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$Unique_ID{BRK03887}
$Pretitle{}
$Title{Job Syndrome}
$Subject{Job Syndrome HIE Syndrome Hyper-IgE Syndrome Hyperimmunoglobulinemia
E-staphylococcal Abscess Syndrome Hyperimmunoglobulin E-Recurrent Infection
Syndrome Hyperimmunoglobulin E Syndrome Job-Buckley Syndrome Dermatitis Atopic
Granulomatous Disease Chronic Wiskott-Aldrich Syndrome }
$Volume{}
$Log{}
Copyright (C) 1991 National Organization for Rare Disorders, Inc.
856:
Job Syndrome
** IMPORTANT **
It is possible that the main title of the article (Job Syndrome) is not
the name you expected. Please check the SYNONYMS listing to find the
alternate names and subdivisions covered by this article.
Synonyms
HIE Syndrome
Hyper-IgE Syndrome
Hyperimmunoglobulinemia E-staphylococcal Abscess Syndrome
Hyperimmunoglobulin E-Recurrent Infection Syndrome
Hyperimmunoglobulin E Syndrome
Job-Buckley Syndrome
Information on the following diseases can be found in the Related
Disorders section of this report:
Dermatitis, Atopic
Granulomatous Disease, Chronic
Wiskott-Aldrich Syndrome
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Job Syndrome is a rare disorder present at birth (congenital) in which
there are large bacterial infections, particularly of the skin, with some
swelling and redness (cold staphylococcal abscesses); a defect in the
attraction of white blood cells (leukocytes) that destroy bacteria, fungi,
and viruses to chemical stimuli (granulocyte chemotactic defect); an
abundance of one of the antibodies that are concentrated in the lungs, skin
and cells of mucous membranes (immunoglobulinemia E); inflammation, redness,
pain or itching of the skin (chronic-eczematoid dermatitis); and a mild
increase in the number of leukocyte white blood cells (mild eosinophilia).
Job Syndrome is often inherited as an autosomal recessive trait.
Symptoms
The main symptoms of Job Syndrome are:
1. Cold staphylococcal abscesses - pus filled holes caused by a
bacterial infection (most often staphylococcal aureus bacteria). These
abscesses are usually found on the skin, but may also be present on the bone
behind the ear (mastoid), joints, gums, air passages in the lungs (bronchi),
and in the lungs themselves.
2. Granulocyte chemotactic defect - The living substance of white blood
cells that destroys bacteria, fungi and viruses (leukocytes) can be attracted
or repelled by chemical stimuli in the body. Patients with Job Syndrome have
a defect in this process allowing the bacteria to thrive.
3. Chronic eczema - swelling of the outer skin with itchy, small red
blisters that become scaly, crusted and thick.
4. Hyperimmunoglobulinemia E - an unusual abundance of Immunoglobulin E
is one of the five fluid antibodies produced by the human body and is
concentrated in the lung, skin and cells of mucous membranes. This antibody
defends against substances foreign to the body and reacts with them to
release chemicals that cause reddening of the skin.
5. Mild eosinophilia - a mild increase in the number of leukocyte white
blood cells (eosinophils). Eosinophils increase in number when infection and
allergies are present.
Some (but not all) of the following additional conditions may be present
in patients with Job Syndrome:
6. Mucocutaneous Candidiasis - a rare form of candida infection
characterized by chronic infection of the skin, nails, scalp and mucous
membranes. This disorder usually develops in people with immune deficiencies
and in particular infants with Job Syndrome. It causes red, pustular,
crusted and thickened lesions. (For more information on this disorder choose
"Candidiasis" as your search term in the Rare Disease Database).
7. Coarse facial features - broad nasal bridge, prominent nose, and
irregularly proportioned cheeks and jaws.
8. Fair skin and reddish hair.
Causes
It is thought that immune complexes may impair the white blood cells
(neutrophils) that destroy bacteria, cell debris and solid particles in the
blood and their attraction to chemical stimuli.
Some patients with Job Syndrome inherit this disorder through an
autosomal recessive trait. Human traits, including the classic genetic
diseases, are the product of the interaction of two genes, one received from
the father and one from the mother. In recessive disorders, the condition
does not appear unless a person inherits the same defective gene for the same
trait from each parent. If one receives one normal gene and one gene for the
disease, the person will be a carrier for the disease, but usually will not
show symptoms. The risk of transmitting the disease to the children of a
couple, both of whom are carriers for a recessive disorder, is twenty-five
percent. Fifty percent of their children will be carriers, but healthy as
described above. Twenty-five percent of their children will receive both
normal genes, one from each parent, and will be genetically normal.
Affected Population
Job Syndrome is a very rare disorder that affects males and females in equal
numbers. Symptoms of this disorder are present at birth or early childhood.
Related Disorders
Symptoms of the following disorders can be similar to those of Job Syndrome.
Comparisons may be useful for a differential diagnosis:
Atopic Dermatitis, is a common chronic form of eczema. Eczema is a skin
condition characterized by redness, swelling, oozing, crusting, scaling,
burning pain, and itching. The causes of eczema fall into two
classifications: 1) constitutional eczema (Atopic dermatitis), and 2)
external eczema which is caused by allergies, irritations, or chemical
reactions. (For more information on this disorder choose "Atopic Dermatitis"
as your search term in the Rare Disease Database).
Chronic Granulomatous Disease is a very rare blood disorder which
primarily affects certain white blood cells (lymphocytes). It is
characterized by widespread granulomatous tumor-like lesions, and an
inability to resist infections. The exact cause of this disorder is not
known but there is a genetic form that primarily affects males and is thought
to be inherited as an X-linked recessive trait. (For more information on
this disorder choose "Granulomatous Disease, Chronic" as your search term in
the Rare Disease Database).
Wiskott-Aldrich Syndrome is a hereditary disorder characterized by a
partial immune deficiency, eczema, and a deficiency of platelets and
structures in the blood involved in clotting (thrombocytopenia). This
disorder affects only males. An early sign of Wiscott-Aldrich Syndrome is
excessive bleeding from the site of circumcision or from other wounds. This
disorder is transmitted to males by an X-linked recessive trait. (For more
information on this disorder choose "Wiskott-Aldrich Syndrome" as your search
term in the Rare Disease Database).
Therapies: Standard
Job Syndrome is treated with antibiotics. Trimethoprim/sulfamethoxazole is
given continuously or intermittently depending on the longevity of the
infections. These antibiotics are usually effective, but patients often
experience repeated infections.
For treatment of Chronic Mucocutaneous Candidiasis, amphotericin B,
nystatin, clotrimazole, miconizole or 5-fluorocytosine are useful drugs.
Antifungal and immune system-stimulating substances (such as the molecule
that can transfer immunity from a sensitized to a non-sensitized individual)
called transfer factor, thymosin, thymus epithelial cell transplantation, and
levamisol, are also used in treatment.
Genetic counseling may be of benefit for patients and their families.
Other treatment is symptomatic and supportive.
Therapies: Investigational
The effects of interferon gamma on excessive immunoglobulin E production in
patients with Job Syndrome (HIE-hyperimmunoglobulinemia E) are being studied
at this time. Long-term safety and effectiveness of this treatment is still
under investigation.
This disease entry is based upon medical information available through
June 1991. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
203-746-6518
Immune Deficiency Foundation
3565 Ellicott Mill Drive, Unit B2
Ellicott City, MD 21043
(800) 296-4433
(410) 461-3127
NIH/National Institute of Allergy & Infectious Diseases (NIAID)
9000 Rockville Pike
Bethesda, MD 20892
301-496-5717
For Genetic Information and Genetic Counseling Referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
914-428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
MENDELIAN INHERITANCE IN MAN, 9th Ed.: Victor A. McKusick, Editor: Johns
Hopkins University Press, 1990. Pp. 1281-82.
HEMATOLOGY, 4th Ed,: William J. Williams, et al,; Editors; McGraw-Hill,
Inc., 1990. Pp. 823, 826.
CLINICAL DERMATOLOGY, 2nd Ed.; Thomas P. Habif, M.D., Editor: The C.V.
Mosby Company, 1990. Pp. 200-1.
USE OF RECOMBINANT HUMAN INTERFERON GAMMA TO ENHANCE NEUTROPHIL
CHEMOTACTIC RESPONSES IN JOB SYNDROME OF HYPERIMMUNOGLOBULINEMIA E AND
RECURRENT INFECTIONS: J.D. Jeppson et al.; J Pediatr (March, 1991; issue
118(3)). Pp. 383-7.
THE HYPERIMMUNOGLOBULINEMIA E AND RECURRENT INFECTIONS SYNDROME IN THE
ADULT: J.P. L'Huillier et al,; Thorax (September, 1990; issue 45(9)). Pp.
707-8.
REGULATION OF IMMUNOGLOBULIN PRODUCTION IN HYPERIMMUNOGLOBULIN E
RECURRENT INFECTION SYNDROME BY INTERFERON GAMMA: C.L. King et al.; Proc Natl
Acad Sci (December, 1989; issue 86(24)). Pp. 10085-9.