Persistent Viral Infections May Signal Primary Immunodeficiency Disease

Although bacterial infections are often the focus of attention when determining the presence of primary immunodeficiency, viral infections may also be signs of the disorder, according to a review published in Frontiers in Immunology.

“Children and adults with an increased frequency or severity of respiratory viral infections are often referred for an immunologic evaluation,” wrote experts from the Children’s Hospital of Philadelphia. “The classic teaching is to investigate humoral function in people with recurrent sinopulmonary infections, but this is often interpreted to mean recurrent bacterial infections. Recurrent or very severe viral infections may also be a harbinger of a primary immunodeficiency as well.”

Articles that address the overall approach to suspected primary immunodeficiency disease usually highlight bacterial infections. Consequently, the authors of this review focused on recurrent viral respiratory tract infections, skin infections, systemic infections, central nervous system infections, and gastrointestinal infections in patients with potential immunodeficiency.

Diagnostic evaluations tend to be specific to the type of virus, and management can be difficult in the presence of particular primary immunodeficiency diseases, according to the review. In one dramatic example, the authors described viral respiratory tract infections in situations involving severe combined immune deficiency.

“There is a race to replace the immune system before the virus can progress to the point of no return,” the authors wrote. “This race is highly dependent on the type of transplant donor, type of conditioning, and type of transplant, but respiratory infections clearly impact the transplant outcome. Any adjunctive measure to improve respiratory status should be sought.”

Reference:

Ruffner MA, Sullivan KE, Henrickson SE. Recurrent and sustained viral infections in primary immunodeficiencies. Front Immunol. 2017;8:665. doi:10.3389/fimmu.2017.00665