{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:26:15Z","timestamp":1787135175157,"version":"build-2736575974"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Kartagener syndrome (KS) is a rare autosomal recessive motile ciliopathy and a well-recognized subtype of primary ciliary dyskinesia, classically defined by the triad of situs inversus totalis, chronic sinusitis, and bronchiectasis, with frequent accompanying infertility. Because of its non-specific clinical manifestations overlapping with common respiratory disorders and limited availability of gold-standard diagnostic tools in primary care settings, KS is frequently misdiagnosed or diagnosed late. This study retrospectively analyzed the clinical data, diagnostic trajectories, and treatment outcomes of three adult patients with clinically diagnosed complete KS admitted to our institution between May 2021 and December 2022. All patients presented with long-standing recurrent cough and expectoration; two presented with hemoptysis and one with type II respiratory failure. Initial misdiagnoses included bronchiectasis, non-tuberculous mycobacterial infection, and chronic obstructive pulmonary disease. Clinical diagnosis of complete KS was established based on the classic triad on imaging combined with core clinical features, as confirmatory genetic or ultrastructural testing was not available. Pathogen testing detected\n                    <jats:italic toggle=\"yes\">Acinetobacter baumannii<\/jats:italic>\n                    in one patient, while another patient had a coinfection of\n                    <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">Enterobacter cloacae<\/jats:italic>\n                    . One more patient received empirical antimicrobial therapy because their family declined bronchoscopy. After individualized treatment, clinical improvement was observed in all patients, with symptom resolution, normalized inflammatory markers, and stable disease during 6\u201312\u2009months of follow-up. These findings underscore that the combined features of \u201csitus inversus totalis\u2009+\u2009bronchiectasis\u2009+\u2009chronic sinusitis\u2009+\u2009childlessness\/infertility (when formally confirmed)\u201d are key diagnostic clues for KS in primary care. Primary care clinicians should strengthen awareness of this rare entity and use a multisystem diagnostic approach to prevent misdiagnosis and underdiagnosis. Prompt targeted antimicrobial therapy and sustained comprehensive long-term management were associated with favorable clinical outcomes in this small case series.\n                  <\/jats:p>","DOI":"10.1177\/2050313x261474111","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:03:27Z","timestamp":1786939407000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical features, misdiagnosis, and treatment of clinically diagnosed complete Kartagener syndrome: A three-case series for primary care"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8246-3919","authenticated-orcid":false,"given":"Dashi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Qionghai People\u2019s Hospital, Qionghai, Hainan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhifeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Qionghai People\u2019s Hospital, Qionghai, Hainan Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Ahmed Z Waseem W Saman U. Kartagener\u2019s syndrome presenting as bilateral recurrent nasal polyposis in a young boy. J Bahria Univ Med Dent Coll 2018; 8: 274\u2013277. https:\/\/doi.org\/10.51985\/JBUMDC2018076","DOI":"10.51985\/JBUMDC2018076"},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","unstructured":"Gupta P Adhikari P Ghimire P et al. An incomplete Kartagener syndrome presenting with recurrent exacerbation of bronchiectasis: a case report. Ann Med Surg (Lond) 2025; 87(3): 1687\u20131691. https:\/\/doi.org\/10.1097\/MS9.0000000000002987","DOI":"10.1097\/MS9.0000000000002987"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1806-37132007000500017"},{"key":"e_1_3_3_5_2","doi-asserted-by":"crossref","unstructured":"Shapiro AJ Davis SD Polineni D et al. Diagnosis of primary ciliary dyskinesia. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 197: e24\u2013e39. https:\/\/doi.org\/10.1164\/rccm.201805-0819ST","DOI":"10.1164\/rccm.201805-0819ST"},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","unstructured":"Knowles MR Daniels LA Davis SD et al. Primary ciliary dyskinesia. Recent advances in diagnostics genetics and characterization of clinical disease. Am J Respir Crit Care Med 2013; 188: 913\u2013922. https:\/\/doi.org\/10.1164\/rccm.201301-0059CI","DOI":"10.1164\/rccm.201301-0059CI"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","unstructured":"Hannah WB Seifert BA Truty R et al. The global prevalence and ethnic heterogeneity of primary ciliary dyskinesia gene variants: a genetic database analysis. Lancet Respir Med 2022; 10: 459\u2013468. https:\/\/doi.org\/10.1016\/S2213-2600(21)00453-7","DOI":"10.1016\/S2213-2600(21)00453-7"},{"key":"e_1_3_3_8_2","doi-asserted-by":"crossref","unstructured":"Doumbia A Kon\u00e9 Y Kon\u00e9 A et al. Syndrome de Kartagener de d\u00e9couverte fortuite au cours d\u2019un bilan d\u2019inf\u00e9condit\u00e9 du couple \u00e0 propos d\u2019un cas [Kartagener\u2019s syndrome found incidentally during assessment of infertile couple: a case study]. Pan Afr Med J 2019; 33: 316. https:\/\/doi.org\/10.11604\/pamj.2019.33.316.16919","DOI":"10.11604\/pamj.2019.33.316.16919"},{"key":"e_1_3_3_9_2","doi-asserted-by":"crossref","unstructured":"Chilvers MA Rutman A O\u2019Callaghan C. Ciliary beat pattern is associated with specific ultrastructural defects in primary ciliary dyskinesia. J Allergy Clin Immunol 2003; 112: 518\u2013524. https:\/\/doi.org\/10.1016\/s0091-6749(03)01799-8","DOI":"10.1016\/S0091-6749(03)00011-3"},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","unstructured":"Leigh MW Pittman JE Carson JL et al. Clinical and genetic aspects of primary ciliary dyskinesia\/Kartagener syndrome. Genet Med 2009; 11(1): 473\u2013487. https:\/\/doi.org\/10.1097\/GIM.0b013e3181a53562","DOI":"10.1097\/GIM.0b013e3181a53562"},{"key":"e_1_3_3_11_2","doi-asserted-by":"crossref","unstructured":"Shoemark A Goutaki M Kinghorn B et al. European Respiratory Society and American Thoracic Society guidelines for the diagnosis of primary ciliary dyskinesia. Eur Respir J 2025; 66(6): 2500745. https:\/\/doi.org\/10.1183\/13993003.00745-2025","DOI":"10.1183\/13993003.00745-2025"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","unstructured":"Kennedy MP Noone PG Leigh MW et al. High-resolution CT of patients with primary ciliary dyskinesia. AJR Am J Roentgenol 2007; 188(5): 1232\u20131238. https:\/\/doi.org\/10.2214\/AJR.06.0965","DOI":"10.2214\/AJR.06.0965"},{"key":"e_1_3_3_13_2","first-page":"109","article-title":"Primary ciliary dyskinesia in children","volume":"33","author":"Blanchon S","year":"2020","unstructured":"Blanchon S, Papon JF, Beydon N, et al. Primary ciliary dyskinesia in children. J Pediatrie Pueric 2020; 33: 109\u2013117.","journal-title":"J Pediatrie Pueric"},{"key":"e_1_3_3_14_2","doi-asserted-by":"crossref","unstructured":"Peng B Gao YH Xie JQ et al. Clinical and genetic spectrum of primary ciliary dyskinesia in Chinese patients: a systematic review. Orphanet J Rare Dis 2022; 17: 283. https:\/\/doi.org\/10.1186\/s13023-022-02427-1","DOI":"10.1186\/s13023-022-02427-1"},{"key":"e_1_3_3_15_2","unstructured":"CDC. Antibiotic resistance threatens everyone [Internet]. Atlanta GA: U.S. Department of Health & Human Services Centers for Disease Control and Prevention https:\/\/www.cdc.gov\/drugresistance\/index.html (2022 accessed 1 February 2023)."},{"key":"e_1_3_3_16_2","unstructured":"WHO. Antimicrobial resistance [Internet]. Geneva: World Health Organization https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/antimicrobial-resistance (2023 1 February 2023)."},{"key":"e_1_3_3_17_2","doi-asserted-by":"crossref","unstructured":"Previtero D Castelli G Padrin Y et al. Long-term macrolides in chronic respiratory diseases: dusk or a new dawn? A narrative review. Antibiotics 2025; 14(11): 1061. https:\/\/doi.org\/10.3390\/antibiotics14111061","DOI":"10.3390\/antibiotics14111061"},{"key":"e_1_3_3_18_2","doi-asserted-by":"crossref","unstructured":"Lin H Cao Z Zhao X et al. Left middle lobectomy for bronchiectasis in a patient with Kartagener syndrome: a case report. J Cardiothorac Surg 2016; 11(1): 37. https:\/\/doi.org\/10.1186\/s13019-016-0426-y","DOI":"10.1186\/s13019-016-0426-y"},{"key":"e_1_3_3_19_2","doi-asserted-by":"crossref","unstructured":"Shapiro AJ Zariwala MA Ferkol T et al. Diagnosis monitoring and treatment of primary ciliary dyskinesia: PCD foundation consensus recommendations based on state of the art review. Pediatr Pulmonol 2016; 51: 115\u2013132. https:\/\/doi.org\/10.1002\/ppul.23304","DOI":"10.1002\/ppul.23304"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261474111","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X261474111","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261474111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:46:11Z","timestamp":1787132771000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X261474111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":18,"alternative-id":["10.1177\/2050313X261474111"],"URL":"https:\/\/doi.org\/10.1177\/2050313x261474111","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X261474111"}}