OP 5 - Infectious manifestations in Common Variable Immunodeficiency: a retrospective cohort from Sri Lankanka

Palipane EG, Karunatilake RMCH, de Silva R, Dasanayake DDepartment of Immunology, Medical Research Institute, Colombo 08

Abstract

Introduction

Common variable immunodeficiency (CVID) is an inborn error of immunity (IEI) characterized by defective antibody production resulting in hypogammaglobulinemia and increased susceptibility to infection. Recurrent infections are the predominant manifestation, contributing substantially to morbidity and mortality. Due to its rarity and clinical heterogeneity, further research is essential to better define clinical phenotypes.

Objectives

To describe the infectious manifestations in patients with CVID managed at MRI and to assess diagnostic delay from the onset of symptoms to diagnosis of CVID.

Design, setting, and methods

This was a descriptive retrospective study conducted in March 2026 at the Department of Immunology, MRI. Patients diagnosed with CVID according to the European Society for Immunodeficiencies diagnostic criteria and registered at the Department of Immunology were included. Data on patient demographics, age of onset of symptoms, age at diagnosis, infectious manifestations, microbiological investigations and radiological findings, were collected retrospectively from patient records and analyzed using descriptive statistics.

Results

The total number of patients was 22. Mean age at onset of symptoms was 19.7 years (SD±13.6). Mean age at diagnosis of CVID was 27.9 years (SD±15) with a diagnostic delay of 9.1 years (SD±8.5). Recurrent respiratory tract infections were reported in all 22 patients, with pneumonia reported in 15/22 (68%). 13/19 available lower respiratory tract specimen culture reports were positive. Frequently isolated organisms were Pseudomonas spp. (5/13), Haemophilus influenzae (3/13), and Streptococcus pneumoniae (2/13). Otitis media was reported in 3/22 (14%) and recurrent sinusitis in 4/22 (18%). Bronchiectasis was detected on 16/22 (73%). Meningitis was reported in 3/22 (14%) and encephalomyelitis in one patient. Among the four available blood culture results, two patients had positive cultures. Chronic/recurrent diarrhoea was reported in 6/22 patients (27.6%), although an infective cause was not identified.

Conclusion

This study highlights the importance of evaluating adults with recurrent or severe infections (requiring hospitalization/ intravenous anti-microbial therapy), for underlying IEIs such as CVID. A significant diagnostic delay was observed in our patient cohort, emphasizing the importance of creating increased awareness among clinicians to facilitate early diagnosis, implement timely management and prevent complications.