Historically, the nitroblue tetrazolium (NBT) test has been the recognized diagnostic test for chronic granulomatous disease (CGD). Relying on light microscopy, the NBT test provides only a qualitative determination of phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity.

The dihydrorhodamine (DHR) test produces fewer false-negative results than the NBT test and is known for its1,2:


Relative ease of use


Ability to distinguish between X-linked (gp91phox) and autosomal
recessive forms of CGD


Ability to detect carrier status


High sensitivity that can detect low levels of NADPH activity


Ability to quantitatively assess residual superoxide production

If you suspect CGD,
get a DHR Collection Kit at no cost to
confirm a diagnosis

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Examples of pre- and post-
activation DHR histograms

What to look for when reading DHR histograms

These values are representations of possible DHR outcomes. Because of heterogeneity in disease severity and genotype, outcomes will vary. Lab results typically include percentage (%) of residual oxidative burst values.

Abbreviations: MFI, mean fluorescence intensity; PMA, phorbol myristate acetate.

*PMA is an activator used to stimulate neutrophil NADPH oxidase activity.

Usually a female with a healthy and a mutated allele for gp91phox

Adapted from Leiding JW, et al (2013)3 and Jirapongsananuruk O, et al (2003).4

Benefits of family testing

CGD is an inherited disorder, and families of patients with CGD may benefit from DHR testing. Testing can help identify carriers who may benefit from genetic counseling prior to starting a family. While CGD carriers are usually not affected, they can exhibit CGD-like symptoms such as5-7:

  • Dermatitis
  • Stomatitis
  • Discoid lupus-like disease
  • Photosensitive rashes

See how to use the DHR
Collection Kit

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If you suspect CGD,
the DHR Collection Kit is being
offered at no cost

Request a Kit

1. Kuhns DB, Alvord WG, Heller T, et al. Residual NADPH oxidase and survival in chronic granulomatous disease. N Engl J Med. 2010;363(27):2600-2610. 2. Leiding JW, Holland SM. Chronic granulomatous disease. In: Pagon RA, Adam MP, Ardinger HH, et al, eds. GeneReviews®. Seattle, WA: University of Washington, Seattle; 1993-2018. 3. Leiding JW, Malech HL, Holland SM. Chronic granulomatous disease. Clinical Focus on Primary Immunodeficiencies. 2013;15:1-9. 4. Jirapongsananuruk O, Malech HL, Kuhns DB, et al. Diagnostic paradigm for evaluation of male patients with chronic granulomatous disease, based on the dihydrorhodamine 123 assay. J Allergy Clin Immunol. 2003;111(2):374-379. 5. Holland SM. Chronic granulomatous disease. Hematol Oncol Clin North Am. 2013;27(1):89-99. 6. Magnani A, Brosselin P, Beauté J, et al. Inflammatory manifestations in a single-center cohort of patients with chronic granulomatous disease. J Allergy Clin Immunol. 2014;134(3):655-662. 7. Song E, Jaishankar GB, Saleh H, Jithpratuck W, Sahni R, Krishnaswamy G. Chronic granulomatous disease: a review of the infectious and inflammatory complications. Clin Mol Allergy. 2011;9(1):10.