Infectious Complications Reporting in Common Variable Immunodeficiency: A Systematic Review and Meta-analysis

Abstract

Objectives Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by hypogammaglobulinemia and increased susceptibility to recurrent infections. Methods We searched PubMed, Web of Science, and Scopus databases to find eligible studies from the earliest available date to January 2018 with standard keywords. Pooled estimates of the infection prevalence and the corresponding 95% confidence intervals were calculated using random-effects models. Results We found that pneumonia (67.7%) was the most prevalent infection followed by upper respiratory tract (59.0%) and gastrointestinal infections (36.3%). Furthermore, bacterial complications (41.7%) were higher in CVID patients compared to viral (25.4%), parasitic (18.8%), or fungal (3.4%) infections. Patients with longer age at diagnosis presented with fewer disease comorbidities. There was an inverse correlation between T lymphocyte count and viral infections. Moreover, we found that immunoglobulin M (IgM) serum level was inversely correlated with hepatitis C and gastrointestinal infections, and IgG serum level was inversely correlated with infectious arthritis. Higher numbers of CD4 and CD8 T cells were associated with the lower frequencies of otitis media. CVID patients with infections had significantly lower percentages of CD3 T cells. In contrast, higher percentages of CD19 lymphocytes were found in CVID patients who had a history of infections. Conclusions Our findings demonstrated that in addition to hypogammaglobulinemia, patients with CVID have an imbalance in the frequency of T lymphocytes, which is in parallel with the higher frequency of infectious complications.

Case Report: Pneumonia in a Patient With Combined Variable Immunodeficiency: COVID-19 or Pneumocystis Pneumonia?

“…They become more infected with bacterial pathogens due to impaired humoral immunity. In contrast, fungal and viral pathogens are less common in them, as they are more likely to infect people with cellular immunodeficiency (8). The case presented also had a history of UC, and the drugs mentioned for its treatment cause impairment of cellular immunity.…”

“…They become more infected with bacterial pathogens due to impaired humoral immunity. In contrast, fungal and viral pathogens are less common in them, as they are more likely to infect people with cellular immunodeficiency ( 8 ).…”

The pediatric common variable immunodeficiency — from genetics to therapy: a review

“…In a systematic review including a large cohort of CVID patients, infection pattern and frequency together with predominating immune response abnormalities have been analyzed [ 42 ]. The reported findings demonstrated that in CVID children, comparably to adults, pneumonia was the most prevalent infection, assessed in as much as 73% of pediatric patients, and it was followed by upper respiratory tract infections, such as otitis media, pharyngitis, and tonsillitis as occurring in 65%, and gastrointestinal infections in 44% of them.…”

“…In single patients, other severe infectious episodes, such as osteomyelitis [ 4 , 13 ], septic arthritis [ 43 ], central nervous system (CNS) infections [ 43 , 44 ], and sepsis [ 4 , 13 , 45 ], were reported. Bacterial etiologies were noted most frequently, in 41.7% of infectious episodes compared to viral, parasitic, or fungal infections, assessed in 25.4%, 18.8%, and 3.4%, respectively [ 42 ]. Interestingly, a higher rate of pneumonia was inversely proportional to the patients’ age, and as respiratory tract infections are the leading clinical indicator of pediatric CVID, they contributed significantly to an early diagnosis of the disease [ 42 ].…”

“…Bacterial etiologies were noted most frequently, in 41.7% of infectious episodes compared to viral, parasitic, or fungal infections, assessed in 25.4%, 18.8%, and 3.4%, respectively [ 42 ]. Interestingly, a higher rate of pneumonia was inversely proportional to the patients’ age, and as respiratory tract infections are the leading clinical indicator of pediatric CVID, they contributed significantly to an early diagnosis of the disease [ 42 ]. Pediatric patients who showed a lower percentage of the total T cell pool and an increased total B cell absolute count with a decreased switched memory B cell subset were more susceptible to the severe infectious phenotype.…”