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Common variable immunodeficiency (CVID) may present at any age but usually presents during adulthood.

Children with chronic illness have been found to be at an increased risk of behavioral and emotional difficulties. To date, children with pediatric immunodeficiency disorders (PIDDs) and their families have not been the focus of extensive published psychosocial research.

Primary ciliary dyskinesia (PCD) results in impaired mucociliary clearance. Patients with this disorder develop chronic sinopulmonary disease with recurrent sinusitis, otitis media, nasal polyposis, pneumonia, and, ultimately, bronchiectasis. Other associated findings of dysfunctional ciliary activity include situs inversus, dextrocardia, and infertility.

The most critical dust mite avoidance technique for asthmatic children with mite allergy is the use of dust mite-proof bedding covers. Adherence to allergen control measures is poor due to cost. The purpose of this study was to determine whether giving families mite-proof bedding encasings at the time of the diagnosis with mite allergy would improve adherence at a home visit 2 months later.

Infantile asthma is commonly thought to be caused by viral respiratory infections and exposure to second-hand cigarette smoke. Allergy has not been felt to be a major cause of infantile asthma and infants and small children are not commonly skin tested.

A 15-year-old girl developed end-stage renal disease requiring renal transplantation. Posttransplantation immunosuppression therapy consisted of antithymocyte globulin, glucocorticosteroids, cyclosporine A, and azathioprine. The patient's clinical course after transplantation was complicated by several episodes of graft rejection, chronic anemia, oral candidiasis, and numerous infections of the sinopulmonary tract that were recalcitrant to antibiotics and surgical intervention. An immunologic evaluation showed marked immune abnormalities beyond that expected by the transplant immunosuppression. Examination of serum samples taken before the transplant confirmed a diagnosis of common variable immunodeficiency. The difficulties of managing posttransplantation immunosuppression in a patient with a primary immunodeficiency are discussed. Patients with end-stage renal disease and a history of recurrent sinopulmonary infections may require immunologic screening before renal transplantation.

Tourette's syndrome is a neurological disorder consisting of chronic motor tics and involuntary vocalizations. Some of these vocalizations include coughing, grunting, and wheezing. We report two adolescents with a history of chronic coughing who presented for further evaluation of previously diagnosed asthma. A careful history suggested that Tourette's syndrome might be responsible for the patients' symptoms. Neurology evaluation confirmed the correct diagnosis of Tourette's syndrome for both patients. Treatment specific for this disease led to ablation of all symptoms. A history of repetitive coughing in adolescents may be the presenting symptom of Tourette's syndrome, thereby mimicking cough-equivalent asthma.

A prospective comparison of nasal cytology with sinus x-rays in 55 patients (35 children and 20 adults) with suspected sinusitis was performed. A sample of the nasal mucosa from the inferior turbinate was obtained with a Rhinoprobe, fixed, and stained with modified Wright-Giemsa. The radiologist and the cytologist were unaware of each other's findings. The x-ray report was considered positive if there was mucoperiosteal thickening, asymmetry, opacification, or air-fluid levels. The cytology report was positive if there was greater than 1 neutrophil per high power field with bacteria present. There was a 79% correlation between the sinus x-rays and nasal cytology reports. Specificity was 0.79 and sensitivity 0.79. When the cytology report was positive with greater than 6 neutrophils per high power field, the x-ray was positive 90% of the time. Two sinus x-rays were uninterpretable by the radiologists. These data indicate that nasal cytology is a safe, noninvasive and useful adjunct in the diagnosis of sinusitis in both adults and children.

The Greer DermaPIK and the Lincoln Diagnostics Duotip-Test are frequently used plastic, disposable, allergy skin testing devices.

• To assess cellular immune function in children following severe blunt trauma, 25 children (mean: age, 7.1 years; Injury Severity Score, 34.9; and Glascow Coma Score, 5.6) admitted with severe trauma were examined with the use of the CMI Multitest system (Merieux Institute, Miami, Fla) to test delayed-type hypersensitivity. Patients were monitored for evidence of infection for the next 3 weeks. Ten children (mean: age, 6.2 years; Injury Severity Score, 31.2; and Glascow Coma Score, 5.4) admitted with severe trauma had the percentage of circulating lymphocyte subpopulations (pan—T cell marker T101, CD4, CD8, and B cells) measured on day 1 and then weekly for 3 weeks. Fourteen (56%; of the 25 children had no reaction to any of the skin tests (anergic). Eleven (79%) of 14 anergic patients became infected, while three (27%) of 11 of the nonanergic children became infected. There were no significant changes in pan—T cell marker T101, CD4, or CD8 lymphocyte populations in the 3 weeks following injury; however, absolute numbers of circulating B cells dropped significantly by day 7. These data indicate that children with severe trauma who are anergic are significantly more susceptible to infection. Unlike the results reported previously in adult trauma patients, these children had no significant fluctuations in T-cell populations; however, there was a significant decrease in circulating B cells in the first week. The use of the delayed-type hypersensitivity skin test can aid in identifying which patients are at an increased risk for nosocomial infection.(AJDC. 1991;145:326-329)

An association between humoral immune deficiency and childhood autoimmune disease has been previously established. We describe a 7-year-old male with severe autoimmune disease, recurrent infections, a marked deficiency of IgG2 and IgG4, and an inability to respond to polysaccharide antigens. This child was also found to have isolated growth hormone (GH) deficiency. Laboratory results included a positive anti-smooth muscle antibody, a positive Raji-cell assay for immune complexes, and normal levels of IgG, IgM, and IgA. IgG subclasses revealed an IgG1 of 1225 (normal for age, 280–1120 mg/dl), IgG2 of <10 (30–630 mg/dl), IgG3 of 36 (40–250 mg/dl), and IgG4 of <4 (11–620 mg/dl). No increase in antibody titer was noted to either Pneumovax or unconjugatedHaemophilus influenzaevaccine. Numbers of circulating B cells (CD19) were markedly diminished (<0.5%). Liver biopsies have shown chronic active hepatitis. Somatomedin C was 0.28 U/ml (normal for age, 0.5–2.06 U/ml). Challenge with eitherl-dopa or clonidine produced a peak GH response of 2.3 ng/ml (normals = >7 ng/ml). Children with autoimmune disorders should be evaluated for IgG subclass deficiencies and ability to make antibody in response to antigen challenge regardless of the serum immunoglobulin levels. Growth failure in immune-deficient children should not be assumed to be due to chronic illness or recurrent infections. Other etiologies for growth failure should be sought.

Mice are a common finding in the indoor environment of many homes. In a recent study, 18% of children with asthma from an inner-city environment were reported to be allergic to mouse allergen.

Two children developed hypersensitivity pneumonitis after extensive exposure to an unventilated basement shower. Commercial precipitin panels were negative. After home inspection, individual mold species were isolated from the household and extracted. Precipitating antibodies to Epicoccum nigrum were found in both children. Resolution of the hypersensitivity pneumonitis occurred with avoidance and glucocorticosteroid therapy. E nigrum is a newly identified etiologie agent for hypersensitivity pneumonitis found in a mold-contaminated home.

Idiopathic anaphylaxis is a disease where no identifiable antigen or disease initiates an anaphylactoid reaction. Unlike classic IgE antibody-mediated anaphylaxis, severe idiopathic anaphylaxis is treatable with corticosteroids. To date, only 22 pediatric cases from one referral center have been reported.

ABSTRACTBackground: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices.Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice.Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes.Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice.Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.

Few studies have examined how developing obesity in early adulthood affects the course of asthma.