Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study

Autor: Simon Cottrell, Tariq El-Shanawany, Catherine Moore, Richard Cousins, Emily Carne, Daniel Farewell, Giles Greene, Alexander Schaub, Nicky Price, Stephen Jolles, Michael D. Perry, Mark J. Ponsford, Colin Price, Paul Williams, Rachael Steven, Cédric Vonarburg
Rok vydání: 2019
Předmět:
Male
Rhinovirus
IgRT
Immunoglobulin replacement therapy
RSV
Respiratory Syncytial Virus
Comorbidity
medicine.disease_cause
Immunology and Allergy
Medicine
Respiratory Health
SNOT-22
Sino-Nasal Outcome Test
Respiratory Tract Infections
education.field_of_study
HRV
Human Rhinovirus
PAD
Primary Antibody Deficiency
Respiratory tract infections
Bacterial Infections
Middle Aged
Bronchiectasis
Hypogammaglobulinaemia
Virus Diseases
ILI
Influenza-like illness
Viruses
SGRQ
St George’s Respiratory Questionnaires
Female
Symptom Assessment
Primary antibody deficiency
Adult
medicine.medical_specialty
Primary Immunodeficiency Diseases
Population
SARSCoV2
ICAM-1
Intercellular adhesion molecule 1
Respiratory Mucosa
Lower risk
Article
Young Adult
Internal medicine
Streptococcus pneumoniae
Humans
Immunodeficiency
SRE
Symptomatic Respiratory Exacerbation
education
Aged
QoL
Quality of Life
SARSCoV2
Severe Acute Respiratory Syndrome Coronavirus 2
Bacteria
business.industry
Common variable immunodeficiency
Odds ratio
medicine.disease
Quality of Life
BIPAD
Burden of Infection in Primary Antibody Deficiency
business
Zdroj: The Journal of Allergy and Clinical Immunology. in Practice
ISSN: 2213-2201
2213-2198
Popis: Background Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections but our understanding of their nature and consequences remains limited. Objective To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls. Methods Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets. Results 44 patients and 42 controls (including 34 household pairs) were recruited, providing over 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrolment, 64% of patients received prophylactic antibiotics with a 34% prevalence of bronchiectasis. On average, PAD patients experienced symptomatic respiratory exacerbations every 6 days compared to 6 weeks for controls, associated with significant impairment of respiratory-specific quality of life scores. Viral detections were associated with worsening of symptom scores from a participant’s baseline. PAD patients had increased odds ratio (OR) for pathogen detection, particularly viral (OR 2.73; 95% CI: 2.09 to 3.57), specifically human rhinovirus HRV (OR 3.60; 2.53-5.13), and parainfluenza (OR 3.06; 1.25-7.50). H. influenzae and S. pneumonia were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR. Conclusion PAD patients have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the PAD-population, and informs future study design.
Highlights 1. What is already known about this topic? Immunoglobulin replacement therapy (IgRT) is a central treatment for primary antibody deficiency patients with a major impact on lower airway infections, however recurrent upper airway infections remain a major challenge despite individualised IgRT dosing. 2. What does this article add to our knowledge? This is the largest upper airway infection study in PAD over 12 months with controls and comparative national sentinel sampling data. It identifies recurrent chronic upper respiratory infection and symptoms from a restricted pathogen subset, despite frequent use of prophylactic antibiotics and individualised IgRT dosing. 3. How does this study impact current management guidelines? The study impacts current guidelines by the identification of the key pathogens, immunological and social risk factors, the effect of prophylactic antibiotics and the requirement for novel treatments to address this unmet clinical need.
Databáze: OpenAIRE
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