Chronic granulamatous disease: two decades of experience from a pediatric immunology unit in a country with high rate of consangineous marriages.
Scand J Immunol. 2018 Dec 01;:e12737
Authors: Kutukculer N, Aykut A, Karaca NE, Durmaz A, Aksu G, Genel F, Pariltay E, Cogulu Ö, Azarsız E
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by susceptibility to bacterial and fungal infections resulting from the inadequacy of phagocytic leukocytes to produce reactive oxygen radicals. CGD is a genetically heterogeneous disease with an X-linked recessive (XR-CGD) form caused by mutations in the CYBB (OMIM #300481) gene encoding the gp91(phox) protein, and an autosomal recessive (AR-CGD) form caused by mutations in the CYBA (OMIM #608508), NCF1 (OMIM #608512), NCF2 (OMIM #608515) and NCF4 (OMIM #601488) genes encoding p22(phox), p47(phox), p67(phox), and p40(phox), respectively. The genetic mutation of one of the cytosolic p47phox/p67phox proteins and membrane-bound gp91phox/p22phox proteins, which constitutes the NADPH oxidase enzyme complex, causes the disease. In this study, we evaluated the clinical, laboratory and genetic findings and the prognostic effects of molecular inheritance of our 24 CGD cases (14 XR, 10 autosomal recessive-AR). Consanguinity (3 XR and all AR cases) showed statistically significant relationship with the type of hereditary inheritance (p< .001). 83% patients had an infection since early infancy. The mean age of initiation of symptoms was earlier in XR cases and 78% patients had respiratory tract infections. Bone marrow transplantation was performed in 5 XR cases (2 ex) and 4 AR (1 ex) cases. 3 of 9 XR and 2 of 6 AR cases deceased on medical follow-up. In countries especially with high consanguinity rates, the early diagnosis for appropriate prophylactic treatment of CGD is quitely important to avoid from recurrent severe infections, early death and fatal complications of late transplantation. This article is protected by copyright. All rights reserved.
PMID: 30506560 [PubMed – as supplied by publisher]
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