Long-term follow-up and outcome of 39 patients with chronic granulomatous disease.
OBJECTIVE
To evaluate the clinical long-term course in patients with chronic granulomatous disease (CGD) with respect to different CGD subtypes and currently used antimicrobial prophylactic measures.


METHODS
The records of 39 patients with CGD who were monitored during a period of 22 years were reviewed. All infections, infectious complications, and clinical outcomes were documented for a total observation period of 610 patient-years and were stratified with respect to different CGD subtypes.


RESULTS
Lymphadenitis, skin abscesses, and pneumonia occurred in 87%, 72%, and 59% of the patients, respectively. In 151 microbiologic isolates Staphylococcus aureus, Aspergillus species, Candida species, Pseudomonas species, and Salmonella species were the most frequently detected microorganisms. There were 167 severe infections requiring hospitalization and intravenous antimicrobial treatment, resulting in an incidence of 3.7 severe infections per 100 patient months (SI/100 PM). Long-term antibiotic prophylaxis significantly reduced the incidence of severe bacterial infections from 4.8 SI/100 PM to 1. 6 SI/100 PM (P =.0035). In contrast, fungal infections increased under antibiotic prophylaxis from a mean incidence of 0.2 SI/100 PM to 1.9 SI/100 PM (P =.04). We found a 50% survival rate through the fourth decade of life, with a plateau after the third decade of life. Patients with a complete absence of cytochrome b(558) showed an earlier manifestation of their disease and a higher incidence of infections and had significant lower survival than patients with only diminished cytochrome b(558) or autosomal recessive CGD.


CONCLUSIONS
Infections with Aspergillus species have become the major cause of infectious complications and death in patients with CGD. Prophylactic and therapeutic measures are needed to further increase life expectancy and quality for patients with CGD.
Liese
J
J
Universitäts-Kinderklinik im Dr. v. Haunerschen Kinderspital, Munich, Germany.
Kloos
S
S
Jendrossek
V
V
Petropoulou
T
T
Wintergerst
U
U
Notheis
G
G
Gahr
M
M
Belohradsky
B H
BH
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006105:Granulomatous Disease, Chronic / Q000145:classification / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007223:Infant; D017964:Itraconazole / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control; D016019:Survival Analysis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000935:Antifungal Agents; D017964:Itraconazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination