BACTERIAL AND VIRAL PULMONARY INFECTIONS IN PRIMARY IMMUNODEFICIENCIES

Seçim Kolak1 Sümeyra Alan Yalım2

1Konya Necmettin Erbakan University, Faculty of Medicine, Department of Immunology and Allergic Diseases, Konya, Türkiye
2Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Immunology and Allergic Diseases, Afyonkarahisar, Türkiye

Kolak S, Alan Yalım S. Bacterial and Viral Pulmonary Infections in Primary Immunodeficiencies. In: Arslan Ş editor. Pulmonary Pathologies and Management Strategies in Primary Immunodeficiencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.33-43.

ABSTRACT

One of the most prominent clinical features of primary immunodeficiencies (PIDs) is the increased susceptibility to recurrent and severe pulmonary infections of bacterial and viral origin. These infections often constitute the earliest clinical manifestations of PIDs and significantly contribute to long-term morbidities such as bronchiectasis and interstitial lung disease. This chapter reviews the clinical characteristics, immunopathogenesis, and diagnostic approaches of bacterial and viral respiratory infections in PIDs. It also discusses infection patterns associated with distinct immunological defects and emphasizes the importance of early diagnosis, targeted antimicrobial therapy, and long-term respiratory monitoring. A better understanding of these infections in the context of PIDs is crucial for improving clinical outcomes and guiding personalized treatment strategies.

Keywords: Primary immunodeficiency; Pulmonary infections; Bacterial and viral respiratory infections; Bronchiectasis; Interstitial lung disease; Antimicrobial therapy

Referanslar

  1. Poli MC, Aksentijevich I, Bousfiha AA, Cunningham-Rundles C, Hambleton S, Klein C, et al. Human inborn errors of immunity: 2024 update on the classification from the International Union of Immunological Societies Expert Committee. Journal of Human Immunity. 2025;1(1). [Crossref]
  2. Gathmann B, Mahlaoui N, Gérard L, Oksenhendler E, Warnatz K, Schulze I, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. The Journal of allergy and clinical immunology. Jul 2014;134(1):116-26. [Crossref]  [PubMed]
  3. Cinetto F, Scarpa R, Carrabba M, Firinu D, Lougaris V, Buso H, et al. Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID): A Multicenter Retrospective Study of Patients From Italian PID Referral Centers. Frontiers in immunology. 2021;12:627423. [Crossref]  [PubMed]  [PMC]
  4. Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham-Rundles C, de la Morena MT, et al. International Consensus Document (ICON): Common Variable Immunodeficiency Disorders. The journal of allergy and clinical immunology In practice. Jan-Feb 2016;4(1):38-59. [Crossref]  [PubMed]  [PMC]
  5. Notarangelo LD. Primary immunodeficiencies. The Journal of allergy and clinical immunology. Feb 2010;125(2 Suppl 2):S182-94. [Crossref]  [PubMed]
  6. Walport MJ. Complement. First of two parts. The New England journal of medicine. Apr 5 2001;344(14):1058-66. [Crossref]  [PubMed]
  7. Seger RA. Modern management of chronic granulomatous disease. British journal of haematology. Feb 2008;140(3):255-66. [Crossref]  [PubMed]
  8. von Bernuth H, Picard C, Jin Z, Pankla R, Xiao H, Ku CL, et al. Pyogenic bacterial infections in humans with MyD88 deficiency. Science (New York, NY). Aug 1 2008;321(5889):691-6. [Crossref]  [PubMed]  [PMC]
  9. Al-Herz W, Bousfiha A, Casanova JL, Chapel H, Conley ME, Cunningham-Rundles C, et al. Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency. Frontiers in immunology. 2011;2:54.
  10. Chapel H, Lucas M, Lee M, Bjorkander J, Webster D, Grimbacher B, et al. Common variable immunodeficiency disorders: division into distinct clinical phenotypes. Blood. Jul 15 2008;112(2):277-86. [Crossref]  [PubMed]
  11. Sun R, Sun L, Bao M, Zhang Y, Wang L, Wu X, et al. A human microsatellite DNA-mimicking oligodeoxynucleotide with CCT repeats negatively regulates TLR7/9-mediated innate immune responses via selected TLR pathways. Clinical immunology (Orlando, Fla). Mar 2010;134(3):262-76. [Crossref]  [PubMed]  [PMC]
  12. Bousfiha A, Jeddane L, Picard C, Ailal F, Bobby Gaspar H, Al-Herz W, et al. The 2017 IUIS Phenotypic Classification for Primary Immunodeficiencies. Journal of clinical immu nology. Jan 2018;38(1):129-143. [Crossref]  [PubMed]  [PMC]
  13. Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C, et al. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. Journal of clinical immunology. May 2007;27(3):308-16. [Crossref]  [PubMed]
  14. Seidel MG, Kindle G, Gathmann B, Quinti I, Buckland M, van Montfrans J, et al. The European Society for Immunodeficiencies (ESID) Registry Working Definitions for the Clinical Diagnosis of Inborn Errors of Immunity. The journal of allergy and clinical immunology In practice. Jul-Aug 2019;7(6):1763-1770.
  15. Oksenhendler E, Gérard L, Fieschi C, Malphettes M, Mouillot G, Jaussaud R, et al. Infections in 252 patients with common variable immunodeficiency. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. May 15 2008;46(10):1547-54. [Crossref]  [PubMed]
  16. Dropulic LK, Cohen JI. Severe viral infections and primary immunodeficiencies. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Nov 2011;53(9):897-909. [Crossref]  [PubMed]  [PMC]
  17. Cinetto F, Scarpa R, Pulvirenti F, Quinti I, Agostini C, Milito C. Appropriate lung management in patients with primary antibody deficiencies. Expert review of respiratory medicine. Sep 2019;13(9):823-838.085. [Crossref]  [PubMed]
  18. Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. The Journal of allergy and clinical immunology. Nov 2015;136(5):1186-205.e1-78.
  19. Holland SM. Chronic granulomatous disease. Clinical reviews in allergy & immunology. Feb 2010;38(1):3-10. [Crossref]  [PubMed]
  20. Kainulainen L, Vuorinen T, Rantakokko-Jalava K, Osterback R, Ruuskanen O. Recurrent and persistent respiratory tract viral infections in patients with primary hypogammaglobulinemia. The Journal of allergy and clinical immunology. Jul 2010;126(1):120-6. [Crossref]  [PubMed]  [PMC]
  21. Ruffner MA, Sullivan KE, Henrickson SE. Recurrent and Sustained Viral Infections in Primary Immunodeficiencies. Frontiers in immunology. 2017;8:665. [Crossref]  [PubMed]  [PMC]
  22. Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoietic cell transplant recipients. Blood. Jun 4 2009;113(23):5711-9. [Crossref]  [PubMed]  [PMC]
  23. Lucas CL, Chandra A, Nejentsev S, Condliffe AM, Okkenhaug K. PI3K and primary immunodeficiencies. Nature reviews Immunology. Nov 2016;16(11):702-714. [Crossref]  [PubMed]  [PMC]
  24. Holland SM, DeLeo FR, Elloumi HZ, Hsu AP, Uzel G, Brodsky N, et al. STAT3 mutations in the hyper-IgE syndrome. The New England journal of medicine. Oct 18 2007;357(16):1608-19. [Crossref]  [PubMed]
  25. Stremenova Spegarova J, Lawless D, Mohamad SMB, Engelhardt KR, Doody G, Shrimpton J, et al. Germline TET2 loss of function causes childhood immunodeficiency and lymphoma. Blood. Aug 27 2020;136(9):1055-1066. [Crossref]  [PubMed]
  26. Payne F, Colnaghi R, Rocha N, Seth A, Harris J, Carpenter G, et al. Hypomorphism in human NSMCE2 linked to primordial dwarfism and insulin resistance. The Journal of clinical investigation. Sep 2014;124(9):4028-38. [Crossref]  [PubMed]  [PMC]
  27. Coulter TI, Chandra A, Bacon CM, Babar J, Curtis J, Screaton N, et al. Clinical spectrum and features of activated phosphoinositide 3-kinase  syndrome: A large patient cohort study. The Journal of allergy and clinical immunology. Feb 2017;139(2):597-606.e4. [Crossref]  [PubMed]  [PMC]
  28. Spencer S, Köstel Bal S, Egner W, Lango Allen H, Raza SI, Ma CA, et al. Loss of the interleukin-6 receptor causes immunodeficiency, atopy, and abnormal inflammatory responses. The Journal of experimental medicine. Sep 2 2019;216(9):1986-1998. [Crossref]  [PubMed]  [PMC]
  29. Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science (New York, NY). Oct 23 2020;370(6515).
  30. Zhang Q, Bastard P, Liu Z, Le Pen J, Moncada-Velez M, Chen J, et al. Inborn errors of type I IFN immunity in patients with life-threatening COVID-19. Science (New York, NY). Oct 23 2020;370(6515) [Crossref]  [PubMed]  [PMC]
  31. de Vries E. Patient-centred screening for primary immunodeficiency, a multi-stage diagnostic protocol designed for non-immunologists: 2011 update. Clinical and experimental immunology. Jan 2012;167(1):108-19. [Crossref]  [PubMed]  [PMC]
  32. Tangye SG, Al-Herz W, Bousfiha A, Cunningham-Rundles C, Franco JL, Holland SM, et al. Human Inborn Errors of Immunity: 2022 Update on the Classification from the International Union of Immunological Societies Expert Committee. Journal of clinical immunology. Oct 2022;42(7):1473-1507. [Crossref]  [PubMed]  [PMC]
  33. Yazdani R, Habibi S, Sharifi L, Azizi G, Abolhassani H, Olbrich P, et al. Common Variable Immunodeficiency: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, Classification, and Management. Journal of investigational allergology & clinical immunology. 2020;30(1):14-34. [Crossref]  [PubMed]
  34. Bousfiha A, Jeddane L, Picard C, Al-Herz W, Ailal F, Chatila T, et al. Human Inborn Errors of Immunity: 2019 Update of the IUIS Phenotypical Classification. Journal of clinical immunology. Jan 2020;40(1):66-81. [Crossref]  [PubMed]  [PMC]
  35. Jolles S, Orange JS, Gardulf A, Stein MR, Shapiro R, Borte M, et al. Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease. Clinical and experimental immunology. Feb 2015;179(2):146-60. [Crossref]  [PubMed]  [PMC]
  36. Kwan A, Abraham RS, Currier R, Brower A, Andruszewski K, Abbott JK, et al. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. Jama. Aug 20 2014;312(7):729-38. [Crossref]  [PubMed]
  37. Sobh A, Bonilla FA. Vaccination in Primary Immunodeficiency Disorders. The journal of allergy and clinical immunology In practice. Nov-Dec 2016;4(6):1066-1075. [Crossref]  [PubMed]
  38. Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S, Chapel H. Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. The Journal of allergy and clinical immunology. Jun 2010;125(6):1354-1360.e4. [Crossref]  [PubMed]
  39. Freeman AF, Holland SM. The hyper-IgE syndromes. Immunology and allergy clinics of North America. May 2008;28(2):277-91, viii. [Crossref]  [PubMed]  [PMC]
  40. Meerburg JJ, Hartmann IJC, Goldacker S, Baumann U, Uhlmann A, Andrinopoulou ER, et al. Analysis of Granulomatous Lymphocytic Interstitial Lung Disease Using Two Scoring Systems for Computed Tomography Scans-A Retrospective Cohort Study. Frontiers in immunology. 2020;11:589148. [Crossref]  [PubMed]  [PMC]
  41. Bonilla FA. Personalized therapy for common variable immunodeficiency. Allergy and asthma proceedings. Jan 1 2020;41(1):19-25. [Crossref]  [PubMed]
  42. Picard C, Al-Herz W, Bousfiha A, Casanova JL, Chatila T, Conley ME, et al. Primary Immunodeficiency Diseases: an Update on the Classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015. Journal of clinical immunology. Nov 2015;35(8):696-726. [Crossref]  [PubMed]  [PMC]
  43. Cabanero-Navalon MD, Garcia-Bustos V, Forero-Naranjo LF, Baettig-Arriagada EJ, Núñez-Beltrán M, Cañada-Martínez AJ, et al. Integrating Clinics, Laboratory, and Imaging for the Diagnosis of Common Variable Immunodeficiency-Related Granulomatous-Lymphocytic Interstitial Lung Disease. Frontiers in immunology. 2022;13:813491. [Crossref]  [PubMed]  [PMC]
  44. Deane S, Selmi C, Naguwa SM, Teuber SS, Gershwin ME. Common variable immunodeficiency: etiological and treatment issues. International archives of allergy and immunology. 2009;150(4):311-24. [Crossref]  [PubMed]  [PMC]