title: CT screening for pulmonary pathology in common variable immunodeficiency disorders and the correlation with clinical and immunological parameters.
abstract: BACKGROUND
  Pulmonary disease is common in patients with common variable immunodeficiency disorders (CVID) and involves infections, chronic airway disease and interstitial lung disease. Chronic pulmonary disease is associated with excess morbidity and early mortality and therefore early detection and monitoring of progression is essential.
  Thin slice CT scan and pulmonary function were used to determine the prevalence and spectrum of chronic (pre-clinical) pulmonary disease in adult CVID patients regardless of symptoms. CT Scans were scored for airway abnormalities (AD) and interstitial lung disease (ILD). Other CVID related complications and B and T lymphocyte subsets were analyzed to identify patients at risk for pulmonary disease.
  
  
  RESULTS
  Significant pulmonary abnormalities were detected in 24 of the 47 patients (51%) consisting of AD in 30% and ILD in 34% of cases. In only 7 (29%) of these 24 patients pulmonary function test proved abnormal. The presence of AD was correlated to (recurrent) lower respiratory tract infections despite IgG therapy. The presence of ILD was correlated to autoimmune disease and a reduction in the numbers of CD4 + T cells, naïve CD4 + T cells, naïve CD8 + T cells and memory B cells and lower IgG through levels over time.
  
  
  CONCLUSIONS
  Preclinical signs of AD and ILD are common in CVID patients despite Ig therapy and do not correlate to pulmonary function testing. Patients at risk for ILD might be identified by the presence of autoimmunity or a deranged T cell pattern. Larger studies are needed to confirm these findings and to determine thresholds for the T lymphocyte subsets.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre of Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands, L.J.Maarschalk-Ellerbroek@umcutrecht.nl.
authors.forename: L J
authors.initials: LJ
authors.lastname: Maarschalk-Ellerbroek
authors.forename: P A
authors.initials: PA
authors.lastname: de Jong
authors.forename: J M
authors.initials: JM
authors.lastname: van Montfrans
authors.forename: J W J
authors.initials: JW
authors.lastname: Lammers
authors.forename: A C
authors.initials: AC
authors.lastname: Bloem
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: P M
authors.initials: PM
authors.lastname: Ellerbroek
mesh_terms: D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D017074:Common Variable Immunodeficiency / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007156:Immunologic Memory; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000276:immunology; D012129:Respiratory Function Tests; D013601:T-Lymphocytes / Q000276:immunology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult