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lüll Chronic granulomatous disease in pediatric patients: 25 years of experience Soler-Palacin P; Margareto C; Llobet P; Asensio O; Hernandez M; Caragol I; Espanol TAllergol Immunopathol (Madr) 2007[May]; 35 (3): 83-9INTRODUCTION: Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency (affecting 1/200,000 newborn infants) caused by a defect in phagocyte production of oxygen metabolites, and resulting in bacterial infections produced by catalase-positive microorganisms and fungal diseases that occasionally may prove fatal. METHODS: A review is made of the clinical records of 13 pediatric patients diagnosed with CGD between 1980 and 2005. RESULTS: All patients were males. The mean age at diagnosis was 36 months. The clinical manifestations at the time of diagnosis comprised the following: Abscesses or abscessified adenopathies 4/13 (Staphylococcus aureus (2), Serratia liquefaciens, S. marcescens and Klebsiella sp.), pneumonia 3/13 (Rhodococcus equi, Salmonella typhimurium plus Pneumocystis jiroveci), osteomyelitis 1/13 (Aspergillus sp.), sepsis 1/13 (S. aureus), urinary infection 1/13 (Klebsiella sp.), severe gastroenteritis 1/13, oral aphthae 1/13 and Crohn-like inflammatory bowel disease 1/13. The diagnosis was initially established by the nitroblue tetrazolium test, and confirmed by flow cytometry 10/13 and genetic techniques (gp91) 9/13. In the course of these disease processes there were 88 infections: abscesses (n = 26), lymphadenitis (n = 12), pneumoniae (n = 10), gastroenteritis (n = 7), sepsis (n = 6), osteomyelitis (n = 3) and others (n = 24). As to the germs isolated, the frequency distribution was as follows (n = 49): Aspergillus sp. (n = 10), Staphylococcus sp. (n = 7), Salmonella sp. (n = 6), Serratia sp. (n = 5), Pseudomonas aeruginosa (n = 4), Klebsiella sp. (n = 4), Proteus sp. (n = 3), Leishmania sp. (n = 2) and others (n = 8). IFN-gamma was administered in 7/13 cases, and itraconazole in 9/13; all received cotrimoxazole. There were four deaths, with one case each of sepsis due to gramnegative bacterial infection; disseminated aspergillosis; visceral leishmaniasis and hemophagocytosis; and post-kidney transplant complications. CONCLUSIONS: Clinical suspicion and flow cytometry are the keys for diagnosis of CGD and detection of carrier relatives. Specific prophylactic measures and medical controls are required to prevent serious infections. IFN-gamma has been used intermittently, though its effectiveness is controversial.|Adolescent[MESH]|Antibiotic Prophylaxis[MESH]|Child[MESH]|Child, Preschool[MESH]|Flow Cytometry[MESH]|Genetic Carrier Screening[MESH]|Granulomatous Disease, Chronic/complications/diagnosis/*epidemiology[MESH]|Humans[MESH]|Immunocompromised Host[MESH]|Infant[MESH]|Infant, Newborn[MESH]|Interferon-gamma/therapeutic use[MESH]|Itraconazole/administration & dosage/therapeutic use[MESH]|Male[MESH]|Nitroblue Tetrazolium[MESH]|Opportunistic Infections/etiology/microbiology/parasitology/prevention & control[MESH]|Recurrence[MESH]|Retrospective Studies[MESH]|Rhodamines[MESH]|Spain/epidemiology[MESH]|Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage/therapeutic use[MESH] |