Kostmann's disease or severe hereditary neutropenia-the man behind the syndrome.

Seventy years ago, the Swedish pediatrician Rolf Kostmann (1909-1982) was the first to report on a previous unknown lethal hereditary neutropenia in infants, Kostmann's disease. This essay presents the man behind the syndrome rather than focusing on the disease itself.

Kostmann's Disease and HCLS1-Associated Protein X-1 (HAX1).

Severe congenital neutropenia (SCN), originally described by the Swedish pediatrician Rolf Kostmann, constitutes a heterogeneous disorder associated with a dramatic decrease of peripheral neutrophil granulocytes. Patients suffer from life-threatening bacterial infections unless treated by recombinant human granulocyte colony stimulating factor (G-CSF) or allogeneic hematopoietic stem cells. This review is focused on the SCN variant caused by mutations in HCLS1 Associated Protein X-1 (HAX1) (SCN3, "Kostmann Disease"). HAX1 is a ubiquitously expressed protein with pleotropic functions, including control of cellular viability, migration, and cancer progression. Even though scientific evidence on the molecular mechanisms regarding HAX1 accumulates, no unified picture has emerged. This review highlights historical milestones and our current understanding of SCN related to mutations in HAX1.

Eponym. Kostmann disease.

Rolf Kostmann (1909-1982) was a Swedish pediatrician and army doctor. He was the first to describe an inherited form of chronic neutropenia in childhood. In 1956, Kostmann published his article "Infantile genetic agranulocytosis" in Acta Paediatrica. "Infantile agranulocytosis," as Rolf Kostmann named this hereditary syndrome, has been known for more than half a century, yet the underlying genetic mutations have remained unknown for many decades. Fifty years later, homozygous mutations in the gene encoding the mitochondrial protein HCLS1-associated X1 were found in affected members of the original Kostmann pedigree. Therefore, the eponym "Kostmann disease" best fits this specific mutation and mode of inheritance. The identification of genetic cause now allows the analysis of genotype-phenotype correlations. After the development of recombinant human granulocyte colony-stimulating factor (G-CSF), the prognosis and quality of life improved dramatically. Hematopoietic stem cell transplantation remains the only currently available treatment for refractory cases to G-CSF and patients who have transformed into leukemia.

Kostmann syndrome or infantile genetic agranulocytosis, part one: celebrating 50 years of clinical and basic research on severe congenital neutropenia.

UNLABELLED: Congenital neutropenia in man was first reported 50 years ago by the Swedish paediatrician Rolf Kostmann. He coined the term "infantile genetic agranulocytosis" for this condition, which is now known as Kostmann syndrome. Recent studies have demonstrated a lack of antibacterial peptides and severe periodontitis in these patients despite recombinant growth factor treatment. Moreover, an increased degree of apoptosis of myeloid progenitor cells in the bone marrow has been shown. CONCLUSION: Future studies should aim to clarify the underlying molecular genetic defect in Kostmann syndrome.

Congenital neutropenia.

The term "congenital neutropenia" signifies neutropenia that is present at birth. It includes a wide variety of disorders, some transient and others life long. Some varieties of congenital neutropenia are mild, with blood neutrophil concentrations below normal but not low enough to constitute a significant host defense deficiency. Other varieties of congenital neutropenia are characterized by low blood neutrophil concentrations and a predisposition to repeated infections.

Infección sistémica por Trichosporon asahii / Disseminated infection due to Trichosporon asahii

La tricosporinosis es una fungemia cada vez más frecuente en pacientes con neoplasias hematológicas; es producida por el Trichosporon asahii cuyo habitat es el suelo, agua y excreciones animales, aunque también forma parte de la flora normal de la piel y aparato respiratorio. En situaciones de neutropenia produce una diseminación con afectación pulmonar y renal de evolución fatal; en el 10 al 50% de los casos aparecen lesiones cutáneas. Se describe un caso de infección sistémica por Trichosporon asahii en una paciente de 40 años afecta de una leucemia mieloide aguda, de curso inicial poco sintomático y de una evolución rápida y fatal, con afectación cutánea, pulmonar y renal. La valoración clínica y el estudio histopatológico con cultivo de la piel fueron diagnósticas. Esta infrecuente fungemia debe tenerse en cuenta al valorar pacientes con neoplasias hematológicas en situación de neutropenia. Sólo el diagnóstico precoz puede evitar una diseminación mortal (AU)

The treatment of febrile neutropenia: from the Dark Ages to the present.

Developments in the treatment of infection in neutropenic patients are traced from the 1950s up to the present. In addition to the various antibiotics applied at different times, the varying predominance of different groups of pathogens is discussed. Finally, future prospects are considered.