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Francis ER, Vu J, Perez CO, Sun C. Vaccinations in patients with chronic lymphocytic leukemia. Semin Hematol 2024; 61:131-138. [PMID: 38302313 PMCID: PMC11162341 DOI: 10.1053/j.seminhematol.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by immune dysfunction resulting in heightened susceptibility to infections and elevated rates of morbidity and mortality. A key strategy to mitigate infection-related complications has been immunization against common pathogens. However, the immunocompromised status of CLL patients poses challenges in eliciting an adequate humoral and cellular immune response to vaccination. Most CLL-directed therapy disproportionately impairs humoral immunity. Vaccine responsiveness also depends on the phase and type of immune response triggered by immunization. In this review, we discuss the immune dysfunction, vaccine responsiveness, and considerations for optimizing vaccine response in patients with CLL.
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Affiliation(s)
| | - Jennifer Vu
- Rosalind Franklin University of Medicine and Science, Chicago Medical School
| | | | - Clare Sun
- National Institutes of Health, National Heart, Lung, and Blood Institute.
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2
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Stabler S, Lamblin C, Gaillard S, Just N, Mihailescu M, Viget N, Sy Ndiaye T, Dzeing Ella A, Brunin G, Weyrich P, Prevotat A, Chenivesse C, Le Rouzic O, Mortuaire G, Vuotto F, Faure K, Leurs A, Wallet F, Loiez C, Titecat M, Le Guern R, Hachulla E, Sanges S, Etienne N, Terriou L, Launay D, Lopez B, Bahuaud M, Batteux F, Dubucquoi S, Gesquière-Lasselin C, Labalette M, Lefèvre G. High Frequency of Specific Polysaccharide Antibody Deficiency in Adults With Unexplained, Recurrent and/or Severe Infections With Encapsulated Bacteria. Clin Infect Dis 2023; 76:800-808. [PMID: 36285530 DOI: 10.1093/cid/ciac842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary immunodeficiencies (PIDs) in adults are mainly revealed by recurrent and/or severe bacterial infections. The objective of this study was to evaluate a systematic research strategy of PIDs in adults with unexplained bacterial infections, with a special focus on specific polysaccharide antibody deficiency (SPAD). METHODS In this prospective multicenter study, inclusion criteria were recurrent benign upper and lower respiratory tract infections (RTIs) for at least two years (group 1), at least one upper or lower RTI requiring hospitalization (group 2), and/or at least one invasive infection documented with encapsulated bacteria (group 3). Main exclusion criteria were all local and general conditions that could explain infections. If no PID diagnosis was made, response to polysaccharide antigens was assessed using a pneumococcal polysaccharide vaccine. RESULTS From March 2015 to March 2020, 118 patients were included (37 males, median age of 41 years): 73, 17, and 28 in groups 1, 2, and 3, respectively. Forty-seven PIDs were diagnosed, giving an estimated frequency of 39.8% (95% confidence interval [CI] [30.4, 48.8]). SPAD was the most frequent diagnosis by far (n = 37/47, 78.7%), and was made in 23, 5, and 9 patients from groups 1 to 3, respectively. All SPAD patients received conjugate vaccines and, according to their infectious history, were on surveillance or treated with preventive antibiotics (n = 6) and/or with immunoglobulins replacement therapy (n = 10), the latter being dramatically efficient in all cases. CONCLUSIONS Considering its high prevalence among adults with unexplained recurrent and/or severe bacterial infections, SPAD should be screened in those patients. CLINICAL TRIALS REGISTRATION NCT02972281.
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Affiliation(s)
- Sarah Stabler
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
| | - Catherine Lamblin
- Département de pneumologie, Hôpital privé La Louvière, Lille, France
| | - Sacha Gaillard
- Département de pneumologie, Clinique Tessier, Valenciennes, France
| | - Nicolas Just
- Département de pneumologie, CH Roubaix, Roubaix, France
| | | | - Nathalie Viget
- Département de maladies infectieuses et tropicales, CH Tourcoing, Tourcoing, France
| | - Thierno Sy Ndiaye
- Département de médecine interne, CH d'Armentières, Armentières, France
| | - Arnaud Dzeing Ella
- Département de maladies infectieuses et tropicales, médecine interne et polyvalente, CH Denain, Denain, France
| | - Guillaume Brunin
- Département de réanimation, CH Boulogne, Boulogne Sur Mer, France
| | - Pierre Weyrich
- Département de maladies infectieuses, Groupement Hospitalier de l'Institut Catholique de Lille, Lille, France
| | - Anne Prevotat
- Département de pneumologie, CHU Lille, Lille, France
| | | | - Olivier Le Rouzic
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
- Département de pneumologie, CHU Lille, Lille, France
| | | | - Fanny Vuotto
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
| | - Karine Faure
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
| | - Amélie Leurs
- Département de médecine interne et maladies infectieuses, CH Dunkerque, Dunkerque, France
| | | | | | - Marie Titecat
- Laboratoire de Bactériologie, CHU Lille, Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - Rémi Le Guern
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
- Laboratoire de Bactériologie, CHU Lille, Lille, France
| | - Eric Hachulla
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Sébastien Sanges
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Nicolas Etienne
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Louis Terriou
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - David Launay
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
| | | | - Mathilde Bahuaud
- Laboratoire d'immunologie, CHU Cochin-Hôtel Dieu-Broca, Paris, France
| | - Frédéric Batteux
- Laboratoire d'immunologie, CHU Cochin-Hôtel Dieu-Broca, Paris, France
| | - Sylvain Dubucquoi
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
| | | | - Myriam Labalette
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
| | - Guillaume Lefèvre
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
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Harnessing Nasal Immunity with IgA to Prevent Respiratory Infections. IMMUNO 2022. [DOI: 10.3390/immuno2040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The nasal cavity is a primary checkpoint for the invasion of respiratory pathogens. Numerous pathogens, including SARS-CoV-2, S. pneumoniae, S. aureus, etc., can adhere/colonize nasal lining to trigger an infection. Secretory IgA (sIgA) serves as the first line of immune defense against foreign pathogens. sIgA facilitates clearance of pathogenic microbes by intercepting their access to epithelial receptors and mucus entrapment through immune exclusion. Elevated levels of neutralizing IgA at the mucosal surfaces are associated with a high level of protection following intranasal immunizations. This review summarizes recent advances in intranasal vaccination technology and challenges in maintaining nominal IgA levels at the mucosal surface. Overall, the review emphasizes the significance of IgA-mediated nasal immunity, which holds a tremendous potential to mount protection against respiratory pathogens.
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Rivera D, Ferrajoli A. Managing the Risk of Infection in Chronic Lymphocytic Leukemia in the Era of New Therapies. Curr Oncol Rep 2022; 24:1003-1014. [PMID: 35366167 PMCID: PMC8976213 DOI: 10.1007/s11912-022-01261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with CLL have an increased susceptibility to infections. Over the years, there has been a shift of the treatment arsenal to an increasing use of chemotherapy-free regimens, particularly small molecule inhibitors. These therapies have proven to be effective and have a favorable toxicity profile. Infections continue to represent a significant complication in the era of novel therapies. RECENT FINDINGS Recent studies continue to bring new insights into the effects of modern therapies on the immune system. Evidence supporting infection prevention strategies is scarce. We will review the available recommendations to prevent infections in patients with CLL treated with novel therapies. New CLL therapies are broadly adopted in routine practice, requiring optimization of their side effects. Timely prevention, recognition, and treatment of infections should remain an important aspect of the standard management of a patient with CLL.
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Affiliation(s)
- Daniel Rivera
- Department of Leukemia, The University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 0428, Houston, TX, 77030, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 0428, Houston, TX, 77030, USA.
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Smith EL, Tan B, Bastas A, Kotsanas D, Dendle C, Ojaimi S. Missed Opportunities? A retrospective study into adults hospitalized with invasive infection from airway pathogens. Open Forum Infect Dis 2022; 9:ofac330. [PMID: 35899285 PMCID: PMC9314888 DOI: 10.1093/ofid/ofac330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background Invasive disease caused by airway pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Moraxella catarrhalis, has high morbidity and mortality worldwide, with immunodeficiency being a known association with recurrent disease. The study aimed to describe the frequency of known immunodeficiency and predisposing factors in adult patients presenting with invasive infections and determine the frequency of screening for and detection of immunodeficiency. Methods A retrospective analysis was conducted at a large tertiary Australian health service, comprising multiple centers. Patients aged 18 years or older, in whom the above pathogens were isolated from sterile sites, were included as identified through a microbiology database, between 2015 and 2020. Using electronic medical records, patient demographics, medical history, outcomes of admission, and pathology results were captured and reviewed to address the aims. Results In 252 patients, S pneumoniae was the most common culprit, isolated in 73% (185/252), compared to 14.3% (36/252) and 11.5% (29/252) of infections caused by H influenzae and N meningitidis, respectively. Known diagnoses of secondary immunodeficiency were common (31% of patients). Of those presenting with invasive pneumococcal disease, 78% had at least 1 predisposing condition, though only 9 patients (6%) had previously received pneumococcal vaccination. Despite poor screening for immunodeficiency, 12 new diagnoses were made. While the commonest immunodeficiency was secondary, due to hematological and solid organ malignancies, 3 new primary immunodeficiency diagnoses were made. Conclusions Immunodeficiency is common in this patient population. Screening should be undertaken to ensure timely diagnosis and treatment of the underlying condition to avoid future morbidity and mortality.
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Affiliation(s)
- Emma L Smith
- Monash Infectious Diseases, Monash Health, Melbourne , Australia, 3168
| | - Bryan Tan
- Monash Infectious Diseases, Monash Health, Melbourne , Australia, 3168
| | | | - Despina Kotsanas
- Monash Infectious Diseases, Monash Health, Melbourne , Australia, 3168
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Melbourne , Australia, 3168
- Monash University, Melbourne , Australia, 3800
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Melbourne , Australia, 3168
- Monash Pathology, Monash Health , Clayton, Australia, 3168
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6
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Kraler B, Bissig P, Nyffeler RW. Devastating Pneumococcal Arthritis of the Shoulder After Two Corticosteroid Injections. Cureus 2022; 14:e21006. [PMID: 35018274 PMCID: PMC8740204 DOI: 10.7759/cureus.21006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
A 36-year-old man was treated with two intraarticular corticoid injections for intense pain and severely decreased range of motion of his left shoulder. After the second injection, he came back with fulminant arthritis. Microbiological examination revealed streptococcus pneumoniae. Open debridement, long-term antibiotics, and total shoulder replacement were necessary to restore acceptable shoulder function.
The fulminant course with rapid destruction of the joint illustrates the risks of intraarticular corticoid injections. This case also shows that the diagnosis should be accurately made and risk factors excluded before considering injection as a treatment.
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Spina G, Elena B, Rita C, Eva PM, Mascolo C, Roversi M, Alberto V. Follow-up evaluation of the immunological status of children admitted for acute cerebral nervous system infections: a retrospective study. Ital J Pediatr 2021; 47:22. [PMID: 33531057 PMCID: PMC7851811 DOI: 10.1186/s13052-021-00973-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Background Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system. Methods Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations. Results Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age. Discussion Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions. Conclusions We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.
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Affiliation(s)
- Giulia Spina
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Bozzola Elena
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carsetti Rita
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Piano Mortari Eva
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Cristina Mascolo
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Villani Alberto
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Brodowski M, Kowalski M, Skwarecka M, Pałka K, Skowicki M, Kula A, Lipiński T, Dettlaff A, Ficek M, Ryl J, Dziąbowska K, Nidzworski D, Bogdanowicz R. Highly selective impedimetric determination of Haemophilus influenzae protein D using maze-like boron-doped carbon nanowall electrodes. Talanta 2021; 221:121623. [DOI: 10.1016/j.talanta.2020.121623] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
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9
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Haemophilus influenzae Conjunctivitis Secondary to Pneumonia in the Setting of Lymphoplasmacytic Lymphoma. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Grammatikos A, Albur M, Gompels M, Barnaby CL, Allan S, Johnston S. Antibiotic prophylaxis for the prevention of respiratory tract infections in antibody deficient patients: A retrospective cohort study. CLINICAL INFECTION IN PRACTICE 2020. [DOI: 10.1016/j.clinpr.2020.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zaidi SZA, Zaidi FZ, AlShehry N, Zaidi ARZ, Zaidi SZ, Abdullah SM. Aging and therapy-related hypogammaglobulinemia causing pneumonia: An overlooked curable entity in the chaotic COVID-19 pandemic. J Med Virol 2020; 93:202-203. [PMID: 32681654 PMCID: PMC7404506 DOI: 10.1002/jmv.26318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
| | - Fatima Zia Zaidi
- University College of Medicine, The University of Lahore, Lahore, Pakistan
| | - Nawal AlShehry
- Department of Adult Hematology/BMT, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Saleha Zia Zaidi
- Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Syed Maaz Abdullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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Disruption of the cpsE and endA Genes Attenuates Streptococcus pneumoniae Virulence: Towards the Development of a Live Attenuated Vaccine Candidate. Vaccines (Basel) 2020; 8:vaccines8020187. [PMID: 32326482 PMCID: PMC7349068 DOI: 10.3390/vaccines8020187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The majority of deaths due to Streptococcus pneumoniae infections are in developing countries. Although polysaccharide-based pneumococcal vaccines are available, newer types of vaccines are needed to increase vaccine affordability, particularly in developing countries, and to provide broader protection across all pneumococcal serotypes. To attenuate pneumococcal virulence with the aim of engineering candidate live attenuated vaccines (LAVs), we constructed knockouts in S. pneumoniae D39 of one of the capsular biosynthetic genes, cpsE that encodes glycosyltransferase, and the endonuclease gene, endA, that had been implicated in the uptake of DNA from the environment as well as bacterial escape from neutrophil-mediated killing. The cpsE gene knockout significantly lowered peak bacterial density, BALB/c mice nasopharyngeal (NP) colonisation but increased biofilm formation when compared to the wild-type D39 strain as well as the endA gene knockout mutant. All constructed mutant strains were able to induce significantly high serum and mucosal antibody response in BALB/c mice. However, the cpsE-endA double mutant strain, designated SPEC, was able to protect mice from high dose mucosal challenge of the D39 wild-type. Furthermore, SPEC showed 23-fold attenuation of virulence compared to the wild-type. Thus, the cpsE-endA double-mutant strain could be a promising candidate for further development of a LAV for S. pneumoniae.
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13
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Cowan J, Do TL, Desjardins S, Ramotar K, Corrales-Medina V, Cameron DW. Prevalence of Hypogammaglobulinemia in Adult Invasive Pneumococcal Disease. Clin Infect Dis 2019; 66:564-569. [PMID: 29401274 DOI: 10.1093/cid/cix836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background Patients with humoral immune deficiency are susceptible to invasive pneumococcal disease (IPD). This study estimates the prevalence of underlying hypogammaglobulinemia in admitted IPD cases and examines whether IPD cases had received preventative treatment. Methods All adult IPD cases (Streptococcus pneumoniae in blood or cerebrospinal fluid) admitted to The Ottawa Hospital (TOH) from January 2013 to December 2015 were identified through the Eastern Ontario Regional Laboratory. Documented clinical demographics, S. pneumoniae serotype, serum immunoglobulins measured previously or in convalescence, and vaccination status of the cases were collected retrospectively for descriptive analyses. Results There were 134 IPD in 133 patients (47.4% male; mean age 63, standard deviation [SD] = 15.6 years) during a 3-year observation period. All-cause mortality rate was 22.6% over a mean follow-up time of 362, SD = 345 days. Fifty-seven patients (42.9%) had serum immunoglobulin levels measured. Eighteen were either found to have hypogammaglobulinemia in convalescence (8/18) or previously known to have hypogammaglobulinemia (10/18). None of the known hypogammaglobulinemic patients had received antibiotic prophylaxis and/or immunoglobulin replacement therapy within 4 months prior to IPD. The high and low estimates of prevalence of hypogammaglobulinemia were 31.6% (of all measured) and 13.5% (of all cases). Among 18 patients with hematological malignancies in our cohort, 13 had hypogammaglobulinemia. Many isolates were vaccine serotypes; however, only 8 had documented previous pneumococcal vaccination. Conclusions IPD has high mortality, and hypogammaglobulinemia was present in at least 13.5% of IPD cases. Secondary hypogammaglobulinemia is especially common in cases with hematological malignancy and IPD.
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Affiliation(s)
- Juthaporn Cowan
- Department of Medicine, The Ottawa Hospital and University of Ottawa.,Ottawa Hospital Research Institute
| | - Thuy Linh Do
- Department of Medicine, The Ottawa Hospital and University of Ottawa
| | - Sacha Desjardins
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Karamchand Ramotar
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ontario
| | - Vicente Corrales-Medina
- Department of Medicine, The Ottawa Hospital and University of Ottawa.,Ottawa Hospital Research Institute
| | - Donald William Cameron
- Department of Medicine, The Ottawa Hospital and University of Ottawa.,Ottawa Hospital Research Institute.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
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14
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Dendle C, Stuart RL, Mulley WR, Polkinghorne KR, Gan PY, Kanellis J, Ngui J, Laurie K, Thursky K, Leung VK, Holdsworth SR. Measurement of Humoral Immune Competence and the Risk of Sinopulmonary Infection in a Cohort of Kidney Transplant Recipients. Transplant Proc 2019; 50:3367-3370. [PMID: 30577209 DOI: 10.1016/j.transproceed.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to determine if measurement of B cell protective immunity was associated with susceptibility to sinopulmonary infection in kidney transplant recipients. METHODS AND MATERIALS A prospective cohort of 168 patients with stable graft function (median 4.1 years) underwent assessment of B-lymphocyte antigen CD19 (CD19+) cell number, immunoglobulin G concentration, and seroresponses to influenza vaccination upon study entry. Patients received a single dose of a trivalent, seasonal influenza vaccine. RESULTS After 2 years follow-up, 31 patients (18%) developed sinopulmonary infection. CD19+ cell number was strongly associated with future sinopulmonary infection. A higher proportion of patients with CD19+ cell counts below the fifth percentile for controls developed sinopulmonary infections than those above the fifth percentile, 30% (23 of 77 patients) compared with 9% (7 of 79 patients; P = .001). There was a trend toward a higher proportion of patients with reduced immunoglobulin G concentrations developing infections than in the normal range for controls, 29% (14 of 48 patients) compared with 15% (16 of 108 patients; P = .060). Influenza vaccination seroresponses were poor in patients and controls such that they could not be used to identify a subgroup of patients at high risk for the development of severe pulmonary infection. CONCLUSIONS Monitoring B-cell numbers represents a simple, inexpensive means of stratifying transplant recipients' risk of sinopulmonary infection.
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Affiliation(s)
- C Dendle
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.
| | - R L Stuart
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - W R Mulley
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - K R Polkinghorne
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - P Y Gan
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Immunology, Monash Pathology, Monash Health, Clayton, Victoria, Australia
| | - J Kanellis
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - J Ngui
- Department of Immunology, Monash Pathology, Monash Health, Clayton, Victoria, Australia
| | - K Laurie
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; School of Applied and Biomedical Sciences, Federation University, Churchill, Victoria, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - K Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - V K Leung
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - S R Holdsworth
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
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15
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Dendle C, Mulley WR, Holdsworth S. Can immune biomarkers predict infections in solid organ transplant recipients? A review of current evidence. Transplant Rev (Orlando) 2018; 33:87-98. [PMID: 30551846 DOI: 10.1016/j.trre.2018.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
Despite improvements in graft survival, solid organ transplantation is still associated with considerable infection induced morbidity and mortality. If we were able to show that serious infection risk was associated with excessive suppression of immune capacity, we would be justified in "personalizing" the extent of immunosuppression by carefully monitored reduction to see if we can improve immune compromize without increasing the risk of rejection. Reliable biomarkers are needed to identify this patients at an increased risk of infection. This review focuses on the currently available evidence in solid organ transplant recipients for immune non-pathogen specific biomarkers to predict severe infections with the susceptibility to particular pathogens according to the component of the immune system that is suppressed. This review is categorized into immune biomarkers representative of the humoral, cellular, phagocytic, natural killer cell and complement system. Biomarkers humoral and cellular systems of the that have demonstrated an association with infections include immunoglobulins, lymphocyte number, lymphocyte subsets, intracellular concentrations of adenosine triphosphate in stimulated CD4+ cells and soluble CD30. Biomarkers of the innate immune system that have demonstrated an association with infections include natural killer cell numbers, complement and mannose binding lectin. Emerging evidence shows that quantification of viral nucleic acid (such as Epstein Barr Virus) can act as a biomarker to predict all-cause infections. Studies that show the most promise are those in which several immune biomarkers are assessed in combination. Ongoing research is required to validate non-pathogen specific immune biomarkers in multi-centre studies using standardized study designs.
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Affiliation(s)
- Claire Dendle
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University and Monash Infectious Diseases, Monash Health, Australia.
| | - William R Mulley
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria 3168, Australia.
| | - Stephen Holdsworth
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Australia; Department of Nephrology, Monash Medical Centre, Clayton, Victoria 3168, Australia.
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16
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Tadmor T, Welslau M, Hus I. A review of the infection pathogenesis and prophylaxis recommendations in patients with chronic lymphocytic leukemia. Expert Rev Hematol 2017; 11:57-70. [DOI: 10.1080/17474086.2018.1407645] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Manfred Welslau
- Haemato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
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17
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Sanges S, Wallet F, Blondiaux N, Theis D, Vérin I, Vachée A, Dessein R, Faure K, Viget N, Senneville E, Leroy O, Maury F, Just N, Poissy J, Mathieu D, Prévotat A, Chenivesse C, Scherpereel A, Smith G, Lopez B, Rosain J, Frémeaux-Bacchi V, Hachulla E, Hatron PY, Bahuaud M, Batteux F, Launay D, Labalette M, Lefèvre G. Diagnosis of primary antibody and complement deficiencies in young adults after a first invasive bacterial infection. Clin Microbiol Infect 2017; 23:576.e1-576.e5. [DOI: 10.1016/j.cmi.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/28/2017] [Accepted: 02/04/2017] [Indexed: 01/29/2023]
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18
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Anderson R, Feldman C. Pneumolysin as a potential therapeutic target in severe pneumococcal disease. J Infect 2017; 74:527-544. [PMID: 28322888 DOI: 10.1016/j.jinf.2017.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/09/2017] [Accepted: 03/11/2017] [Indexed: 12/13/2022]
Abstract
Acute pulmonary and cardiac injury remain significant causes of morbidity and mortality in those afflicted with severe pneumococcal disease, with the risk for early mortality often persisting several years beyond clinical recovery. Although remaining to be firmly established in the clinical setting, a considerable body of evidence, mostly derived from murine models of experimental infection, has implicated the pneumococcal, cholesterol-binding, pore-forming toxin, pneumolysin (Ply), in the pathogenesis of lung and myocardial dysfunction. Topics covered in this review include the burden of pneumococcal disease, risk factors, virulence determinants of the pneumococcus, complications of severe disease, antibiotic and adjuvant therapies, as well as the structure of Ply and the role of the toxin in disease pathogenesis. Given the increasing recognition of the clinical potential of Ply-neutralisation strategies, the remaining sections of the review are focused on updates of the types, benefits and limitations of currently available therapies which may attenuate, directly and/or indirectly, the injurious actions of Ply. These include recently described experimental therapies such as various phytochemicals and lipids, and a second group of more conventional agents the members of which remain the subject of ongoing clinical evaluation. This latter group, which is covered more extensively, encompasses macrolides, statins, corticosteroids, and platelet-targeted therapies, particularly aspirin.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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19
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Campbell SJ, Kynyk JA, Davis JA. Disseminated adenovirus infection causing severe ARDS. BMJ Case Rep 2017; 2017:bcr-2016-217524. [PMID: 28096226 DOI: 10.1136/bcr-2016-217524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure. His serum adenovirus load was markedly elevated. Treatment was started once the diagnosis of disseminated adenovirus infection was made; however, at that time patient was suffering from refractory hypoxaemia, respiratory acidosis, right heart failure and septic shock. Despite maximal supportive measures our patient ultimately expired over the course of 6 days.
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Affiliation(s)
- Steven J Campbell
- Department of Pulmonary, Critical Care, and Sleep, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica A Kynyk
- Department of Pulmonary, Critical Care, and Sleep, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - John A Davis
- Department of Infectious Diseases, Ohio State University College of Medicine, Columbus, Ohio, USA
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20
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Azar MM, Folk D, Henderson T, Mehra S, Vining E, Banach DB. Cervicofacial necrotizing fasciitis caused by Haemophilus influenzae serotype e in a patient with Sjogren's syndrome, systemic lupus erythematosus and hypocomplementaemia. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Marwan M. Azar
- Section of Infectious Diseases, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - David Folk
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Triona Henderson
- Department of Pathology, Yale School of Medicine, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Saral Mehra
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - Eugenia Vining
- Section of Otolaryngology Head and Neck Surgery, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
| | - David B. Banach
- Section of Infectious Diseases, Yale School of Medicine, 333 Cedars Street, PO Box 208022, 25 New Haven, CT 06520-8022, USA
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21
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Bahr NC, Boulware DR. Methods of rapid diagnosis for the etiology of meningitis in adults. Biomark Med 2015; 8:1085-103. [PMID: 25402579 DOI: 10.2217/bmm.14.67] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infectious meningitis may be due to bacterial, mycobacterial, fungal or viral agents. Diagnosis of meningitis must take into account numerous items of patient history and symptomatology along with regional epidemiology and basic cerebrospinal fluid testing (protein, etc.) to allow the clinician to stratify the likelihood of etiology possibilities and rationally select additional diagnostic tests. Culture is the mainstay for diagnosis in many cases, but technology is evolving to provide more rapid, reliable diagnosis. The cryptococcal antigen lateral flow assay (Immuno-Mycologics) has revolutionized diagnosis of cryptococcosis and automated nucleic acid amplification assays hold promise for improving diagnosis of bacterial and mycobacterial meningitis. This review will focus on a holistic approach to diagnosis of meningitis as well as recent technological advances.
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Affiliation(s)
- Nathan C Bahr
- Division of Infectious Disease & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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22
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Blot M, Boyer P, Samson M, Audia S, Devilliers H, Leguy V, Berthier S, Besancenot JF, Lorcerie B, Lakomy D, Bonnotte B. Should mild hypogammaglobulinemia be managed as severe hypogammaglobulinemia? A study of 389 patients with secondary hypogammaglobulinemia. Eur J Intern Med 2014; 25:837-42. [PMID: 25307285 DOI: 10.1016/j.ejim.2014.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/21/2014] [Accepted: 09/15/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia. METHODS This retrospective observational study included all adult patients with a gammaglobulin level <6.4g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin <5g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin <6.4 and ≥5g/L, mild hypogammaglobulinemia). RESULTS Among the 4011 serum electrophoreses, 570 samples from 389 patients had gammaglobulin levels below 6.4g/L: 156 (40%) in group 1 and 233 (60%) in group 2. Mean age±SD was 67 (15) years, and sex ratio was 1.04 (M/F) with no difference between the two groups. An etiology was identified in 79% and 58% of patients in groups 1 and 2, respectively (p<0.0001). The main etiologies were similar in both groups and included malignant hemopathy treated with cytostatic agents (n=129, 33%), smoldering or newly-diagnosed hemopathy without treatment (n=49, 13%) and immunosuppressive treatment (n=91, 23%). The incidence of hypogammaglobulinemia-related infections was 22/100/year, with no significant difference between the two groups (p=0.17). Vaccination coverage against pneumococcus was 33%, and higher in group 1 (46% vs. 24%; p<0.0001). When no cause was known at inclusion, an etiology was discovered in 22/130 patients (17%), 11 in each group. CONCLUSIONS Though mild hypogammaglobulinemia does not meet the classical criteria for hypogammaglobulinemia (<5g/L), the etiology and infectious risk are similar. It therefore requires investigation and vaccination.
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Affiliation(s)
- Mathieu Blot
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Pierre Boyer
- Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France
| | - Hervé Devilliers
- Faculty of Medicine, University of Burgundy, Dijon, France; Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, 21079 Dijon, France
| | - Vanessa Leguy
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Sabine Berthier
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Jean-François Besancenot
- Faculty of Medicine, University of Burgundy, Dijon, France; Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, 21079 Dijon, France
| | - Bernard Lorcerie
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
| | - Daniela Lakomy
- Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France.
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