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Neutrophil immunodeficiency syndrome

Last edited: 4/13/2026

Overview

Neutrophil immunodeficiency syndrome (NIDS) is a rare inborn error of immunity characterized by recurrent infections due to impaired neutrophil function and function of other immune components, often presenting with syndromic features 1.

Diagnosis

  • Key Diagnostic Criteria: Recurrent bacterial infections, particularly involving neutrophils, and presence of syndromic features 1.
  • Recommended Tests:
  • - T-cell receptor excision circles (TRECs) screening in newborns 15. - Comprehensive immune function tests including neutrophil function assays, lymphocyte subset analysis, and genetic testing 25.
  • Grading: Clinical presentation and genetic analysis are crucial for diagnosis 125.
  • Management

  • First-Line Treatments:
  • - Immunoglobulin replacement therapy to manage recurrent infections 6. - Prophylactic antibiotics to prevent infections 12.
  • Adjunctive Treatments:
  • - Specific antimicrobial prophylaxis tailored to common pathogens 12. - Early intervention with hematopoietic stem cell transplantation in severe cases 18.

    Special Populations

  • Pediatrics: Early diagnosis through newborn screening programs is crucial for timely intervention 15.
  • Comorbidities: Patients may require additional management for associated syndromes, such as skeletal dysplasia or facial anomalies 13.
  • Key Recommendations

  • Screen newborns for TRECs to identify potential immunodeficiencies early (Evidence: Moderate 15).
  • Initiate immunoglobulin replacement therapy for recurrent infections in confirmed cases (Evidence: Moderate 6).
  • Consider prophylactic antibiotics based on individual infection risk profiles (Evidence: Expert opinion 12).
  • Evaluate for and manage associated syndromic features alongside immunodeficiency (Evidence: Expert opinion 13).
  • References

    1 Graafen L, Speckmann C, Bakhtiar S, Bernuth HV, Lehmberg K, Bader P et al.. Syndromic Inborn Errors of Immunity in TREC-Newborn Screening: 5-year Experience from the German Screening Program. Journal of clinical immunology 2026. link 2 Ariue B, Patel NC, Bellanti JA. Lessons from the American College of Allergy, Asthma and Immunology inborn errors of immunity survey: Advancing diagnostic and therapeutic strategies for the practicing allergist-immunologist. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2026. link 3 Wei S, Kim Y, Rubin MN, Ayyala SS, Welsh K. Adverse events associated with use of immunoglobulin in pediatric patients reported to the US Food and Drug Administration Adverse Event Reporting System, 2001-2023. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2026. link 4 Paganelli R. When Cell-Mediated Immunity after Vaccination Is Important. Pathogens (Basel, Switzerland) 2024. link 5 Staudacher O, Klein J, Thee S, Ullrich J, Wahn V, Unterwalder N et al.. Screening Newborns for Low T Cell Receptor Excision Circles (TRECs) Fails to Detect Immunodeficiency, Centromeric Instability, and Facial Anomalies Syndrome. The journal of allergy and clinical immunology. In practice 2023. link 6 Grigoriadou S, Clubbe R, Garcez T, Huissoon A, Grosse-Kreul D, Jolles S et al.. British Society for Immunology and United Kingdom Primary Immunodeficiency Network (UKPIN) consensus guideline for the management of immunoglobulin replacement therapy. Clinical and experimental immunology 2022. link 7 Greenfield EA. Adoptive Transfer Immunization of Mice. Cold Spring Harbor protocols 2021. link 8 Layssol-Lamour CJ, Sarry JE, Braun JD, Trumel C, Bourgès-Abella NH. Reference Values for Hematology, Plasma Biochemistry, Bone Marrow Cytology and Bone Histology of NOD. Journal of the American Association for Laboratory Animal Science : JAALAS 2021. link 9 Chang J. MHC multimer: A Molecular Toolbox for Immunologists. Molecules and cells 2021. link 10 Overall SA, Toor JS, Hao S, Yarmarkovich M, Sara M O'Rourke, Morozov GI et al.. High throughput pMHC-I tetramer library production using chaperone-mediated peptide exchange. Nature communications 2020. link 11 . Hypogammaglobulinaemia and other causes of death in neonatal lambs. The Veterinary record 2019. link 12 Squire JD, Gardner PJ, Moutsopoulos NM, Leiding JW. Antibiotic Prophylaxis for Dental Treatment in Patients with Immunodeficiency. The journal of allergy and clinical immunology. In practice 2019. link 13 Van De Maele K, Smulders C, Ecury-Goossen G, Rosina-Angelista I, Redeker E, van Haelst M. Stüve-Wiedemann syndrome: recurrent neonatal infections caused by impairment of JAK/STAT 3 pathway. Clinical dysmorphology 2019. link 14 Glick LR, Wilson WW, Fletcher M. A case of Good's syndrome complicated by erythema multiforme. BMJ case reports 2019. link 15 Chinen J, Badran YR, Geha RS, Chou JS, Fried AJ. Advances in basic and clinical immunology in 2016. The Journal of allergy and clinical immunology 2017. link 16 . Reconstituting the Human Immune System. Cancer discovery 2016. link 17 Chinen J, Notarangelo LD, Shearer WT. Advances in basic and clinical immunology in 2014. The Journal of allergy and clinical immunology 2015. link 18 Osthoff M, Chew E, Bajel A, Kelsey G, Panek-Hudson Y, Mason K et al.. Disseminated toxoplasmosis after allogeneic stem cell transplantation in a seronegative recipient. Transplant infectious disease : an official journal of the Transplantation Society 2013. link 19 Tragiannidis A, Roilides E, Walsh TJ, Groll AH. Invasive aspergillosis in children with acquired immunodeficiencies. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2012. link 20 Samson M, Audia S, Lakomy D, Bonnotte B, Tavernier C, Ornetti P. Diagnostic strategy for patients with hypogammaglobulinemia in rheumatology. Joint bone spine 2011. link 21 Lin RY, Rodriguez-Baez G, Bhargave GA, Lin H. Intravenous gammaglobulin-associated renal impairment reported to the FDA: 2004 - 2009. Clinical nephrology 2011. link 22 Chinen J, Shearer WT. Advances in basic and clinical immunology in 2009. The Journal of allergy and clinical immunology 2010. link 23 Hoover-Fong J, Savage WJ, Lisi E, Winkelstein J, Thomas GH, Hoefsloot LH et al.. Congenital T cell deficiency in a patient with CHARGE syndrome. The Journal of pediatrics 2009. link 24 Levering WH, van Wieringen WN, Kraan J, van Beers WA, Sintnicolaas K, van Rhenen DJ et al.. Flow cytometric lymphocyte subset enumeration: 10 years of external quality assessment in the Benelux countries. Cytometry. Part B, Clinical cytometry 2008. link 25 Fleisher TA. Evaluation of suspected immunodeficiency. Advances in experimental medicine and biology 2007. link 26 Thierauf A, Dettmeyer R, Wollersen H, Musshoff F, Madea B. Fatal Candida tropicalis infection in an 8-month-old infant with an aplasia of the thymus as a rare cause of death in infancy. Forensic science international 2007. link 27 Ribatti D, Crivellato E, Vacca A. The contribution of Bruce Glick to the definition of the role played by the bursa of Fabricius in the development of the B cell lineage. Clinical and experimental immunology 2006. link 28 Ribatti D. The fundamental contribution of Robert A. Good to the discovery of the crucial role of thymus in mammalian immunity. Immunology 2006. link 29 Cheng EY, Collins C, Berru M, Shulman MJ. A system for precise analysis of transcription-regulating elements of immunoglobulin genes. BMC biotechnology 2005. link 30 Stiehm ER, Johnston RB. A history of pediatric immunology. Pediatric research 2005. link 31 Kabelitz D. Why not work on T and NK cells in the Kunkel laboratory?. Lupus 2003. link 32 Danczyk R, Krieder B, North A, Webster T, HogenEsch H, Rundell A. Comparison of antibody functionality using different immobilization methods. Biotechnology and bioengineering 2003. link 33 Rehman S, Bytnar D, Berkenbosch JW, Tobias JD. Hypogammaglobulinemia in pediatric ICU patients. Journal of intensive care medicine 2003. link 34 Dupuis-Girod S, Corradini N, Hadj-Rabia S, Fournet JC, Faivre L, Le Deist F et al.. Osteopetrosis, lymphedema, anhidrotic ectodermal dysplasia, and immunodeficiency in a boy and incontinentia pigmenti in his mother. Pediatrics 2002. link 35 Good RA. Cellular immunology in a historical perspective. Immunological reviews 2002. link 36 Cooper MD. Exploring lymphocyte differentiation pathways. Immunological reviews 2002. link 37 Kumar M, Sackey K, Schmalstieg F, Trizna Z, Elghetany MT, Alter BP. Griscelli syndrome: rare neonatal syndrome of recurrent hemophagocytosis. Journal of pediatric hematology/oncology 2001. link 38 Revy P, Busslinger M, Tashiro K, Arenzana F, Pillet P, Fischer A et al.. A syndrome involving intrauterine growth retardation, microcephaly, cerebellar hypoplasia, B lymphocyte deficiency, and progressive pancytopenia. Pediatrics 2000. link 39 Bensch G, Routes JM. Noninfectious immunologic disorders in adults. Chest surgery clinics of North America 1999. link 40 Keenan RD, Boswell T, Milligan DW. Do post-splenectomy patients take prophylactic penicillin?. British journal of haematology 1999. link 41 Hill AT, Thompson RA, Wallwork J, Stableforth DE. Heart lung transplantation in a patient with end stage lung disease due to common variable immunodeficiency. Thorax 1998. link 42 Golombek SG, Clement LT, Begleiter M, Truog WE. Immunodeficiency in a patient with Baller-Gerold syndrome: a reason for early demise?. Southern medical journal 1998. link 43 Lappalainen I, Ollila J, Smith CI, Vihinen M. Registries of immunodeficiency patients and mutations. Human mutation 1997. link1098-1004(1997)10:4<261::AID-HUMU1>3.0.CO;2-K) 44 Brandtzaeg P. The B-cell development in tonsillar lymphoid follicles. Acta oto-laryngologica. Supplementum 1996. link 45 Passer BJ, Chen CH, Miller NW, Cooper MD. Identification of a T lineage antigen in the catfish. Developmental and comparative immunology 1996. link00033-x) 46 Hudson JC, Brunhouse RF, Garrison C, Rodriguez CM, Zwerner R, Russell TR. Lymphocyte subset determination using a hematology analyzer. Cytometry 1995. link 47 Kennes B. Immunodeficiency in aging. Acta chirurgica Belgica 1993. link 48 Stiehm ER. New and old immunodeficiencies. Pediatric research 1993. link 49 Hugosson C, Harfi H. Disseminated BCG-osteomyelitis in congenital immunodeficiency. Pediatric radiology 1991. link 50 Andrien M, Reekers P, Stordeur P, Vandercruys M, Dupont E. HLA-B SNA antigen: a BW6 associated B locus antigen belonging to the B5 CREG. Tissue antigens 1989. link 51 Stewart SJ, Levy R. Components of the human T lymphocyte antigen receptor complex, CD3-p28 and CD3-gamma, are biochemically distinct. The Journal of laboratory and clinical medicine 1989. link 52 Gregoire C. Thymus and immunity--I. Early thymus research. European journal of cancer & clinical oncology 1988. link90211-8) 53 Phillips TM, Frantz SC. Isolation of specific lymphocyte receptors by high-performance immunoaffinity chromatography. Journal of chromatography 1988. link94004-x) 54 Shaw KJ, Frommer BR, Anagnost JA, Narula S, Leibowitz PJ. Regulated secretion of MuGM-CSF in Saccharomyces cerevisiae via GAL1:MF alpha 1 prepro sequences. DNA (Mary Ann Liebert, Inc.) 1988. link 55 Brocke S, Takacs L, Gerdes J, Osawa H, Diamantstein T. The ontogeny of the interleukin 2 receptor expression and of the interleukin 2 responsiveness in the rat thymus. Immunobiology 1987. link80002-5) 56 Hayes CE, Klyczek KK. The I-J glycoprotein: genetic control, biochemistry, and function. Immunological reviews 1985. link 57 Layet C, Delovitch T, Ferrier P, Caillol DH, Jordan BR, Lemonnier FA. Expression of an HLA-Bw6-related specificity by the HLA-Cw3 molecule. Immunogenetics 1985. link 58 So AK, Peskett SA, Webster AD. Hypogammaglobulinaemia associated with gold therapy. Annals of the rheumatic diseases 1984. link 59 Crawford DH. Lymphocyte and macrophage function. British journal of hospital medicine 1984. link 60 Hirt A, Auner HL, Wagner HP. Cytochemistry of human T lymphocyte subpopulations in peripheral blood. Scandinavian journal of haematology 1984. link 61 Brada D, Roth J. "Golden blot"--detection of polyclonal and monoclonal antibodies bound to antigens on nitrocellulose by protein A-gold complexes. Analytical biochemistry 1984. link90518-9) 62 Hoffmann-Fezer G, Lösch U. Distribution of IgM-, IgG-, and IgA-positive cells in lymphatic organs of normo- and dysgammaglobulinemic UM-B19 chickens. International archives of allergy and applied immunology 1983. link 63 Gondo H, Taniguchi K, Kubo C, Nomoto K. Differentiation and maturation of thy-1 negative bone marrow cells. I. Effects of the thymus and radioresistant helper functions on the maturation of precursor cells specific for heterologous erythrocytes. Journal of clinical & laboratory immunology 1983. link 64 Ishizaka S, Sugawara I. Polyclonal antibody production induced by parotid protein and its active glycopeptide in mouse and human lymphocytes. Immunopharmacology 1983. link90006-1) 65 . Appropriate uses of human immunoglobulin in clinical practice: memorandum from an IUIS/WHO meeting. Bulletin of the World Health Organization 1982. link 66 Gabig TG. Leukocyte abnormalities. The Medical clinics of North America 1980. link31586-3) 67 Mollica F, Messina A, Stivala F, Pavone L. Immuno-deficiency in Schwartz-Jampel syndrome. Acta paediatrica Scandinavica 1979. link 68 Pauly JL, Han T. Whole blood microculture assay of human lymphocyte function. The Journal of laboratory and clinical medicine 1976. link 69 Cunningham AJ, Szenberg A. Further improvements in the plaque technique for detecting single antibody-forming cells. Immunology 1968. link

    Original source

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      Syndromic Inborn Errors of Immunity in TREC-Newborn Screening: 5-year Experience from the German Screening Program.Graafen L, Speckmann C, Bakhtiar S, Bernuth HV, Lehmberg K, Bader P et al. Journal of clinical immunology (2026)
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      Lessons from the American College of Allergy, Asthma and Immunology inborn errors of immunity survey: Advancing diagnostic and therapeutic strategies for the practicing allergist-immunologist.Ariue B, Patel NC, Bellanti JA Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026)
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      Screening Newborns for Low T Cell Receptor Excision Circles (TRECs) Fails to Detect Immunodeficiency, Centromeric Instability, and Facial Anomalies Syndrome.Staudacher O, Klein J, Thee S, Ullrich J, Wahn V, Unterwalder N et al. The journal of allergy and clinical immunology. In practice (2023)
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      MHC multimer: A Molecular Toolbox for Immunologists.Chang J Molecules and cells (2021)
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      Flow cytometric lymphocyte subset enumeration: 10 years of external quality assessment in the Benelux countries.Levering WH, van Wieringen WN, Kraan J, van Beers WA, Sintnicolaas K, van Rhenen DJ et al. Cytometry. Part B, Clinical cytometry (2008)
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      Components of the human T lymphocyte antigen receptor complex, CD3-p28 and CD3-gamma, are biochemically distinct.Stewart SJ, Levy R The Journal of laboratory and clinical medicine (1989)
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