Summary An international group of multidisciplinary experts on middle-ear and paediatric infections met to explore where consensus exists on the management of acute otitis media. After informal ...discussions among several specialists of paediatric infectious disease, the group was expanded to include a larger spectrum of professionals with complementary expertise in middle-ear disease. Acute otitis media is a very common bacterial infection in children worldwide, leading to excessive antibiotic consumption in children in most countries and to a substantial burden of deafness and suppurative complications in developing countries. The group attempted to move beyond the existing controversies surrounding guidelines on acute otitis media, and to propose to clinicians and public health officials their views on the actions needed to be taken to reduce the disease burden caused by acute otitis media and the microbial antibiotic resistance from the resulting use of antibiotics. Definition of acute otitis media and diagnostic accuracy are crucial steps to identify children who will potentially benefit from treatment with antibiotics and to eliminate unnecessary prescribing. Although the group agreed that antibiotics are distributed indiscriminately, even to children who do not seem to have the disease, no consensus could be reached on whether antibiotics should be given to all appropriately diagnosed children, reflecting the wide range of practices and lack of convincing evidence from observational studies. The major unanimous concern was an urgent need to reduce unnecessary prescribing of antibiotics to prevent further increases in antibiotic resistance. Prevention of acute otitis media with existing and future viral and bacterial vaccines seems the most promising approach to affect disease burden and consequences, both in developed and developing countries.
Background CD27 is a lymphocyte costimulatory molecule that regulates T-cell, natural killer (NK) cell, B-cell, and plasma cell function, survival, and differentiation. On the basis of its function ...and expression pattern, we considered CD27 a candidate gene in patients with hypogammaglobulinemia. Objective We sought to describe the clinical and immunologic phenotypes of patients with genetic CD27 deficiency. Methods A molecular and extended immunologic analysis was performed on 2 patients lacking CD27 expression. Results We identified 2 brothers with a homozygous mutation in CD27 leading to absence of CD27 expression. Both patients had persistent symptomatic EBV viremia. The index patient was hypogammaglobulinemic, and immunoglobulin replacement therapy was initiated. His brother had aplastic anemia in the course of his EBV infection and died from fulminant gram-positive bacterial sepsis. Immunologically, lack of CD27 expression was associated with impaired T cell–dependent B-cell responses and T-cell dysfunction. Conclusion Our findings identify a role for CD27 in human subjects and suggest that this deficiency can explain particular cases of persistent symptomatic EBV viremia with hypogammaglobulinemia and impaired T cell–dependent antibody generation.
...the most prevalent comorbidities in adult CVID are recurrent pneumonia (32%) and chronic lung disease (28%), with lung failure being the most prevalent cause of death.1 Pulmonary comorbidities ...include structural airway disease (AD) due to recurrent pulmonary infections and interstitial lung disease (ILD), in particular in patients with autoimmune phenomena.2 Both disease entities are well detected by high-resolution computed tomography (CT).2,3 In this study, we investigated progression of pulmonary disease in pediatric and in adult CVID patients in a 3- to 5-year follow-up period using a uniform CT scanning and scoring protocol.4,5 Pediatric and adult CVID patients were allocated to low- or high-risk profiles for AD and/or ILD disease progression. In support of the increased AD scores, we found that the AD score progression correlated to a decrease in predicted FEV1/forced vital capacity percentage (FVC%), although still within normal range in the group with low AD scores at baseline (r = −0.6; P = .048) (see Fig E1 in this article's Online Repository at www.jacionline.org). ...the AD score increase could not be predicted by upper or lower respiratory tract infection episodes or by abnormal PFTs. Because no radiologically proven pneumonias occurred during follow-up time and immunological phenotypes were normal in most cases in this group, we explored whether treatment parameters influenced AD score progression. Low-risk children High-risk children High-risk adults Total AB prophylaxis Continuous use 4/19 (21) 6/13 (46) 1/23 (4) 11/55 (20) Stopped during FU 9/19 (47) 5/13 (39) 7/23 (30) 21/55 (38) None 6/19 (32) 2/13 (15) 15/23...
Since his treatment, the clinical condition had improved. Because of Cryptosporidium parvum-related diarrhea, progressive lymphopenia, and failure to thrive, bone marrow transplantation was performed ...at the age of 8 years.
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