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Severe Combined Immunodeficiency in Serbia and Montenegro Between Years 1986 and 2010: A Single-Center Experience

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Abstract

Severe combined immunodeficiency (SCID), including the ‘variant’ Omenn syndrome (OS), represent a heterogeneous group of monogenic disorders characterized by defect in differentiation of T- and/or B lymphocytes and susceptibility to infections since birth. In the period of 25 years, between January 1986 and December 2010, a total of 21 patients (15 SCID, 6 OS) were diagnosed in Mother & Child Health Institute of Serbia, a tertiary-care teaching University hospital and a national referral center for patients affected with primary immunodeficiency (PID). The diagnoses were based on anamnestic data, clinical findings, and immunological and genetic analysis. The median age at the onset of the first infection was the 2nd month of life. Seven (33 %) patients had positive family history for SCID. Out of five male infants with T-B+NK- SCID phenotype, mutation analysis revealed interleukin-2 (common) gamma-chain receptor (IL2RG) mutations in 3 with positive X-linked family history, and Janus-kinase (JAK)-3 gene defects in the other two. Six patients had T-B-NK+ SCID phenotype and further 6 features of OS, 11 of which had recombinase-activating gene (RAG1or RAG2) and 1 Artemis gene mutations. One child with T+B+NK+ SCID phenotype as well had proven RAG mutation. One child each with T-B+NK+ SCID phenotype, CD8 lymphopenia and unknown phenotype remained without known underlying genetic defect. Of the eight patients who underwent hematopoetic stem cell transplant (HSCT) 5 survived, the other 13 died between 2 days and 12 months after diagnosis was made. Early diagnosis of SCID, before onset of severe infections, offers possibility for HSCT and cure. Education of primary-care pediatricians, in particular including awareness of the risk of using live vaccines and non-irradiated blood products, should improve prognosis of SCID in our setting.

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Acknowledgments

This manuscript is partially funded to SP through the grants (No. 175073 and No. 175065) of Ministry of Science and Technology, Republic of Serbia.

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Authors and Affiliations

  1. Pediatric Clinic, Mother & Child Health Institute “Dr Vukan Čupić”, Belgrade, Serbia

    Srdjan Pasic, Dragana Vujic, Dobrila Veljković, Bojana Slavkovic, Predrag Minic, Aleksandra Minic & Goran Ristic

  2. Institute for Microbiology and Immunology, Medical Faculty, University of Belgrade, Belgrade, Serbia

    Marija Mostarica-Stojkovic

  3. Clinica Pediatrica, Spedali Civili, Brescia, Italy

    Silvia Giliani

  4. Istituto per Technologie Biologiche Avanzzate, Segrate, Milan, Italy

    Anna Villa & Cristina Sobacchi

  5. Institute of Cellular Medicine, Medical School, University of Newcastle, Newcastle upon Tyne, UK

    Desa Lilić

  6. Department of Paediatric Immunology, Great North Children’s Hospital, Newcastle upon Tyne, UK

    Mario Abinun

  7. Mother and Child Health Institute, Medical Faculty, University of Belgrade, Radoja Dakića 8, 11070, Belgrade, Serbia

    Srdjan Pasic

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  1. Srdjan Pasic
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  2. Dragana Vujic
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  9. Silvia Giliani
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  10. Anna Villa
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  11. Cristina Sobacchi
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  12. Desa Lilić
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  13. Mario Abinun
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Correspondence to Srdjan Pasic.

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Pasic, S., Vujic, D., Veljković, D. et al. Severe Combined Immunodeficiency in Serbia and Montenegro Between Years 1986 and 2010: A Single-Center Experience. J Clin Immunol 34, 304–308 (2014). https://doi.org/10.1007/s10875-014-9991-9

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  • DOI: https://doi.org/10.1007/s10875-014-9991-9

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