[CIS PIDD] [cis-pidd] XLA, Bronchiectasis, Chronic sinsusitis

[CIS-PIDD]

 Gelfand EW.  Unique susceptibility to
mycoplasma infection in patients with antibody deficiency.  Clin
Infect Dis 17:250-253, 1993





Erwin W. Gelfand, M.D.
Department of Pediatrics
National Jewish Health
1400 Jackson Street
Denver, CO 80206
Ph: 303-398-1196
Fax: 303-270-2105
E-mail: gelfande at njhealth.org










On 4/13/17, 11:27 AM, "cis-pidd at lyris.dundee.net on behalf of CIS-PIDD"
<cis-pidd at lyris.dundee.net on behalf of cis-pidd at lists.clinimmsoc.org>
wrote:

>Hi Dr. Kumar,
>
>I would consider doing sputum cx looking for Campylobacter species such
>Helicobacter and Flexispira (although more in GI, they have been reported
>in the lung in XLA), they require selective media ( blood/blood products
>or egg yolk emulsion) to grow on, and it grows slowly .Sometimes it will
>be only detected by PCR. Below is a reference for your consideration
>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165598/
>
>Good luck!
>Joud
>
>Joud Hajjar MD
>Assistant Professor of Medicine
>Service Chief, Adult Allergy and Immunology
>Baylor College of Medicine and Texas Children's Hospital
>Section of Immunology, Allergy & Rheumatology
>joud.hajjar at bcm.edu
> 
> 
>1102 Bates FC 330
>Houston, TX 77303
>Office: 832-824-2595
>Fax :   832-825-1260
> 
>
>On 4/13/17, 10:48 AM, "cis-pidd at lyris.dundee.net on behalf of CIS-PIDD"
><cis-pidd at lyris.dundee.net on behalf of cis-pidd at lists.clinimmsoc.org>
>wrote:
>
>    Hi Everyone,
>    Any thoughts regarding this case is greatly appreciated.
>      I have a now 8-year-old male with XLA (BTK gene mutation confirmed)
>on IVIG replacement.  He has bronchiectasis in the lower lobes, chronic
>rhinosinusitis status post sinus surgery x 1. His trough IgG level have
>been >800mg/dl. 
>    
>    My questions are:
>    1. Pt has had chronic cough likely related to his bronchiectasis and
>his chronic rhinosinusitis and we have been unsuccessful in treating it
>in spite of doing chest physical therapy, asthma controller medication,
>sinus surgery, saline rinse, Tobramycin rinse. Pt has been treated with
>multiple courses of antibiotics in the past with no significant relief of
>symptoms. ENT is recommending one more sinus surgery but I am hesitant as
>the first one did not help. His direct sinus cultures have not yielded
>much except for occasional scant growth of H.Influence.  Anything else we
>could do to help this little guy.
>    
>    2. He also has this weird history of yellow mucus coming from his
>eyes on and off with evidence of conjunctival injection. This discharge
>is more visible when he sneezes and coughs. He was checked by an
>ophthalmologist who ruled out lacrimal duct obstruction. ENT thinks this
>is related to his chronic sinusitis and the constant yellow drainage he
>has in his nose. Any thoughts?
>    
>    Thank you,
>    
>    Santhosh Kumar, MD, FAAAI
>    Assistant Professor
>    Children's Hospital of Richmond at VCU
>    VCU Heath
>    Richmond, VA
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