Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study
Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited. To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls....
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| Veröffentlicht in: | The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2021-02, Vol.9 (2), p.735-744.e6 |
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| creator | Ponsford, Mark J. Price, Colin Farewell, Daniel Greene, Giles Moore, Catherine Perry, Michael Price, Nicky Cottrell, Simon Steven, Rachael El-Shanawany, Tariq Carne, Emily Cousins, Richard Williams, Paul Schaub, Alexander Vonarburg, Cedric Jolles, Stephen |
| description | Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited.
To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls.
Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets.
A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR.
Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design. |
| doi_str_mv | 10.1016/j.jaip.2020.08.016 |
| format | Article |
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To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls.
Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets.
A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR.
Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.</description><identifier>ISSN: 2213-2198</identifier><identifier>EISSN: 2213-2201</identifier><identifier>DOI: 10.1016/j.jaip.2020.08.016</identifier><identifier>PMID: 32841749</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenoviruses ; Adult ; Aged ; Antibiotics ; Antibodies ; Bacteria - isolation & purification ; Bacterial Infections - diagnosis ; Bacterial Infections - microbiology ; Bronchiectasis ; Clinical trials ; Comorbidity ; Coronaviruses ; COVID-19 ; Female ; Health care ; Humans ; Hypogammaglobulinemia ; Immunodeficiency ; Immunoglobulin M ; Immunoglobulins ; Influenza ; Male ; Middle Aged ; Mortality ; Original ; Parainfluenza ; Pathogens ; Primary antibody deficiency ; Primary Immunodeficiency Diseases - epidemiology ; Primary Immunodeficiency Diseases - microbiology ; Quality of life ; Respiratory health ; Respiratory Mucosa - microbiology ; Respiratory syncytial virus ; Respiratory tract diseases ; Respiratory Tract Infections - diagnosis ; Respiratory Tract Infections - epidemiology ; Respiratory Tract Infections - microbiology ; Rhinovirus ; Risk factors ; Streptococcus infections ; Symptom Assessment ; Viral infections ; Virus Diseases - diagnosis ; Virus Diseases - epidemiology ; Virus Diseases - microbiology ; Viruses - isolation & purification ; Young Adult</subject><ispartof>The journal of allergy and clinical immunology in practice (Cambridge, MA), 2021-02, Vol.9 (2), p.735-744.e6</ispartof><rights>2020 The Authors</rights><rights>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2020. The Authors</rights><rights>2020 The Authors 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-db68eb23dab8ec96159b5794949fe35e3eac399bdd55e5d567ed8b811cce28e43</citedby><cites>FETCH-LOGICAL-c483t-db68eb23dab8ec96159b5794949fe35e3eac399bdd55e5d567ed8b811cce28e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,27913,27914</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32841749$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ponsford, Mark J.</creatorcontrib><creatorcontrib>Price, Colin</creatorcontrib><creatorcontrib>Farewell, Daniel</creatorcontrib><creatorcontrib>Greene, Giles</creatorcontrib><creatorcontrib>Moore, Catherine</creatorcontrib><creatorcontrib>Perry, Michael</creatorcontrib><creatorcontrib>Price, Nicky</creatorcontrib><creatorcontrib>Cottrell, Simon</creatorcontrib><creatorcontrib>Steven, Rachael</creatorcontrib><creatorcontrib>El-Shanawany, Tariq</creatorcontrib><creatorcontrib>Carne, Emily</creatorcontrib><creatorcontrib>Cousins, Richard</creatorcontrib><creatorcontrib>Williams, Paul</creatorcontrib><creatorcontrib>Schaub, Alexander</creatorcontrib><creatorcontrib>Vonarburg, Cedric</creatorcontrib><creatorcontrib>Jolles, Stephen</creatorcontrib><title>Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study</title><title>The journal of allergy and clinical immunology in practice (Cambridge, MA)</title><addtitle>J Allergy Clin Immunol Pract</addtitle><description>Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited.
To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls.
Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets.
A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR.
Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.</description><subject>Adenoviruses</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Antibodies</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - microbiology</subject><subject>Bronchiectasis</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Female</subject><subject>Health care</subject><subject>Humans</subject><subject>Hypogammaglobulinemia</subject><subject>Immunodeficiency</subject><subject>Immunoglobulin M</subject><subject>Immunoglobulins</subject><subject>Influenza</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original</subject><subject>Parainfluenza</subject><subject>Pathogens</subject><subject>Primary antibody deficiency</subject><subject>Primary Immunodeficiency Diseases - epidemiology</subject><subject>Primary Immunodeficiency Diseases - microbiology</subject><subject>Quality of life</subject><subject>Respiratory health</subject><subject>Respiratory Mucosa - microbiology</subject><subject>Respiratory syncytial virus</subject><subject>Respiratory tract diseases</subject><subject>Respiratory Tract Infections - diagnosis</subject><subject>Respiratory Tract Infections - epidemiology</subject><subject>Respiratory Tract Infections - microbiology</subject><subject>Rhinovirus</subject><subject>Risk factors</subject><subject>Streptococcus infections</subject><subject>Symptom Assessment</subject><subject>Viral infections</subject><subject>Virus Diseases - diagnosis</subject><subject>Virus Diseases - epidemiology</subject><subject>Virus Diseases - microbiology</subject><subject>Viruses - isolation & purification</subject><subject>Young Adult</subject><issn>2213-2198</issn><issn>2213-2201</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxiMEotXSF-CALHHhssF2nMRBCGn7B1ipEisKXC3HnnQdJXFqO0V5AZ67DttWwAHPwaPxbz7N-EuSlwSnBJPibZu20owpxRSnmKex9CQ5ppRka0oxefqQk4ofJSfetzgeTkrM8PPkKKOckZJVx8mv7aAcSA8afQU_GieDdTP6EZMOnUMAFYwdkBw0upr7MdgenU5Ow4A2vR2u0U4GA0Pw6KcJe7RzppexfTMEU1s9R4XGqAio-d2iP3WRbFwUCXtAp9vd5hxdhUnPL5Jnjew8nNzfq-T7x4tvZ5_Xl18-bc82l2vFeBbWui441DTTsuagqoLkVZ2XFYvRQJZDBlJlVVVrneeQ67woQfOaE6IUUA4sWyUfDrrjVPegVRw9LirGw9zCSiP-fhnMXlzbW1EyRitaRIE39wLO3kzgg-iNV9B1cgA7eUFZVjLMaEEj-voftLWTG-J6keIFoWyxaJXQA6Wc9d5B8zgMwWJxWrRicVosTgvMRSzFpld_rvHY8uBrBN4fAIifeWvACf_bBtDGRUuFtuZ_-nds6bxW</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Ponsford, Mark J.</creator><creator>Price, Colin</creator><creator>Farewell, Daniel</creator><creator>Greene, Giles</creator><creator>Moore, Catherine</creator><creator>Perry, Michael</creator><creator>Price, Nicky</creator><creator>Cottrell, Simon</creator><creator>Steven, Rachael</creator><creator>El-Shanawany, Tariq</creator><creator>Carne, Emily</creator><creator>Cousins, Richard</creator><creator>Williams, Paul</creator><creator>Schaub, Alexander</creator><creator>Vonarburg, Cedric</creator><creator>Jolles, Stephen</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210201</creationdate><title>Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study</title><author>Ponsford, Mark J. ; Price, Colin ; Farewell, Daniel ; Greene, Giles ; Moore, Catherine ; Perry, Michael ; Price, Nicky ; Cottrell, Simon ; Steven, Rachael ; El-Shanawany, Tariq ; Carne, Emily ; Cousins, Richard ; Williams, Paul ; Schaub, Alexander ; Vonarburg, Cedric ; Jolles, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-db68eb23dab8ec96159b5794949fe35e3eac399bdd55e5d567ed8b811cce28e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenoviruses</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibiotics</topic><topic>Antibodies</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - microbiology</topic><topic>Bronchiectasis</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Female</topic><topic>Health care</topic><topic>Humans</topic><topic>Hypogammaglobulinemia</topic><topic>Immunodeficiency</topic><topic>Immunoglobulin M</topic><topic>Immunoglobulins</topic><topic>Influenza</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original</topic><topic>Parainfluenza</topic><topic>Pathogens</topic><topic>Primary antibody deficiency</topic><topic>Primary Immunodeficiency Diseases - epidemiology</topic><topic>Primary Immunodeficiency Diseases - microbiology</topic><topic>Quality of life</topic><topic>Respiratory health</topic><topic>Respiratory Mucosa - microbiology</topic><topic>Respiratory syncytial virus</topic><topic>Respiratory tract diseases</topic><topic>Respiratory Tract Infections - diagnosis</topic><topic>Respiratory Tract Infections - epidemiology</topic><topic>Respiratory Tract Infections - microbiology</topic><topic>Rhinovirus</topic><topic>Risk factors</topic><topic>Streptococcus infections</topic><topic>Symptom Assessment</topic><topic>Viral infections</topic><topic>Virus Diseases - diagnosis</topic><topic>Virus Diseases - epidemiology</topic><topic>Virus Diseases - microbiology</topic><topic>Viruses - isolation & purification</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ponsford, Mark J.</creatorcontrib><creatorcontrib>Price, Colin</creatorcontrib><creatorcontrib>Farewell, Daniel</creatorcontrib><creatorcontrib>Greene, Giles</creatorcontrib><creatorcontrib>Moore, Catherine</creatorcontrib><creatorcontrib>Perry, Michael</creatorcontrib><creatorcontrib>Price, Nicky</creatorcontrib><creatorcontrib>Cottrell, Simon</creatorcontrib><creatorcontrib>Steven, Rachael</creatorcontrib><creatorcontrib>El-Shanawany, Tariq</creatorcontrib><creatorcontrib>Carne, Emily</creatorcontrib><creatorcontrib>Cousins, Richard</creatorcontrib><creatorcontrib>Williams, Paul</creatorcontrib><creatorcontrib>Schaub, Alexander</creatorcontrib><creatorcontrib>Vonarburg, Cedric</creatorcontrib><creatorcontrib>Jolles, Stephen</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ponsford, Mark J.</au><au>Price, Colin</au><au>Farewell, Daniel</au><au>Greene, Giles</au><au>Moore, Catherine</au><au>Perry, Michael</au><au>Price, Nicky</au><au>Cottrell, Simon</au><au>Steven, Rachael</au><au>El-Shanawany, Tariq</au><au>Carne, Emily</au><au>Cousins, Richard</au><au>Williams, Paul</au><au>Schaub, Alexander</au><au>Vonarburg, Cedric</au><au>Jolles, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study</atitle><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle><addtitle>J Allergy Clin Immunol Pract</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>9</volume><issue>2</issue><spage>735</spage><epage>744.e6</epage><pages>735-744.e6</pages><issn>2213-2198</issn><eissn>2213-2201</eissn><abstract>Patients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited.
To define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls.
Prospective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets.
A total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR.
Patients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32841749</pmid><doi>10.1016/j.jaip.2020.08.016</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adenoviruses Adult Aged Antibiotics Antibodies Bacteria - isolation & purification Bacterial Infections - diagnosis Bacterial Infections - microbiology Bronchiectasis Clinical trials Comorbidity Coronaviruses COVID-19 Female Health care Humans Hypogammaglobulinemia Immunodeficiency Immunoglobulin M Immunoglobulins Influenza Male Middle Aged Mortality Original Parainfluenza Pathogens Primary antibody deficiency Primary Immunodeficiency Diseases - epidemiology Primary Immunodeficiency Diseases - microbiology Quality of life Respiratory health Respiratory Mucosa - microbiology Respiratory syncytial virus Respiratory tract diseases Respiratory Tract Infections - diagnosis Respiratory Tract Infections - epidemiology Respiratory Tract Infections - microbiology Rhinovirus Risk factors Streptococcus infections Symptom Assessment Viral infections Virus Diseases - diagnosis Virus Diseases - epidemiology Virus Diseases - microbiology Viruses - isolation & purification Young Adult |
| title | Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study |
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