Long-term clinical profile of children with the low-penetrance R92Q mutation of the TNFRSF1A gene.

OBJECTIVE: To analyze the long-term impact of the R92Q mutation of TNFRSF1A in children with periodic fever, in comparison with children with tumor necrosis factor receptor-associated periodic syndrome (TRAPS) with TNFRSF1A structural mutations and children with periodic fever of unknown origin fulfilling the criteria for periodic fever, aphthosis, pharyngitis, and adenitis syndrome (PFAPA). METHODS: The extracellular region of TNFRSF1A was analyzed in 720 consecutive children with periodic fever, using denaturing high-performance liquid chromatography and DNA sequencing. Followup data on 11 pediatric patients with TNFRSF1A structural mutations (cysteine or T50M), 23 pediatric patients with an R92Q substitution, and 64 pediatric patients with PFAPA were collected during routine clinic visits. The 50-item Child Health Questionnaire was used to assess health-related quality of life (HRQOL). RESULTS: The frequency of typical TRAPS-related clinical manifestations was significantly lower and the impact of the disease on HRQOL was significantly reduced in patients with the R92Q mutation compared with TRAPS patients carrying structural mutations of TNFRSF1A. Followup data on 11 TRAPS patients with TNFRSF1A structural mutations (mean followup 7.9 years), 16 patients with theR92Q substitution (mean followup 7.3 years), and 64 patients with PFAPA (mean followup 5.2 years) were available. Patients with R92Q mutations and patients with PFAPA displayed a higher rate of self-resolution or amelioration of the fever episodes than did TRAPS patients with structural mutations. CONCLUSION: Although some cases may progress to a more chronic disease course, the majority of children with an R92Q mutation of the TNFRSFA1 gene show a milder disease course than that in children with TNFRSFA1 structural mutations and have a high rate of spontaneous resolution and amelioration of the recurrent fever episodes.

Susceptibility of colostrum-deprived swine of various ages to streptococcic lymphadenitis.

The effect of age on susceptibility of young pigs to streptococcic lymphadenitis was investigated. Twenty-nine cesarean-derived, colostrum-deprived pigs were allotted to 7 groups exposed to type IV group E Streptococcus (GES) at 5, 14, 28, 35, 56, 70, and 84 days of age. Four cesarean-derived, colostrum-deprived pigs were maintained as nonexposed controls. Six naturally farrowed, susceptible controls were exposed to GES at 63 to 84 days of age. All exposed pigs were killed and necropsied 28 days after exposure. Lesions of streptococcic lymphadenitis were not observed in pigs exposed at 5 or 14 days of age, except for 1 microabscess in a mandibular lymph node in a pig exposed at 14 days, but GES was recovered from 11% of lymph nodes examined from pigs of those age groups. Lesions and GES-positive lymph nodes were frequent in cesarean-derived, colostrum-deprived pigs exposed at 28 days and older and in susceptible controls. Serologic response to exposure, as determined by microtitration agglutination test and bactericidal test, was observed only in pigs exposed at 14 days and older. The absence of abscess development in pigs exposed at 5 or 14 days of age was not caused by antibody or failure of infecting organisms to reach the target organs.