Fungal infections in primary immunodeficiencies

Charalampos Antachopoulos, Thomas J. Walsh, Emmanuel Roilides

Research output: Contribution to journalArticle

Abstract

Patients with phagocytic, cellular, combined and other primary immunodeficiencies exhibit immune deficits that confer increased susceptibility to fungal infections. A number of yeasts and moulds, most commonly Candida and Aspergillus but also Cryptococcus, Histoplasma, Paecilomyces, Scedosporium, Trichosporon, Penicillium and other, rarely isolated, fungal organisms, have been variably implicated in causing disease in patients with chronic granulomatous disease, severe combined immunodeficiency, chronic mucocutaneous candidiasis, hyper-IgE syndrome, myeloperoxidase deficiency, leukocyte adhesion deficiency, defects in the interferon-γ/interleukin-12 axis, DiGeorge syndrome, X-linked hyper-IgM syndrome, Wiskott-Aldrich syndrome and common variable immunodeficiency. Differences in the spectrum of fungal pathogens as well as in the incidence and clinical presentation of the infections may be observed among patients, depending upon different immune disorders. Fungal infections in these individuals may occasionally be the presenting clinical manifestation of a primary immunodeficiency and can cause significant morbidity and potentially fatal outcome if misdiagnosed or mistreated. A high degree of suspicion is needed and establishment of diagnosis should actively be pursued using appropriate imaging, mycological and histological studies. A number of antifungal agents introduced over the last fifteen years, such as the lipid formulations of amphotericin B, the second-generation triazoles, and the echinocandins, increase the options for medical management of these infections. Surgery may also be needed in some cases, while the role of adjunctive immunotherapy has not been systematically evaluated. The low incidence of primary immunodeficiencies in the general population complicates single-center prospective or retrospective clinical studies aiming to address diagnostic or therapeutic issues pertaining to fungal infections in these patients.

Original languageEnglish (US)
Pages (from-to)1099-1117
Number of pages19
JournalEuropean Journal of Pediatrics
Volume166
Issue number11
DOIs
StatePublished - Nov 2007
Externally publishedYes

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Mycoses
Type 1 Hyper-IgM Immunodeficiency Syndrome
Chronic Mucocutaneous Candidiasis
Job Syndrome
Scedosporium
Paecilomyces
Wiskott-Aldrich Syndrome
Echinocandins
Trichosporon
Common Variable Immunodeficiency
DiGeorge Syndrome
Histoplasma
Chronic Granulomatous Disease
Cryptococcus
Severe Combined Immunodeficiency
Triazoles
Fatal Outcome
Antifungal Agents
Penicillium
Immune System Diseases

Keywords

  • Antifungal agents
  • Aspergillus
  • Candida
  • Fungal infections
  • Primary immunodeficiencies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Antachopoulos, C., Walsh, T. J., & Roilides, E. (2007). Fungal infections in primary immunodeficiencies. European Journal of Pediatrics, 166(11), 1099-1117. https://doi.org/10.1007/s00431-007-0527-7

Fungal infections in primary immunodeficiencies. / Antachopoulos, Charalampos; Walsh, Thomas J.; Roilides, Emmanuel.

In: European Journal of Pediatrics, Vol. 166, No. 11, 11.2007, p. 1099-1117.

Research output: Contribution to journalArticle

Antachopoulos, C, Walsh, TJ & Roilides, E 2007, 'Fungal infections in primary immunodeficiencies', European Journal of Pediatrics, vol. 166, no. 11, pp. 1099-1117. https://doi.org/10.1007/s00431-007-0527-7
Antachopoulos, Charalampos ; Walsh, Thomas J. ; Roilides, Emmanuel. / Fungal infections in primary immunodeficiencies. In: European Journal of Pediatrics. 2007 ; Vol. 166, No. 11. pp. 1099-1117.
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