Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom; Center for Chronic Immunodeficiency, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany.
Center for Chronic Immunodeficiency, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany; Institute of Immunity and Transplantation, University College London, London, United Kingdom.
J Allergy Clin Immunol Pract. 2018 Jan-Feb;6(1):159-168.e3. doi: 10.1016/j.jaip.2017.05.024. Epub 2017 Jul 19.
Patients with common variable immunodeficiency (CVID) suffer frequent respiratory tract infections despite immunoglobulin replacement and are prescribed significant quantities of antibiotics. The clinical and microbiological nature of these exacerbations, the symptomatic triggers to take antibiotics, and the response to treatment have not been previously investigated.
To describe the nature, frequency, treatment, and clinical course of respiratory tract exacerbations in patients with CVID and to describe pathogens isolated during respiratory tract exacerbations.
We performed a prospective diary card exercise in 69 patients with CVID recruited from a primary immunodeficiency clinic in the United Kingdom, generating 6210 days of symptom data. We collected microbiology (sputum microscopy and culture, atypical bacterial PCR, and mycobacterial culture) and virology (nasopharyngeal swab multiplex PCR) samples from symptomatic patients with CVID.
There were 170 symptomatic exacerbations and 76 exacerbations treated by antibiotics. The strongest symptomatic predictors for commencing antibiotics were cough, shortness of breath, and purulent sputum. There was a median delay of 5 days from the onset of symptoms to commencing antibiotics. Episodes characterized by purulent sputum responded more quickly to antibiotics, whereas sore throat and upper respiratory tract symptoms responded less quickly. A pathogenic virus was isolated in 56% of respiratory exacerbations and a potentially pathogenic bacteria in 33%.
Patients with CVID delay and avoid treatment of symptomatic respiratory exacerbations, which could result in structural lung damage. However, viruses are commonly represented and illnesses dominated by upper respiratory tract symptoms respond poorly to antibiotics, suggesting that antibiotic usage could be better targeted.
患有普通变异性免疫缺陷症（CVID）的患者尽管接受了免疫球蛋白替代治疗，但仍经常发生呼吸道感染，并大量使用抗生素。这些加重病情的临床和微生物学性质、使用抗生素的症状触发因素以及治疗反应以前都没有被调查过。
描述 CVID 患者呼吸道加重的性质、频率、治疗和临床过程，并描述呼吸道加重期间分离的病原体。
我们对英国一家原发性免疫缺陷诊所招募的 69 名 CVID 患者进行了前瞻性病历卡研究，共生成了 6210 天的症状数据。我们从有症状的 CVID 患者中收集了微生物学（痰显微镜检查和培养、非典型细菌 PCR 和分枝杆菌培养）和病毒学（鼻咽拭子多重 PCR）样本。
有 170 次症状加重和 76 次因加重而使用抗生素的病例。开始使用抗生素的最强症状预测因子是咳嗽、呼吸急促和脓性痰。从症状开始到开始使用抗生素的中位数时间为 5 天。有脓性痰的发作对抗生素的反应更快，而喉咙痛和上呼吸道症状的反应较慢。56%的呼吸道加重病例分离出了一种致病病毒，33%的病例分离出了一种潜在的致病细菌。
CVID 患者会延迟并避免治疗有症状的呼吸道加重，这可能导致结构性肺损伤。然而，病毒通常存在，以上呼吸道症状为主的疾病对抗生素反应不佳，这表明抗生素的使用可以更有针对性。
