AWARENESS OF PRIMARY IMMUNODEFICIENCY DISEASES AMONG MEDICAL STUDENTS

Primary immunodeficiency diseases (PID) are a group of more than 300 rare, chronic disorders in which a part of the body's immune system is missing or functions improperly. The issue of early diagnosis, timely and effective treatment, prevention of complications and improved prognosis remains extremely relevant. The aim of this study was to assess the awareness of graduating medical university students about the signs of primary immunodeficiency in children and adults. A survey on awareness of primary immunodeficiencies was conducted among sixth year (graduating) students of the Faculty of Medicine of I.Horbachevsky Ternopil State Medical University, Ukraine. Questionnaires were offered to 271 students. The questionnaire consisted of 25 questions. The average percentage of correct answers given by the surveyed students for each question was 59.2% (ranging from 22.5% to 82.3%). The percentage of correct answers to the questions about warning signs of PID in children was 64.4%, and in adults was 54.2% (p=0.0491). The percentage of correct answers to the questions about general signs of PID was 61.6% and about specific signs of PID 51.7% (p=0.0016). The percentages of correct answers among surveyed students ranged from 26 to 88%. 223 (82.3%) medical students gave more than 50% of correct answers to all questions, but only 21 surveyed students (7.7%) gave more than 75% of correct answers. This study has revealed the lack of awareness for PID among medical students. The lowest knowledge was about PID warning signs in adults and the specific signs of PID, especially those concerning verification and management of Nijmegan breakage syndrome and common variable immunodeficiency. This study indicates a significant need to increase knowledge of medical students about primary immunodeficiencies, taking into account low levels of diagnosis of these diseases in Ukraine and the need to raise knowledge and awareness about PID among physicians of all specialties.

Rheumatoid arthritis in a patient with common variable immunodeficiency: difficulty in diagnosis and therapy

Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency syndrome in adults with equal sex prevalence. The syndrome typically presents as recurrent infections, with onset in childhood or young adulthood (between 20 and 30 years). CVID patients also have a higher prevalence of autoimmune diseases. A 38-year-old woman presented to the Rheumatology Department with polyarthralgia and fever of 39 degrees C of several months' duration. She had recurrent respiratory and gastrointestinal tract infections and pernicious anemia. Immunological studies showed decreased levels of IgG, IgM, complete IgA deficiency, increased percentage of CD8 lymphocytes, and a reduced CD4:CD8 ratio. HLA-DR typing was performed and we identified HLA-DRB1*01. Adequate intravenous immune globulin substitution as well as antibiotic and anti-inflammatory treatment resulted in the remission of arthritis. Hand radiograms repeated after 12 months showed narrowing of the intra-articular space in the right metacarpophalangeal and radiocarpal joints with multiple bone cysts and erosions. Erosions were found in both humeral heads as well. This prompted the diagnosis of rheumatoid arthritis. Arthritis can be a presenting symptom of primary immunodeficiency in adults, especially when accompanied by recurrent infections or autoimmune diseases. These patients require more advanced diagnostic procedures and therapeutic cooperation of different specialists.