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Cutajar J, Gkrania-Klotsas E, Sander C, Floto A, Chandra A, Manson A, Kumararatne D. Respiratory infectious burden in a cohort of antibody deficiency patients treated with immunoglobulin replacement therapy: The impact of lung pathology and gastroesophageal reflux disease. J Allergy Clin Immunol Glob 2023; 2:100133. [PMID: 37781665 PMCID: PMC10509975 DOI: 10.1016/j.jacig.2023.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 10/03/2023]
Abstract
Background Antibody deficiencies result from reduced immunoglobulin levels and function, increasing susceptibility to, primarily, bacterial infection. Primary antibody deficiencies comprise intrinsic defects in B-cell physiology, often due to inherited errors. Hematological malignancies or B-cell suppressive therapy are major causes of secondary antibody deficiency. Although immunoglobulin replacement therapy (IGRT) reduces infectious burden in antibody deficiency patients, respiratory tract infections remain a significant health burden. We hypothesize that lung pathology and gastroesophageal reflux disease (GORD) increase the risk of pneumonia in antibody deficiency patients, as in the general population. Objective For our cohort of patients with primary antibody deficiency and secondary antibody deficiency, we reviewed their respiratory infectious burden and the impact of lung pathologies and GORD. Methods The medical records of 231 patients on IGRT at a tertiary referral center, from October 26, 2014, to February 19, 2021, were reviewed to determine microbial isolates from sputum samples and prevalence of common lung pathologies and GORD. Results Haemophilus and Pseudomonas species represent a large infectious burden, being identified in 30.2% and 21.4% of sputum samples demonstrating growth, respectively; filamentous fungal and mycobacterial infections were rare. Diagnosed lung pathology increased the proportion of patients with Pseudomonas, Klebsiella, Stenotrophomonas, and Candida species isolated in their sputum, and diagnosed GORD increased the proportion with Enterobacter and Candida species isolated. Conclusions Bacterial respiratory infectious burden remains in primary antibody deficiency and secondary antibody deficiency despite IGRT. Lung pathologies encourage growth of species less susceptible to IGRT, so specialist respiratory medicine input and additional treatments such as inhaled antibiotics are indicated to optimize respiratory outcomes.
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Affiliation(s)
- Jonathan Cutajar
- John Radcliffe Hospital, Department of Medicine, Oxford, United Kingdom
| | | | - Clare Sander
- Addenbrooke’s Hospital, Respiratory Medicine, Cambridge, United Kingdom
| | - Andres Floto
- Royal Papworth Hospital, Cambridge Centre for Lung Infection, Cambridge, United Kingdom
| | - Anita Chandra
- Addenbrooke’s Hospital, Clinical Immunology, Cambridge, United Kingdom
| | - Ania Manson
- Addenbrooke’s Hospital, Clinical Immunology, Cambridge, United Kingdom
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2
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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 Immunol Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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González-Morcillo G, Calderón-Hernanz B, Serrano-López de Las Hazas J, de Hita-Santabaya AI, Riera-Oliver J. Ribavirin-resistant chronic norovirus infection-associated enteropathy in common variable immunodeficiency. Case report and review of the literature. Clin Res Hepatol Gastroenterol 2022; 46:101956. [PMID: 35613691 DOI: 10.1016/j.clinre.2022.101956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
Chronic Norovirus infection is particularly challenging in patients with common variable immunodeficiency (CVID) because of their inability to achieve viral clearance and the risk of developing enteropathy leading to intestinal villous atrophy and malabsorption. To date, therapeutic options to eliminate the virus are limited and only ribavirin has been shown to induce viral clearance in norovirus enteropathy associated with CVID. We report a case of a 48-year-old female patient diagnosed with CVID enteropathy possibly related to norovirus infection who failed a ribavirin-based therapy despite dosage optimization through drug plasma level monitoring.
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Affiliation(s)
- Gonzalo González-Morcillo
- Department of Pharmacy, Servicio de Farmacia Hospitalaria, Son Llàtzer Hospital, Instituto de Investigación Sanitaria de las Islas Baleares (IdISba), Carretera. Manacor Km 4, Palma de Mallorca 07198, Spain.
| | - Beatriz Calderón-Hernanz
- Department of Pharmacy, Servicio de Farmacia Hospitalaria, Son Llàtzer Hospital, Instituto de Investigación Sanitaria de las Islas Baleares (IdISba), Carretera. Manacor Km 4, Palma de Mallorca 07198, Spain
| | - Joaquín Serrano-López de Las Hazas
- Department of Pharmacy, Servicio de Farmacia Hospitalaria, Son Llàtzer Hospital, Instituto de Investigación Sanitaria de las Islas Baleares (IdISba), Carretera. Manacor Km 4, Palma de Mallorca 07198, Spain
| | - Ana Isabel de Hita-Santabaya
- Department of Pathology, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de las Islas Baleares (IdISba), Carretera. Manacor Km 4, Palma de Mallorca 07198, Spain
| | - Joan Riera-Oliver
- Gastroenterology Unit, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de las Islas Baleares (IdISba), Carretera. Manacor Km 4, Palma de Mallorca 07198, Spain
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4
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Abstract
INTRODUCTION There is a wide spectrum of noninfectious gastrointestinal pathology, causing considerable morbidity and mortality in CVID, where both etiology and effective therapy are under debate. AREAS COVERED This review will focus on the noninfectious inflammation in the GI tract in CVID patients, covering the both the upper and lower GI tract inflammation, including the liver. The controversy of the CVID enteropathy definition and that of gluten-free diet for celiac-like disease in CVID will be discussed. Furthermore, the review will cover the link between GI inflammation and GI cancer. Finally, the role of gut microbiota, IgA, and genetics and its relationship with CVID enteropathy is scrutinized. The authors reviewed literature from PubMed. EXPERT OPINION The heterogeneity and the unknown mechanism behind CVID enteropathy, and thereby the lack of effective treatment, is one of the key challenges in the field of CVID. Celiac-like disease in CVID is due to immune dysregulation, and a gluten-free diet is therefore not indicated. Gut microbial dysbiosis and mucosal IgA can initiate systemic and local inflammation and is involved in the immune dysregulation in CVID. Considering the heterogeneity of CVID enteropathy, personalized medicine is probably the future for these patients.
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Affiliation(s)
- I M Andersen
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway
| | - S F Jørgensen
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway.,Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Norway
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5
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Szczawinska-Poplonyk A, Schwartzmann E, Bukowska-Olech E, Biernat M, Gattner S, Korobacz T, Nowicki F, Wiczuk-Wiczewska M. The pediatric common variable immunodeficiency - from genetics to therapy: a review. Eur J Pediatr 2022; 181:1371-83. [PMID: 34939152 DOI: 10.1007/s00431-021-04287-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/20/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED Common variable immunodeficiency (CVID) is the most prevalent antibody deficiency, characterized by remarkable genetic, immunological, and clinical heterogeneity. The diagnosis of pediatric CVID is challenging due to the immaturity of the immune response and sustained actively developing antibody affinity to antigens and immunological memory that may overlap with the inborn error of immunity. Significant progress has been recently done in the field of immunogenetics, yet a paucity of experimental and clinical studies on different systemic manifestations and immunological features of CVID in children may contribute to a delayed diagnosis and therapy. In this review, we aimed at defining the variable epidemiological, etiological, and clinical aspects of pediatric CVID with special emphasis on predominating infectious and non-infectious phenotypes in affected children. CONCLUSION While pediatric CVID is a multifaceted and notorious disease, increasing the pediatricians' awareness of this disease entity and preventing the diagnostic and therapeutic delay are needed, thereby improving the prognosis and survival of pediatric CVID patients. WHAT IS KNOWN • CVID is an umbrella diagnosis characterized by complex pathophysiology with an antibody deficiency as a common denominator. • It is a multifaceted disease characterized by marked genetic, immunological, and clinical heterogeneity.. WHAT IS NEW • The diagnosis of pediatric CVID is challenging due to the immaturity of innate and adaptive immune response. • Increasing the pediatricians' awareness of CVID for the early disease recognition, timely therapeutic intervention, and improving the prognosis is needed.
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6
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Naylor-Adamson L, Chacko AR, Booth Z, Caserta S, Jarvis J, Khan S, Hart SP, Rivero F, Allsup DJ, Arman M. Bruton's Tyrosine Kinase Inhibitors Impair FcγRIIA-Driven Platelet Responses to Bacteria in Chronic Lymphocytic Leukemia. Front Immunol 2021; 12:766272. [PMID: 34912339 PMCID: PMC8667317 DOI: 10.3389/fimmu.2021.766272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023] Open
Abstract
Bacterial infections are a major cause of morbidity and mortality in chronic lymphocytic leukemia (CLL), and infection risk increases in patients treated with the Bruton’s tyrosine kinase (Btk) inhibitor, ibrutinib. Btk and related kinases (like Tec) are expressed in non-leukemic hematopoietic cells and can be targeted by ibrutinib. In platelets, ibrutinib therapy is associated with bleeding complications mostly due to off-target effects. But the ability of platelets to respond to bacteria in CLL, and the potential impact of ibrutinib on platelet innate immune functions remain unknown. FcγRIIA is a tyrosine kinase-dependent receptor critical for platelet activation in response to IgG-coated pathogens. Crosslinking of this receptor with monoclonal antibodies causes downstream activation of Btk and Tec in platelets, however, this has not been investigated in response to bacteria. We asked whether ibrutinib impacts on FcγRIIA-mediated activation of platelets derived from CLL patients and healthy donors after exposure to Staphylococcus aureus Newman and Escherichia coli RS218. Platelet aggregation, α-granule secretion and integrin αIIbβ3-dependent scavenging of bacteria were detected in CLL platelets but impaired in platelets from ibrutinib-treated patients and in healthy donor-derived platelets exposed to ibrutinib in vitro. While levels of surface FcγRIIA remained unaffected, CLL platelets had reduced expression of integrin αIIbβ3 and GPVI compared to controls regardless of therapy. In respect of intracellular signaling, bacteria induced Btk and Tec phosphorylation in both CLL and control platelets that was inhibited by ibrutinib. To address if Btk is essential for platelet activation in response to bacteria, platelets derived from X-linked agammaglobulinemia patients (lacking functional Btk) were exposed to S. aureus Newman and E. coli RS218, and FcγRIIA-dependent aggregation was observed. Our data suggest that ibrutinib impairment of FcγRIIA-mediated platelet activation by bacteria results from a combination of Btk and Tec inhibition, although off-target effects on additional kinases cannot be discarded. This is potentially relevant to control infection-risk in CLL patients and, thus, future studies should carefully evaluate the effects of CLL therapies, including Btk inhibitors with higher specificity for Btk, on platelet-mediated immune functions.
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Affiliation(s)
- Leigh Naylor-Adamson
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Anisha R Chacko
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Zoe Booth
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Stefano Caserta
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Jenna Jarvis
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Sujoy Khan
- Department of Immunology & Allergy, Queens Centre, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Francisco Rivero
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - David J Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom.,Department of Haematology, Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Mònica Arman
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
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7
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Esenboga S, Oguz B, Cagdas D, Karaatmaca B, Emiralioglu N, Yalcin E, Dogru D, Ozcelik U, Kiper N, Tezcan İ. Respiratory system findings in pediatric patients with primary immunodeficiency. Pediatr Pulmonol 2021; 56:4011-4019. [PMID: 34499824 DOI: 10.1002/ppul.25657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary involvement which can be infectious or noninfectious is one of the most frequent complications in patients with primary immunodeficiency (PID). OBJECTIVE The aim of this study is to assess the pulmonary system of the pediatric patients with PID and report the demographical, clinical, and radiological findings regarding the underlying PID. METHODS The present study included pediatric patients who were receiving immunoglobulin replacement therapy (IGRT) for PID (combined immunodeficiency [CVID] (23), common variable immunodeficiency (15), and agamaglobulinemia [10]) so far or newly diagnosed and started IGRT at Hacettepe University Immunology Department, between January 2015 and January 2018. RESULTS A total of 48 patients (60.4% male), aged 9.9 (6.1-14) years were included. Time of delay in the diagnosis of immundeficiency was 2.27 (interquartile range: 1.0-6.75) years. CVID patients exhibited higher respiratory system symptoms, as well as a history of recurrent lung infection and hospitalization. Hilar and mediastinal lymphadenopathies, peribronchial thickening, and bronchiectasis were the most common pulmonary complications and more than three lung lobes were affected in 69%. Among the newly diagnosed patients, bronchiectasis was present in 25% and more than three lobes were affected in 62.5%. Although pulmonary nodules and mediastinal lymphadenopathy were frequently computed tomography findings in our patients, only two patients (4.16%) were diagnosed with interstitial lung disease. CONCLUSION Although bronchiectasis is predominantly reported as a long-term complication in adult patients with PID, half of our pediatric patient cohort with PID had bronchiectasis, even the newly diagnosed patients. Long-term follow-up is needed to assess the extent to which these pulmonary complications that develop in the natural course of the disease can be prevented by IGRT.
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Affiliation(s)
- Saliha Esenboga
- Division of Immunology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Cagdas
- Division of Immunology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Betül Karaatmaca
- Department of Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Uğur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - İlhan Tezcan
- Division of Immunology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
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8
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Patra PK, Banday AZ, Sadanand R, Sharma B, Angrup A, Vignesh P, Rawat A. Achromobacter xylosoxidans Pneumonia in a Young Child with Chronic Granulomatous Disease-a Case-Based Review. J Clin Immunol 2021; 41:1686-1692. [PMID: 34263392 DOI: 10.1007/s10875-021-01079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Pratap Kumar Patra
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Aaqib Zaffar Banday
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rohit Sadanand
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Bhawna Sharma
- Department of Microbiology, PGIMER, Chandigarh, India
| | | | - Pandiarajan Vignesh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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9
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Méndez-Echevarría A, Caminoa MB, Del Rosal T, Casas I, Pozo F, Pascual-Pascual SI, García-Romero M, Cámara C, Calvo C. The Role of Respiratory Viruses in Children with Ataxia-Telangiectasia. Viruses 2021; 13:867. [PMID: 34065066 DOI: 10.3390/v13050867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The impact of respiratory virus infection in patients diagnosed with ataxia-telangiectasia (A-T) has not been well studied. Methods: A prospective case control study was performed at a National Reference Unit for Primary Immunodeficiency in Spain (from November 2018 to July 2019), including patients younger than 20 years. Symptom questionnaires and nasopharyngeal swabs from multiple respiratory viruses’ polymerase chain reaction were collected monthly, and between visits in case of symptoms. Results: Twenty-two individuals were included (11 patients; 11 controls); 164 samples were obtained (81 patients; 84 controls). Patients presented respiratory symptoms more frequently compared with controls (26.5% vs. 3.5%; p < 0.01). Viral detection was observed in 23 (27.3%) episodes in patients and in 15 (17.8%) episodes in controls (p = 0.1). Rhinovirus was the most frequent virus in patients and controls (60% and 53.3%, respectively). Episodes with positive viral detection had associated symptoms in 54% of patients and 18% of controls (p = 0.07). However, patients with A-T presented a similar rate of symptoms during episodes with positive and negative viral detection (26% vs. 27%). The median points given for each questionnaire during symptomatic episodes with negative viral detection were 13/23 points, and during symptomatic positive detection, 7.5/23 points (p = 0.1). In the control group, all but two were asymptomatic during positive viral episodes (score: 2/23 and 3/23 points). Symptomatic episodes, with either positive or negative viral detection, were associated with lower IgA and higher IgM titers and higher CD8+ counts (p < 0.05), particularly when these episodes were moderate/severe. Conclusions: Patients with A-T more frequently present symptomatic viral infections than controls, especially those with lower IgA and higher IgM titers and higher CD8+ counts.
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10
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Ponsford MJ, Price C, Farewell D, Greene G, Moore C, Perry M, Price N, Cottrell S, Steven R, El-Shanawany T, Carne E, Cousins R, Williams P, Schaub A, Vonarburg C, Jolles S. Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study. J Allergy Clin Immunol Pract 2021; 9:735-744.e6. [PMID: 32841749 DOI: 10.1016/j.jaip.2020.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited. OBJECTIVE To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls. METHODS Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets. RESULTS A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR. CONCLUSIONS Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Wong GK, Barmettler S, Heather JM, Millar D, Penny SA, Huissoon A, Richter A, Cobbold M. Aberrant X chromosome skewing and acquired clonal hematopoiesis in adult-onset common variable immunodeficiency. JCI Insight 2019; 4:127614. [PMID: 31341110 PMCID: PMC6675553 DOI: 10.1172/jci.insight.127614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022] Open
Abstract
Advances in genomic medicine have elucidated an increasing number of genetic etiologies for patients with common variable immunodeficiency (CVID). However, there is heterogeneity in clinical and immunophenotypic presentations and a limited understanding of the underlying pathophysiology of many cases. The primary defects in CVID may extend beyond the adaptive immune system, and the combined defect in both the myeloid and lymphoid compartments suggests the mechanism may involve bone marrow output and earlier progenitors. Using the methylation profile of the human androgen receptor (AR) gene as a surrogate epigenetic marker for bone marrow clonality, we examined the hematopoietic compartments of patients with CVID. Our data show that clonal hematopoiesis is common among patients with adult-onset CVID who do not have associated noninfectious complications. Nonblood tissues did not show a skewed AR methylation status, supporting a model of an acquired clonal hematopoietic event. Attenuation of memory B cell differentiation into long-lived plasma cells (CD20–CD27+CD38+CD138+) was associated with marked changes in the postdifferentiation methylation profile, demonstrating the functional consequence of clonal hematopoiesis on humoral immunity in these patients. This study sheds light on a potential etiology of a subset of patients with CVID, and the findings suggest that it is a stage of an acquired lymphocyte maturation disorder. Clonal hematopoiesis is common among a subset of patients with common variable immunodeficiency (CVID), suggesting that CVID may be a stage of lymphoid dysplasia.
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Affiliation(s)
- Gabriel K Wong
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, United Kingdom
| | - Sara Barmettler
- Allergy and Clinical Immunology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James M Heather
- Massachusetts General Hospital, Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - David Millar
- Massachusetts General Hospital, Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah A Penny
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, United Kingdom
| | - Aarnoud Huissoon
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, United Kingdom.,West Midlands Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Alex Richter
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, United Kingdom
| | - Mark Cobbold
- Massachusetts General Hospital, Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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13
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Jones TPW, Buckland M, Breuer J, Lowe DM. Viral infection in primary antibody deficiency syndromes. Rev Med Virol 2019; 29:e2049. [PMID: 31016825 DOI: 10.1002/rmv.2049] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
Abstract
Patients with primary antibody deficiency syndromes such as X-linked agammaglobulinemia (XLA) and common variable immunodeficiency (CVID) are at increased risk of severe and invasive infection. Viral infection in these populations has been of increasing interest as evidence mounts that viruses contribute significant morbidity and mortality: this is mediated both directly and via aberrant immune responses. We explain the importance of the humoral immune system in defence against viral pathogens before highlighting several significant viral syndromes in patients with antibody deficiency. We explore historical cases of hepatitis C via contaminated immunoglobulin products, the predisposition to invasive enteroviral infections, prolonged excretion of vaccine-derived poliovirus, the morbidity of chronic norovirus infection, and recent literature revealing the importance of respiratory viral infections. We discuss evidence that herpesviruses may play a role in driving the inflammatory disease seen in a subset of patients. We explore the phenomenon of within-host evolution during chronic viral infection and the potential emergence of new pathogenic strains. We highlight novel and emerging viruses identified via deep sequencing techniques. We describe the treatment strategies that have been attempted in all these scenarios and the urgent outstanding questions for research.
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Affiliation(s)
- Timothy P W Jones
- Department of Infectious Disease and Microbiology, Royal Free Hospital, London, UK
| | - Matthew Buckland
- Institute of Immunity and Transplantation, Royal Free Campus, University College, London, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - David M Lowe
- Institute of Immunity and Transplantation, Royal Free Campus, University College, London, UK
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14
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Wijetilleka S, Mukhtyar C, Jayne D, Ala A, Bright P, Chinoy H, Harper L, Kazmi M, Kiani-Alikhan S, Li C, Misbah S, Oni L, Price-Kuehne F, Salama A, Workman S, Wrench D, Karim MY. Immunoglobulin replacement for secondary immunodeficiency after B-cell targeted therapies in autoimmune rheumatic disease: Systematic literature review. Autoimmun Rev 2019; 18:535-541. [PMID: 30844552 DOI: 10.1016/j.autrev.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/25/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease. OBJECTIVES To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD). METHODS Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10 years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology. RESULTS 222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT. CONCLUSION The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required.
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Affiliation(s)
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
| | - David Jayne
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
| | - Philip Bright
- Department of Immunology, North Bristol NHS Trust, Bristol, UK.
| | - Hector Chinoy
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
| | - Lorraine Harper
- Department of Nephrology, Institute of Clinical Sciences, College of Medical and Dental Science, University of Birmingham, Birmingham, UK.
| | - Majid Kazmi
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Charles Li
- Department of Rheumatology, Royal Surrey County Hospital, Guildford, UK.
| | - Siraj Misbah
- Department of Immunology, Oxford University Hospitals, Oxford, UK.
| | - Louise Oni
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
| | - Fiona Price-Kuehne
- Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Alan Salama
- Department of Nephrology, University College London Centre for Nephrology, Royal Free Hospital, London, UK.
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK.
| | - David Wrench
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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15
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Benavides-Nieto M, Méndez-Echevarría A, Del Rosal T, García-García ML, Casas I, Pozo F, de la Serna O, Lopez-Granados E, Rodriguez-Pena R, Calvo C. The role of respiratory viruses in children with humoral immunodeficiency on immunoglobulin replacement therapy. Pediatr Pulmonol 2019; 54:194-199. [PMID: 30575324 PMCID: PMC7167964 DOI: 10.1002/ppul.24214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of viruses in children with respiratory tract infections and humoral immunodeficiencies has hardly been studied. We have evaluated these infections in children with humoral immunodeficiencies who required immunoglobulin replacement therapy, considering their relationship with symptoms, lung function, bacterial co-infection, and outcomes. METHODS We conducted a prospective case-control study during a 1-year period, including children with humoral immunodeficiencies receiving immunoglobulin replacement therapy. For each patient, at least one healthy family member was included. Respiratory samples for viral detection were taken every 1-3 months, and in case of respiratory tract infections. Symptoms questionnaires were filled biweekly. Spirometry and sputum culture were performed in every episode. RESULTS Sixty-six episodes were analyzed in 14 patients (median age 12 years; IQR 7-17), identifying 18 respiratory viruses (27.3%), being rhinovirus the most frequently isolated one (12/18; 66%). Positive viral episodes were associated with clinical symptoms (89% vs 43%), more frequent antibiotic treatment (44% vs 15%) or hospital admission (22% vs 0%) than negative ones. Patients with positive viral detection showed impaired lung function, with lower FEV1 and FVC values. CONCLUSIONS In our experience, viral respiratory tract infections can cause significant respiratory symptoms and impaired lung function, in children with HID, despite immunoglobulin replacement therapy. These patients could benefit from the monitoring of viral infections, as these may be a gateway for ongoing lung damage.
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Affiliation(s)
- Marta Benavides-Nieto
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Fundación IdiPaz, Madrid, Spain
| | - Ana Méndez-Echevarría
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Fundación IdiPaz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Teresa Del Rosal
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Fundación IdiPaz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - María Luz García-García
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Pediatrics and Pneumology Department, Severo Ochoa Hospital, Leganés, Madrid, Spain
| | - Inmaculada Casas
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Respiratory Virus and Influenza Unit, CNM, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Pozo
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Respiratory Virus and Influenza Unit, CNM, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Olga de la Serna
- Paediatric Pneumology Department, Hospital La Paz, Madrid, Spain
| | | | - Rebeca Rodriguez-Pena
- Immunology Department, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Fundación IdiPaz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,TEDDY Network (European Network of Excellence for Pediatric Clinical Research), Pavia, Italy
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16
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Wijetilleka S, Jayne D, Mukhtyar C, Karim MY. Re: 'ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies' by Mikulska et al. Clin Microbiol Infect 2018; 25:531-532. [PMID: 30594651 DOI: 10.1016/j.cmi.2018.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022]
Affiliation(s)
- S Wijetilleka
- Department of Immunology, University Hospital of Wales, UK
| | - D Jayne
- Department of Medicine, University of Cambridge School of Clinical Medicine, UK
| | - C Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - M Y Karim
- Department of Pathology, Sidra Medical and Research Center, Qatar.
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17
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Cinetto F, Scarpa R, Rattazzi M, Agostini C. The broad spectrum of lung diseases in primary antibody deficiencies. Eur Respir Rev 2018; 27:27/149/180019. [PMID: 30158276 PMCID: PMC9488739 DOI: 10.1183/16000617.0019-2018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022] Open
Abstract
Human primary immunodeficiency diseases (PIDs) represent a heterogeneous group of more than 350 disorders. They are rare diseases, but their global incidence is more relevant than generally thought. The underlying defect may involve different branches of the innate and/or adaptive immune response. Thus, the clinical picture may range from severe phenotypes characterised by a broad spectrum of infections to milder infectious phenotypes due to more selective (and frequent) immune defects. Moreover, infections may not be the main clinical features in some PIDs that might present with autoimmunity, auto-inflammation and/or cancer. Primary antibody deficiencies (PADs) represent a small percentage of the known PIDs but they are the most frequently diagnosed, particularly in adulthood. Common variable immunodeficiency (CVID) is the most prevalent symptomatic PAD. PAD patients share a significant susceptibility to respiratory diseases that represent a relevant cause of morbidity and mortality. Pulmonary complications include acute and chronic infection-related diseases, such as pneumonia and bronchiectasis. They also include immune-mediated interstitial lung diseases, such as granulomatous-lymphocytic interstitial lung disease (GLILD) and cancer. Herein we will discuss the main pulmonary manifestations of PADs, the associated functional and imaging findings, and the relevant role of pulmonologists and chest radiologists in diagnosis and surveillance. The spectrum of lung complications in primary antibody deficiency ranges from asthma or COPD to extremely rare and specific ILDs. Early diagnosis of the underlying immune defect might significantly improve patients' lung disease, QoL and long-term prognosis.http://ow.ly/5cP230kZvOB
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Affiliation(s)
- Francesco Cinetto
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Marcello Rattazzi
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Agostini
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
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18
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Rolfes MC, Sriaroon P, Dávila Saldaña BJ, Dvorak CC, Chapdelaine H, Ferdman RM, Chen K, Jolles S, Patel NC, Kim YJ, Tarrant TK, Martelius T, Seppanen M, Joshi AY. Chronic norovirus infection in primary immune deficiency disorders: an international case series. Diagn Microbiol Infect Dis 2018; 93:69-73. [PMID: 30174143 DOI: 10.1016/j.diagmicrobio.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Predictive factors associated with clinical outcomes of chronic norovirus infection (CNI) in primary immunodeficiency diseases (PIDD) are lacking. METHOD We sought to characterize CNI using a multi-institutional cohort of patients with PIDD and CNI using the Clinical Immunology Society's CIS-PIDD Listserv e-mail group. RESULTS Thirty-four subjects (21 males and 13 females) were reported from centers across North America, Europe, and Asia. All subjects were receiving high doses (median IgG dose: 1200 mg/kg/month) of supplemental immunoglobulin therapy. Fifty-three percent had a complete absence of B cells (median B-cell count 0; range 0-139 cells/μL). Common Variable Immune Deficiency (CVID) subjects manifested a unique phenotype with B-cell lymphopenia, non O+ blood type, and villous atrophy (logistic regression model, P = 0.01). Five subjects died, all of whom had no evidence of villous atrophy. CONCLUSION While Norovirus (NoV) is thought to replicate in B cells, in this PIDD cohort of CNI, B-cell lymphopenia was common, indicating that the presence of B lymphocytes is not essential for CNI.
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Affiliation(s)
- M C Rolfes
- Mayo Clinic School of Medicine, Rochester, MN
| | - P Sriaroon
- USF/All Children's Hospital Allergy/Immunology, St. Petersburg, FL
| | - B J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - C C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, CA
| | - H Chapdelaine
- Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R M Ferdman
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - K Chen
- Department of Pediatrics, Division of Allergy and Immunology, University of Utah School of Medicine, Salt Lake City, UT
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - N C Patel
- Division of Pediatric Infectious Disease and Immunology, Levine Children's Hospital, Carolinas Medical Center, Charlotte, NC
| | - Y J Kim
- Division of Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - T K Tarrant
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC
| | - T Martelius
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Seppanen
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Rare Disease Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Y Joshi
- Mayo Clinic School of Medicine, Rochester, MN; Division of Pediatric Allergy and Immunology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN.
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19
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Sperlich JM, Grimbacher B, Workman S, Haque T, Seneviratne SL, Burns SO, Reiser V, Vach W, Hurst JR, Lowe DM. Respiratory Infections and Antibiotic Usage in Common Variable Immunodeficiency. J Allergy Clin Immunol Pract 2018; 6:159-168.e3. [PMID: 28734862 PMCID: PMC7185402 DOI: 10.1016/j.jaip.2017.05.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with common variable immunodeficiency (CVID) suffer frequent respiratory tract infections despite immunoglobulin replacement and are prescribed significant quantities of antibiotics. The clinical and microbiological nature of these exacerbations, the symptomatic triggers to take antibiotics, and the response to treatment have not been previously investigated. OBJECTIVES To describe the nature, frequency, treatment, and clinical course of respiratory tract exacerbations in patients with CVID and to describe pathogens isolated during respiratory tract exacerbations. METHODS We performed a prospective diary card exercise in 69 patients with CVID recruited from a primary immunodeficiency clinic in the United Kingdom, generating 6210 days of symptom data. We collected microbiology (sputum microscopy and culture, atypical bacterial PCR, and mycobacterial culture) and virology (nasopharyngeal swab multiplex PCR) samples from symptomatic patients with CVID. RESULTS There were 170 symptomatic exacerbations and 76 exacerbations treated by antibiotics. The strongest symptomatic predictors for commencing antibiotics were cough, shortness of breath, and purulent sputum. There was a median delay of 5 days from the onset of symptoms to commencing antibiotics. Episodes characterized by purulent sputum responded more quickly to antibiotics, whereas sore throat and upper respiratory tract symptoms responded less quickly. A pathogenic virus was isolated in 56% of respiratory exacerbations and a potentially pathogenic bacteria in 33%. CONCLUSIONS Patients with CVID delay and avoid treatment of symptomatic respiratory exacerbations, which could result in structural lung damage. However, viruses are commonly represented and illnesses dominated by upper respiratory tract symptoms respond poorly to antibiotics, suggesting that antibiotic usage could be better targeted.
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Affiliation(s)
- Johannes M Sperlich
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom; Center for Chronic Immunodeficiency, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany; Institute of Immunity and Transplantation, University College London, London, United Kingdom.
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tanzina Haque
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Suranjith L Seneviratne
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Siobhan O Burns
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom; Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Veronika Reiser
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | | | - David M Lowe
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom; Institute of Immunity and Transplantation, University College London, London, United Kingdom.
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20
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Jolles S, Sánchez-Ramón S, Quinti I, Soler-Palacín P, Agostini C, Florkin B, Couderc LJ, Brodszki N, Jones A, Longhurst H, Warnatz K, Haerynck F, Matucci A, de Vries E. Screening protocols to monitor respiratory status in primary immunodeficiency disease: findings from a European survey and subclinical infection working group. Clin Exp Immunol 2017; 190:226-234. [PMID: 28708268 PMCID: PMC5629444 DOI: 10.1111/cei.13012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 02/01/2023] Open
Abstract
Many patients with primary immunodeficiency (PID) who have antibody deficiency develop progressive lung disease due to underlying subclinical infection and inflammation. To understand how these patients are monitored we conducted a retrospective survey based on patient records of 13 PID centres across Europe, regarding the care of 1061 adult and 178 paediatric patients with PID on immunoglobulin (Ig) G replacement. The most common diagnosis was common variable immunodeficiency in adults (75%) and hypogammaglobulinaemia in children (39%). The frequency of clinic visits varied both within and between centres: every 1-12 months for adult patients and every 3-6 months for paediatric patients. Patients diagnosed with lung diseases were more likely to receive pharmaceutical therapies and received a wider range of therapies than patients without lung disease. Variation existed between centres in the frequency with which some clinical and laboratory monitoring tests are performed, including exercise tests, laboratory testing for IgG subclass levels and specific antibodies, and lung function tests such as spirometry. Some tests were carried out more frequently in adults than in children, probably due to difficulties conducting these tests in younger children. The percentage of patients seen regularly by a chest physician, or who had microbiology tests performed following chest and sinus exacerbations, also varied widely between centres. Our survey revealed a great deal of variation across Europe in how frequently patients with PID visit the clinic and how frequently some monitoring tests are carried out. These results highlight the urgent need for consensus guidelines on how to monitor lung complications in PID patients.
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Affiliation(s)
- S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - S Sánchez-Ramón
- Department of Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - I Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - P Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Agostini
- Department of Medicine (DIMED), Clinical Immunology Unit, University of Padua, Italy
| | - B Florkin
- University Department of Pediatrics, CHR Liege, Belgium
| | - L-J Couderc
- Respiratory Diseases Department, Hôpital FOCH, University Versailles-St Quentin, Suresnes, France
| | - N Brodszki
- The Children's Hospital, Skåne University Hospital, Lund, Sweden
| | - A Jones
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - H Longhurst
- Department of Immunology, Barts and The London National Health Service Trust, London, UK
| | - K Warnatz
- Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - F Haerynck
- Center for Primary Immunodeficiency, Department of Paediatric Immunology and Pulmonology, Jeffrey Modell Diagnostic and Research Centre, Ghent University Hospital, Belgium
| | - A Matucci
- Department of Biomedicine, Immunoallergology Unit, AOU Craeggi, University of Florence, Italy
| | - E de Vries
- Jeroen Bosch Academy, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.,Tranzo, Tilburg University, Tilburg, the Netherlands
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21
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Mooney D, Edgar D, Einarsson G, Downey D, Elborn S, Tunney M. Chronic lung disease in common variable immune deficiency (CVID): A pathophysiological role for microbial and non-B cell immune factors. Crit Rev Microbiol 2017; 43:508-519. [PMID: 28068853 DOI: 10.1080/1040841x.2016.1268568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
One of the most common and most severe forms of primary antibody deficiency encountered in the clinical setting is a heterogeneous group of syndromes termed common variable immune deficiency (CVID). This disorder is characterized by reduced immunoglobulin production and increased susceptibility to infection, particularly of the respiratory tract. Infection and subsequent immunological/inflammatory processes may contribute to the development of pulmonary complications such as bronchiectasis and interstitial lung disease. Immunoglobulin replacement and/or antibiotic therapy, to prevent infection, are routinely prescribed treatments. However, chronic lung disease, the major cause of morbidity and mortality in this patient cohort, may still progress. This clinical progression suggests that pathogens recalcitrant to currently prescribed treatments and other immunological defects may be contributing to the development of pulmonary disease. This review describes the potential role of microbiological and non-B cell immunological factors, including T-cells, neutrophils, complement, toll like receptors, and antimicrobial peptides, in the pathogenicity of chronic lung disease in patients with CVID.
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Affiliation(s)
- Denver Mooney
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - David Edgar
- c T he Royal Hospitals, Belfast Health and Social Care Trust , Regional Immunology Service , Belfast , United Kingdom
| | - Gisli Einarsson
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - Damian Downey
- d Belfast City Hospital, Belfast Health and Social Care Trust , Regional Respiratory Centre , Belfast , United Kingdom
| | - Stuart Elborn
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- b Centre for Experimental Medicine, School of Medicine , Dentistry and Biomedical Sciences. Queen's University Belfast , Belfast , United Kingdom
| | - Michael Tunney
- a Halo Research Group, Queen's University Belfast , Belfast , United Kingdom
- e School of Pharmacy , Queen's University Belfast , Belfast , United Kingdom
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Abstract
Abstract
Antibody deficiencies can be either primary or secondary, leading to significant morbidity and mortality without appropriate management. Secondary antibody deficiency can be due to various diseases or iatrogenic causes, especially with the use of immunosuppressive agents such as B-cell depleting therapies. Unlike its primary counterpart, little is known regarding the management of secondary antibody deficiency and it remains an underappreciated entity. This is a growing concern with the growing numbers of patients on various immunosuppressant therapies and increasing survivors of autoimmune diseases and haematological malignancies. In this report, we review the diagnosis and management of secondary antibody deficiency, especially after rituximab-induced hypogammaglobulinemia.
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Affiliation(s)
- Philip H. Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital , University of Hong Kong , Hong Kong , Hong Kong
| | - Chak-Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital , University of Hong Kong , Hong Kong , Hong Kong
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Wong GK, King LZ, Stephens M, Huissoon AP. Fatal fungal endocarditis in a patient with primary antibody deficiency. Clin Mol Pathol 2017; 70:368-369. [DOI: 10.1136/jclinpath-2016-204232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 11/03/2022]
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Brown LAK, Clark I, Brown JR, Breuer J, Lowe DM. Norovirus infection in primary immune deficiency. Rev Med Virol 2017; 27:e1926. [DOI: 10.1002/rmv.1926] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | - Ian Clark
- Department of Cellular Pathology; Royal Free London NHS Foundation Trust; London UK
| | - Julianne R. Brown
- Microbiology, Virology and Infection Control; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- NIHR Biomedical Research Centre; Great Ormond Street Hospital for Children NHS Foundation Trust and University College; London UK
| | - Judith Breuer
- Division of Infection and Immunity; University College London; London UK
| | - David M. Lowe
- Institute of Immunity and Transplantation; University College London, Royal Free Campus; London UK
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Pan T, Tan R, Li M, Liu Z, Wang X, Tian L, Liu J, Qu H. IL17-Producing γδ T Cells May Enhance Humoral Immunity during Pulmonary Pseudomonas aeruginosa Infection in Mice. Front Cell Infect Microbiol 2016; 6:170. [PMID: 27999768 PMCID: PMC5138229 DOI: 10.3389/fcimb.2016.00170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
The host acquired immune response, especially the humoral immunity, plays key roles in preventing bacterial pneumonia in the lung. Our previous research demonstrated that interleukin 17-producing γδ T cells (IL17-γδ T cells) have a protective effect on the early innate immune response during acute pulmonary Pseudomonas aeruginosa infection. However, whether IL17-γδ T cells also play a role in humoral immunity is unknown. In this study, an acute pulmonary P. aeruginosa infection model was established in wild-type and γδ TCR−/− C57BL/6 mice. The expression of IL-17 on γδ T cells isolated from infected lung tissues increased rapidly and peaked at day 7 after acute infection with P. aeruginosa. Compared with wild-type infected mice, the levels of total immunoglobulins including IgA, IgG, and IgM in the serum and BALF were significantly decreased in γδ TCR−/− mice, with the exception of IgM in the BALF. Moreover, CD69 expression in B cells from the lungs and spleen and the level of BAFF in the plasma were also decreased in γδ TCR−/− mice. IL17-γδ T cell transfusion significantly improved the production of immunoglobulins, B cell activation and BAFF levels in γδ TCR−/− mice compared with γδ TCR−/− mice without transfusion; this effect was blocked when cells were pretreated with an IL-17 antibody. Together, these data demonstrate that IL17-γδ T cells are involved in CD19+ B cell activation and the production of immunoglobulins during acute pulmonary P. aeruginosa infection. Thus, we conclude that IL17-γδ T cells may facilitate the elimination of bacteria and improve survival through not only innate immunity but also humoral immunity.
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Affiliation(s)
- Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Meiling Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Zhaojun Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Lijun Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
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