of immunity have been associated with reduced health-related quality of life and increased fatigue. Sleep disorders, which have been shown to contribute to fatigue and other health concerns, are prevalent in the general population, but there are limited studies evaluating these conditions in patients with common variable immunodeficiency (CVID). Our aim was to evaluate the prevalence of fatigue, sleep disturbances, and sleep-disordered breathing in adults with CVID. Patients completed 4 validated, self-administered questionnaires and a 1-night disposable home sleep apnea test. Our results demonstrated increased median Patient-Reported Outcomes Measurement Information System fatigue scores of 58.7 in patients with CVID in addition to clinically significant fatigue as measured by Fatigue Severity Scale score (median, 5.2) and overall poor sleep quality based on global Pittsburgh Sleep Quality Index score (median, 9.0). For CVID patients who completed the home sleep apnea test, 76.9% met criteria for sleep-disordered breathing with an Apnea-Hypopnea Index score of 5 or greater. The results of our study indicate that patients with CVID may have increased rates of undiagnosed sleep disorders that may contribute to increased fatigue and reduced health-related quality of life.
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Affiliation(s)
- Mantavya Punj
- Kadlec Regional Medical Center, Richland, Washington, USA
| | | | | | - Joseph Cheung
- Research Fellow in the Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jacqueline D Squire
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA.
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2
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Grenier PA, Brun AL, Longchampt E, Lipski M, Mellot F, Catherinot E. Primary immunodeficiency diseases of adults: a review of pulmonary complication imaging findings. Eur Radiol 2023:10.1007/s00330-023-10334-7. [PMID: 37935849 DOI: 10.1007/s00330-023-10334-7] [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: 07/13/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/09/2023]
Abstract
Our objective in this review is to familiarize radiologists with the spectrum of initial and progressive CT manifestations of pulmonary complications observed in adult patients with primary immunodeficiency diseases, including primary antibody deficiency (PAD), hyper-IgE syndrome (HIES), and chronic granulomatous disease (CGD). In patients with PAD, recurrent pulmonary infections may lead to airway remodeling with bronchial wall-thickening, bronchiectasis, mucus-plugging, mosaic perfusion, and expiratory air-trapping. Interstitial lung disease associates pulmonary lymphoid hyperplasia, granulomatous inflammation, and organizing pneumonia and is called granulomatous-lymphocytic interstitial lung disease (GLILD). The CT features of GLILD are solid and semi-solid pulmonary nodules and areas of air space consolidation, reticular opacities, and lymphadenopathy. These features may overlap those of mucosa-associated lymphoid tissue (MALT) lymphoma, justifying biopsies. In patients with HIES, particularly the autosomal dominant type (Job syndrome), recurrent pyogenic infections lead to permanent lung damage. Secondary infections with aspergillus species develop in pre-existing pneumatocele and bronchiectasis areas, leading to chronic airway infection. The complete spectrum of CT pulmonary aspergillosis may be seen including aspergillomas, chronic cavitary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis (ABPA)-like pattern, mixed pattern, and invasive. Patients with CGD present with recurrent bacterial and fungal infections leading to parenchymal scarring, traction bronchiectasis, cicatricial emphysema, airway remodeling, and mosaicism. Invasive aspergillosis, the major cause of mortality, manifests as single or multiple nodules, areas of airspace consolidation that may be complicated by abscess, empyema, or contiguous extension to the pleura or chest wall. CLINICAL RELEVANCE STATEMENT: Awareness of the imaging findings spectrum of pulmonary complications that can occur in adult patients with primary immunodeficiency diseases is important to minimize diagnostic delay and improve patient outcomes. KEY POINTS: • Unexplained bronchiectasis, associated or not with CT findings of obliterative bronchiolitis, should evoke a potential diagnosis of primary autoantibody deficiency. • The CT evidence of various patterns of aspergillosis developed in severe bronchiectasis or pneumatocele in a young adult characterizes the pulmonary complications of hyper-IgE syndrome. • In patients with chronic granulomatous disease, invasive aspergillosis is relatively frequent, often asymptomatic, and sometimes mimicking or associated with non-infectious inflammatory pulmonary lesions.
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Affiliation(s)
- Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, France.
| | | | | | | | | | - Emilie Catherinot
- Department of Pneumology, Hôpital Foch, Suresnes, France
- CEDITH (Centre de Référence Des Déficits Immunitaires Héréditaires), Hôpital Foch Affiliated to Versailles-Saint Quentin University, 40 Rue Worth, 92150, Suresnes, France
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3
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Scarpa R, Cinetto F, Milito C, Gianese S, Soccodato V, Buso H, Garzi G, Carrabba M, Messina E, Panebianco V, Catalano C, Morana G, Lougaris V, Landini N, Bondioni MP. Common and Uncommon CT Findings in CVID-Related GL-ILD: Correlations with Clinical Parameters, Therapeutic Decisions and Potential Implications in the Differential Diagnosis. J Clin Immunol 2023; 43:1903-1915. [PMID: 37548814 PMCID: PMC10661728 DOI: 10.1007/s10875-023-01552-1] [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: 09/17/2022] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To investigate computed tomography (CT) findings of Granulomatous Lymphocytic Interstitial Lung Disease (GL-ILD) in Common Variable Immunodeficiency (CVID), also in comparison with non-GL-ILD abnormalities, correlating GL-ILD features with functional/immunological parameters and looking for GL-ILD therapy predictive elements. METHODS CT features of 38 GL-ILD and 38 matched non-GL-ILD subjects were retrospectively described. Correlations of GL-ILD features with functional/immunological features were assessed. A logistic regression was performed to find a predictive model of GL-ILD therapeutic decisions. RESULTS Most common GL-ILD CT findings were bronchiectasis, non-perilymphatic nodules, consolidations, Ground Glass Opacities (GGO), bands and enlarged lymphnodes. GL-ILD was usually predominant in lower fields. Multiple small nodules (≤10 mm), consolidations, reticulations and fibrotic ILD are more indicative of GL-ILD. Bronchiectasis, GGO, Reticulations and fibrotic ILD correlated with decreased lung performance. Bronchiectasis, GGO and fibrotic ILD were associated with low IgA levels, whereas high CD4+ T cells percentage was related to GGO. Twenty out of 38 patients underwent GL-ILD therapy. A model combining Marginal Zone (MZ) B cells percentage, IgA levels, lower field consolidations and lymphnodes enlargement showed a good discriminatory capacity with regards to GL-ILD treatment. CONCLUSIONS GL-ILD is a lower field predominant disease, commonly characterized by bronchiectasis, non-perilymphatic small nodules, consolidations, GGO and bands. Multiple small nodules, consolidations, reticulations and fibrotic ILD may suggest the presence of GL-ILD in CVID. MZ B cells percentage, IgA levels at diagnosis, lower field consolidations and mediastinal lymphnodes enlargement may predict the need of a specific GL-ILD therapy.
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Affiliation(s)
- Riccardo Scarpa
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.
| | - Sabrina Gianese
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Valentina Soccodato
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Helena Buso
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maria Carrabba
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
- ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Nicholas Landini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
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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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Jang JH, Kim JH, Park HS. Current Issues in the Management of IgG Subclass Deficiencies in Adults With Chronic Respiratory Diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:562-579. [PMID: 37827977 PMCID: PMC10570785 DOI: 10.4168/aair.2023.15.5.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
Primary immunodeficiency diseases (PIDs) are uncommon in adults; however, immunoglobulin G subclass deficiency (IGGSCD) is often found in a subset of adult patients with chronic respiratory diseases. As quantitative laboratory tests are used to diagnose IGGSCD, the clinical significance of IGGSCD remains controversial. However, respiratory infection is a common presenting feature of IGGSCD, and respiratory complications are responsible for subsequent morbidities, such as severe asthma, bronchiectasis, chronic obstructive airway diseases, and mortality. This review summarizes the current epidemiological data for PIDs, focusing on IGGSCD in the adult population. In addition, the investigation, treatment, and management strategies are detailed, including distinct issues faced by patients with chronic airway disease and their physicians in the proper diagnosis and treatment of IGGSCD.
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Affiliation(s)
- Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
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6
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Mohammadi F, Yadegar A, Mardani M, Ayati A, Abolhassani H, Rezaei N. Organ-based clues for diagnosis of inborn errors of immunity: A practical guide for clinicians. Immun Inflamm Dis 2023; 11:e833. [PMID: 37102642 PMCID: PMC10091206 DOI: 10.1002/iid3.833] [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: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
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.
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Affiliation(s)
- Fatemeh Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Tehran, Iran
| | - Amirhossein Yadegar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Tehran, Iran
| | - Mahta Mardani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Tehran, Iran
| | - Aryan Ayati
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Primary Immunodeficiency Diseases Network (PIDNet), Tehran, Iran
- Children's Medical Center, Tehran, Iran
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7
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Cheng GS, Crothers K, Aliberti S, Bergeron A, Boeckh M, Chien JW, Cilloniz C, Cohen K, Dean N, Dela Cruz CS, Dickson RP, Greninger AL, Hage CA, Hohl TM, Holland SM, Jones BE, Keane J, Metersky M, Miller R, Puel A, Ramirez J, Restrepo MI, Sheshadri A, Staitieh B, Tarrand J, Winthrop KL, Wunderink RG, Evans SE. Immunocompromised Host Pneumonia: Definitions and Diagnostic Criteria: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:341-353. [PMID: 36856712 PMCID: PMC9993146 DOI: 10.1513/annalsats.202212-1019st] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Pneumonia imposes a significant clinical burden on people with immunocompromising conditions. Millions of individuals live with compromised immunity because of cytotoxic cancer treatments, biological therapies, organ transplants, inherited and acquired immunodeficiencies, and other immune disorders. Despite broad awareness among clinicians that these patients are at increased risk for developing infectious pneumonia, immunocompromised people are often excluded from pneumonia clinical guidelines and treatment trials. The absence of a widely accepted definition for immunocompromised host pneumonia is a significant knowledge gap that hampers consistent clinical care and research for infectious pneumonia in these vulnerable populations. To address this gap, the American Thoracic Society convened a workshop whose participants had expertise in pulmonary disease, infectious diseases, immunology, genetics, and laboratory medicine, with the goal of defining the entity of immunocompromised host pneumonia and its diagnostic criteria.
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Grochowalska K, Ziętkiewicz M, Więsik-Szewczyk E, Matyja-Bednarczyk A, Napiórkowska-Baran K, Nowicka-Sauer K, Hajduk A, Sołdacki D, Zdrojewski Z. Subjective sleep quality and fatigue assessment in Polish adult patients with primary immunodeficiencies: A pilot study. Front Immunol 2023; 13:1028890. [PMID: 36713442 PMCID: PMC9880253 DOI: 10.3389/fimmu.2022.1028890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Primary immunodeficiencies (PIDs) are clinically heterogeneous disorders caused by abnormalities in the immune system. However, PIDs are genetically determined and may occur at any age from early childhood to elderly age. Due to chronic patterns, the risk of malignancy and organ damage in patients with PIDs may affect any aspect of life, including sleep patterns. To our knowledge, the prevalence of insomnia and subjective sleep quality have not been investigated in patients with PIDs. Therefore, this pilot study was conducted to investigate sleep quality, the prevalence of sleep disturbances, and fatigue in adult patients with PIDs in Poland. Methods All participants were surveyed using the Athens Insomnia Scale, Pittsburgh Sleep Quality Index, Fatigue Severity Scale, and a questionnaire concerning general health and demographic data. We included 92 participants: 48 women (52.2%) and 44 men (47.8%). Results Participants' mean age was 41.9 ± 13.9 years. The mean sleep duration was 7.0 ± 1.5 hours, and the mean sleep latency was 41.2 ± 53.1 minutes. Additionally, 44.6% of patients (n=41) had symptoms of insomnia and 44.6% (n=42) had poor sleep quality. Less than one-fourth (n=22; 23.9%) of the patients reported the use of sleeping pills; moreover, clinically significant fatigue was reported in 52.2% (n=48). Discussion Our investigation provides insight into the problem of sleep disturbances in patients with PIDs. Data have demonstrated that sleeping disorders with concomitant fatigue are common in patients with PID. Further studies are needed to determine the determinants of poor sleep quality in this specific group of patients.
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Affiliation(s)
- Kinga Grochowalska
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland,*Correspondence: Kinga Grochowalska,
| | - Marcin Ziętkiewicz
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Aleksandra Matyja-Bednarczyk
- Outpatient Clinic for the Immunological Hypercoagulable Diseases, The University Hospital in Krakow, Kraków, Poland
| | - Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | | | - Adam Hajduk
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Sołdacki
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Zbigniew Zdrojewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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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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10
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Ziętkiewicz M, Buda N, Więsik-Szewczyk E, Piskunowicz M, Grzegowska D, Jahnz-Różyk K, Zdrojewski Z. Comparison of pulmonary lesions using lung ultrasound and high-resolution computed tomography in adult patients with primary humoral immunodeficiencies. Front Immunol 2022; 13:1031258. [PMID: 36389742 PMCID: PMC9640693 DOI: 10.3389/fimmu.2022.1031258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/11/2022] [Indexed: 02/05/2024] Open
Abstract
Pulmonary involvement is the most common complication in patients with predominantly antibody deficiencies (PADs). Therefore, patients require repeated imaging tests. Unlike high-resolution computed tomography (HRCT), lung ultrasonography (LUS) does not expose patients to X-rays or contrast agents, and can be performed even at the bedside. This study aimed to evaluate lung lesions using simultaneous LUS and HRCT in a group of patients with PADs. Twenty-nine adult patients (13 women and 16 men) diagnosed with PADs according to the ESID criteria (23 Common variable immunodeficiency, 2 X-linked agammaglobulinemia, 2 IgG subclass deficiencies, and 2 Unspecified hypogammaglobulinemia) were included in the study. The mean age was 39.0 ± 11.9 years. The mean time elapsed between the first symptoms of PADs and the examination was 15.4 ± 10.1 years. Lung ultrasonography and high-resolution computed tomography were performed simultaneously according to a defined protocol during the clinic visits. In both examinations, lesions were compared in the same 12 regions: for each lung in the upper, middle, and lower parts, separately, front and back. A total of 435 lesions were described on LUS, whereas 209 lesions were described on HRCT. The frequencies of lesions in the lung regions were similar between LUS and HRCT. In both examinations, lesions in the lower parts of the lungs were most often reported (LUS 60.9% vs. HRCT 55.5%) and least often in the upper parts of the lungs (LUS 12.7% vs. HRCT 12.0%). The most frequently described lesions were LUS consolidations (99; 22.8%) and HRCT fibrosis (74; 16.5%). A statistically significant relationship was found in the detection of fibrosis in 11 of the 12 regions (phi = 0.4-1.0). Maximum values of the phi coefficient for the upper part of the left lung were recorded. Compared with HRCT, LUS is an effective alternative for evaluating and monitoring pulmonary lesions in adult patients with PADs, especially for pulmonary fibrosis.
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Affiliation(s)
- Marcin Ziętkiewicz
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Natalia Buda
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | | | | | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Zbigniew Zdrojewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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11
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Pulmonary Manifestations of Primary Humoral Deficiencies. Can Respir J 2022; 2022:7140919. [PMID: 35440951 PMCID: PMC9013573 DOI: 10.1155/2022/7140919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 01/13/2023] Open
Abstract
Primary immunodeficiencies are a group of conditions characterized by developmental or functional alterations in the immune system caused by hereditary genetic defects. Primary immunodeficiencies may affect either the innate or the adaptive (humoral and cellular) immune system. Pulmonary complications in primary humoral deficiencies are frequent and varied and are associated with high morbidity and mortality rates. The types of complications include bronchiectasis secondary to recurrent respiratory infections and interstitial pulmonary involvement, which can be associated with autoimmune cytopenias, lymphoproliferation, and a range of immunological manifestations. Early detection is key to timely management. Immunoglobulin replacement therapy reduces the severity of disease, the frequency of exacerbations, and hospital admissions in some primary humoral deficiencies. Therefore, the presence of pulmonary disease with concomitant infectious and/or autoimmune complications should raise suspicion of primary humoral deficiencies and warrants a request for immunoglobulin determination in blood. Once diagnosis is confirmed; early immunoglobulin replacement therapy will improve the course of the disease. Further studies are needed to better understand the pathogenesis of pulmonary disease related to primary humoral deficiencies and favor the development of targeted therapies that improve the prognosis of patients.
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12
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Laenger FP, Schwerk N, Dingemann J, Welte T, Auber B, Verleden S, Ackermann M, Mentzer SJ, Griese M, Jonigk D. Interstitial lung disease in infancy and early childhood: a clinicopathological primer. Eur Respir Rev 2022; 31:31/163/210251. [PMID: 35264412 PMCID: PMC9488843 DOI: 10.1183/16000617.0251-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Children's interstitial lung disease (chILD) encompasses a wide and heterogeneous spectrum of diseases substantially different from that of adults. Established classification systems divide chILD into conditions more prevalent in infancy and other conditions occurring at any age. This categorisation is based on a multidisciplinary approach including clinical, radiological, genetic and histological findings. The diagnostic evaluation may include lung biopsies if other diagnostic approaches failed to identify a precise chILD entity, or if severe or refractory respiratory distress of unknown cause is present. As the majority of children will be evaluated and diagnosed outside of specialist centres, this review summarises relevant clinical, genetic and histological findings of chILD to provide assistance in clinical assessment and rational diagnostics. ILD of childhood is comparable by name only to lung disease in adults. A dedicated interdisciplinary team is required to achieve the best possible outcome. This review summarises the current clinicopathological criteria and associated genetic alterations.https://bit.ly/3mpxI3b
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Affiliation(s)
- Florian Peter Laenger
- Institute of Pathology, Medical School Hannover, Hannover, Germany .,German Center for Lung Research (DZL), Hannover, Germany
| | - Nicolaus Schwerk
- German Center for Lung Research (DZL), Hannover, Germany.,Clinic for Pediatric Pneumology, Allergology and Neonatology, Medical School Hannover, Hannover, Germany
| | - Jens Dingemann
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Pediatric Surgery, Medical School Hannover, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Dept of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Stijn Verleden
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Antwerp, Belgium
| | - Maximilian Ackermann
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven J Mentzer
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthias Griese
- German Center for Lung Research (DZL), Hannover, Germany.,Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Danny Jonigk
- Institute of Pathology, Medical School Hannover, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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13
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Assaad M, Aqeel A, Walsh J. Follicular Bronchiolitis Associated With Primary IgG2/IgG4 Deficiency in a Previously Healthy 40-Year-Old Woman. Cureus 2022; 14:e22183. [PMID: 35308746 PMCID: PMC8923243 DOI: 10.7759/cureus.22183] [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] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Follicular bronchiolitis (FB) associated with immunodeficiency is not commonly reported in peer-reviewed literature. Herein, we present a case of FB associated with IgG2/IgG4 deficiency. The presence of non-specific respiratory symptoms, including cough and dyspnea with exertion, led to a CT scan of the chest, which showed diffuse, peripheral, micronodular tree-in-bud opacities and an isolated area of bronchiectasis. Despite an extensive workup, including a non-diagnostic transbronchial biopsy, no obvious etiology for the patient’s clinical presentation was established, and a surgical lung biopsy was needed to confirm the diagnosis of FB. Further lab testing to evaluate for immunodeficiency confirmed an isolated deficiency in both IgG2 and IgG4. Although treating the underlying cause of FB is the standard of care, there are no established guidelines regarding standard management of FB associated with immunodeficiency, specifically IgG2/IgG4 deficiency. Therefore, a careful evaluation for immunodeficiency should be considered when evaluating for the underlying etiology of FB, as management options differ depending on the underlying diagnosis.
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14
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Todd NW, Atamas SP, Hines SE, Luzina IG, Shah NG, Britt EJ, Ghio AJ, Galvin JR. Demystifying idiopathic interstitial pneumonia: time for more etiology-focused nomenclature in interstitial lung disease. Expert Rev Respir Med 2022; 16:235-245. [PMID: 35034567 PMCID: PMC8983480 DOI: 10.1080/17476348.2022.2030710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A major focus of interstitial lung disease (ILD) has centered on disorders termed idiopathic interstitial pneumonias (IIPs) which include, among others, idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and respiratory bronchiolitis-interstitial lung disease. AREAS COVERED We review the radiologic and histologic patterns for the nine disorders classified by multidisciplinary approach as IIP, and describe the remarkable amount of published epidemiologic, translational, and molecular studies demonstrating their associations with numerous yet definitive environmental exposures, occupational exposures, pulmonary diseases, systemic diseases, medication toxicities, and genetic variants. EXPERT OPINION In the 21st century, these disorders termed IIPs are rarely idiopathic, but rather are well-described radiologic and histologic patterns of lung injury that are associated with a wide array of diverse etiologies. Accordingly, the idiopathic nomenclature is misleading and confusing, and may also promote a lack of inquisitiveness, suggesting the end rather than the beginning of a thorough diagnostic process to identify ILD etiology and initiate patient-centered management. A shift toward more etiology-focused nomenclature will be beneficial to all, including patients hoping for better life quality and disease outcome, general medicine and pulmonary physicians furthering their ILD knowledge, and expert ILD clinicians and researchers who are advancing the ILD field.
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Affiliation(s)
- Nevins W. Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Sergei P. Atamas
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Stella E. Hines
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Irina G. Luzina
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Nirav G. Shah
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Edward J. Britt
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew J. Ghio
- Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Jeffrey R. Galvin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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Health-related quality of life in primary immunodeficiencies: Impact of delayed diagnosis and treatment burden. Clin Immunol 2022; 236:108931. [DOI: 10.1016/j.clim.2022.108931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/13/2022] [Indexed: 12/28/2022]
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16
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Alshukairi A, Aldabbagh Y, Sayes N, Al Gethamy M, Alghamdi M, Rahbeeni Z, Dada A. A COVID-19 family cluster with retinitis pigmentosa and hypogammaglobulinemia. Ann Thorac Med 2022; 17:66-69. [PMID: 35198051 PMCID: PMC8809126 DOI: 10.4103/atm.atm_520_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
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17
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Secchi T, Baselli LA, Russo MC, Borzani IM, Carta F, Lopopolo MA, Foà M, La Vecchia A, Agostoni C, Agosti M, Dellepiane RM. Multiple Breath Washout for Early Assessment of Pulmonary Complications in Patients With Primary Antibody Deficiencies: An Observational Study in Pediatric Age. Front Pediatr 2022; 10:773751. [PMID: 35656375 PMCID: PMC9152221 DOI: 10.3389/fped.2022.773751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In primary antibody deficiencies (PADs), pulmonary complications are the main cause of morbidity, despite immunoglobulin substitutive therapy, antibiotic treatment of exacerbations, and respiratory physiotherapy. Current Italian recommendations for surveillance of PADs respiratory complications include an annual assessment of spirometry and execution of chest high-resolution computed tomography (HRCT) every 4 years. OBJECTIVE This study aimed to evaluate the effectiveness of the lung clearance index (LCI) as an early marker of lung damage in patients with PADs. LCI is measured by multiple breath washout (MBW), a non-invasive and highly specific test widely used in patients with cystic fibrosis (CF). METHODS Pediatric patients with PADs (n = 17, 10 male, 7 female, and age range 5-15 years) underwent baseline assessment of lung involvement with chest HRCT, spirometry, and multiple breath nitrogen washout. Among them, 13 patients were followed up to repeat HRCT after 4 years, while performing pulmonary function tests annually. Their baseline and follow-up LCI and forced expiratory volume at 1 s (FEV1) values were compared, taking HRCT as the gold standard, using logistic regression analysis. RESULTS Lung clearance index [odds ratio (OR) 2.3 (confidence interval (CI) 0.1-52) at baseline, OR 3.9 (CI 0.2-191) at follow-up] has a stronger discriminating power between altered and normal HRCT rather than FEV1 [OR 0.6 (CI 0.2-2) at baseline, OR 1.6 (CI 0.1-13.6) at follow-up]. CONCLUSION Within the context of a limited sample size, LCI seems to be more predictive of HRCT alterations than FEV1 and more sensitive than HRCT in detecting non-uniform ventilation in the absence of bronchiectasis. A study of a larger cohort of pediatric patients followed longitudinally in adulthood is needed to challenge these findings.
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Affiliation(s)
| | - Lucia Augusta Baselli
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Chiara Russo
- Cystic Fibrosis Regional Reference Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Maria Borzani
- Radiology Unit-Pediatric Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Carta
- Cystic Fibrosis Regional Reference Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Amalia Lopopolo
- Pediatric Rehabilitation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michaela Foà
- Pediatric Rehabilitation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Massimo Agosti
- Woman and Child Department, Ospedale "Filippo Del Ponte," University of Insubria, Varese, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Krtinić D, Stojanović M. Clinical and laboratory parameter analysis in patients with common Variable Immunodeficiency. MEDICINSKI PODMLADAK 2022. [DOI: 10.5937/mp73-38819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Introduction: Common Variable Immunodeficiency (CVID) is the most prevalent primary immunodeficiency in adult population. The diagnosis is based on low concentration of at least 2 immunoglobulin classes, mostly IgG, with low IgA and/or IgM. Beside recurrent infections, patients with CVID usually suffer from different respiratory, gastrointestinal, autoimmune and malignant diseases. Leading therapeutic approach to managing CVID is regular intravenous (IVIG) and subcutaneous (SCIG) immunoglobulin replacement therapy. Aim: The aim of the study was to analyze clinical and laboratory parameters in patients with CVID. Material and methods: The present study included 24 patients with CVID who were treated at Clinic of Allergy and Immunology, University Clinical Center of Serbia from 2012 to 2022. Demographic data, clinical and laboratory parameters were obtained from the patients' medical records. The concentrations of IgG, IgM and IgA were measured by nephelometry. Statistical analysis was performed using descriptive methods, Student t test for independent samples and Fisher exact test. Results: Respiratory manifestations were found in 70.8% of patients, gastrointestinal in 45.8%, autoimmune in 29.2% and malignancies in 20.8%. The presence of autoimmune diseases was the most common within the patients aged between 20 to 30 years, and it was statistically significantly higher comparing to other age groups (p = 0.014). Serum IgG concentration of 7.6 ± 2.7 g/l was measured. Statistically significantly higher IgG concentrations were observed in patients receiving SCIG (10.2 ± 1.6), compared to those receiving IVIG (6.7 ± 2.4) (t = -3.3, p = 0.003). Premedication was required in 44.4% of patients receiving IVIG. Conclusion: The most common complication of CVID are chronic lung diseases. Autoimmune diseases are the most frequently diagnosed in patients between the ages of 20 and 30. The use of SCIG is identified as better form of immunoglobulin replacement therapy. Total immunoglobulin serum concentration measuring in patients with recurrent infections and autoimmune diseases can contribute to timely diagnosis.
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19
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Schnell A, Davrandi M, Saxenhofer M, Leboreiro C, Graeter S, Moreira F, Hauswald M, Witte C, Irincheeva I, Feussner A, Vonarburg C, Schulze I, Schaub A, Burns SO, Lowe DM. Airway inflammation and dysbiosis in antibody deficiency despite the presence of IgG. J Allergy Clin Immunol 2021; 149:2105-2115.e10. [PMID: 34968528 DOI: 10.1016/j.jaci.2021.12.778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with antibody deficiency suffer chronic respiratory symptoms, recurrent exacerbations and progressive airways disease despite systemic replacement of Immunoglobulin G. Little is known about the respiratory tract biology of these patients. OBJECTIVE To measure immunoglobulin levels, inflammatory cytokines and mediators of tissue damage in serum and sputum from patients with antibody deficiency and healthy controls; to analyse the respiratory microbiome in the same cohorts. METHODS We obtained paired sputum and serum samples from 31 immunocompetent subjects and 67 antibody deficient patients, the latter divided on computed tomography scan appearance into 'abnormal airways' (bronchiectasis or airway thickening) or 'normal airways'. We measured inflammatory cytokines, immunoglobulin levels, neutrophil elastase, matrix-metalloproteinase-9, urea, albumin and total protein levels using standard assays. We employed V3-V4 region 16S sequencing for microbiome analysis. RESULTS Immunodeficient patients had markedly reduced Immunoglobulin A in sputum but higher concentrations of Immunoglobulin G compared to healthy controls. Inflammatory cytokines and tissue damage markers were higher in immunodeficient patients, who also exhibited dysbiosis with over-representation of pathogenic taxa and significantly reduced alpha diversity compared to immunocompetent individuals. These differences were seen regardless of airway morphology. Sputum matrix metalloproteinase-9 and elastase correlated inversely with alpha diversity in the antibody deficient group, as did sputum Immunoglobulin G, which correlated positively with several inflammatory markers, even after correction for albumin levels. CONCLUSION Patients with antibody deficiency, even with normal lung imaging, exhibit inflammation and dysbiosis in their airways despite higher levels of Immunoglobulin G compared to healthy controls.
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Affiliation(s)
- Anna Schnell
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Mehmet Davrandi
- Institute of Immunity and Transplantation, University College London, London, United Kingdom; Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Moritz Saxenhofer
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Clara Leboreiro
- Institute of Immunity and Transplantation, University College London, London, United Kingdom; Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Stefanie Graeter
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Fernando Moreira
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maria Hauswald
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Carolin Witte
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Irina Irincheeva
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Annette Feussner
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Cedric Vonarburg
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Ilka Schulze
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Alexander Schaub
- CSL Behring, Research Europe, Bern, Switzerland; CSL Behring, Research Europe, Marburg, Germany
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, United Kingdom; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, United Kingdom; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom.
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20
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COVID-19 in complex common variable immunodeficiency patients affected by lung diseases. Curr Opin Allergy Clin Immunol 2021; 21:535-544. [PMID: 34580250 DOI: 10.1097/aci.0000000000000789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In the general population, the risk of severe COVID-19 is associated with old age, male sex, hypertension, obesity and chronic diseases. Chronic lung diseases are listed as additional risk factors for hospitalization and ICU admission. The purpose of this review is to define whether chronic lung diseases, such as bronchiectasis and interstitial diseases, represent a risk for a severe SARS-CoV-2 infection in patients affected by common variable immunodeficiency (CVID), the most common symptomatic primary antibody defect. RECENT FINDINGS CVID patients with SARS-CoV-2 infection have been reported since the beginning of the pandemic with a wide range of clinical presentations ranging from asymptomatic to mild/moderate and severe COVID-19. The meta-analysis of 88 CVID cases described in large cohorts and case reports demonstrated that CVID patients with chronic lung involvement have an increased risk for severe COVID-19 in comparison to CVID without lung diseases (50 vs. 28%, relative risk 1.75, 95% confidence interval 1.04--2.92, P = 0.043). Differently from the general population, age and metabolic comorbidities did not represent a risk factor for severe course in this patient's population. SUMMARY Underlying chronic lung diseases but not age represent a risk factor for severe COVID-19 in CVID. Prompt therapeutic intervention should be adopted in SARS-CoV-2 positive CVID patients with chronic lung diseases independently of their age.
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21
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Slimmen LJM, Janssens HM, van Rossum AMC, Unger WWJ. Antigen-Presenting Cells in the Airways: Moderating Asymptomatic Bacterial Carriage. Pathogens 2021; 10:pathogens10080945. [PMID: 34451409 PMCID: PMC8400527 DOI: 10.3390/pathogens10080945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022] Open
Abstract
Bacterial respiratory tract infections (RTIs) are a major global health burden, and the role of antigen-presenting cells (APCs) in mounting an immune response to contain and clear invading pathogens is well-described. However, most encounters between a host and a bacterial pathogen do not result in symptomatic infection, but in asymptomatic carriage instead. The fact that a pathogen will cause infection in one individual, but not in another does not appear to be directly related to bacterial density, but rather depend on qualitative differences in the host response. Understanding the interactions between respiratory pathogens and airway APCs that result in asymptomatic carriage, will provide better insight into the factors that can skew this interaction towards infection. This review will discuss the currently available knowledge on airway APCs in the context of asymptomatic bacterial carriage along the entire respiratory tract. Furthermore, in order to interpret past and futures studies into this topic, we propose a standardized nomenclature of the different stages of carriage and infection, based on the pathogen’s position with regard to the epithelium and the amount of inflammation present.
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Affiliation(s)
- Lisa J. M. Slimmen
- Laboratory of Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Hettie M. Janssens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Annemarie M. C. van Rossum
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Wendy W. J. Unger
- Laboratory of Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Correspondence:
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22
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Rosen Y. Pathology of Granulomatous Pulmonary Diseases. Arch Pathol Lab Med 2021; 146:233-251. [PMID: 33905479 DOI: 10.5858/arpa.2020-0543-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Because granulomas are represented in almost every disease category, the number of clinically and pathologically important granulomatous pulmonary diseases is large. Their diagnosis by pathologists is particularly challenging because of their nonspecificity. A specific diagnosis can be achieved only when a granuloma-inciting agent(s) (eg, acid-fast bacilli, fungi, foreign bodies, etc) are identified microscopically or by culture; this does not occur in most cases. Furthermore, a specific diagnosis cannot be reached in a high percentage of cases. Although sarcoidosis and infectious diseases account for approximately half of pulmonary granulomatous diseases worldwide, there is significant geographic variation in their prevalence. OBJECTIVES.— To present updated information to serve as a guide to pathologic diagnosis of pulmonary granulomatous diseases, to address some commonly held misconceptions and to stress the importance of multidisciplinary coordination. Presentation of basic aspects of granulomas is followed by discussion of specific disease entities, such as tuberculous and nontuberculous Mycobacterial infections, fungal, bacterial, and parasitic infections, sarcoidosis, necrotizing sarcoid granulomatosis, berylliosis, hypersensitivity pneumonitis, hot tub lung, rheumatoid nodule, bronchocentric granulomatosis, aspirated, inhaled, and embolized foreign bodies, drug-induced granulomas, chronic granulomatous disease, common variable immunodeficiency, and granulomatous lesions associated with various types of cancer. DATA SOURCES.— Review of pertinent medical literature using the PubMed search engine and the author's practical experience. CONCLUSIONS.— Although the diagnosis of granulomatous lung diseases continues to present significant challenges to pathologists, the information presented in this review can be helpful in overcoming them. The importance of multidisciplinary coordination in cases where morphologic diagnosis is not possible cannot be overstated.
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Affiliation(s)
- Yale Rosen
- From the Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York
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23
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Unninayar D, Abdallah SJ, Cameron DW, Cowan J. Polyvalent Immunoglobulin as a Potential Treatment Option for Patients with Recurrent COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:545-552. [PMID: 33688179 PMCID: PMC7936713 DOI: 10.2147/copd.s283832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/01/2021] [Indexed: 12/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation and episodes of worsening respiratory symptoms and pulmonary function, termed acute exacerbations of COPD (AECOPD). AECOPD episodes are associated with heightened airway inflammation and are often triggered by infection. A subset of COPD patients develops frequent exacerbations despite maximal existing standard medical therapy. It is therefore clear that a targeted and more effective prevention strategy is needed. Immunoglobulins are glycoprotein molecules that are secreted by B lymphocytes and plasma cells and play a critical role in the adaptive immune response against many pathogens. Altered serum immunoglobulin levels have been observed in patients with immunodeficiencies and inflammatory diseases. Serum immunoglobulin has also been identified as potential biomarkers of AECOPD frequency. Since plasma-derived polyvalent immunoglobulin treatment is effective in preventing recurrent infections in immunodeficient patients and in suppressing inflammation in many inflammatory diseases, it may be conceivable that immunoglobulin treatment may be effective in preventing recurrent AECOPD. In this article, we provide a review of the current knowledge on immunoglobulin treatment in patients with COPD and discuss plausible mechanisms as to how immunoglobulin treatment may work to reduce AECOPD frequency.
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Affiliation(s)
- Dana Unninayar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara J Abdallah
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D William Cameron
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre of Infection, Immunity and Inflammation, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Juthaporn Cowan
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre of Infection, Immunity and Inflammation, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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Kim JH, Jang JH, Lee SH, Yang EM, Jang SH, Jung KS, Park HS. Specific Antibody Deficiency in Adult Patients With IgG or IgG Subclass Deficiency. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:271-283. [PMID: 33474861 PMCID: PMC7840874 DOI: 10.4168/aair.2021.13.2.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
Abstract
Purpose Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine despite having normal immunoglobulin levels. The failure of the polysaccharide response can be observed as a component of various primary antibody deficiencies. However, only a few studies have described the clinical and immunological profiles in SAD and/or other primary immunodeficiencies (PIDs) in adults. Methods A total of 47 patients who had a clinical history suggestive of antibody deficiency or had already been diagnosed with various antibody deficiencies were enrolled. Polysaccharide responses to 7 pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) were measured using the World Health Organization enzyme-linked immunosorbent assay (WHO-ELISA), and postvaccination immunoglobulin G (IgG) titers were compared to clinical and laboratory parameters. Results Based on the American Academy of Allergy, Asthma, and Immunology (AAAAI) criteria for the WHO-ELISA, 11 (23.4%) patients were diagnosed as having SAD. Sixteen-three percent of them had combined with other types of PID, such as IgG subclass deficiency and hypogammaglobulinemia. Postvaccination IgG titers for the serotypes 4/9V/18C correlated with IgG2 (P = 0.012, P = 0.001, and P = 0.004) and for 6B/9V/14 with IgG3 (P = 0.003, P = 0.041, and P = 0.036, respectively). The IgG3 subclass levels negatively correlated with forced expiratory volume in 1 second (FEV1, %) and FEV1/forced vital capacity (P < 0.001 and P = 0.001, respectively). Conclusion SAD can be diagnosed in patients with normal IgG levels as well as in those deficient in IgG or the IgG3 subclass, implicating that restricted responses to Streptococcus pneumoniae polysaccharide antigens commonly exist in patients with predominantly antibody deficiency.
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Affiliation(s)
- Joo Hee Kim
- Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Hyuk Jang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - So Hee Lee
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Yang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hun Jang
- Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ki Suck Jung
- Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hae Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Vandebotermet M, Staels F, Giovannozzi S, Delforge M, Tousseyn T, Steelandt T, Corveleyn A, Meyts I, Maertens J, Yserbyt J, Schrijvers R. A double-edged sword. Breathe (Sheff) 2020; 16:200017. [PMID: 33447267 PMCID: PMC7792833 DOI: 10.1183/20734735.0017-2020] [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] [Indexed: 11/24/2022] Open
Abstract
A 33-year old man presented because of progressive fatigue, loss of appetite and malaise for 2 months. While carrying out his job as a baggage handler at the airport, he noticed exertional dyspnoea (New York Heart Association class II) with a slight nonproductive cough. There was no weight loss or fever, although he mentioned paroxysmal hot flushes. There were no recent infections and his past medical and familial history were negative. The patient denied the use of drugs, nicotine or alcohol, reported no recent travel and had a stable relationship. In medicine, not everything is what it seems and sometimes you need all the pieces of the puzzle in order to complete the diagnosis. This is a case of a disease with two different faces and a review of its respiratory impact.https://bit.ly/2SDKwE5
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Affiliation(s)
| | - Frederik Staels
- Dept of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Simone Giovannozzi
- Dept of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Michel Delforge
- Dept of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Tousseyn
- Dept of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anniek Corveleyn
- Center for Human Genetics, University of Leuven, Leuven, Belgium
| | - Isabelle Meyts
- Depts of Pediatrics, and Microbiology and Immunology, Laboratory for Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | - Johan Maertens
- Dept of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Dept of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
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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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Pedini V, Verga JU, Terrenato I, Menghini D, Mezzanotte C, Danieli MG. Incidence of malignancy in patients with common variable immunodeficiency according to therapeutic delay: an Italian retrospective, monocentric cohort study. Allergy Asthma Clin Immunol 2020; 16:54. [PMID: 32944022 PMCID: PMC7491341 DOI: 10.1186/s13223-020-00451-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
Background Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency and has a broad spectrum of clinical manifestations. Among non-infectious complications, an increased incidence of malignancies may have a special relevance for survival, but little is known about treatment efficacy on malignant complications. Methods This was a monocenter retrospective study on CVID patients, designed to provide preliminary data for the investigation of the possible link between therapeutic delay and tumor incidence. Results A total of 67 CVID subjects were included. The median diagnostic delay was 7.5 years (range: 0–63 years), and the median therapeutic delay was 8.5 years (range: 0–67 years). Malignancies were diagnosed in 18 (27%) patients. Eight out of 18 (44%) patients with a malignancy had lymphoma. Patients who developed a malignancy showed a longer therapeutic delay in comparison to patients with no malignancy, although no statistical significance was achieved (11 years vs 8 years, respectively, p = 0.424). We observed a lower frequency of malignancy in CVID patients with reduced therapeutic delay compared with patients with therapeutic delay ≥ 10 years. With a therapeutic delay of > 1 year, 74% had no tumor, and 25% had a tumor; with a therapeutic delay of > 10 years, 65% had no tumor and 35% had a malignancy. Among patients who had no malignancy, 64% had a therapeutic delay of < 10 years, and 36% had a therapeutic delay of ≥ 10 years. Among patients with malignancy, 47% of subjects had a therapeutic delay < 10 years, and 53% a therapeutic delay ≥ 10 years. Conclusions The observation of clinical characteristics of our patients with CVID may suggest that an early institution of IgG replacement therapy could be of benefit for the prevention of malignant complications. Name of the registry: Comitato Etico Regionale delle Marche. Trial registration number: 1505. Date of registration: 27/10/2016, Retrospectively registered URL of trial registry record: http://www.ospedaliriuniti.marche.it/portale/archivio13_cerm-ancona_0_446_1.html. The trial was not registered before the first participant was enrolled
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Affiliation(s)
- Veronica Pedini
- Medical Clinic, United Hospitals and DISCLIMO, Polytechnic University of Marche, Ancona, Italy.,Medicine Departement, Destra Secchia Hospital, Pieve di Coriano, ASST Mantova, Mantua, Italy
| | | | - Irene Terrenato
- Biostatistic and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Denise Menghini
- Medical Clinic, United Hospitals and DISCLIMO, Polytechnic University of Marche, Ancona, Italy
| | - Cristina Mezzanotte
- Medical Clinic, United Hospitals and DISCLIMO, Polytechnic University of Marche, Ancona, Italy
| | - Maria Giovanna Danieli
- Medical Clinic, United Hospitals and DISCLIMO, Polytechnic University of Marche, Ancona, Italy
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Evaluation of pulmonary findings in patients with humoral immunodeficiency. Turk Arch Pediatr 2020; 55:174-183. [PMID: 32684763 PMCID: PMC7344133 DOI: 10.14744/turkpediatriars.2020.46656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/07/2020] [Indexed: 11/20/2022]
Abstract
Aim: To determine the frequency of sinopulmonary infections, detect changes in the respiratory system, and measure functional capacity of the lungs in our patients with humoral immunodeficiency. Material and Methods: Fifty-six patients with humoral immunodeficiency were enrolled in this study. The clinical, laboratory, and radiologic data, and pulmonary function tests of the subjects were evaluated from their file records, retrospectively. Results: The distribution of our patients was as follows: 25 patients had common variable immune deficiency, three patients had X-linked agammaglobulinemia, five patients had hyper immunoglobulin M syndrome, 19 patients had deficiency of immunoglobulin G subset, and four patients had selective immunoglobulin A deficiency. The most common symptom of the patients was chronic cough (n=47, 83.9%). The most common pathologies on high-resolution computed tomography of the chest were atelectasis and bronchiectasis (27.7%). The most common pathology in pulmonary function tests was the presence of moderate obstructive patterns along with restrictive patterns (n=6,12.5%). The FEV 1, FVC, and FEF 25–75 values were significantly lower in patients with common variable immunodeficiency compared with the patients who had IgG subset deficiencies (p=0.001, p=0.01, p=0.01). Among the patients who were treated with intravenous immunoglobulin, the age at the diagnosis of immunodeficiency was higher in patients with bronchiectasis (14.2±8.4 years) compared with those without bronchiectasis (10.1±11.4 years) (p=0.04). Conclusion: Clinical findings are not sufficient to monitor the structural and functional changes in the respiratory system, and patients should be evaluated using high-resolution computed tomography of the chest and pulmonary function tests.
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Boton Pereira DH, Primo LS, Pelizari G, Flores E, de Moraes-Vasconcelos D, Condino-Neto A, Prestes-Carneiro LE. Primary Immunodeficiencies in a Mesoregion of São Paulo, Brazil: Epidemiologic, Clinical, and Geospatial Approach. Front Immunol 2020; 11:862. [PMID: 32477349 PMCID: PMC7235164 DOI: 10.3389/fimmu.2020.00862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Primary immunodeficiencies (PIDs) are rare genetic disorders leading to immunologic abnormalities that can affect different organs and systems. We determined the epidemiology, clinical, and geospatial characteristics of PID disorders among patients diagnosed over a 5 year period in a reference hospital covering a mesoregion in São Paulo, Brazil. Methods: A retrospective analysis of 39 patients with recognizable PIDs according to the criteria of the European Society of Primary Immunodeficiencies were enrolled. Thirty-four patients came from outpatient immunodeficiency clinics and five patients from active search. Demographic, clinical, and immunologic data were collected, and maps were constructed using a geographic information system. Results: The ratio of females to males was 1.4:1, and 48.7% of patients were younger than 17 years of age. The mean age at the onset of symptoms in children was 2.0 years [standard error of the mean (SEM), 1.7 years] and the diagnosis lag was 5.1 years (SEM, 3.1 years); the mean age at diagnosis in adults was 16.3 years (SEM, 11.8 years) and the lag was 10.8 years (SEM, 10.9 years). Antibody deficiency and common variable immunodeficiencies were the most common categories and phenotypes, respectively. The need for intravenous antibiotics and respiratory tract infections were the most prevalent warning signs, with an overall mortality rate of 15.3%. Autoimmune diseases were diagnosed in 56.4% and visceral leishmaniasis in 5.1% of patients. In the active search, 29 patients were investigated and 17.2% were diagnosed; early diagnosis, the involvement of multidisciplinary professionals, and dissemination of knowledge achieved milestone benefits. The distribution of PID networks in Brazil shows great asymmetry between regions and at a regional level; it was shown that the patients lived mainly in Presidente Prudente municipality. Conclusions: The implementation of an immunodeficiency outpatient clinic in a referral hospital covering a mesoregion with a large population has led to the generation of policies and practices to improve the diagnosis, quality of life, and care of patients with PIDs and their families. Furthermore, the search for hospitalized patients with warning signs for PIDs showed great benefits. Inequality in the distribution of PID network centers in Brazil was demonstrated.
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Affiliation(s)
| | - Lívia Souza Primo
- Imunnodeficiencies Outpatient Clinic, Regional Hospital of Presidente Prudente, Presidente Prudente, Brazil
| | - Giovana Pelizari
- Department of Pediatrics, Oeste Paulista University, Presidente Prudente, Brazil
| | - Edilson Flores
- Department of Statistics, Paulista State University, Presidente Prudente, Brazil
| | - Dewton de Moraes-Vasconcelos
- Laboratory of Medical Investigation Unit 56, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luiz Euribel Prestes-Carneiro
- Imunnodeficiencies Outpatient Clinic, Regional Hospital of Presidente Prudente, Presidente Prudente, Brazil.,Department of Internal Medicine, Oeste Paulista University, Presidente Prudente, Brazil
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Moazzami B, Mohayeji Nasrabadi MA, Abolhassani H, Olbrich P, Azizi G, Shirzadi R, Modaresi M, Sohani M, Delavari S, Shahkarami S, Yazdani R, Aghamohammadi A. Comprehensive assessment of respiratory complications in patients with common variable immunodeficiency. Ann Allergy Asthma Immunol 2020; 124:505-511.e3. [PMID: 32007567 DOI: 10.1016/j.anai.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Common variable immunodeficiency (CVID) is a heterogeneous group of disorders, characterized by recurrent upper and lower respiratory tract infections and some noninfectious clinical complications. OBJECTIVE To provide a detailed evaluation of respiratory presentations and complications in a cohort of Iranian patients with CVID. METHODS A retrospective cohort study was conducted on 245 CVID patients who were recorded in the Iranian primary immunodeficiency disorders registry network. Respiratory manifestations were evaluated by reviewing clinical hospital records, immunologic findings, pulmonary function tests (PFT), and high-resolution computed tomography (HRCT) scans. RESULTS Most of the patients (n = 208, 85.2%) had experienced at least 1 episode of acute respiratory manifestation, and pneumonia was observed in 31.6 % (n = 77) of cases as a first disease manifestation. During the follow-up, pneumonia, sinusitis, and otitis media were documented in 166 (68.6%), 125 (51.2%), and 103 (42.6%) cases, respectively. Abnormal PFT measurements were documented in 53.8% of patients. Among these patients, 21.5% showed restrictive changes, whereas 18.4% of patients showed an obstructive pattern. Bronchiectasis was the most frequent radiological finding, confirmed in 27.2% of patients. Patients with bronchiectasis were older at the time of immunodeficiency diagnosis (P < .001) and had longer diagnosis delay (P < .001) when compared with patients without bronchiectasis. CONCLUSION This study highlights the importance of monitoring the respiratory tract system even in asymptomatic patients. Pulmonary function tests and CT scans are the most commonly used techniques aiming to identify these patients early, aiming to reduce the rate of long-term respiratory complications.
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Affiliation(s)
- Bobak Moazzami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Ali Mohayeji Nasrabadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Hassan Abolhassani
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at the Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Peter Olbrich
- Sección de Infectología e Inmunopatología, Unidad de Pediatría, Hospital Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Rohola Shirzadi
- Department of Pediatric Pulmonary and Sleep Medicine, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Modaresi
- Department of Pediatric Pulmonary and Sleep Medicine, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Sohani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Sepideh Shahkarami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.
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Tang X, Li H, Liu H, Xu H, Yang H, Liu J, Zhao S. Etiologic spectrum of interstitial lung diseases in Chinese children older than 2 years of age. Orphanet J Rare Dis 2020; 15:25. [PMID: 31969166 PMCID: PMC6977247 DOI: 10.1186/s13023-019-1270-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background Childhood interstitial lung diseases (ILD) (chILD) refer to a rare heterogeneous group of disorders. Global collaborations have been working on the etiologies and classification scheme of chILD. With the development of medical technologies, some new diseases were identified to be associated with chILD and its etiologic spectrum is expanding. The aim of this study is to describe the etiologic spectrum of chILD in children older than 2 years of age and summarize the approaches to diagnosis of chILD. Methods We made a retrospective analysis of children older than 2 years of age with chILD who referred to Beijing Children’s Hospital from 21 provinces all over China from 2013 to 2018. After excluding pulmonary infection, congenital heart disease, bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiectasis, 133 patients were included and categorized by etiology. Clinical manifestations, high-resolution computed tomography, laboratory data, genetic data and pathologic findings were all collected and reviewed. Results Systemic disease associated ILD were the most common causes, accounting for 49.6% of the patients, followed by alveolar structure disorder-associated ILD (27%), exposure related ILD (13.5%), and disorders masquerading as ILD (3.8%). In systemic disease associated ILD, in addition to common etiologies such as vasculitis (10.5%) and connective tissue diseases (9.0%), primary immunodeficiency diseases (PID) associated ILD (9.8%), interstitial pneumonia with autoimmune features (6.8%), and metabolic diseases (6.8%) were not rarely found. Some newly reported etiologies such as STING–associated vasculopathy with onset in infancy, COPA syndrome and STAT3 mutation were included in PID associated ILD. Genetic tests contributed to 15% of the diagnoses which mainly distributed in PID associated ILD, metabolic diseases and surfactant dysfunction disorders, and contributed to the final diagnoses more than lung biopsies (13.5%) and biopsies of rashes or other tissues (12%). Conclusions This study first demonstrated an etiologic spectrum of chILD in Chinese children older than 2 years of age and summarized the approaches to diagnosis. The etiologic spectrum of chILD is expanding with more genetic etiologies being recognized.
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Affiliation(s)
- Xiaolei Tang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Huimin Li
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Hui Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Hui Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Haiming Yang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, China, No. 56 Nailishi Road, Xicheng District, Beijing, 100045, China.
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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: 11] [Impact Index Per Article: 2.8] [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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Luo D, Baheti G, Tortorici MA, Hofmann J, Rojavin MA. Pharmacometric Analysis of IgPro10 in Japanese and Non-Japanese Patients With Primary Immunodeficiency. Clin Ther 2020; 42:196-209.e5. [PMID: 31910997 DOI: 10.1016/j.clinthera.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Immunoglobulin (Ig) G replacement therapy, administered intravenously (IVIG) or subcutaneously (SCIG), is the standard treatment in patients with primary immunodeficiencies (PID). We aimed to characterize the pharmacokinetic (PK) characteristics of serum IgG following administration of IgPro10 every 3 or 4 weeks in Japanese patients with PID, and compare with PK in non-Japanese patients. A previously developed population PK (PPK) model was validated, and predicted parameters were compared with the results from the clinical study. METHODS The previously developed PPK model, containing IgG concentration data from 5 non-Japanese studies, was supplemented with data from 3 Japanese studies of IgPro10 or IgPro20 to compare the IgG PK parameters between Japanese and non-Japanese patients. The model was externally validated by simulating IgG concentration-time profiles in Japanese patients to predict serum IgG PK characteristics and to compare them with observed Japanese PK data from Study IgPro10_3004. FINDINGS The analysis included 4502 serum IgG concentration values (from 34 Japanese and 168 non-Japanese patients). PPK estimates from the current analysis demonstrated a clearance (CL) of 0.139 L/d, central volume (V2) of 4.01 L, inter-compartmental clearance (Q) of 0.30 L/d, and peripheral volume of 3.51 L. These results were consistent with those from the previously published PPK model, with similar bootstrap means and 95% CIs. Goodness-of-fit criteria indicated that the final PPK model was consistent with observed data, with no systemic bias in model prediction. Prediction-corrected visual predictive checks confirmed a good description of data on both SCIG and IVIG. PK parameters were equivalent between Japanese and non-Japanese patients. Body weight was determined to be a significant covariate on both CL and V2. Simulated and observed AUC and maximum and minimum serum IgG concentrations were similar, with 90% CIs overlapping between simulated and observed IgG concentrations in Japanese patients. IMPLICATIONS PK parameter estimates of serum IgG were similar between Japanese and non-Japanese patients with PID. The PPK model, updated with Japanese data, was consistent with the previously published PPK model and could accurately predict both individual and population serum IgG concentration-time profiles following IgPro10 IV infusions every 3 or 4 weeks. EudraCT identifier: 2016-001631-12.
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Affiliation(s)
- Dandan Luo
- CSL Behring LLC, King of Prussia, PA, USA.
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Pac M, Bielecka T, Grzela K, Komarnicka J, Langfort R, Koltan S, Dabrowska-Leonik N, Bernat-Sitarz K, Pronicki M, Dmenska H, Pituch-Noworolska A, Mikoluc B, Piatosa B, Tkaczyk K, Bernatowska E, Wojsyk-Banaszak I, Krenke K. Interstitial Lung Disease in Children With Selected Primary Immunodeficiency Disorders-A Multicenter Observational Study. Front Immunol 2020; 11:1950. [PMID: 32973798 PMCID: PMC7481462 DOI: 10.3389/fimmu.2020.01950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022] Open
Abstract
Primary immunodeficiencies (PIDs) are rare disorders of the immune system encompassing inborn errors of immunity. Primary antibody deficiencies constitute the largest group of PID with common variable immunodeficiency (CVID) being the most common symptomatic form. Combined immunodeficiencies (CID) accompanied by antibody deficiency can mimic CVID and these patients need the verification of the final diagnosis. Respiratory involvement, especially interstitial lung disease (ILD), poses a relevant cause of morbidity and mortality among patients with PID and in some cases is the first manifestation of immunodeficiency. In this study we present a retrospective analysis of a group of children with primary immunodeficiency and ILD - the clinical, radiological, histological characteristics, treatment strategies and outcomes. Eleven children with PID-related ILD were described. The majority of them presented CVID, in three patients CID was recognized. All patients underwent detailed pulmonary diagnostics. In eight of them histological analysis of lung biopsy was performed. We noted that in two out of 11 patients acute onset of ILD with respiratory failure was the first manifestation of the disease and preceded PID diagnosis. The most common histopathological diagnosis was GLILD. Among the analyzed patients three did not require any immunosuppressive therapy. All eight treated children received corticosteroids as initial treatment, but in some of them second-line therapy was introduced. The relevant side effects in some patients were observed. The study demonstrated that the response to corticosteroids is usually prompt. However, the resolution of pulmonary changes may be incomplete and second-line treatment may be necessary.
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Affiliation(s)
- Małgorzata Pac
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Teresa Bielecka
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Grzela
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Katarzyna Grzela
| | - Justyna Komarnicka
- Department of Radiology, Jan Polikarp Brudziński Pediatric Hospital, Warsaw, Poland
- Department of Radiology, Children's Memorial Health Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Sylwia Koltan
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum Bydgoszcz, UMK Toruń, Bydgoszcz, Poland
| | | | | | - Maciej Pronicki
- Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland
| | - Hanna Dmenska
- The Pulmonology Outpatient's Clinic, Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Pituch-Noworolska
- University Children Hospital in Cracow, Medical College, Jagiellonian University, Cracow, Poland
| | - Bozena Mikoluc
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Piatosa
- Histocompatibility Laboratory, Children's Memorial Health Institute (IPCZD), Warsaw, Poland
| | - Katarzyna Tkaczyk
- Histocompatibility Laboratory, Children's Memorial Health Institute (IPCZD), Warsaw, Poland
| | - Ewa Bernatowska
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Irena Wojsyk-Banaszak
- Department of Pneumonology, Pediatric Allergology and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Focus on Chronic Variable Immunodeficiency for Primary Care Practitioners, the Gatekeepers to Optimal Health Outcomes for Primary Immunodeficiency Syndromes. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose of Review
This review sought to assess the extent and causes of suboptimal healthcare outcomes for chronic variable immunodeficiency (CVID).
Recent Findings
Significant improvements in diagnostic technology and treatment protocols over time were found, leading to reduced morbidity and mortality for those accessing therapies. Treatments continue to be largely non-curative with financing (mainly insurance coverage) an obstacle. Symptom recognition by primary care practitioners (PCP) remains a gating factor to treatment and a widespread and persistent barrier to optimal health outcomes.
Summary
CVID is a subtype of primary immunodeficiency (PIDD) associated with under-diagnosis. It has emerged as a health issue more prevalent than historically known. No symptom-recognition framework for early detection of CVID has been generally accepted; those proposed for primary immunodeficiencies have shown low sensitivity, low specificity or both. Positive trends in cases diagnosed have been aided by awareness campaigns and international collaborations. However, treatments for CVID will not realize full potential without effective, accepted frameworks for timely identification in the clinic.
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Cinetto F, Scarpa R, Pulvirenti F, Quinti I, Agostini C, Milito C. Appropriate lung management in patients with primary antibody deficiencies. Expert Rev Respir Med 2019; 13:823-838. [PMID: 31361157 DOI: 10.1080/17476348.2019.1641085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Human primary immunodeficiency diseases (PIDs) include a broad spectrum of more than 350 disorders, involving different branches of the immune system and classified as 'rare diseases.' Predominantly antibody deficiencies (PADs) represent more than half of the PIDs diagnosed in Europe and are often diagnosed in the adulthood. Areas covered: Although PAD could first present with autoimmune or neoplastic features, respiratory infections are frequent and respiratory disease represents a relevant cause of morbidity and mortality. Pulmonary complications may be classified as infection-related (acute and chronic), immune-mediated, and neoplastic. Expert opinion: At present, no consensus guidelines are available on how to monitor and manage lung complications in PAD patients. In this review, we will discuss the available diagnostic, prognostic and therapeutic instruments and we will suggest an appropriate and evidence-based approach to lung diseases in primary antibody deficiencies. We will also highlight the possible role of promising new tools and strategies in the management of pulmonary complications. However, future studies are needed to reduce of diagnostic delay of PAD and to better understand lung diseases mechanisms, with the final aim to ameliorate therapeutic options that will have a strong impact on Quality of Life and long-term prognosis of PAD patients.
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Affiliation(s)
- Francesco Cinetto
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Riccardo Scarpa
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Federica Pulvirenti
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
| | - Carlo Agostini
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
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Gupta S, Pattanaik D, Krishnaswamy G. Common Variable Immune Deficiency and Associated Complications. Chest 2019; 156:579-593. [PMID: 31128118 DOI: 10.1016/j.chest.2019.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/05/2019] [Accepted: 05/13/2019] [Indexed: 12/25/2022] Open
Abstract
Common variable immunodeficiency disorders refer to a relatively common primary immune deficiency group of diseases that present with infectious and inflammatory complications secondary to defects in antibody production and sometimes in cellular immunity. The disorder often presents in middle age or later with recurrent sinopulmonary infections, bronchiectasis, or a plethora of noninfectious complications such as autoimmune disorders, granulomatous interstitial lung disease, GI diseases, malignancies (including lymphoma), and multisystem granulomatous disease resembling sarcoidosis. Infusion of immunoglobulin by IV or subcutaneous is the mainstay of therapy. Management of complications is often difficult as immune suppression may be necessary in these conditions and entails the use of medications and biologicals which may further increase the risk for infections. Specifically, bronchiectasis, granulomatous lymphocytic interstitial lung disease, repeated sinopulmonary infections, and malignancies are sequelae of antibody deficiency that may present to the pulmonologist. This review will provide an updated understanding of the molecular aspects, differential diagnosis, presentations, and the management of common variable immunodeficiency disorders.
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Affiliation(s)
- Siddhi Gupta
- Department of Medicine, Division of Infectious Disease, Wake Forest School of Medicine, Winston Salem, NC
| | - Debendra Pattanaik
- Division of Allergy, Immunology and Rheumatology, University of Tennessee Health Science Center, Memphis TN
| | - Guha Krishnaswamy
- Department of Medicine, Division of Infectious Disease, Wake Forest School of Medicine, Winston Salem, NC; Division of Infectious Disease, Pulmonary, Allergy and Immunology, Wake Forest School of Medicine, Winston Salem, NC; Department of Medicine, Division of Allergy and Immunology, W.G. (Bill) Hefner VA Medical Center, Salisbury, NC.
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Life-threatening pulmonary interstitial lung disease complicating pediatric nonhumoral immunodeficiencies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2456-2458.e4. [PMID: 30951883 DOI: 10.1016/j.jaip.2019.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022]
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Bush A, Floto RA. Pathophysiology, causes and genetics of paediatric and adult bronchiectasis. Respirology 2019; 24:1053-1062. [PMID: 30801930 DOI: 10.1111/resp.13509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible' be dropped from the definition. The upper limit of normal for the ratio of airway to arterial development increases with age, and a developmental perspective is essential. Bronchiectasis (and persistent bacterial bronchitis, PBB) is a descriptive term and not a diagnosis, and should be the start not the end of the patient's diagnostic journey. PBB, characterized by airway infection and neutrophilic inflammation but without significant airway dilatation may be a precursor of bronchiectasis, and there are many commonalities in the microbiology and the pathology, which are reviewed in this article. A high index of suspicion is essential, and a history of chronic wet or productive cough for more than 4-8 weeks should prompt investigation. There are numerous underlying causes of bronchiectasis, although in many cases no cause is found. Causes include post-infectious, especially after tuberculosis, adenoviral or pertussis infection; aspiration syndromes; defects in host defence, which may solely affect the airways (cystic fibrosis, not considered in this review, and primary ciliary dyskinesia); and primary ciliary dyskinesia or be systemic, such as common variable immunodeficiency; genetic syndromes; and anatomical defects such as intraluminal airway obstruction (e.g. foreign body), intramural obstruction (e.g. complete cartilage rings) and external airway compression (e.g. by tuberculous lymph nodes). Identification of the underlying cause is important, because some of these conditions have specific treatments and others genetic implications for the family.
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Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Department of Paediatric Respirology, National Heart and Lung Institute, London, UK.,Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - R Andres Floto
- Department of Respiratory Biology, University of Cambridge, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
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