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Transpl Infect Dis. 2026 Jan 13:e70162. doi: 10.1111/tid.70162. Online ahead of print.

ABSTRACT

BACKGROUND: Herpes simplex virus (HSV) infection is a significant risk in hematopoietic stem cell transplant (HSCT) recipients, and antiviral resistance poses many clinical challenges.

METHODS: A retrospective case series of eight pediatric patients with acyclovir-resistant HSV infection, determined via genotypic sequencing, post allogeneic HSCT between 2012 and 2025.

RESULTS: Indications for HSCT included primary immunodeficiency, sickle cell disease, myelodysplastic syndrome (MDS), and relapsed/refractory leukemia. All patients received acyclovir prophylaxis. TK mutations were most common (n = 7, 87.5%). Infections manifested as mucocutaneous disease, pneumonitis, keratitis, enterocolitis, and blood viremia. A total of 87.5% of patients (n = 7) were treated with second-line antivirals (foscarnet and/or cidofovir), and three patients were treated with third-line antivirals (pritelivir). Treatment was complicated by nephrotoxicity (n = 3, 37.5%). Adjunct treatments included intravenous immunoglobulin (n = 3, 37.5%) and donor lymphocyte infusion (n = 1, 12.5%). Poor outcomes were seen across the cohort, including death (n = 3, 37.5%). T-cell depletion was used in 50% of patients (n = 4). Concomitant immunosuppressive therapy was used in 100% of patients (n = 8) and high-dose steroids were used in 50% of patients (n = 4). Graft versus host disease occurred in four patients (50%). Secondary complications included transplant-associated thrombotic microangiopathy (n = 3, 37.5%), idiopathic pulmonary syndrome (n = 3, 37.5%), and graft failure (n = 1, 12.5%).

CONCLUSION: Acyclovir-resistant HSV infection in pediatric HSCT recipients is associated with high morbidity and mortality, limited therapeutic options, and significant treatment-related nephrotoxicity. Early recognition, early resistance testing, prompt initiation of second-line therapy, and weaning of immunosuppression are critical. Emerging therapies, such as helicase-primase inhibitors and adoptive T-cell therapy, hold promise but remain limited by access and pediatric data.

PMID:41531120 | DOI:10.1111/tid.70162

Pediatr Pulmonol. 2026 Jan;61(1):e71457. doi: 10.1002/ppul.71457.

ABSTRACT

BACKGROUND: The primary risk factor determining the progression of tuberculosis (TB) infection is the host’s immune status. However, reports of TB cases in children diagnosed with primary immunodeficiency (PID), also referred to as inborn errors of immunity (IEI), remain scarce. In this study, we describe the impact of PID/IEI on childhood TB disease.

METHODS: In this retrospective cohort study, data of patients aged 1 month to 18 years who were diagnosed with TB between January 2012 and January 2025 were collected. TB patients were compared according to PID status. Additionally, radiological, histopathological, and microbiological diagnostic findings, as well as clinical features and treatments of TB patients with PID, were evaluated.

RESULTS: A total of 217 TB patients were included, with a median age of 118 months (IQR: 42-169.5). PID was detected in 5.5% (n = 12) of the patients. In 6 (50%) of the PID patients, the immunodeficiency was not known before the TB diagnosis. The median age of patients with PID was 17 months (IQR: 10.3-58.5), which was significantly lower compared to other patients (p = 0.001). The diagnosis of extrapulmonary TB was significantly more common among PID patients (p = 0.049). Treatment durations in patients with PID ranged from 6 to 24 months, and no mortality was observed.

CONCLUSION: Investigating PID in children diagnosed with TB may be a critical step in enabling early diagnosis and treatment before the development of potentially fatal complications. We also believe that expanding immunological investigations will contribute to a better understanding of childhood TB pathogenesis.

PMID:41521825 | DOI:10.1002/ppul.71457

J Pediatr Nurs. 2026 Jan 10;87:112-117. doi: 10.1016/j.pedn.2025.12.027. Online ahead of print.

ABSTRACT

BACKGROUND: The study aimed to examine the predictive effect of having a child with primary immunodeficiency (PID) on the psychological resilience, general self-efficacy, and spiritual well-being of parents.

METHODS: A cross-sectional, correlational, and comparative study was conducted with parents of children with PID (N = 88) and healthy controls (n = 168) in Türkiye from June 2024 to February 2025. Study data were collected through the Connor-Davidson Resilience Scale Short Form, the General Self-Efficacy Scale, and the Spiritual Well-being Scale.

RESULTS: The mean general self-efficacy of parents of children with PID was significantly lower than that of parents of healthy controls (p < 0.05). However, no significant difference was found between the groups in psychological resilience or spiritual well-being (p > 0.05). There were significant positive relationships among psychological resilience, general self-efficacy, and spiritual well-being among parents of children with PID (p < 0.05). The disease has no statistically significant effect on spiritual well-being in parents (p > 0.05).

CONCLUSIONS: The mean general self-efficacy of parents of children with PID was lower than that of parents of healthy controls. Although no difference in psychological resilience was detected between the groups in the descriptive comparison, the multivariate analysis indicated that having a child with PID is a negative factor affecting parents’ resilience. Having a child with PID also had a statistically significant effect on the general self-efficacy of parents.

PRACTICE IMPLICATIONS: The findings will guide the planning of family-centred nursing interventions to enhance the psychological resilience, general self-efficacy, and spiritual well-being of parents of children with PID.

PMID:41520468 | DOI:10.1016/j.pedn.2025.12.027

J Clin Immunol. 2026 Jan 10;46(1):4. doi: 10.1007/s10875-025-01967-y.

ABSTRACT

We describe a 3-year-old patient with xeroderma pigmentosum (XP) and genetically confirmed XPA deficiency who presented with recurrent infections in early childhood. Immunological assessment revealed mild hypogammaglobulinemia with IgG2 and IgG3 subclass deficiencies, as well as impaired humoral immunity demonstrated by a reduced antibody response to repeated vaccinations against bacterial antigens. Flow cytometric analysis further showed an altered distribution of peripheral T helper (TH) cell subsets. In addition, we report a second case: a 33-year-old XP patient with ERCC4 deficiency who also exhibited IgG3 subclass deficiency and reduced response to booster vaccination. Functional studies revealed defective nucleotide excision repair (NER) following UV-C exposure, along with reduced B-cell activation capacity. These findings suggest a potential link between XP and immunoglobulin subclass deficiencies, indicating a susceptibility to infections in affected individuals. We therefore recommend that patients diagnosed with XP undergo comprehensive immunological evaluation to allow early detection of immunodeficiency and timely intervention, including booster vaccinations or prophylactic measures such as low-dose antibiotics or immunoglobulin replacement therapy when indicated.

PMID:41518476 | DOI:10.1007/s10875-025-01967-y

Congenit Anom (Kyoto). 2026 Jan-Dec;66(1):e70040. doi: 10.1002/cga.70040.

ABSTRACT

Bloom syndrome (BS) is an autosomal recessive disorder characterized by prenatal and postnatal growth deficiency, photosensitive skin changes, immune deficiency, insulin resistance, greatly increased risk of early-onset cancer, and the development of multiple malignancies. Few cases of BS diagnosed during the prenatal period have been reported. Here, I present the comprehensive clinical and genetic characterization of two unrelated fetuses diagnosed with BS. Two pregnant women with abnormal ultrasound findings underwent amniocentesis for karyotype analysis, copy number variation sequencing (CNV-seq), and trio-whole exome sequencing (Trio-WES). Both fetuses exhibited severe fetal growth restriction. One fetus had a pericardial effusion. The karyotype analysis and CNV-seq revealed no apparent abnormalities. Trio-WES revealed biallelically likely pathogenic or pathogenic BLM variants in the fetuses. All parents were BLM variant carriers. These cases indicate that affected fetuses are more likely to have severe fetal growth restriction and do not display significant chromosomal abnormalities before birth. Clarification of the molecular diagnosis had important implications for these parents because they carried a 25% risk of recurrence. They were recommended to plan future pregnancies with preimplantation genetic testing for monogenic disorders to avoid future offspring with BS.

PMID:41518008 | DOI:10.1002/cga.70040

Medicine (Baltimore). 2026 Jan 9;105(2):e47005. doi: 10.1097/MD.0000000000047005.

ABSTRACT

RATIONALE: Cartilage-hair hypoplasia (CHH) is an autosomal recessive disorder caused by homozygous or compound heterozygous mutations in the RMRP gene, which is extremely rare in the population, and its most common feature is disproportionately short limb shortness with short and thickened long bones, usually found in newborns, occasionally found in the prenatal stage, and other clinical features include a series of extracutaneous manifestations, such as hypoglycemia, gastrointestinal dysfunction, immunodeficiency, anemia and increased risk of malignant tumors, etc, the specific pathogenesis is unknown.

PATIENT CONCERNS: The case of a 1.5-year-old male patient with severe short stature (height 70 cm, <-3 SD), sparse scalp hair, and short limbs, without ligamentous laxity or anemia.

DIAGNOSES: Family-based whole-exome sequencing revealed compound heterozygous variants in RMRP: NR_003051.3: n.-21_-9dup and n.5C > T. Classified as pathogenic or likely pathogenic according to ACMG guidelines, these variants confirm the diagnosis of CHH.

INTERVENTIONS: Due to the elevated tumor predisposition associated with CHH, and because growth hormone therapy is currently contraindicated, no disease-specific interventions have been initiated.

OUTCOMES: We have confirmed that the child has been diagnosed with CHH, but no intervention has been given, and we will do further follow-up and look forward to finding a treatment for the disease.

LESSONS: This report describes a rare case of RMRP-associated CHH. This case broadens the clinical understanding of the RMRP mutational spectrum and phenotypic variability, providing new insights into genotype-phenotype correlations in RMRP-associated disorders. We were currently unable to take effective treatment measures for this child, and we hope that in the future, there will be treatments such as gene therapy to bring hope to children and their families.

PMID:41517791 | DOI:10.1097/MD.0000000000047005

J Clin Med. 2025 Dec 26;15(1):179. doi: 10.3390/jcm15010179.

ABSTRACT

Primary humoral immunodeficiencies are a heterogeneous group of disorders defined by quantitative and/or functional defects in one or more immunoglobulin classes, often with associated cellular immune abnormalities. Their link with bronchiectasis, whose prevalence varies across specific defects, is largely driven by recurrent respiratory infections. Selective Immunoglobulin-(Ig)A deficiency and IgG2 subclass deficiency are the most frequent forms, but common variable immunodeficiency (CVID) is the condition most often associated with bronchiectasis and is usually diagnosed earlier because of its characteristic phenotype. In contrast, the contribution of isolated IgA deficiency or selective IgG subclass deficiencies to bronchiectasis remains controversial. Other reported associations include X-linked agammaglobulinemia, selective IgM or IgG deficiency, and rarer entities such as selective IgE deficiency, unclassified hypogammaglobulinemia, specific antibody deficiency, specific polysaccharide antibody deficiency, and heavy- or light-chain deficiencies. Current bronchiectasis guidelines recommend measurement of serum immunoglobulins and IgG subclasses in patients with compatible features, recurrent infections, or no clear etiology before labeling disease as idiopathic. Identifying immunoglobulin defects is clinically important because they represent treatable traits. The potential role of emerging therapies such as the DPP1 inhibitor brensocatib in immunodeficiency-related bronchiectasis remains uncertain, and ongoing registries will be key to clarifying these relationships.

PMID:41517428 | DOI:10.3390/jcm15010179

Int J Mol Sci. 2025 Dec 19;27(1):14. doi: 10.3390/ijms27010014.

ABSTRACT

Primary immune regulatory disorders (PIRDs) are a group of conditions characterised by a loss of immune tolerance. Two such disorders, CHAI and LATAIE, share common molecular mechanisms, leading to significant clinical overlap. Here, we report demographic, clinical, immunological, and molecular findings in 29 patients referred from different parts of India with a diagnosis of CHAI or LATAIE. LATAIE patients demonstrated a higher prevalence of consanguinity, while CHAI patients more often had a positive family history. Both disorders presented with overlapping clinical features, predominately autoimmune cytopenias, benign lymphoproliferation, and inflammatory bowel disease (IBD). However, the incidence of recurrent infections, otitis media, bronchiectasis, and hypogammaglobulinemia was higher among LATAIE patients as compared to CHAI. Flow cytometry analysis revealed significant differences in T cell subsets, particularly in percentages of CD4+ naïve cells and T regulatory cells (Treg), between the two disorders. B cell abnormalities were also observed. Molecular diagnosis was achieved using targeted or clinical exome sequencing, and specific protein expression was employed to validate the novel variants.

PMID:41515894 | DOI:10.3390/ijms27010014

Allergol Immunopathol (Madr). 2026 Jan 1;54(1):87-95. doi: 10.15586/aei.v54i1.1465. eCollection 2026.

ABSTRACT

BACKGROUND: Primary immunodeficiency diseases (PIDs) are an expanding group of rarely observed immune system disorders. Various clinical conditions, such as autoimmunity, immune dysregulation, and inflammation, could affect multiple organ systems in PID patients. The heart may be one of these organs; however, studies on this topic are rare. Atrial fibrillation (AF) is a significant cause of mortality and morbidity in the community and an increased P-wave dispersion (PWD) and atrial electromechanical delay (AED) are well-known markers indicating a predisposition to AF. We aimed to determine whether AED and/or increased PWD predict the early risk of AF in PID patients.

METHODS: This single-center, prospective controlled study included 61 PID and 60 control group patients. All participants underwent resting electrocardiography, echocardiography, and atrial electromechanical conduction time (AECT) monitoring using tissue Doppler imaging evaluated by an experienced cardiologist.

RESULTS: The PID group had a statistically significantly higher Pmax, Pmin, and PWD values, compared to the control group (102 [92-108] vs. 88 [82-99] ms, P < 0.001; 74 [70-80] vs. 68 [62-72] ms, P < 0.001; 26 [22-30] vs. 21 [18-26] ms, P = 0.001, respectively). Right atrial delay and interatrial delay were discovered to be statistically significantly higher in PID group (4 [2-6] vs. 2 [2-4] ms, P < 0.001; 6 [4-8] vs. 4 [4-6] ms, P = 0.039, respectively). Left atrial delay was also discovered to be high in the PID group, although this difference was not statistically significant (6 [4-6] vs. 4 [3-6] ms; P = 0.05).

CONCLUSION: We demonstrated that the well-known predictors of AF, AECT, and PWD were increased in PID patients. This result aids in the follow up and survival of PID patients, who experience multiple complications, by enabling the early identification of AF-related mortality and morbidity risk.

PMID:41510927 | DOI:10.15586/aei.v54i1.1465

Allergol Immunopathol (Madr). 2026 Jan 1;54(1):72-78. doi: 10.15586/aei.v54i1.1489. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aimed to determine the frequency of neutropenia in patients with common variable immunodeficiency (CVID) and investigate its relationship with disease prognosis.

METHODS: Data from 84 patients diagnosed with CVID and followed between 2019 and 2024 at the Department of Adult Clinical Immunology and Allergy, Necmettin Erbakan University, were retrospectively reviewed. Patients were divided into two groups based on the presence or absence of neutropenia. Demographic data, clinical findings, laboratory parameters, and survival rates were compared. Statistical analyses included the Mann-Whitney U test, the Chi-square test, and the Kaplan-Meier survival analysis.

RESULTS: A total of 84 patients diagnosed with CVID were included in the study, with a median age of 38 years (range, 20-79 years). Of the participants, 48.8% were females (n = 41). Neutropenia was observed in 28.5% of patients (n = 24). The most common presenting complaints included autoimmune cytopenias, such as anemia and thrombocytopenia. Compared to non-neutropenic patients (n = 60), those with neutropenic CVID had a significantly higher mortality rate (33.3% vs 6.7%, P = 0.004). According to Kaplan-Meier survival analysis, the 8-year survival rates were 57.5 and 92.5% for neutropenic and for non-neutropenic CVID patients (p < 0.001), respectively.

CONCLUSION: This study suggests that neutropenia in CVID patients may be more than just a hematological issue; it could also serve as an important clinical marker associated with increased mortality. Recognizing and closely monitoring neutropenia is essential for effective CVID management.

PMID:41510925 | DOI:10.15586/aei.v54i1.1489