Recurrent and Sustained Viral Infections in Primary Immunodeficiencies

Abstract

Viral infections are commonplace and often innocuous. Nevertheless, within the population of patients with primary immunodeficiencies (PIDDs), viral infections can be the feature that drives a diagnostic evaluation or can be the most significant morbidity for the patient. This review is focused on the viral complications of PIDDs. It will focus on respiratory viruses, the most common type of viral infection in the general population. Children and adults with an increased frequency or severity of respiratory viral infections are often referred for an immunologic evaluation. 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. This review will also cover persistent cutaneous viral infections, systemic infections, central nervous system infections, and gastrointestinal infections. In each case, the specific viral infections may drive a diagnostic evaluation that is specific for that type of virus. This review also discusses the management of these infections, which can become problematic in patients with PIDDs.

Absence of Persistent Hepatitis E Virus Infection in Antibody-Deficient Patients Is Associated With Transfer of Antigen-Neutralizing Antibodies From Immunoglobulin Products

“…Nearly a quarter were also taking immunosuppressive medication. This is a significant finding in the current context of a high risk of HEV acquisition from dietary sources in the UK and the longstanding immune dysfunction in patients with antibody deficiency which renders them susceptible to a number of persistent and severe viral infections[2,[14][15][16][17][23][24][25]. The results are consistent with studies in similar cohorts, neither of which displayed any evidence of persistent HEV infection amongst 73 CVID patients in Germany or 27…”

Herpesviruses: Harmonious Pathogens but Relevant Cofactors in Other Diseases?

“…Many of these deficiencies result in uncontrolled and aberrant immune responses in infected individuals leading to immunopathologies (Parvaneh et al, 2013 ). Some of these conditions can also cause neoplastic transformations, especially in γ-herpesvirus infected individuals (Parvaneh et al, 2013 ; Ruffner et al, 2017 ). Defects in some anti-inflammatory response such as the inability of host to mount an appropriate anti-inflammatory response can also result in severe immunopathologies caused by some herpesviruses.…”

Primary Immunodeficiency

“…The unique clinical characteristics of infections in PIDs are recurring, chronic, and can appear in multiple anatomic sites. Recurrent infections in both the sinuses and the respiratory tract, such as sinusitis, bronchitis, otitis, and pneumonia, are the most frequent symptoms observed in patients with PID [16], while recurrent systemic infections (e.g., meningitis and bacteremia) are also not rare [17,18]. Patients with SCID may suffer from unusual or opportunistic infections leading to unexpected complications or death [19].…”