Presentation
Primary immunodeficiencies are generally determined and can present early or at birth as opposed to acquired infections which present later. [pedclerk.bsd.uchicago.edu]
Clinically, CVID patients may present similarly to patients with XLA. Certain atypical XLA varieties with a delayed presentation are known to mimic CVID. [hindawi.com]
The disorder presents clinically as marked susceptibility to infections, severe malabsorption and failure to thrive and is often fatal in early childhood. [orpha.net]
For example, severe T-cell or combined immune deficiencies typically present in infancy. However, some antibody deficiencies may present in older children or adults. [aaaai.org]
Presentation The most common presenting feature is frequent infections. [patient.info]
Entire Body System
- Recurrent Infection
Underlying factors of recurrent infections in patients with down syndrome [North Clin Istanb] North Clin Istanb. 2018; 5(2): 163-168 | DOI: 10.14744/nci.2017.69379 Underlying factors of recurrent infections in patients with down syndrome Turkan Patiroglu [kuzeyklinikleri.com]
ZAP-70 deficiency causes recurrent infections similar to those in severe combined immunodeficiency (SCID) in infants and young children. However, the deficiency may not be diagnosed until children are several years old. [msdmanuals.com]
SCID patients are usually diagnosed in the first year of life with symptoms such as recurrent infections and failure to thrive. [immunology.org]
The most typical manifestations of PIDs are recurrent infections. [scielo.br]
- Candidiasis
Improvement of the candidiasis was associated with remission of the delayed cutaneous anergy and lymphopenia. [annals.org]
[…] susceptibility to candidiasis, a fungal infection caused by Candida yeast. [niaid.nih.gov]
In autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) also autoimmunity and infections coexist: organ-specific autoimmune manifestations (e.g., hypoparathyroidism and adrenocortical failure) and chronic mucocutaneous candidiasis. [en.wikipedia.org]
The syndrome results from a breakdown of the body's disease-fighting mechanism that leaves it defenceless against infections, such as pulmonary tuberculosis, Pneumocystis pneumonia, certain blood infections, candidiasis, invasive cervical cancer, Kaposi's [kpv.arso.gov.si]
[…] receptor deficiency Autosomal recessive inheritance Decreased IL-12 → impaired Th1 response → no release of IFN-γ Onset varies but usually 1–3 years of age Disseminated disease, especially tuberculosis Fungal infections Low IFN-γ Chronic mucocutaneous candidiasis [amboss.com]
- Weight Loss
Clinical examination of HIV and AIDS On examination, the following may be found: Thrush ; Rashes ; Weight loss ; Lung infections such as pneumonia or tuberculosis; Fungal nail infections; Fever ; Bacterial infections (i.e. infections of muscles, bones [myvmc.com]
Constitutional symptoms or signs, as used in these listings, means severe fatigue, fever, malaise, or involuntary weight loss. [ssa.gov]
[…] of entertainment and in the fields of social and community interest groups hr Vidim da se nimalo nisi promijenila, mala en (See AIDS [ Acquired Immunodeficiency Syndrome ]) en Pharmaceutical preparation for the treatment of anorexia associated with weight [hr.glosbe.com]
Significant, unexplained weight loss also is an AIDS-defining condition. [medicinenet.com]
Common symptoms are fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. See the signs and tests section below for a list of common opportunistic infections and major symptoms associated with them. [ihv.org]
- Lymphadenopathy
Persistent, generalized lymphadenopathy among homosexual males. MMWR 1982;31:249-51. Kornfeld H, Vande Stouwe RA, Lange M, Reddy MM, Grieco MH. T-lymphocyte subpopulations in homosexual men. N Engl J Med 1982;307:729-31. [cdc.gov]
Persistent generalized lymphadenopathy 26. [slideshare.net]
Lymph node biopsy For some patients with lymphadenopathy, to determine whether germinal centers are normal and to exclude cancer and infection Interpretation varies by histology. [merckmanuals.com]
cutaneous reaction to Candida antigens is absent In vitro T-cell proliferation is absent when exposed to Candida antigens IPEX syndrome X-linked recessive inheritance FOXP3 mutation → impaired regulatory T cells → autoimmunity Onset: early infancy Lymphadenopathy [amboss.com]
Immune System
- Splenomegaly
Low lymphocyte counts could not be assigned to splenomegaly and hypersplenism because counts remained lower than those observed among patients with CVID with splenomegaly (data not shown). [academic.oup.com]
Hepatomegaly and splenomegaly may be detected in the abdomen. In infants, crusting around the anus may be a sign of chronic diarrhoea. Delayed developmental milestones or ataxia may be evident. [patient.info]
On physical examination, patients with this subtype often have splenomegaly and bronchiectasis. [emedicine.medscape.com]
A 41-year-old female with poor adherence to antiretroviral therapy was admitted to hospital with nonspecific symptoms; an abdominal computed tomography (CT) scan revealed substantial ascites, splenomegaly, and lymphadenopathy. [ekjm.org]
Due to abnormalities in the maturation of B cells, and dysregulation of the immune system, some individuals with CVID may have abnormal accumulations of lymphocytes in lymphoid tissues such as lymph nodes (lymphadenopathy) or spleen (splenomegaly). [rarediseases.org]
Respiratoric
- Pneumonia
"Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients". The Cochrane Database of Systematic Reviews. 10 (10): CD005590. doi:10.1002/14651858.CD005590.pub3. PMC 6457644. PMID 25269391. [en.wikipedia.org]
The person is now severely wasted, has severe recurrent bacterial infections, develops cancers such as Kaposi sarcoma, and other infections like Pneumocystis carinii pneumonia (PCP), toxoplasmosis and HIV encephalopathy. [myvmc.com]
Pneumocystis pneumonia 45. Pneumocystis pneumonia 46. TBC 47. Fungal colony 48. Fungal pneumonia 49. Histoplasmosis 50. Interstitial pneumonia 51. GIT INFECTIONS 52. Erosive gastritis 53. Haemorrhagic colitis 54. CMV colitis 55. CMV colitis 56. [slideshare.net]
Hypoplasia of tonsils and other lymphoid tissue Recurrent, severe pyogenic infections (e.g., pneumonia, otitis media), especially with encapsulated organisms (S. pneumoniae, N. meningitidis, and H. influenzae) Hepatitis virus and enterovirus (e.g., Coxsackie [amboss.com]
Infections with Haemophilus influenzae, Streptococcus pneumoniae and other encapsulated bacterial organisms are most common. [worldallergy.org]
Gastrointestinal
- Chronic Diarrhea
He or she will be at constant risk for: pneumonia chronic diarrhea thrush infections of the mouth and skin many other types of infection, including severe viral infections and invasive bacterial or fungal infections How we care for severe combined immunodeficiency [childrenshospital.org]
chronic candidiasis (thrush), viral and protozoal infections Failure to thrive Chronic diarrhea Lymph nodes and tonsils may be absent Diagnosis Quantitative PCR: ↓ T-cell receptor excision circles (TRECs) Flow cytometry: absent T cells CXR: absent thymic [amboss.com]
Babies with SCID may appear healthy at birth, but problems can start soon after, such as: failure to thrive chronic diarrhea frequent, often serious respiratory infections oral thrush (a type of yeast infection in the mouth) other bacterial, viral, or [kidshealth.org]
Many of these infections, such as bronchitis, chronic sinusitis, otitis and pneumonia, affect the sinopulmonary system (i.e. sinuses, middle ear and/or lungs). Others affect the gastrointestinal system, triggering symptoms such as chronic diarrhea. [massgeneral.org]
Infants or young children may have chronic diarrhea and may not grow and develop as expected (called failure to thrive). Immunodeficiency may be more severe if symptoms develop in early childhood than if they develop later. [merckmanuals.com]
Musculoskeletal
- Macrocephaly
Deletions in this region of chromosome 16 are associated with intellectual disability, congenital anomalies, obesity, macrocephaly, and autism [47]. This matches the clinical picture of one of our patients. [ojrd.biomedcentral.com]
Skin
- Eczema
STAT3 mutation → decreased Th17 cells Defective neutrophil/macrophage chemotaxis Remember the acronym FATED Facies: coarse facial features Abscesses: mainly staphylococcal Teeth: retained primary teeth Hyper-IgE (eosinophilia) Dermatologic: severe eczema [amboss.com]
Various skin manifestations may be apparent, such as rashes, vesicles, pyoderma, eczema and telangectasia. The eyes may be inflamed and infected. [patient.info]
Board of Internal Medicine Internal Medicine, American Board of Internal Medicine Locations Boston: Allergy Associates Waltham: MGH Waltham Allergy Hesterberg, Paul E., MD Clinical Interests Food allergy Anaphylaxis Food sensitivity Immunodeficiency Eczema [massgeneral.org]
Findings on Physical Examination Poor growth and chronically ill appearance Absence or decreased lymph tissue including tonsils Enlarged liver and spleen Thrush Skin changes including petechiae, telangectasia (ataxia telangectasia, abscesses (CGD), eczema [pedclerk.bsd.uchicago.edu]
</li></ul><ul><li>mainly T-cell defect : DiGeorge syndrom (thymic hypoplasia), hyper-IgM syndrome </li></ul><ul><li>B- and T-cell defect : severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome (immunodeficiency with thrombocytopenia and eczema [slideshare.net]
- Angioedema
Banerji, Aleena, MD Clinical Interests Drug hypersensitivity Angioedema Asthma Immunodeficiency Rhinosinusitis Cough Anaphylaxis Eosinophilic disorders Food sensitivity Dermatitis Urticaria Board Certifications Allergy & Immunology, American Board of [massgeneral.org]
See bradykinin-mediated angioedema in angioedema. [amboss.com]
Impairment of the regulatory proteins involved in C1 inhibitor produces clinical symptoms that include episodic nonpruritic angioedema of the airway, soft tissues and gastrointestinal tract. [worldallergy.org]
[…] to 1:75,000 for common variable immunodeficiency; 1:100,000 for X-linked agammaglobulinemia; 1:183,000 to 1:200,000 for chronic granulomatous disease; 1:30,000 to 1:100,000 for severe combined immunodeficiency; and 1:10,000 to 1:50,000 for hereditary angioedema [scielo.br]
- Dermatitis
Banerji, Aleena, MD Clinical Interests Drug hypersensitivity Angioedema Asthma Immunodeficiency Rhinosinusitis Cough Anaphylaxis Eosinophilic disorders Food sensitivity Dermatitis Urticaria Board Certifications Allergy & Immunology, American Board of [massgeneral.org]
A second patient had unexplained chronic autoaggressive dermatitis, immunoglobulin M (IgM) antinuclear antibody, severely reduced creatinine clearance, and familial dysimmunoglobulinemia associated with a history of allergic diathesis. [annals.org]
It is an antibody for parasitic diseases, Hodgkin's disease, hay fever, atopic dermatitis, and allergic asthma. All antibodies are made by B-lymphocytes (B-cells). [encyclopedia.com]
- Skin Disease
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Handout on Health [On-line information]. [labtestsonline.org.tr]
Neurologic
- Neurologic Manifestation
Levy RM, Bredesen DE, Rosenblum ML (19850 Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62:475–495 Google Scholar 18. [link.springer.com]
Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of the literature. Journal of Neurosurgery 62:475-495, 1985. [ Links ] 24. LuftBJ, HafnerR. Toxoplasmicencephalitis. [scielo.br]
Workup
The blood workup with differential cell count is essential for all patients with suspected PID; it provides important information regarding suspected cytopenias (neutropenia, lymphopenia or thrombocytopenia) or qualitative alterations of cells, such as [scielo.br]
(suggestive of granuloma annulare). [11] Procedures Biopsy - Should be considered to exclude infection or malignancy in enlarging lymph nodes Bronchoscopy or endoscopy - Can provide information regarding specific lesions or infectious processes See Workup [emedicine.medscape.com]
Serum
- Neutropenia
S182-194 Segel G, Halterman J.Evaluation of Neutropenia in Pediatric PracticePediatrics in Review January 2008 Back to Table of Contents [pedclerk.bsd.uchicago.edu]
Etiology: autosomal recessive mutation in the MPO gene Clinical features Diagnosis Treatment No specific treatment or prophylaxis Treatment of fungal infections Severe congenital neutropenia Definition: A deficiency of neutrophils that occurs at or around [amboss.com]
Read more about congenital neutropenia syndromes. [niaid.nih.gov]
[…] causes secondary disorders such as acquired immune deficiency syndrome (AIDS).[4] Granulocyte deficiency, including decreased numbers of granulocytes (called as granulocytopenia or, if absent, agranulocytosis) such as of neutrophil granulocytes (termed neutropenia [en.wikipedia.org]
[…] immunomodulatory, and immunosuppressive drug therapy: corticosteroids, calcineurin inhibitors, cytotoxic agents Lymphopenia Decreased cellular immune response and anergy Decreased proinflammatory cytokines Decreased phagocytosis Decreased chemotaxis Neutropenia [incodom.kr]
- Cytopenia
Conclusions Peripheral cytopenias and several lymphoproliferative disorders should prompt a suspicion of PID. [frontiersin.org]
[…] trauma Disruption of epithelial and mucosal barriers T-cell anergy caused by nonspecific immune activation Environmental conditions UV light, radiation, hypoxia, space Flight Increased lymphocyte apoptosis Increased secretion of tolerogenic cytokines Cytopenias [incodom.kr]
CVID management includes immunoglobulin replacement therapy, infection avoidance, pulmonary status monitoring, and evaluations for cytopenia and malignancy. [hindawi.com]
Manifestations are not limited to sinopulmonary infections, as chronic Giardia enteritis, gastrointestinal lymphoid hyperplasia, polymyositis, autoimmune cytopenias, and chronic arthritis also occur. [worldallergy.org]
Microbiology
- Staphylococcus Aureus
Lymphocyte function tests included in vitro T lymphocyte proliferation tests (to Concanavalin A (ConA), phytohaemagglutinin (PHA), pokeweed mitogen (PWD) and Staphylococcus aureus enterotoxin A (SAE)), natural killer (NK) cell and cytotoxic T cell toxicity [ojrd.biomedcentral.com]
Transient hypogammaglobulinemia of infancy presenting as Staphylococcus aureus sepsis with deep neck infection. J Microbiol Immunol Infect. 2005; 38 (2):141–144. [ PubMed ] [ Google Scholar ] 49. Dalal I, Reid B, Nisbet-Brown E, Roifman CM. [ncbi.nlm.nih.gov]
Systemic infections with catalase-positive organisms such as Staphylococcus aureus, Serratia, Aspergillus, Burkholderia cepacia and Nocardia are the hallmark of chronic granulomatous disease which is defective in oxidative burst capacity. [worldallergy.org]
Treatment
Primary Immunodeficiency Disease Treatment & Management Research in primary immunodefeciency is making great strides, improving treatment options and enhancing the quality of life for most people with these complex conditions. [aaaai.org]
[…] labor and short-term treatment of the infant after birth. [stanfordchildrens.org]
Etiology: autosomal recessive mutation in the MPO gene Clinical features Diagnosis Treatment No specific treatment or prophylaxis Treatment of fungal infections Severe congenital neutropenia Definition: A deficiency of neutrophils that occurs at or around [amboss.com]
Top of page Is there effective treatment for SCID? The most effective treatment for SCID is transplantation of blood-forming stem cells from the bone marrow of a healthy person. [genome.gov]
Combined Immunodeficiency Treatment The goal of treating CID is to prevent your child from getting infections, which can become life-threatening. Enzyme-replacement therapy can treat certain types of CID. This treatment does not cure the disease. [chp.edu]
Prognosis
Some conditions such as selective IgAD have a good prognosis. [patient.info]
Ig replacement therapy are infusions that can be either subcutaneous or intravenously administrated, resulting in higher Ig levels for about three to four weeks, although this varies with each patient.[10] Prognosis[edit] Prognosis depends greatly on [en.wikipedia.org]
Prognosis of HIV and AIDS How is HIV and AIDS treated? HIV and AIDS prevention References What is HIV and AIDS? HIV is a retrovirus that causes AIDS. HIV attacks the immune system. [myvmc.com]
Prognosis The prognosis is variable; many infants with DiGeorge syndrome die from overwhelming infection, seizures, or heart failure within the first year. [encyclopedia.com]
The prognosis in congenital immunodeficiency disorders is variable and depends on the specific disorder. [amboss.com]
Etiology
Overview Congenital B-cell immunodeficiencies Immunodeficiency Etiology Clinical features Diagnostic findings Bruton agammaglobulinemia X-linked recessive inheritance BTK gene defect → defective Bruton tyrosine kinase expressed in B cells → complete deficiency [amboss.com]
analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital cytology diagnosis diagnostic imaging diet therapy drug effects drug therapy economics embryology enzymology epidemiology ethnology etiology [ncbi.nlm.nih.gov]
Then, progressing to modern time, to the immunological theory and finally the advent of genetics and their role in the etiology of TS. Key words: Tourette syndrome; tics; psychoanalysis; genes. [scielo.br]
Etiologic diagnosis can be made by examination of aqueous by use of polymerase chain reaction (PCR). [southsudanmedicaljournal.com]
Etiology The primary cause of common variable immunodeficiency (CVID) remains unknown despite 40 years of research. Part of the problem is the heterogeneity of the disease. Genetic factors may be involved. [emedicine.medscape.com]
Epidemiology
This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world. [ovid.com]
During submission, authors are given the option to submit papers to one of the following tracks: Basic Science, Clinical Science, Translational Research, Epidemiology, Implementation Science, Prevention Research, and Critical Review. [journals.lww.com]
Epidemiology: CD40 ligand deficiency is the most common form. [amboss.com]
[…] builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital cytology diagnosis diagnostic imaging diet therapy drug effects drug therapy economics embryology enzymology epidemiology [ncbi.nlm.nih.gov]
Abstract In the absence of direct epidemiological evidence, molecular evolutionary studies of primate lentiviruses provide the most definitive information about the origins of human immunodeficiency virus (HIV)–1 and HIV–2. [rstb.royalsocietypublishing.org]
Pathophysiology
Internal Medicine (337) Paediatrics, Neonatology (298) Pathology and Forensic Medicine (289) Neurology (218) Physiology and Pathophysiology (174) Infectology (162) Surgery, Traumatology and Orthopaedics (158) Medical Chemistry and Biochemistry (121) Microbiology [portal.mefanet.cz]
However, intrinsic factors related to the pathophysiology of SLE are implicated in susceptibility to infection in patients with SLE. [tandfonline.com]
Diagnosis: CH50 assay screening test Treatment Meningococcal vaccine Prophylactic antibiotics C3 deficiency Definition: deficiency of the complement factor C3 and its cleaved fragments (e.g., C3b) Pathophysiology: decreased levels of the opsonin C3b → [amboss.com]
Pathophysiology In patients with common variable immunodeficiency (CVID), numerous immune-system abnormalities are reported, the most common of which is defective antibody formation. [emedicine.medscape.com]
Pathophysiology, diagnosis and management, vol 2. Livingstone, New York, pp 903–917 Google Scholar 5. [link.springer.com]
Prevention
[…] defects, there's no way to prevent them. [mayoclinic.org]
Some of the disorders that can cause secondary immunodeficiency can be prevented and/or treated, thus helping prevent immunodeficiency from developing. [merckmanuals.com]
Besides medicines and therapies to help prevent infections, other precautions are used. Children with SCID: are placed in isolation to help prevent the spread of infection should not get live vaccines. [kidshealth.org]
Primary immunodeficiency disorders can be controlled and treated, but they can’t be prevented. Secondary disorders can be prevented in a number of ways. [healthline.com]