Parvaneh L, Sharifi N, Azizi G, Abolhassani H, Sharifi L, Mohebbi A, Bahraminia E, Delavari S, Alebouyeh M, Tajeddin E, Mohebbi S R, Yazdani R, Behniafard N, Aghamohammadi A
Department of Biology, Central Tehran Branch, Islamic Azad University, Tehran, Iran. Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Eur Ann Allergy Clin Immunol. 2019 Jan;51(1):32-37. doi: 10.23822/EurAnnACI.1764-1489.77. Epub 2018 Nov 12.
Primary immunodeficiency diseases (PIDs) are life-threatening disorders, which manifest commonly with gastrointestinal (GI) signs, mainly as chronic diarrhea. To investigate and compare infectious etiology of chronic diarrhea in different PIDs. Assessing clinical features, obtaining immunological profiles, as well as characterizing infectious etiology of diarrhea were performed in 38 PID patients with chronic diarrhea. Stool samples and/or biopsy specimens were checked using culture, microscopic examination, RT-PCR, and PCR, as appropriate. The patients were diagnosed to have common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), X-linked agammaglobulinemia (XLA), and hyper-IgM (HIgM) syndrome. In 32 patients we identified 41 infectious agents including 16 parasitic (39.0%, the most common Giardia lamblia), 11 bacterial (26.8%, the most common salmonella spp), 8 viral (19.5%, the most frequent group A rotavirus), and 6 fungal organisms (14.7%, the most common Candida albicans). From 6 of the patients, no infectious agent was isolated. In CVID bacteria and parasites, in SCID bacteria and viruses, in XLA parasites, and in individuals with HIgM syndrome parasites were the leading causes of chronic diarrhea. Infection with giardia and cryptosporidium were more frequent in XLA and HIgM, respectively. The current study suggests considering both usual and unusual pathogens in laboratory investigation and in the empiric treatment of chronic diarrhea. Opportunistic pathogens should be taken into account when no other pathogen is identified, especially in patients on long-term treatment or prophylaxis with antifungals/antibiotics and in those from geographical locations that favor pathogenicity of these organisms.
原发性免疫缺陷病（PIDs）是危及生命的疾病，通常表现为胃肠道（GI）症状，主要是慢性腹泻。为了调查和比较不同原发性免疫缺陷病中慢性腹泻的感染病因。对38例患有慢性腹泻的原发性免疫缺陷病患者进行了临床特征评估、免疫谱分析以及腹泻感染病因的鉴定。根据情况，使用培养、显微镜检查、逆转录聚合酶链反应（RT-PCR）和聚合酶链反应（PCR）对粪便样本和/或活检标本进行检查。这些患者被诊断患有常见变异型免疫缺陷（CVID）、严重联合免疫缺陷（SCID）、X连锁无丙种球蛋白血症（XLA）和高IgM（HIgM）综合征。在32例患者中，我们鉴定出41种感染因子，包括16种寄生虫（39.0%，最常见的是蓝氏贾第鞭毛虫）、11种细菌（26.8%，最常见的是沙门氏菌属）、8种病毒（19.5%，最常见的是A组轮状病毒）和6种真菌（14.7%，最常见的是白色念珠菌）。6例患者未分离出感染因子。在CVID中，细菌和寄生虫是慢性腹泻的主要原因；在SCID中，细菌和病毒是主要原因；在XLA中，寄生虫是主要原因；在HIgM综合征患者中，寄生虫是慢性腹泻的主要原因。贾第虫和隐孢子虫感染在XLA和HIgM中分别更为常见。本研究表明，在慢性腹泻的实验室检查和经验性治疗中，应同时考虑常见和不常见的病原体。当未鉴定出其他病原体时，应考虑机会性病原体，特别是在长期接受抗真菌/抗生素治疗或预防的患者以及来自有利于这些病原体致病性的地理位置的患者中。
