Background: Primary immunodeficiency disorders (PIDs) or inborn errors of immunity (IEI) are inherited disorders that impair the immune response in children. PIDs are much more common than it was previously estimated. Unfortunately, the majority of these patients remain undiagnosed and untreated. Objective: To assess the demography, clinical profiles, and sub-types of PID cases. Method: It was a retrospective study conducted in the pediatric rheumatology division of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2012 to June 2020. All the diagnosed immune-deficient patients who fulfilled the inclusion criteria were included in this study. The PID patients were screened for CBC, serum immunoglobulin classes and subset of lymphocytes, including the T-B-NK cell markers, detected by flow cytometric analysis. Result: Among twenty-five PID cases included in this study, majority were antibody deficiency (40%) and combined immunodeficiency disorders (32%), followed by complement deficiencies, NK cell defect, and autoinflammatory disorders (CANDLE syndrome). Recurrent respiratory tract infection, ear infection, sinusitis and skin infection were the common clinical manifestations of this cohort. Late presentation and late diagnosis were found in almost every case. A comparison with PIDs reported from other countries showed that predominantly antibody deficiency cases were more common in those countries, but combined immunodeficiency was the most common (32%) sub-type in our country. Conclusion: Antibody deficiency and combined immune deficiency disorders were the predominant types of PIDs in this cohort. Late presentation and late diagnosis with different systemic infections in the disease course were observed.
References
[1]
Rezaei, N., Aghamohammadi, A. and Notarangelo, L.D. (2017) Primary Immunodeficiency Diseases: Definition, Diagnosis, and Management. 2nd Edition, Springer Verlag. https://doi.org/10.1007/978-3-662-52909-6
[2]
McCusker, C., Upton, J. and Warrington, R. (2018) Primary Immunodeficiency. Allergy, Asthma&ClinicalImmunology, 14, Article No. 61. https://doi.org/10.1186/s13223-018-0290-5
[3]
Bousfiha, A.A., Jeddane, L., Ailal, F., Benhsaien, I., Mahlaoui, N., Casanova, J., etal. (2012) Primary Immunodeficiency Diseases Worldwide: More Common than Generally Thought. JournalofClinicalImmunology, 33, 1-7. https://doi.org/10.1007/s10875-012-9751-7
[4]
van Zelm, M.C., Condino-Neto, A. and Barbouche, M. (2020) Editorial: Primary Immunodeficiencies Worldwide. FrontiersinImmunology, 10, Article 3148. https://doi.org/10.3389/fimmu.2019.03148
[5]
CEREDIH: The French PID Study Group (2010) The French National Registry of Primary Immunodeficiency Diseases. Clinical Immunology, 135, 264-272. https://doi.org/10.1016/j.clim.2010.02.021
[6]
Ishimura, M., Takada, H., Doi, T., Imai, K., Sasahara, Y., Kanegane, H., etal. (2011) Nationwide Survey of Patients with Primary Immunodeficiency Diseases in Japan. JournalofClinicalImmunology, 31, 968-976. https://doi.org/10.1007/s10875-011-9594-7
[7]
Rhim, J.W., Kim, K.H., Kim, D.S., Kim, B.S., Kim, J.S., Kim, C.H., etal. (2012) Prevalence of Primary Immunodeficiency in Korea. JournalofKoreanMedicalScience, 27, 788-793. https://doi.org/10.3346/jkms.2012.27.7.788
[8]
Primary Immunedeficiency Care and Research (PICAR) Institute.
[9]
Gupta, S. and Sehgal, S. (2021) Editorial: Advances in Primary Immunodeficiencies in India. FrontiersinImmunology, 12, Article 701335. https://doi.org/10.3389/fimmu.2021.701335
[10]
Bousfiha, A., Moundir, A., Tangye, S.G., Picard, C., Jeddane, L., Al-Herz, W., etal. (2022) The 2022 Update of IUIS Phenotypical Classification for Human Inborn Errors of Immunity. JournalofClinicalImmunology, 42, 1508-1520. https://doi.org/10.1007/s10875-022-01352-z
[11]
Quinn, J., Modell, V., Orange, J.S. and Modell, F. (2022) Growth in Diagnosis and Treatment of Primary Immunodeficiency within the Global Jeffrey Modell Centers Network. Allergy, Asthma&ClinicalImmunology, 18, Article No. 19. https://doi.org/10.1186/s13223-022-00662-6
[12]
National Institute of Allergy and Infectious Diseases (n.d.) Primary Immune Deficiency Diseases (PIDDs). https://www.niaid.nih.gov/diseases-conditions/primary-immune-deficiency-diseases-pidds
[13]
Symptoms of PID. https://www.immunodeficiencyuk.org/immunodeficiency/secondary-immunodeficiency/symptoms-diagnosis/
[14]
Raje, N. and Dinakar, C. (2015) Overview of Immunodeficiency Disorders. ImmunologyandAllergyClinicsofNorthAmerica, 35, 599-623. https://doi.org/10.1016/j.iac.2015.07.001
[15]
Bonilla, F.A., Khan, D.A., Ballas, Z.K., Chinen, J., Frank, M.M., Hsu, J.T., etal. (2015) Practice Parameter for the Diagnosis and Management of Primary Immunodeficiency. JournalofAllergyandClinicalImmunology, 136, 1186-1205.e78. https://doi.org/10.1016/j.jaci.2015.04.049
[16]
Bousfiha, A., Jeddane, L., Picard, C., Ailal, F., Bobby Gaspar, H., Al-Herz, W., etal. (2017) The 2017 IUIS Phenotypic Classification for Primary Immunodeficiencies. JournalofClinicalImmunology, 38, 129-143. https://doi.org/10.1007/s10875-017-0465-8
[17]
Aguilar, C., Malphettes, M., Donadieu, J., Chandesris, O., Coignard-Biehler, H., Catherinot, E., etal. (2014) Prevention of Infections during Primary Immunodeficiency. ClinicalInfectiousDiseases, 59, 1462-1470. https://doi.org/10.1093/cid/ciu646
Sazzad, H.M.S., Rainey, J.J., Kahn, A.-L., Mach, O., Liyanage, J.B.L., Alam, A.N., etal. (2014) Screening for Long-Term Poliovirus Excretion among Children with Primary Immunodeficiency Disorders: Preparation for the Polio Posteradication Era in Bangladesh. JournalofInfectiousDiseases, 210, S373-S379. https://doi.org/10.1093/infdis/jiu221
Wu, J., Zhong, W., Yin, Y. and Zhang, H. (2019) Primary Immunodeficiency Disease: A Retrospective Study of 112 Chinese Children in a Single Tertiary Care Center. BMCPediatrics, 19, Article No. 410. https://doi.org/10.1186/s12887-019-1729-7
[22]
Aghamohammadi, A., Mohammadinejad, P., Abolhassani, H., Mirminachi, B., Movahedi, M., Gharagozlou, M., etal. (2014) Primary Immunodeficiency Disorders in Iran: Update and New Insights from the Third Report of the National Registry. JournalofClinicalImmunology, 34, 478-490. https://doi.org/10.1007/s10875-014-0001-z
[23]
Noh, L.M., Nasuruddin, B.A., Abdul Latiff, A.H., Noah, R.M., Kamarul Azahar, M.R. and Norzila, M.Z. (2013) Clinical-Epidemiological Pattern of Primary Immunodeficiencies in Malaysia 1987-2006: A 20 Year Experience in Four Malaysian Hospitals. Medical Journal of Malaysia, 68, 13-17.
[24]
Gupta, D., Thakral, D., Kumar, P., Kabra, S.K., Lodha, R., Kumari, R., etal. (2019) Primary Immunodeficiency Disorders among North Indian Children. TheIndianJournalofPediatrics, 86, 885-891. https://doi.org/10.1007/s12098-019-02971-y
[25]
de Silva, N.R., Gunawardena, S., Rathnayake, D. and Wickramasingha, G.D. (2013) Spectrum of Primary Immunodeficiency Disorders in Sri Lanka. Allergy, Asthma&ClinicalImmunology, 9, Article No. 50. https://doi.org/10.1186/1710-1492-9-50
[26]
Guaní-Guerra, E., García-Ramírez, U.N., Jiménez-Romero, A.I., Velázquez-Ávalos, J.M., Gallardo-Martínez, G. and Mendoza-Espinoza, F. (2013) Primary Immunodeficiency Diseases at Reference and High-Specialty Hospitals in the State of Guanajuato, Mexico. BioMedResearchInternational, 2013, Article 187254. https://doi.org/10.1155/2013/187254
[27]
Aghamohammadi, A., Moin, M. and Rezaei, N. (2010) History of Primary Immunodeficiency Diseases in Iran. Iranian Journal of Pediatrics, 20, 16-34.
[28]
Reda, S.M., Afifi, H.M. and Amine, M.M. (2008) Primary Immunodeficiency Diseases in Egyptian Children: A Single-Center Study. JournalofClinicalImmunology, 29, 343-351. https://doi.org/10.1007/s10875-008-9260-x
[29]
Baumgart, K.W., Britton, W.J., Kemp, A., French, M. and Roberton, D. (1997) The Spectrum of Primary Immunodeficiency Disorders in Australia. JournalofAllergyandClinicalImmunology, 100, 415-423. https://doi.org/10.1016/s0091-6749(97)70257-4
[30]
Al-Herz, W. (2007) Primary Immunodeficiency Disorders in Kuwait: First Report from Kuwait National Primary Immunodeficiency Registry (2004-2006). JournalofClinicalImmunology, 28, 186-193. https://doi.org/10.1007/s10875-007-9144-5
[31]
Fasth, A. (1982) Primary Immunodeficiency Disorders in Sweden: Cases among Children, 1974-1979. JournalofClinicalImmunology, 2, 86-92. https://doi.org/10.1007/bf00916891
[32]
Pandit, C., Hsu, P., van Asperen, P. and Mehr, S. (2016) Respiratory Manifestations and Management in Children with Common Variable Immunodeficiency. PaediatricRespiratoryReviews, 19, 56-61. https://doi.org/10.1016/j.prrv.2015.12.003
[33]
Modell, V., Quinn, J., Orange, J., Notarangelo, L.D. and Modell, F. (2016) Primary Immunodeficiencies Worldwide: An Updated Overview from the Jeffrey Modell Centers Global Network. ImmunologicResearch, 64, 736-753. https://doi.org/10.1007/s12026-016-8784-z
[34]
Reisi, M., Azizi, G., Kiaee, F., etal. (2017) Evaluation of Pulmonary Complications in Patients with Primary Immunodeficiency Disorders. European Annals of Allergy and Clinical Immunology, 49, 122-128.
[35]
Kabir, A.L. and Roy, S. (2018) Pulmonary Manifestations of Primary Immunodeficiencies in Children—A Review. BangladeshJournalofChildHealth, 42, 86-93. https://doi.org/10.3329/bjch.v42i2.37764
[36]
Oniankitan, O., Tagbor, K.C., Kakpovi, K., Fianyo, E., Houzou, P., Koffi-Tessio, V.E.S., etal. (2014) Human Immunodeficiency Virus Can Affect the Semiology of Osteoarticular Infections? OpenJournalofRheumatologyandAutoimmuneDiseases, 4, 235-239. https://doi.org/10.4236/ojra.2014.44032
[37]
Anwar, S., Taslem Mourosi, J., Arafat, Y. and Hosen, M.J. (2020) Genetic and Reproductive Consequences of Consanguineous Marriage in Bangladesh. PLOSONE, 15, e0241610. https://doi.org/10.1371/journal.pone.0241610
[38]
Abuzakouk, M. and Feighery, C. (2005) Primary Immunodeficiency Disorders in the Republic of Ireland: First Report of the National Registry in Children and Adults. JournalofClinicalImmunology, 25, 73-77. https://doi.org/10.1007/s10875-005-0360-9
[39]
Baumgart, K.W., Britton, W.J., Kemp, A., French, M. and Roberton, D. (1997) The Spectrum of Primary Immunodeficiency Disorders in Australia. JournalofAllergyandClinicalImmunology, 100, 415-423. https://doi.org/10.1016/s0091-6749(97)70257-4
[40]
Ehlayel, M., Bener, A. and Laban, M.A. (2013) Effects of Family History and Consanguinity in Primary Immunodeficiency Diseases in Children in Qatar. OpenJournalofImmunology, 3, 47-53. https://doi.org/10.4236/oji.2013.32008
[41]
Arunachalam, A.K., Maddali, M., Aboobacker, F.N., Korula, A., George, B., Mathews, V., etal. (2020) Primary Immunodeficiencies in India: Molecular Diagnosis and the Role of Next-Generation Sequencing. JournalofClinicalImmunology, 41, 393-413. https://doi.org/10.1007/s10875-020-00923-2