Living without pain: A 10-year study of congenital insensitivity to pain with anhidrosis

Shai Shlomi Klaitman; Galina Ling; Eyal Kristal; Odeya David; Siham Elamour; Eli Hershkovitz; Eduard Ling

doi:10.1038/s41390-024-03565-x

Living without pain: A 10-year study of congenital insensitivity to pain with anhidrosis

Pediatr Res. 2024 Oct 25. doi: 10.1038/s41390-024-03565-x. Online ahead of print.

Authors

Shai Shlomi Klaitman^#^{1

2}, Galina Ling^#^{3

4

5}, Eyal Kristal^{3

4

5

6}, Odeya David^{3

7}, Siham Elamour^{3

4

5

8}, Eli Hershkovitz^{3

4

9

10}, Eduard Ling^{3

11}

Affiliations

¹ Faculty of Health Sciences, Ben Gurion University Medical Center, Beer Sheva, Israel. Shaiklait@gmail.com.
² Soroka University Medical Center, Rager Avenue, Beer Sheva, Israel. Shaiklait@gmail.com.
³ Faculty of Health Sciences, Ben Gurion University Medical Center, Beer Sheva, Israel.
⁴ Soroka University Medical Center, Rager Avenue, Beer Sheva, Israel.
⁵ Pediatric Ambulatory Unit, Soroka University Medical Center, Rager Avenue, Beer Sheva, Israel.
⁶ Immunology Unit, Soroka University Medical Center, Beer Sheva, Israel.
⁷ Pediatric Endocrinology And Diabetes Unit, Assuta Ashdod Hospital, Ashdod, Israel.
⁸ The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
⁹ Department of Pediatrics D, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.
¹⁰ Pediatric Endocrinology Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.
¹¹ Rheumatology Clinic, Clalit Health Services, Southern District, Beer Sheva, Israel.

^# Contributed equally.

PMID: 39455857
DOI: 10.1038/s41390-024-03565-x

Abstract

Background: Congenital Insensitivity to Pain with Anhidrosis (CIPA) is a rare hereditary neuropathy caused by NTRK1 gene mutations, predisposing patients to recurrent infections and chronic wounds. Long-term studies on microbial and clinical outcomes in CIPA are limited. This study presents analysis of infection patterns, antibiotic resistance, and clinical outcomes in CIPA patients.

Methods: A comprehensive ten-year retrospective cohort study was conducted at Soroka University Medical Center, Beer Sheva, Israel, from January 2014 to January 2023. Electronic medical records were reviewed to identify 63 CIPA patients, all were of consanguineous Bedouin families. Data collection included demographic details, clinical presentations, genetic analysis, documentation of infections, wound sites, hospital duration, and surgical interventions.

Results: Staphylococcus aureus, notably methicillin-resistant, dominated, with Gram-negative bacteria common in lower limbs. The study noted reduced extended-spectrum beta-lactamase bacteria and linked demographic factors to infection traits, antibiotic resistance, and surgical needs.

Conclusion: This study provides valuable insights into the clinical and microbial patterns of CIPA, highlighting dynamic shifts in microbial compositions and antibiotic resistance profiles over time. Staphylococcus aureus, and Gram-negative bacteria particularly in lower limb infections, pose significant challenges in patient management. The findings underscore the importance of tailored approaches to address evolving microbial profiles and optimize patient care in CIPA.

Impact: Key Message: This is the largest cohort study on CIPA to date, highlighting the dominance of Staphylococcus aureus, including methicillin-resistant strains, and significant Gram-negative bacterial infections in lower limbs. Contribution to Literature: It draws parallels between infection dynamics in CIPA and diabetic foot ulcers, emphasizing similar challenges due to neuropathy and ischemia, enhancing understanding of infection susceptibility and management in neuropathic conditions.

Impact: The findings inform clinical practices by detailing infection and resistance patterns, supporting the development of targeted treatment strategies to improve outcomes for CIPA and similar conditions.