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Rubella Virus Associated Chronic Inflammation in Primary Immunodeficiency Diseases
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12 2020
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Source: Curr Opin Allergy Clin Immunol. 20(6):574-581
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Alternative Title:Curr Opin Allergy Clin Immunol
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Description:Purpose of the review
To summarize recent data on rubella virus (RuV) vaccine in chronic inflammation focusing on granulomas in individuals with primary immunodeficiencies (PID).
Recent findings
The live attenuated RuV vaccine has been recently associated with cutaneous and visceral granulomas in children with various PIDs. RuV vaccine strain can persist for decades subclinically in currently unknown body site(s) before emerging in granulomas. Histologically, RuV is predominately localized in M2 macrophages in the granuloma centers. Multiple mutations accumulate during persistence resulting in emergence of immunodeficiency-related vaccine-derived rubella viruses (iVDRV) with altered immunological, replication and persistence properties. Viral RNA was detected in granuloma biopsies and nasopharyngeal secretions and infectious virus was isolated from the granuloma lesions. The risk of iVDRV transmissibility to contacts needs to be evaluated. Several broad-spectrum antiviral drugs have been tested recently but did not provide significant clinical improvement. Hematopoietic stem cell transplantation remains the only reliable option for curing chronic RuV-associated granulomas in PID.
Summary
Persistence of vaccine-derived rubella viruses appears to be a crucial factor in a significant proportion of granulomatous disease in PID. RuV testing of granulomas in PID individuals might help with case management.
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Pubmed ID:33044342
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Pubmed Central ID:PMC7730704
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Volume:20
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Issue:6
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