Neonatal respiratory distress occurs in many cases. Some of the respiratory symptoms presented include chronic rhinitis, reduced sense of smell and chronic rhinorrhoea that begins from early childhood. Otitis media is recurrent in many cases [7].

Chronic obstructive pulmonary disease (COPD) and bronchiectasis as well as recurrent pneumonia are all components of this syndrome.

The condition may bring about male infertility due to immobile spermatozoa as well as decreased fertility in females.

• Fatigue

  There was a significantly higher fatigue perception at the end of the MSWT in KS/PCD patients than that of the PCD-only patients (p<0.05). [erj.ersjournals.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  In addition there may be fatigue and general feeling of unwell. Many patients may also develop fever. Sleep may also be disturbed due to the blocked nose and sinuses and the pain. [news-medical.net]

  Common symptoms of bronchiectasis include chronic cough, shortness of breath, and fatigue. In some cases, your fingers and toes may become clubbed. This is probably caused by a lack of oxygen to your extremities. [healthline.com]

• Sepsis

  A missing or poorly functioning spleen may leave individuals more susceptible to repeated infections including infection of the blood (sepsis). [rarediseases.org]

  […] on the prevention of repeated infections that might worsen bronchiectasis, resulting in a more severe airflow limitation and a more rapid decline of the lung function, together with a run-down condition due to possible severe pneumonia with risk of sepsis [mrmjournal.biomedcentral.com]

• Movement Disorder

  In the embryonic stage, the position of the organ is determined by the uniform beating of the ciliary body, but in KS, due to the movement disorder of the ciliary body, the heart and other organs cannot move to the left, resulting in dextrocardia and [frontiersin.org]

• Intermittent Fever

  Chiu A 23-year-old woman presented to our emergency department with chief complaints of recurrent episodes of intermittent fever and productive cough with greenish phlegm for the past few days. [academic.oup.com]

• Acute Abdomen

  Acute appendicitis is one of the main causes of acute abdomen that requires a surgical procedure, and its diagnosis is based on patient’s symptoms and clinical signs. [hindawi.com]

  In some cases, additional findings have been reported including sudden, severe pain in the abdomen (acute abdomen) often due to abnormal twisting or the intestines (volvulus), narrowing (atresia) of the ducts that carry bile from the liver to the gallbladder [rarediseases.org]

• Hearing Impairment

  Repeated middle ear infections may cause hearing impairment. The mucus accumulated in bronchi can cause their dilation and emergence of so-called bronchiectasis. Disruption of the reproductive system may cause infertility in both sexes. [health-tutor.com]

• Suggestibility

  Genetic counselor recommended this couples to have a baby because the pattern was suggested according to their pedigree is autosomal recessive. [scialert.net]

  From this concordance, we suggest that the fertility of Kartagener's women is explained by the dyskinetic motion of oviductal cilia, and that the ciliated endosalpinx is essential for human reproduction. [ncbi.nlm.nih.gov]

X-Ray studies may reveal lung over-inflation, thickening of the bronchial wall and peribronchial infiltrates and dextrocardia. Right sided heart disease with chronic respiratory tract symptom is very indicative and it occurs in more than half of patients [8].

CT scan will reveal bronchiectasis and also demonstrate involvement of paranasal sinuses poorly aerated mastoids and absence of frontal sinuses.

Transmission electron microscopy of the cilia from an airway biopsy needs to be examined for ciliary movement, coordination, beat frequency and amplitude. This biopsy has been useful in the past in the diagnosis of two newborns. The absence or decrease in the number of dynein arms is the most common ultrastructural defect noted here. Transmission electron microscopy is very important when it comes to differentiating between primary and ciliary dysfunction.

In postpubertal males, semen analysis will reveal abnormal sperm motility and ultrastructure.

In pragmatic difficulties, the saccharin test may be used. The saccharin is placed in the nose while measuring the speed of transportation to the nasopharynx.

• Atelectasis

  The computed tomography images revealed an endobronchial massive shadow at the ostial site of the right upper lobe bronchus and atelectasis of the right upper lobe (Fig. 2). [bmcpulmmed.biomedcentral.com]

  […] dysfunction Retinitis pigmentosa All have ciliary dyskinesia in common Incidence 1:12,500-40,000 Autosomal recessive inheritance Cilary dyskinesis can also be acquired Smokers most commonly Imaging findings Bronchial wall thickening Hyperinflation Segmental atelectasis [learningradiology.com]

  Chest X-ray may reveal bronchial wall thickening hyperinflation, atelectasis, features of bronchiectasis, and situs inversus (in 50% of patients with primary ciliary dyskinesia). [xpertdox.com]

  Chest radiographs may illustrate bronchial wall thickening as an early manifestation of chronic infection, hyperinflation, atelectasis, bronchiectasis, and situs inversus (in 50% of patients with primary ciliary dyskinesia) Bronchiectasis occurs in the [flipper.diff.org]

  Symptoms often begin shortly after birth and can include coughing, gagging, choking and lung atelectasis (neonatal respiratory distress). [rarediseases.org]

Intravenous, oral, intermittent or continuous antibiotics are used in the treatment of upper and lower airway infections. The most common organisms inhibited by the antibiotics are Staphylococcus aureus and Haemophilus influenzae. In some children, long term low-dose prophylactic antibiotics may be necessary.

Obstructive lung disease or bronchiectasis should be treated with mucolytics, chest physiotherapy bronchodilators and inhaled bronchodilators. Although the effectiveness of deoxyribonuclease and other mucolytic agents like hypertonic saline has not been fully assessed, it may be worth trying in some patients with persistent respiratory symptoms or recurrent infections.
There may equally be use for inhaled antibiotics and inhaled/oral corticosteroids even though the evidence base is still anecdotal.

Influenza and pneumococcal vaccination has to be encouraged as well.

Conductive hearing loss and recurrent infections can be reduced with tympanostomy tubes. Repeated insertions may be required and chronic suppurative otitis media may present as complication. In some cases, topical and systemic antibiotic therapy, otomicrosopy, acetic acid irrigations and other aural hygiene measures may be needed [9].

A transient improvement in upper and lower respiratory tract symptoms can be induced by endoscopic sinus surgery and the formation of a nasal antral window underneath the inferior turbinate.

For associated bronchiectasis lobectomy may sometimes be required. In severe cases, lung transplantation and heart lung transplantation have been tried occasionally in many cases with some degree of success [10].

Treatment with antibiotics, physiotherapy, and the right surgical intervention means that prognosis in patients with this syndrome have improved greatly. In most cases, lifespan is normal.

However, early diagnosis is vital because as soon as bronchiectasis is fully established, prognosis worsens [6].

The Kartagener syndrome is made up of the following triad: primary ciliary dyskinesia, abnormal frontal sinuses (bringing about bronchiectasis and sinusitis) and situs inversus (transposition of the viscera) [2].

When the defective cilia lining the respiratory tract is unable to clear the airways of secretions as well as pathogenic bacteria, mucus retention and recurrent or chronic infection of the respiratory tract results leading to the airway walls’ damage. Generally, over 50% of patients with primary ciliary dyskinesia (PCD) have the complete triad of the Kartagener syndrome. In some cases, hearing loss and retinitis pigmentosa is recorded [3].

Studies have shown that visceral rotation in the embryo is dependent on normal ciliary action thus the association between situs inversus abnormality and primary ciliary dyskinesis.

The incidence of this genetic disorder is 1 in every 32,000 births. However, there have been cases of higher incidences in communities where consanguineous marriages are relatively common [4].

The disease is one that is genetically inherited. Structures that make up the cilia such as the inner and outer dynein arms, radial spokes, central apparatus etc. are either missing or dysfunctional and therefore the axoneme structure lacks the ability to move. Axonemes are the elongated structures that make up the flagella and cilia [5]. Additionally, there may be chemical defects that will interfere with ciliary function in the presence of adequate structure. Regardless of the underlying cause, the dysfunction of the cilia begins and as well as affects the embryologic phases of human development.

At the heart of this problem are specialised monocilia. These often lack the central-pair microtubules seen in ordinary motile cilia and therefore they rotate clockwise instead of beating in Hensen's node at the anterior end of the primitive streak in the embryo, these are angled posteriorly such that they prescribe a D-shape rather than a circle.

However, in some individuals with the condition, mutations believed to be in the gene coding for the key structural protein- left right dynein result in monocilia and these do not rotate. This therefore brings about no flow in the node. 50% of individuals affected develop situs inversus which can happen with or without dextrocardia, where the laterality of the internal organs is the replica of normal.

The condition is genetic so the only way to prevent it is to ensure adequate genetic counselling to prevent birthing children with the condition.

The Kartagener syndrome (KS) is an autosomal recessive inherited syndrome. Multiple ciliopathies result following genetic defects in the structure and function of sensory and motile cilia [1]. Many structural defects of the cilia have been recorded but a reduction in the number of dynein arms, (arms which propel mucus) is a common abnormality. Patients that have normal cilia morphology but abnormal mucus propulsion have been detected on many occasions and this is why both the ciliary structure as well as motility has to be assessed during diagnosis of the syndrome.

Kartagener syndrome is a genetic defect affecting the respiratory tract. When present, it stops the respiratory tract from automatically getting rid of mucus secretion and also pathogenic bacteria. The disease is seen in 1 out of 32,000 live births. 

Treatment is mostly with the aid of antibiotics and is often very successful.

Many patients in the past have gone on to live and enjoy normal lives following adequate treatment. The positive prognosis means that this condition, though problematic, can be recovered from as long you co-operate with the right medical practitioners. 

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3. Ciliary dyskinesia, primary, 1, CILD1; Online Mendelian Inheritance in Man (OMIM), 2013
4. Krawczynski MR, Witt M; PCD and RP: X-linked inheritance of both disorders? Pediatr Pulmonol. 2004 Jul;38(1):88-9.
5. Chuhwak EK; Kartagener syndrome in a Nigerian African--a case report and literature review. Niger J Med. 2009 Oct-Dec;18(4):424-7.
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