Publications by authors named "Ailal F"

Introduction: Pediatric sepsis remains a leading cause of morbidity and mortality in Africa. Nearly half of pediatric sepsis deaths occur in previously healthy children. The role of inborn errors of immunity (IEI) in susceptibility to sepsis is yet to be identified and their prevalence amongst previously healthy children admitted to the pediatric intensive care unit (PICU) is unclear.

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Congenital neutropenia (CoN) is a heterogeneous group of inborn errors of immunity (IEI) characterized by recurrent infections and early onset of neutropenia (NP). This study aimed to investigate the demographic and clinical data of children with CoN and idiopathic neutropenia (IN) in Morocco. We performed a retrospective study of patients with CoN and analyzed the clinical and laboratory findings of patients with CoN and IN diagnosed between 1999 and 2018 in a clinical immunology unit of a large pediatric hospital.

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Glycogen Storage Disease Type Ib (GSD-Ib) is a rare autosomal recessive metabolic disorder caused by mutations in SLC37A4, leading to a deficiency in glucose-6-phosphate translocase. This disorder is characterized by impaired glycogenolysis and gluconeogenesis, resulting in clinical and metabolic manifestations. We report a three-month-old Moroccan female patient presenting with doll-like facies, hepatomegaly, dysmorphic features, and developmental delays.

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. This study aims to describe the clinical and paraclinical characteristics of Multisysteminflammatory syndrome in children (MIS-C). .

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  • Hyper-IgE syndrome (HIES) is an inherited immune disorder marked by high IgE levels, chronic eczema, and recurrent staphylococcal infections.
  • This study examined Moroccan patients likely suffering from HIES, focusing on their clinical and immunological features based on specific NIH criteria over a 25-year period.
  • Findings revealed a wide range of symptoms, with eczema and skin infections being the most common, emphasizing the need for molecular analysis for accurate diagnosis and treatment in light of overlapping symptoms.
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  • SARS-CoV-2 causes pneumonia and severe respiratory issues, especially in patients with genetic defects in type I interferon, impacting individuals differently based on age and gender.
  • About 3-5% of critical COVID-19 patients under 60 years have genetic defects in interferon production, while around 15-20% of those over 70 show autoantibodies against type I interferons.
  • This review discusses the links between genetic and immunological factors contributing to severe COVID-19 and pediatric multisystem inflammatory syndrome (MIS-C), emphasizing the need for more research to develop targeted treatments and strategies for future viral infections.
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  • Morocco has seen progress in tackling tuberculosis, but the Covid-19 pandemic disrupted tuberculosis control worldwide and altered its epidemiology.
  • A retrospective study of children hospitalized for tuberculosis at a Casablanca hospital from 2018 to 2022 revealed significant fluctuations in case numbers before, during, and after the pandemic.
  • The data showed a drop in annual cases during quarantine (23) compared to pre-pandemic (49) and a rise post-quarantine (81), with more extrapulmonary cases observed during the pandemic.
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Autoimmune cytopenias are defined by autoantibodies' immune destruction of one or more blood elements. Most often it is autoimmune hemolytic anemia or immune thrombocytopenia or both that define Evans syndrome. It may be secondary to infection or to underlying pathology such as systemic autoimmune disease or primary immunodeficiency, especially when it becomes chronic over several years.

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The detection of a high serum immunoglobulin E (IgE) level is first suggestive of allergy, atopy or parasitosis. However, some very high values can be a sign of more severe diseases. We propose a diagnostic strategy based on clinical and biological data to identify the various hereditary immune diseases that also present with abnormally high serum IgE levels.

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In the era of genomics, orientation in the face of hereditary neutropenia still requires, first and foremost, a good clinical and cytological analysis. The thirty responsible genes now explain 60% of congenital neutropenia. These are rare since they are only found in 1‰ of all congenital neutropenia, estimated at 1% of the population.

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Common variable immunodeficiency (CVID) is a complex inborn error of humoral immunity with complications of both infectious and non-infectious origins. Classifications of CVID patients provide a clearer understanding of the pathogenesis, prediction, and management of non-infectious complications. This study aims to classify Moroccan CVID patients based on the European classification (EUROclass).

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  • A study conducted at Ibn Rochd University Hospital-Casablanca from 2017 to 2021 found that unusual viral skin infections were often the first signs of inborn errors of immunity in children, affecting 1.3% of patients with suspected IEI.
  • The research involved 591 newly diagnosed patients, identifying specific genetic deficiencies like GATA2, STK4, and COPA in some, linked to chronic or resistant viral skin infections.
  • The study emphasizes the importance of recognizing these skin infections as potential indicators of underlying immunological issues, which could improve diagnosis and treatment for affected children and their families.
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  • Patients with X-linked recessive deficiency of TLR7, a crucial immune sensor, struggle to recognize SARS-CoV-2 and produce necessary type I interferons, leading to severe pneumonia cases.
  • A study included 22 unvaccinated individuals with MyD88 or IRAK-4 deficiencies from multiple countries, primarily affecting children and young adults, with a significant portion requiring hospitalization.
  • The findings highlight that these genetic deficiencies, previously linked to bacterial infections, also significantly increase vulnerability to hypoxemic pneumonia caused by COVID-19, especially as patients age.
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Purpose: The first molecular evidence of a monogenic predisposition to mycobacteria came from the study of Mendelian susceptibility to mycobacterial disease (MSMD). We aimed to study this Mendelian susceptibility to mycobacterial diseases in Moroccan kindreds through clinical, immunological, and genetic analysis.

Methods: Patients presented with clinical features of MSMD were recruited into this study.

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Immune deficiencies in adults are quite common conditions in medical practice. However, they present with different clinical phenotypes, whether primary or secondary, which makes their diagnosis more tedious, hence diagnostic and management delays. Through this update, we will review the most common immune deficiencies, their presentations and features.

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Autoimmune lymphoproliferative syndrome (ALPS) is a rare genetic disorder of lymphocyte homeostasis, resulting from mutations in the Fas apoptotic pathway. It is characterized by non-infectious and non-malignant chronic lymphoproliferation and an increased risk of lymphoid malignancy. The diagnosis of this condition usually combines chronic lymphadenopathy and/or splenomegaly exceeding 6 months, autoimmune cytopenias, with an elevated level of CD3+CD4-CD8- Tαβ lymphocytes, known as "double-negative" T cells.

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Article Synopsis
  • Genetic testing is crucial for diagnosing inborn errors of immunity (IEI), but high costs and advanced tech limit accessibility, especially in low-income countries like Morocco.
  • A study analyzed 742 patients over 12 years, finding that 29% received genetic diagnoses, with 55 defects identified, including 7 new ones.
  • Collaborative thesis projects were key to achieving these results, highlighting progress in genetic diagnosis and offering a foundation for better patient care in Morocco.
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Patients with inborn errors of immunity (IEI) are prone to develop infections, either due to a broad spectrum of pathogens or to only one microbe. Since skin is a major barrier tissue, cutaneous infections are among the most prevalent in patients with IEI due to high exposures to many microbes. In the general population, human papillomaviruses (HPVs) cause asymptomatic or self-healing infections, but, in patients with IEI, unusual clinical expression of HPV infection is observed ranging from epidermodysplasia verruciformis (EV) (a rare disease due to β-HPVs) to profuse, persistent, and recalcitrant warts (due to α-, γ-, and μ-HPVs) or even tree man syndrome (due to HPV2).

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  • The report discusses a child with Mendelian susceptibility to mycobacterial disease (MSMD) caused by a complete deficiency of the T-bet protein, leading to impaired production of the immune signaling molecule IFN-γ.
  • The patient shows persistent upper airway inflammation and high levels of eosinophils due to excessive production of T helper 2 (Th2) cytokines like IL-5 and IL-13, which is linked to the mutant T-bet failing to regulate these cytokines.
  • The study concludes that T-bet deficiency results in both the child's susceptibility to mycobacterial infections and the increased Th2 cytokine production, causing symptoms like blood eosinophilia and upper airway inflammation.
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Human USP18 is an interferon (IFN)-stimulated gene product and a negative regulator of type I IFN (IFN-I) signaling. It also removes covalently linked ISG15 from proteins, in a process called deISGylation. In turn, ISG15 prevents USP18 from being degraded by the proteasome.

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  • Common variable immunodeficiency (CVID) is a common primary immunodeficiency marked by low antibody levels, increased infection risk, and poor vaccine responses, and shows great variability in its clinical and genetic profiles.
  • Advances in genetic technologies like next generation sequencing are uncovering more genes associated with CVID, leading to its recognition as a complex polygenic condition that includes many distinct types of disorders.
  • The review highlights the need for a multi-omic approach—integrating genomics, epigenetics, and proteomics—to better understand CVID's complex mechanisms and to develop personalized treatment strategies.
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We studied a child with severe viral, bacterial, fungal, and parasitic diseases, who was homozygous for a loss-of-function mutation of REL, encoding c-Rel, which is selectively expressed in lymphoid and myeloid cells. The patient had low frequencies of NK, effector memory cells reexpressing CD45RA (Temra) CD8+ T cells, memory CD4+ T cells, including Th1 and Th1*, Tregs, and memory B cells, whereas the counts and proportions of other leukocyte subsets were normal. Functional deficits of myeloid cells included the abolition of IL-12 and IL-23 production by conventional DC1s (cDC1s) and monocytes, but not cDC2s.

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Mucocutaneous fungal infections are common and usually occur in the presence of certain risk factors. However, these infections can occur in patients with no known risk factors. This indicates the presence of an underlying genetic susceptibility to fungi reflecting an innate or adaptive immune deficiency.

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Severe combined immunodeficiency (SCID) comprises a heterogeneous group of inherited immunologic disorders with profound defects in cellular and humoral immunity. SCID is the most severe PID and constitutes a pediatric emergency. Affected children are highly susceptible to bacterial, viral, fungal, and opportunistic infections with life-threatening in the absence of hematopoietic stem cell transplantation.

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Severe combined immunodeficiency (SCID) is a heterogeneous group of primary immunodeficiency diseases (PIDs) characterized by a lack of autologous T lymphocytes. This severe PID is rare, but has a higher prevalence in populations with high rates of consanguinity. The epidemiological, clinical, and immunological features of SCIDs in Moroccan patients have never been reported.

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