Common severe infections in chronic granulomatous disease.

Abstract

BACKGROUND:

Chronic granulomatous disease (CGD) is due to defective nicotinamide adenine dinucleotide phosphate oxidase activity and characterized by recurrent infections with a limited spectrum of bacteria and fungi as well as inflammatory complications. To understand the impact of common severe infections in CGD, we examined the records of 268 patients followed at a single center over 4 decades.

METHODS:

All patients had confirmed diagnoses of CGD, and genotype was determined where possible. Medical records were excerpted into a standard format. Microbiologic analyses were restricted to Staphylococcus, Burkholderia, Serratia, Nocardia, and Aspergillus.

RESULTS:

Aspergillus incidence was estimated at 2.6 cases per 100 patient-years; Burkholderia, 1.06 per 100 patient-years; Nocardia, 0.81 per 100 patient-years; Serratia, 0.98 per 100 patient-years, and severe Staphylococcus infection, 1.44 per 100 patient-years. Lung infection occurred in 87% of patients, whereas liver abscess occurred in 32%. Aspergillus incidence was 55% in the lower superoxide-producing quartiles (quartiles 1 and 2) but only 41% in the higher quartiles (rate ratio, <0.0001). Aspergillus and Serratia were somewhat more common in lower superoxide producing gp91phox deficiency. The median age at death has increased from 15.53 years before 1990 to 28.12 years in the last decade. Fungal infection carried a higher risk of mortality than bacterial infection and was the most common cause of death (55%). Gastrointestinal complications were not associated with either infection or mortality.

CONCLUSIONS:

Fungal infections remain a major determinant of survival in CGD. X-linked patients generally had more severe disease, and this was generally in those with lower residual superoxide production. Survival in CGD has increased over the years, but infections are still major causes of morbidity and mortality.

• Authors: Beatriz E Marciano, Christine Spalding, Alan Fitzgerald, Daphne Mann, Thomas Brown, Sharon Osgood, Lynne Yockey, Dirk N Darnell, Lisa Barnhart, Janine Daub, Lisa Boris, Amy P Rump, Victoria L Anderson, Carissa Haney, Douglas B Kuhns, Sergio D Rosenzweig, Corin Kelly, Adrian Zelazny, Tamika Mason, Suk See DeRavin, Elizabeth Kang, John I Gallin, Harry L Malech, Kenneth N Olivier, Gulbu Uzel, Alexandra F Freeman, Theo Heller, Christa S Zerbe, Steven M Holland
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 60 Issue 8 Pg. 1176-83 (Apr 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 25537876 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)
• Copyright: Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Topics

• Adolescent
• Adult
• Aspergillosis (epidemiology)
• Bacterial Infections (epidemiology)
• Child
• Child, Preschool
• Cohort Studies
• Female
• Granulomatous Disease, Chronic (complications)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Young Adult