The Journal of Allergy and Clinical Immunology, June 2015, Vol.135(6), pp.1558-1568.e2
Invasive infections of the central nervous system (CNS) or digestive tract caused by commensal fungi of the genus are rare and life-threatening. The known risk factors include acquired and inherited immunodeficiencies, with patients often displaying a history of multiple infections. Cases of meningoencephalitis, colitis, or both caused by species remain unexplained. We studied 5 previously healthy children and adults with unexplained invasive disease of the CNS, digestive tract, or both caused by species. The patients were aged 39, 7, 17, 37, and 26 years at the time of infection and were unrelated, but each was born to consanguineous parents of Turkish (2 patients), Iranian, Moroccan, or Pakistani origin. Meningoencephalitis was reported in 3 patients, meningoencephalitis associated with colitis was reported in a fourth patient, and the fifth patient had colitis only. Inherited caspase recruitment domain family, member 9 (CARD9) deficiency was recently reported in otherwise healthy patients with other forms of severe disease caused by , , , and species, including meningoencephalitis but not colitis caused by and species. Therefore we sequenced in the 5 patients. All patients were found to be homozygous for rare and deleterious mutant alleles: R70W and Q289* for the 3 patients with –induced meningoencephalitis, R35Q for the patient with meningoencephalitis and colitis caused by , and Q295* for the patient with –induced colitis. Regardless of their levels of mutant CARD9 protein, the patients' monocyte-derived dendritic cells responded poorly to CARD9-dependent fungal agonists (curdlan, heat-killed , , and ). Invasive infections of the CNS or digestive tract caused by species in previously healthy children and even adults might be caused by inherited CARD9 deficiency.
Inborn Error of Immunity ; Primary Immunodeficiency ; Invasive Fungal Diseases ; Inherited Card9 Deficiency ; Central Nervous System ; Colitis ; Candida Species ; Human ; Medicine
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