Susceptibility to mycobacterial infections in children with X-linked chronic granulomatous disease - A review of 17 patients living in a region endemic for tuberculosis

Background: Chronic granulomatous disease (CGD) is a rare disorder of phagocytic oxidative bursts leading to recurrent pyogenic infections. Affected individuals are most prone to infections caused by staphylococei, Salmonella, Candida, and Aspergillus, but previously we observed a high incidence of Mycobacterium tuberculosis infection in Chinese children with CGD. Objective: To determine the spectrum of infections in patients with X-linked CGD, with an emphasis on mycobacterial infections, and to review all CYB13 gene mutations identified in our center. Results: From 1988 to 2005, 17 Chinese male children were diagnosed to have X-linked CGD. Fifteen mutations were identified, including 3 splice site defects (IVS1-1G > C, 266G > A, IVS3-1G > A), 5 missense mutations (591T > C, 627T>A, 949T > A, 1039T > A, 1512G > C), 3 nonsense mutations (882C > T, 1451C > A, 1569G > T), 1 insertion (756_757insA), and 3 deletions (660_662deITTC, 727delT, 1341deIT). Fight of these were novel mutations. Recurrent pneumonia, lymphadenitis, and bacterial skin abscess were the commonest types of infection. Seven patients had tuberculosis (TB). Seven patients had prolonged scarring or abscess formation at the Calmette-Guerin bacillus (BCG) injection site, and I had disseminated BCG infection. Three patients had pulmonary aspergillosis. Four patients underwent hemopoietic stem cell transplantation, but 2 died of complications. Conclusions: Patients with CGD are susceptible to TB and BCG complications. Our observation suggests that oxidative burst is probably important in host defense against mycobacterial infections. Because interferon-gamma is the key cytokine involved in mycobacterial immunity, there may be a stronger indication for its use in CGD patients living in areas endemic for TB.