Chronic Granulomatous Disease
(CGD; Fatal Granulomatosis of Childhood; Chronic Granulomatous Disease of Childhood; Progressive Septic Granulomatosis)
Pronounced: Kron-ik gran-u-lo-ma-tus disease
Chronic granulomatous disease develops when a specific gene from both parent passes to the child. This gene causes abnormal cells to develop in the immune system. The abnormal cells are called phagocytic cells. They normally kill bacteria. With this disease, these cells are impaired. As a result, the body can not fight some types of bacteria. It also makes infections likely to recur.
The increased risk of infections can lead to premature death. Repeated lung infections are often the cause of death with this disease. Preventative care and treatment, can help to reduce and temporarily control infections.
CGD is a rare condition, occurring in about one in 200,000 births in the US.
The disease is usually caused by a recessive gene. This means two of this defective gene have to be present for the disease to develop. This gene is carried on the X chromosome. Some individuals inherit the disease in an autosomal recessive pattern. In other words, both parents must have the gene.
The following factors increase your chance of developing CGD:
- Parents who have the recessive trait
- Being female
- Swollen lymph nodes in the neck
- Abscesses in the neck's lymph nodes or liver
- Frequent skin infections that are resistant to treatment:
- Frequent ]]>pneumonia]]> that is resistant to treatment
- Persistent ]]>diarrhea]]>
- Infections of the bones
- Infections of the joints
- Fungal infections
Bacterial Skin Infection
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include the following:
- Biopsy]]> —removal of a sample of tissue to test for the condition
- Dihydrorhodamine reduction (DHR) flow cytometry test—a blood test that looks at the ability of phagocytes to make chemicals that can destroy bacteria
- Erythrocyte sedimentation rate (ESR)—to test for inflammation
- ]]>Chest x-ray]]> —a test that uses radiation to take pictures of structures inside the chest cavity
- ]]>Bone scan]]>
- Liver scan
- Complete blood count (CBC)
Talk with your doctor about the best plan for you. Treatment options include:
- Antibiotics—used for preventative and fungal treatments, and new infections
- Interferon gamma]]> —reduces the number of infections in patients; not useful in acute (newly active) infections
Bone Marrow Transplantation
Bone marrow transplantation may be an option. A suitable donor will need to be found. It is a definitive cure.
Surgery may involve the debridement or removal of abscesses.
Some live viral vaccines should be avoided. You should consult with an immunologist before receiving one.
CGD is an inherited disease. There are no preventive steps to reduce the risk of being born with the disease. Genetic counseling may be helpful. It can be used to detect carrier status in woman. Early diagnosis is essential. It will allow for early treatment. The bone marrow transplant donor search can also be started.
National Organization of Rare Disorders
University of Maryland Medical Center
Sick Kids (The Hospital for Sick Children)
Bernhisel-Broadbent J, Camargo EE, Jaffe HS, et al. Recombinant human interferon-gamma as adjunct therapy for Aspergillus infection in a patient with chronic granulomatous disease. J Infect Dis . 1991;163(4):908-911.
Chronic granulomatous disease. IDF Patient/Family Handbook . Immune Deficiency Foundation website. Available at: http://www.primaryimmune.org/pubs/book_pats/e_ch06.pdf . Accessed May 30, 2007.
Chronic granulomatous disease. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001239.htm . Accessed June 6, 2007.
Chronic granulomatous disease. Primary Immunodeficiency Resource Center website. Available at: http://npi.jmfworld.org/patienttopatient/index.cfm?section=patienttopatient&content=syndromes&area=7&CFID=20238377&CFTOKEN=8591889 . Accessed May 30, 2007.
Dinauer, MC, Lekstrom-Himes, JA, Dale, DC. Inherited Neutrophil Disorders: Molecular Basis and New Therapies. Hematology (Am Soc Hematol Educ Program) 2000; :303.
Doepel L. Chronic granulomatous disease research advances on several fronts. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/publications/dateline/0196/page3.htm . Accessed May 31, 2007.
Lekstrom-Himes, JA, Gallin JI. Immunodeficiency diseases caused by defects in phagocytes. N Engl J Med . 2000; 343:1703.
Pogrebniak HW, Gallin JI, Malech HL. Surgical management of pulmonary infections in chronic granulomatous disease of childhood. Ann Thorac Surg . 1993;55(4):844-849.
Last reviewed January 2009 by ]]>Julie D.K. McNairn, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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