Clinical Immunology Unit, Department of Pediatrics, CHU Ibn Rochd, Casablanca, Morocco.
Clin Immunol. 2010 May;135(2):204-9. doi: 10.1016/j.clim.2010.02.001. Epub 2010 Mar 16.
The vast majority of primary immunodeficiencies (PIDs) predispose affected individuals to recurrent or chronic infectious diseases, because they affect protective immunity to both primary and secondary or latent infections. We discuss here three recently described groups of PIDs that seem to impair immunity to primary infections without compromising immunity to secondary and latent infections. Patients with mutations in IL12B or IL12RB1 typically present mycobacterial disease in childhood with a favorable progression thereafter. Cross-protection between mycobacterial infections has even been observed. Patients with mutations in IRAK4 or MYD88 suffer from pyogenic bacterial diseases, including invasive pneumococcal diseases in particular. These diseases often recur, although not always with the same serotype, but the frequency of these recurrences tails off, with no further infections observed from adolescence onwards. Finally, mutations in UNC93B1 and TLR3 are associated with childhood herpes simplex encephalitis, which strikes only once in most patients, with almost no recorded cases of more than two bouts of this disease. Unlike infections in patients with other PIDs, the clinical course of which typically deteriorates with age even if appropriate treatment is given, the prognosis of patients with these three newly described PIDs tends to improve spontaneously with age, provided, of course, that the initial infection is properly managed. In other words, although life-threatening in early childhood, these new PIDs are associated with a favorable outcome in adulthood. They provide proof-of-principle that infectious diseases of childhood striking only once may result from single-gene inborn errors of immunity.
绝大多数原发性免疫缺陷病(PID)使患者易患反复或慢性感染性疾病,因为它们会影响对原发性、继发性或潜伏性感染的保护性免疫。在这里,我们讨论了最近描述的三组 PID,它们似乎会损害对原发性感染的免疫,但不影响对继发性和潜伏性感染的免疫。IL12B 或 IL12RB1 基因突变的患者通常在儿童期表现为分枝杆菌病,此后病情进展良好。甚至观察到分枝杆菌感染之间的交叉保护。IRAK4 或 MYD88 基因突变的患者患有化脓性细菌病,特别是侵袭性肺炎球菌病。这些疾病经常复发,尽管并非总是相同的血清型,但随着年龄的增长,这些复发的频率逐渐减少,青春期后不再观察到进一步的感染。最后,UNC93B1 和 TLR3 基因突变与儿童单纯疱疹脑炎有关,大多数患者仅发作一次,几乎没有记录到两次以上的病例。与其他 PID 患者的感染不同,这些患者的临床病程通常会随着年龄的增长而恶化,即使给予适当的治疗,而这三种新描述的 PID 患者的预后往往会随着年龄的增长而自然改善,当然前提是适当管理初始感染。换句话说,尽管这些 PID 在儿童早期具有致命性,但它们与成年后的良好预后相关。它们提供了一个原则性的证明,即儿童期仅发作一次的传染病可能是由单一基因先天性免疫缺陷引起的。