The clinical characteristics of 17 cases of primary ciliary dyskinesia
Objective: To review the clinical data of cases of primary ciliary dyskinesia (PCD), and to explore the clinical characteristics for the understanding of PCD. Methods: We retrospectively summarized 17 patients with PCD diagnosed in Peking Union Medical College Hospital from Jan 2009 to Dec 2014. There were 7 male and 10 female patients, with the age from 6 to 57 years at the time of diagnosis. The mean onset age of the disease was 11.7±2.1 years, and the mean age at diagnosis was 29.5±3.5 years. We analyzed their clinical symtoms, radiologic images, pulmonary function test and the electron microscopic findings for the clinical characteristics of PCD. Results: The most common onset symptoms were cough (15/17) or sputum (13/17) among our 17 patients with PCD. Only 5 patients had situs inversus in our group. Sixteen patients had bronchiectasis on chest CT scan. Nasal sinusitis was confirmed by nasal CT scan in 15 patients. The most common pathogens from sputum cultures included Pseudomonas aeruginosa, Haemophilus influenzea, Aspergillus fumigates and Candida (3/14 respectively). None of the patients had evidence of mycobacterial infection. Twelve patients underwent spirometry and obstructive pattern was the most common disorder (8/12). Diffusion impairment (5/10) and restrictive pattern dysfunction (3/10) were also present in our patients. Two patients had normal pulmonary function test results. Thirteen patients underwent bronchial mucosal ciliary electron microscopy and the most abnormalities were outer or inner dynein arms deficiency (8/13), and other abnormalities included microtubule arrangement disorder (3/13), reduction of the number of microtubules (3/13) and reduction of the number of dynein arms (2/13). Four of our patients had multiple dysfunctions on their ciliaries. Conclusions: PCD should be considered in bronchiectasis patients with disease onset at childhood even without situs inverse, especially those accompanied with nasal sinusitis or otitis media. Chest or paranasal sinus CT scan, and male sperm examination were helpful for the diagnosis. Mucosal ciliary electron microscopy was an efficient diagnostic method for PCD.