Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome

Yıl: 2021 Cilt: 11 Sayı: 2 Sayfa Aralığı: 181 - 187 Metin Dili: İngilizce DOI: 10.5222/buchd.2021.72325 İndeks Tarihi: 14-02-2022

Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome

Öz:
Objective: Infections are an important cause of morbidity and mortality for patients with congenital neutropenia. In the present study, we report on the incidence, type, localization of documented infections, as well as the clinical features and long-term outcome in patients with congenital neutropenia in our clinic. Method: We performed a retrospective chart review of children with neutropenia seen at our hospital from 2000-2018. The data of 15 patients with congenital neutropenia were included in this study. Clinical and laboratory data were analyzed retrospectively using patients’ files and an electronic data system. Results: The median age at diagnosis was 34 months (range, four months- 150 months) and the median follow-up time was 48 months (range, 13-179 months). The leading causes of hospital admission before the establishment of the diagnosis were upper respiratory tract infection in six, pneumonia in four, gingival stomatitis in three and soft tissue infection in two patients. We reached the documented 74 hospitalization episodes and the most common reasons for hospitalization were pneumonia (35%), fever (21%), stomatitis (16%), cutaneous and deep soft tissue infections (12%). Conclusion: The management of infectious complications in children with congenital neutropenia is crucial. Early diagnosis is essential to prevent infections and permanent organ damage. Congenital neutropenia should be suspected in patients with a history of frequent upper respiratory tract infection, and necessary investigations should be performed accordingly. However, it should be kept in mind that the clinical findings of the patients may vary despite having the same mutation.
Anahtar Kelime:

Konjenital Nötropenili Çocuklarda Enfeksiyon Ataklarının, Tedavi ve Uzun Dönem Sonuçlarının Değerlendirilmesi

Öz:
Amaç: Enfeksiyonlar konjenital nötropeni hastalarında önemli bir morbidite ve mortalite nedenidir. Bu çalışmada konjenital nötropeni hastalarının geçirdiği enfeksiyon ataklarının sıklığını, tipini ve bölgesini klinik bulgular ve uzun dönem sonuçları ile birlikte değerlendirdik. Yöntem: Hastanemizde 2000-2018 yılları arasında konjenital nötropeni tanısı ile takip edilen 15 hasta çalışmaya alındı. Hastalara ait klinik ve laboratuvar bilgileri hasta dosyaları ve elektronik kayıt sistemi kullanılarak retrospektif olarak incelendi. Bulgular: Çalışmaya dahil edilen 15 hastanın (6 erkek, 9 kız) medyan tanı yaşı 34 ay (aralık, 4 ay - 150 ay), medyan izlem süresi 48 ay (aralık, 13 ay -179 ay) idi. Hastaların tanı öncesi en sık hastaneye başvuru nedeni 6 hastada üst solunum yolu enfeksiyonu, 4’ünde alt solunum yolu enfeksiyonu, 3’ünde stomatit ve 2’sinde cilt bulguları idi. Yetmiş dört hastane yatış episoduna ulasıldı. En sık hospitalizasyon nedeni alt solunum yolu enfeksiyonu (%35), ateş (%21), stomatit (%16), cilt ve derin doku enfeksiyonu (%12) idi. Sonuç: Konjenital nötropenili hastalarda enfeksiyonların yönetimi çok önemlidir. Erken tanı, enfeksiyon ataklarını ve kalıcı organ hasarını önlemek için gereklidir. Sık üst solunum yolu enfeksiyonu geçiren hastalarda konjenital nötropeniden şüphelenilmeli ve gerekli araştırmalar yapılmalıdır. Aynı mutasyonu taşımalarına rağmen klinik bulguların değişken olabileceği akılda tutulmalıdır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Shu Z, Li XH, Bai XM, Zhang ZY, Jiang LP, Tang XM, et al. Clinical characteristics of severe congenital neutropenia caused by novel ELANE gene mutations. Pediatr Infect Dis J. 2015;34(2):203-7. https://doi.org/10.1097/INF.0000000000000522 2. Lee N, Lee BC. Incidence of severe chronic neutropenia in South Korea and related clinical manifestations: A National Health Insurance Database Study. Medicina (Kaunas). 2020;56(6):262. https://doi.org/10.3390/medicina56060262 3. Donadieu J, Beaupain B, Mahlaoui N, Bellanné-Chantelot C. Epidemiology of Congenital Neutropenia. Hematol Oncol Clin N Am 2013;27:1-17. https://doi.org/10.1016/j.hoc.2012.11.003 4. Fioredda F, Calvillo M, Burlando O, Riccardi F, Caviglia I, Tucci F, et al. Infectious complications in children with severe congenital, autoimmune or idiopathic neutropenia: a retrospective study from the Italian Neutropenia Registry. Pediatr Infect Dis J. 2013;32(4):410-2. https://doi.org/10.1097/INF.0b013e3182814b5a 5. Fioredda F, Calvillo M, Lanciotti M, Cefalo MG, Tucci F, Farruggia P,et al. Lethal sepsis and malignant transformation in severe congenital neutropenia: report from the Italian Neutropenia Registry. Pediatr Blood Cancer. 2015;62(6):1110-2. https://doi.org/10.1002/pbc.25401
  • 6. Donadieu J, Leblanc T, Bader Meunier B, Barkaoui M, Fenneteau O, Bertrand Y, et al. Analysis of risk factors for myelodysplasias, leukemias and death from infection among patients with congenital neutropenia. Experience of the French Severe Chronic Neutropenia Study Group. Haematologica. 2005;90(1):45-53. 7. Saettini F, Mantovani P, De Lorenzo P, Biondi A, Bonanomi S. Severe and recurrent infections identify severe congenital neutropenia and primary immunodeficiencies in pediatric isolated neutropenia. Clin Immunol. 2021;223:108643. https://doi.org/10.1016/j.clim.2020.108643 8. Aydogmus C, Cipe F, Tas M, Akinel A, Öner Ö, Keskindemirci G, et al. HAX-1 deficiency: Characteristics of five cases including an asymptomatic patient. Asian Pac J Allergy Immunol. 2016;34(1):73-6. https://doi.org/10.12932/AP0618.34.1.2016
  • 9. Yılmaz Karapınar D, Patıroğlu T, Metin A, Çalışkan Ü, Celkan T, Yılmaz B, et al. Homozygous c.130-131 ins A (pW44X) mutation in the HAX1 gene as the most common cause of congenital neutropenia in Turkey: Report from the Turkish Severe Congenital Neutropenia Registry. Pediatr Blood Cancer. 2019;66(10):e27923. https://doi.org/10.1002/pbc.27923
  • 10. Cho HK, Jeon IS. Different clinical phenotypes in familial severe congenital neutropenia cases with same mutation of the ELANE gene. J Korean Med Sci. 2014;29(3):452-5. https://doi.org/10.3346/jkms.2014.29.3.452
  • 11. Karapınar TH, Yılmaz Karapinar D, Oymak Y, Ay Y, Demirağ B, Aykut A, et al. HAX1 mutation positive children presenting with haemophagocytic lymphohistiocytosis. Br J Haematol. 2017;177(4):597-600. https://doi.org/10.1111/bjh.14574
  • 12. Xia J, Bolyard AA, Rodger E, Stein S, Aprikyan AA, Dale DC, et al. Prevalence of mutations in ELANE, GFI1, HAX1, SBDS, WAS and G6PC3 in patients with severe congenital neutropenia. Br J Haematol. 2009;147(4):535-42. https://doi.org/10.1111/j.1365-2141.2009.07888.x
  • 13. Dhanraj S, Matveev A, Li H, Lauhasurayotin S, Jardine L, Cada M, et al. Biallelic mutations in DNAJC21 cause ShwachmanDiamond syndrome. Blood. 2017;16;129(11):1557-62. https://doi.org/10.1182/blood-2016-08-735431
  • 14. Donadieu J, Beaupain B, Fenneteau O, Bellanné-Chantelot C. Congenital neutropenia in the era of genomics: classification, diagnosis, and natural history. Br J Haematol. 2017;179(4): 557-74. https://doi.org/10.1111/bjh.14887
  • 15. Bellanné-Chantelot C, Schmaltz-Panneau B, Marty C, Fenneteau O, Callebaut I, Clauin S, et al. Mutations in the SRP54 gene cause severe congenital neutropenia as well as Shwachman-Diamond-like syndrome. Blood. 2018;132(12): 1318-31. https://doi.org/10.1182/blood-2017-12-820308
  • 16. Boxer LA, Newburger PE. A molecular classification of congenital neutropenia syndromes. Pediatr Blood Cancer. 2007;49(5):609-14. https://doi.org/10.1002/pbc.21282
  • 17. Zeidler C, Germeshausen M, Klein C, Welte K. Clinical implications of ELA2-, HAX1-, and G-CSF-receptor (CSF3R) mutations in severe congenital neutropenia. Br J Haematol. 2009;144(4):459-67. https://doi.org/10.1111/j.1365-2141.2008.07425.x
  • 18. Boztug K, Appaswamy G, Ashikov A, Schäffer AA, Salzer U, Diestelhorst J, et al. A syndrome with congenital neutropenia and mutations in G6PC3. N Engl J Med. 2009;360(1):32-43. https://doi.org/10.1056/NEJMoa0805051
  • 19. Boztug K, Klein C. Genetic etiologies of severe congenital neutropenia. Curr Opin Pediatr. 2011;23(1):21-26. https://doi.org/10.1097/MOP.0b013e32834262f8
  • 20. Link DC. Mechanisms of leukemic transformation in congenital neutropenia. Curr Opin Hematol. 2019;26(1):34- 40. https://doi.org/10.1097/MOH.0000000000000479
  • 21. Chou JY, Jun HS, Mansfield BC. Neutropenia in type Ib glycogen storage disease. Curr Opin Hematol. 2010 Jan;17(1):36-42. https://doi.org/10.1097/MOH.0b013e328331df85
  • 22. Donini M, Fontana S, Savoldi G, Vermi W, Tassone L, Gentili F, et al. G-CSF treatment of severe congenital neutropenia reverses neutropenia but does not correct the underlying functional deficiency of the neutrophil in defending against microorganisms. Blood. 2007;109(11):4716-23. https://doi.org/10.1182/blood-2006-09-045427
  • 23. Goenka A, Doherty JA, Al-Farsi T, Jagger C, Banka S, Cheesman E, Fagbemi A, Hughes SM, Wynn RF, Hussell T, Arkwright PD. Neutrophil dysfunction triggers inflammatory bowel disease in G6PC3 deficiency. J Leukoc Biol. 2020 Sep 15. Epub ahead of print. PMID: 32930428. https://doi.org/10.1002/JLB.5AB1219-699RR
  • 24. Rosenberg PS, Alter BP, Bolyard AA, Bonilla MA, Boxer LA, Cham B, et al. Severe Chronic Neutropenia International Registry. The incidence of leukemia and mortality from sepsis in patients with severe congenital neutropenia receiving long-term G-CSF therapy. Blood. 2006;107(12): 4628-35. https://doi.org/10.1182/blood-2005-11-4370
  • 25. Skokowa J, Dale DC, Touw IP, Zeidler C, Welte K. Severe congenital neutropenias. Nat Rev Dis Primers. 2017;3:17032. https://doi.org/10.1038/nrdp.2017.32
APA Odaman Al I, Oymak Y, Karapınar T, Gözmen S, Tahta N, ERDEM M, okur acar s, çağlar i, Bayram N, devrim i (2021). Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. , 181 - 187. 10.5222/buchd.2021.72325
Chicago Odaman Al Işık,Oymak Yeşim,Karapınar Tuba Hilkay,Gözmen Salih,Tahta Neryal,ERDEM MELEK,okur acar sultan,çağlar ilknur,Bayram Nuri,devrim ilker Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. (2021): 181 - 187. 10.5222/buchd.2021.72325
MLA Odaman Al Işık,Oymak Yeşim,Karapınar Tuba Hilkay,Gözmen Salih,Tahta Neryal,ERDEM MELEK,okur acar sultan,çağlar ilknur,Bayram Nuri,devrim ilker Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. , 2021, ss.181 - 187. 10.5222/buchd.2021.72325
AMA Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. . 2021; 181 - 187. 10.5222/buchd.2021.72325
Vancouver Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. . 2021; 181 - 187. 10.5222/buchd.2021.72325
IEEE Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i "Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome." , ss.181 - 187, 2021. 10.5222/buchd.2021.72325
ISNAD Odaman Al, Işık vd. "Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome". (2021), 181-187. https://doi.org/10.5222/buchd.2021.72325
APA Odaman Al I, Oymak Y, Karapınar T, Gözmen S, Tahta N, ERDEM M, okur acar s, çağlar i, Bayram N, devrim i (2021). Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi, 11(2), 181 - 187. 10.5222/buchd.2021.72325
Chicago Odaman Al Işık,Oymak Yeşim,Karapınar Tuba Hilkay,Gözmen Salih,Tahta Neryal,ERDEM MELEK,okur acar sultan,çağlar ilknur,Bayram Nuri,devrim ilker Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi 11, no.2 (2021): 181 - 187. 10.5222/buchd.2021.72325
MLA Odaman Al Işık,Oymak Yeşim,Karapınar Tuba Hilkay,Gözmen Salih,Tahta Neryal,ERDEM MELEK,okur acar sultan,çağlar ilknur,Bayram Nuri,devrim ilker Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi, vol.11, no.2, 2021, ss.181 - 187. 10.5222/buchd.2021.72325
AMA Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2021; 11(2): 181 - 187. 10.5222/buchd.2021.72325
Vancouver Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2021; 11(2): 181 - 187. 10.5222/buchd.2021.72325
IEEE Odaman Al I,Oymak Y,Karapınar T,Gözmen S,Tahta N,ERDEM M,okur acar s,çağlar i,Bayram N,devrim i "Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome." İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi, 11, ss.181 - 187, 2021. 10.5222/buchd.2021.72325
ISNAD Odaman Al, Işık vd. "Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome". İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi 11/2 (2021), 181-187. https://doi.org/10.5222/buchd.2021.72325