Job Syndrome
Tuesday, 17 June 2003
Last Updated Monday, 29 November 2004
What
A suspected genetic defect that results in the production of high levels of the
antibody immunoglobulin E (IgE), causing serious skin and lung infections as well as
eczema, a chronic condition characterized by scaly and itching rashes.
Who
Hyper IgE syndrome can run in families with high frequency. In most cases it is inherited in a dominant fashion meaning that only one damaged copy of the
gene is needed to have the disease. The condition also appears to occur spontaneously in all racial and ethnic groups.
Signs and Symptoms
Persistent skin abscesses and infection. These abscesses are characteristic in that they are not very warm or tender, unlike the boils and abscess that most people get. Recurrent sinusitis
eczema Chronic Runny Nose Asthma Recurrent skin infections High
incidence of lung infections Older patients exhibit coarse faces, a prominent forehead, a broad nasal bridge, and a bulbous nose. Midline facial anomalies such as cleft lip and palatal (roof of mouth) abnormalities may be observed. Patients are also at high risk for bone fractures and some specific problems with their teeth.
Possible Causes
The molecular basis for the syndrome remains unknown. Some believe that the immunologic basis arises from a deficiency in the ability of suppressor T
cells to inhibit IgE production. The condition, as a result, increases the individual’s chances of getting infections. The most commonly involved
bacteria is Staphylococcus aureus. Other common organisms are Streptococcus pneumoniae (bacterium), Hemophilus influenzae (bacterium), Candida albicans (yeast), and the herpes virus.
Diagnosis
The diagnosis is based on the overall picture, though several tests are used to help indentify Hyper IgE syndrome: High serum levels are detected in blood samples Marked eosinophilia (an increase in a specific type of white blood
cells) A blood analysis to detect if there is poor response to movement of
cells , especially certain white
cells—also known as chemotaxis ( i.e. defective chemotaxis leads to poor response of
cells towards infection). There is no one specific test that will confirm or refute the diagnosis.
Treatment
The goal of treatment is control of the recurrent infections. Medications include intermittent or continous antibiotic treatment of infections with an appropriate antibiotic for the organism causing the infection. Antifungal agents are prescribed when appropriate. Antiviral agents are given when appropriate. In addition, surgery is often needed to drain abscesses. During severe infections, intravenous gamma globulin (IVIG) protein may help to build up the
immune system temporarily when there are severe infections.
Prognosis
Hyper IgE Syndrome is a life-long condition requiring treament for each new infection. Some complications include repeated infection and sepsis (bloodstream infection). Some physicians, however, recommend good general hygiene as a preventitive measure.
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Weblinks
E-Medicine
A comprehensive article on Hyper IgE sundrome with specific information on diagnosis and treatment.
Clinical Trials.Gov
A list of ongoing clinical trials relating to Hyper IgE Syndrome.
Google Search for Hyper IgE Syndrome
References and Sources
Mandell: Principles and Practice of Infectious Diseases, 5th ed., Copyright © 2000 Churchill Livingstone, Inc. 101, 152-153 www.mdconsult.com