**2.2 Brasil**

It is estimated that Brazil has 2,000 patients on treatment and approximately 20,000 patients with PID (Leiva *et al.,* 2007). Immunological diagnosis is supported by numerous centers located in São Paulo, Minas Gerais, Paraná, Rio Grande do Sul, Bahia and Rio de Janeiro (Grumach *et al.,* 1997; Leiva *et al.,* 2007). Centers located in southeast of country have specialized researchers, structure and molecular diagnostics. In Brazil, the federal government assists the movement of patients from regions without infrastructure to specialized centers, and coverage for certain screening tests of PID (Ocké-Reis & Marmor, 2010; Paim *et al.,* 2011). High costs and access to specialized laboratories are considered major problems by doctors for the diagnosis of PID (results available http://www.bragid.org.br/download/graphicos.pps), with strong educational, whose website presents PID centers throughout Brazil, journals, reviews and articles, case discussions, and announcements of meetings. This is supported by St. Jude's Hospital children and government agencies FAPESP and CNPq. Activities of this group include completion of first and second Summer School of PID by LAGID, implementation of Electronic Registration of Latin America Immunodeficiencies (http://imuno.unicamp.br:8080/) with installation of hardware in UNICAMP center computing support of ESID. The Federal University of São Paulo-UNIFESP, in partnership with Jeffrey Modell Foundation and Baxter International, created the first Jeffrey Modell Diagnostic Center for PID in Latin America; with goal of enabling physicians perform diagnostic, treatment and education of patients and PID cases reported in Brazil and Latin America. Patients with PID who need IVIG in Brazil receive government financial support, and not institutions or private health insurance, where patients should be initially admitted for diagnostic and treatment center. In Brazil, there are numerous funding agencies to residency

Primary Immunodeficiency Diseases in Latin America 363

Mexico has specialized centers diagnosis of PID in Mexico City, Monterrey and Guadalajara, and molecular diagnosis of some PID can be performed only in Mexico City. Mexico has serious access problems to laboratory tests, cost and medical education in PID (Romero-Márquez & Romero-Zepeda, 2010; Yavich *et al.,* 2010). The Access to IVIG is extended to public health system and is administered in public hospitals and clinics, but doctors do not follow specific guidelines for the administration of IVIG. The use of IVIG represents 20% of coast in obtaining drugs by National Institute of Pediatrics in Mexico City. In Mexico, there are plenty residency programs in allergy and immunology, with emphasis on allergies. Only the National Institute of Pediatrics in Mexico City has residency program with emphasis on

One of major problems of records diseases in underdeveloped countries has been limitation of diagnostic and treatment, and send reports of cases by physicians, resulting in overestimation in certain clinical centers in collection of samples, since most of these centers is reference to some types of PID, and lack of standardized definitions of cases makes it impossible to calculate rates of healthy population from this source, by only reporting

The PID diagnosis is performed in immunology centers, usually located in major cities of Latin American countries, and the vast majority of pediatricians and general practitioners are not prepared to establish PID diagnosis. The medical community educator has a role in awareness of population and health professionals in PID. In 1997, the University of São Paulo, Brazil, 166 cases of PID were registered with frequency of predominantly humoral defects (60.8%), T cell defects (4.9%), combined T-and B-cell deficiencies (9, 6%), phagocyte disorders (18.7%) and complement deficiency (6%). During observed period, 13.8% of children died, primarily of recurrent infections. In comparison with other reports, was higher relative frequency of phagocyte and complement deficiency. This is the first report on PID over 15 year's observation (1981-1996) (Grumach *et al.,* 1997). In 1998, a Colombia study with 83 PID patients demonstrated most common disturbance was antibody deficiency (74,6%), followed abnormalities of unspecific mechanisms (13,3%), deficiencies of cell mediated immunity (9,6%), and mortality ratio was 6% especially in patients with

In Antioquia, Colombia, between August of 1994 and July of 2002, 98 patients was registered with diagnosis of PID, with most frequent report antibodies deficiency (40,8%), followed by combined deficiencies (21,4%)(Montoya *et al.,* 2002). In Latin America, in 1993, immunologists from four Latin American countries (Argentina, Brazil, Chile, Colombia), created the Latin American Group for Immunodeficiencies (LAGID) to study the frequency of PID and promote knowledge by general practitioners and specialists in allergy and immunology, including Latin American countries, creating a record in each participating country. Currently, 14 countries belong to this group, which had record 3321

LAGID was implemented in 1993 with the mission to include several Latin American countries, spread the educational and awareness programs, establish PIDD registries, and

positive cases without reference population data (Condino-Neto *et al.,* 2011).

pediatric allergy and immunology (Condino-Neto *et al.,* 2011).

**3. Latin American group of immunodeficiency** 

cellular deficiency (Núñes, 1988).

patients in 2004.

**2.6 Mexico** 

programs in allergy and immunology, although only few centers are able to train professionals and PID treatment, located in São Paulo (Costa-Carvalho *et al.,* 2011; Condino-Neto *et al.,* 2011).
