Kostmann syndrome: Difference between revisions
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{{main|Neutropenia}} | |||
First described in 1956,<ref>{{citation | First described in 1956,<ref>{{citation | ||
| author = Kostmann R. Infantile genetic agranulocytosis. A new recessive lethal disease in man | | author = Kostmann R. Infantile genetic agranulocytosis. A new recessive lethal disease in man | ||
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promyelocytic stage of differentiation and | promyelocytic stage of differentiation and | ||
low levels of mature neutrophils in peripheral | low levels of mature neutrophils in peripheral | ||
blood." It was generally lethal before treatment with [[granulocyte colony-stimulating factor]] was available, although some individuals were protected with antibiotics.<ref>{{citation | blood." It was generally lethal before treatment with [[granulocyte colony-stimulating factor]] was available, although some individuals were protected with antibiotics.<ref name=Carlsson>{{citation | ||
| url = http://www.haematologica.org/cgi/reprint/91/5/589 | | url = http://www.haematologica.org/cgi/reprint/91/5/589 | ||
| journal = Haematologica | | journal = Haematologica | ||
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| title = Neutrophil elastase and granulocyte colony-stimulating factor receptor mutation analyses and leukemia evolution in severe congenital neutropenia patients belonging to the original Kostmann family in northern Sweden | | title = Neutrophil elastase and granulocyte colony-stimulating factor receptor mutation analyses and leukemia evolution in severe congenital neutropenia patients belonging to the original Kostmann family in northern Sweden | ||
}}</ref> | }}</ref> | ||
==Genetics and molecular biology== | |||
As mentioned, the disease was first described in a group with considerable intermarriage. It had been believed to be an [[autosomal recessive]] disorder, but two suggested genes, ELA-2, the neutrophil elastase gene, or G-CSFR, which defines the [[G-CSF]] receptor, are normal in the survivors with the disease. One patient had an ELA-2 defect but her parents did not, suggesting a spontaneous mutation.<ref name=Carlsson/> | |||
While the G-CSFR gene may be normal, G-CSF an intracellular signal transduction pathway may be abnormal. "Neutrophils from patients are shown to have dramatically increased levels of 2 cytosolic protein tyrosine phosphatases that contain src-homology 2 (SH2): SHP-1 and SHP-2. One hypothesis is that overexpression of these proteins, which are involved in cytokine receptor signaling, plays a role in altering intracellular signal transduction processes. | |||
"A selective decrease of B-cell lymphoma-2 (Bcl-2) expression in myeloid cells and an increase in apoptosis in bone marrow progenitor cells have been observed." <ref name=eMed-Over>{{citation | |||
| title =Kostmann Disease: overview | |||
| url = http://emedicine.medscape.com/article/887140-overview | |||
| author = Michael S Tankersley | |||
| date = 11 November 2008 | |||
| journal = eMedicine: Pediatrics: General Medicine > Allergy & Immunology}}</ref> | |||
==Diagnosis== | |||
The disease is usually detected after an infant presents with a severe infection, with severe neutropenia and:<ref name=eMed-Over/> | |||
* Temperature instability in newborn period | |||
* Fever | |||
* Irritability | |||
* Localized site(s) of infection | |||
No cases have been reported in an infant of less than 33 weeks, but diagnosis of may have been missed in neonates who died of overwhelming sepsis. In one case, the syndrome was noted only because a twin did not have sepsis. | |||
"Their bone marrow examination is characterized by normal concentrations of granulocyte progenitors and precursors, but an arrested neutrophil development at the promyelocyte or myelocyte stage."<ref>{{citation | |||
| journal = Pediatrics | |||
| author = Darlene A. Calhoun and Robert D. Christensen | |||
| title = (Abstract) The Occurrence of Kostmann Syndrome in Preterm Neonates | |||
| volume = 99 | issue = 2 | date =February 1997| page = 259 |doi=10.1542/peds.99.2.259 | |||
| url = http://pediatrics.aappublications.org/cgi/content/extract/99/2/259}}</ref> | |||
==Differential diagnosis== | ==Differential diagnosis== | ||
To be considered are:<ref>{{citation | To be considered are:<ref>{{citation | ||
| Line 22: | Line 51: | ||
| date = 11 November 2008 | | date = 11 November 2008 | ||
| journal = eMedicine: Pediatrics: General Medicine > Allergy & Immunology}}</ref> | | journal = eMedicine: Pediatrics: General Medicine > Allergy & Immunology}}</ref> | ||
{{col-begin}} | |||
{{col-break|width=50%}} | |||
{| | |||
|- valign=top | |||
| | |||
*[[Agammaglobulinemia]] | *[[Agammaglobulinemia]] | ||
*[[Severe | *[[Severe combined immunodeficiency disease]] | ||
*[[Autoimmune neutropenia]] | *[[Autoimmune neutropenia]] | ||
*[[Chronic | *[[Chronic benign neutropenia]] | ||
*[[Shwachman-Diamond | *[[Shwachman-Diamond syndrome]] | ||
*[[Glycogen- | *[[Glycogen-storage disease Type I]] | ||
*[[Methylmalonic | {{col-break|width=50%}} | ||
*[[Pearson | *[[Methylmalonic acidemia]] | ||
*[[Pearson syndrome]] | |||
*[[Cyclic neutropenia]] | *[[Cyclic neutropenia]] | ||
*[[Chediak-Higashi syndrome]] | *[[Chediak-Higashi syndrome]] | ||
*[[Myelokathexis]] | *[[Myelokathexis]] | ||
|} | |||
==Treatment== | |||
[[G-CSF]], often in high dosage, is the core of treatment, although stem cell transplantation has an increasing role. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 17:07, 30 July 2010
First described in 1956,[1] Kostmann syndrome, also called congenital neutropenia, is characterized as "is characterized by an arrest of the maturation of neutrophil precursors at the promyelocytic stage of differentiation and low levels of mature neutrophils in peripheral blood." It was generally lethal before treatment with granulocyte colony-stimulating factor was available, although some individuals were protected with antibiotics.[2]
Genetics and molecular biology
As mentioned, the disease was first described in a group with considerable intermarriage. It had been believed to be an autosomal recessive disorder, but two suggested genes, ELA-2, the neutrophil elastase gene, or G-CSFR, which defines the G-CSF receptor, are normal in the survivors with the disease. One patient had an ELA-2 defect but her parents did not, suggesting a spontaneous mutation.[2]
While the G-CSFR gene may be normal, G-CSF an intracellular signal transduction pathway may be abnormal. "Neutrophils from patients are shown to have dramatically increased levels of 2 cytosolic protein tyrosine phosphatases that contain src-homology 2 (SH2): SHP-1 and SHP-2. One hypothesis is that overexpression of these proteins, which are involved in cytokine receptor signaling, plays a role in altering intracellular signal transduction processes.
"A selective decrease of B-cell lymphoma-2 (Bcl-2) expression in myeloid cells and an increase in apoptosis in bone marrow progenitor cells have been observed." [3]
Diagnosis
The disease is usually detected after an infant presents with a severe infection, with severe neutropenia and:[3]
- Temperature instability in newborn period
- Fever
- Irritability
- Localized site(s) of infection
No cases have been reported in an infant of less than 33 weeks, but diagnosis of may have been missed in neonates who died of overwhelming sepsis. In one case, the syndrome was noted only because a twin did not have sepsis.
"Their bone marrow examination is characterized by normal concentrations of granulocyte progenitors and precursors, but an arrested neutrophil development at the promyelocyte or myelocyte stage."[4]
Differential diagnosis
To be considered are:[5]
TreatmentG-CSF, often in high dosage, is the core of treatment, although stem cell transplantation has an increasing role. References
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