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Primary Ciliary Dyskinesia

Diagnostic and Phenotypic Features

Department of Medicine and Pediatrics and the Center for Environmental Medicine, the University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

Correspondence and requests for reprints should be addressed to Peadar G. Noone, M.D., Level 8, Respiratory Department, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland, UK. E-mail: peadar_noone{at}med.unc.edu

Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. We hypothesized that the major clinical and biologic phenotypic markers of the disease could be evaluated by studying a cohort of subjects suspected of having PCD. Of 110 subjects evaluated, PCD was diagnosed in 78 subjects using a combination of compatible clinical features coupled with tests of ciliary ultrastructure and function. Chronic rhinitis/sinusitis (n = 78; 100%), recurrent otitis media (n = 74; 95%), neonatal respiratory symptoms (n = 57; 73%), and situs inversus (n = 43; 55%) are strong phenotypic markers of the disease. Mucoid Pseudomonas aeruginosa (n = 12; 15%) and nontuberculous mycobacteria (n = 8; 10%) were present in older (> 30 years) patients with PCD. All subjects had defects in ciliary structure, 66% in the outer dynein arm. Nasal nitric oxide production was very low in PCD (nl/minute; 19 ± 17 vs. 376 ± 124 in normal control subjects). Rigorous clinical and ciliary phenotyping and measures of nasal nitric oxide are useful for the diagnosis of PCD. An increased awareness of the clinical presentation and diagnostic criteria for PCD will help lead to better diagnosis and care for this orphan disease.

Key Words: primary ciliary dyskinesia • ciliary ultrastructure • nitric oxide • situs inversus • Pseudomonas aeruginosa

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