[PAGID] patient who lacks long-term memory antibody responses

[Prof. Dr. Antonio Condino Neto]

I repeated Pneumoccocal vaccine 4 times for my two patients (2 doses  
of the 23 valent and 2 doses of the 7 valent conjugated). The specific  
antibodies did not last more than 3 months, and the infections did not  
control.

The only solution was IVIG
-- 
Antonio Condino-Neto, MD, PhD
Associate Professor - Department of Immunology
Institute of Biomedical Sciences - University of São Paulo
1730 Lineu Prestes Avenue, São Paulo - SP. ZIP 05508-000. Brazil
Tel (55) (11) 3091-7387 / Fax (55) (11) 3091-7224



Citando Nicholas Rider <nrider at clinicforspecialchildren.org>:


> Hi Dr. Lederman,

>

> Thanks for sharing the interesting case.

>

> I wondered how closely your patient's infection frequency correlates  

> to his waning vaccine titers?  My reason for asking is that I wonder  

> about hyperimmunization with non-live vaccines based upon titer  

> levels or a routine schedule based upon what you already know about  

> the kinetics of his dropping titers.  If it works, this would be  

> less expensive than gamma globulin replacement and may be worth a  

> try in a patient with relatively low risk (to this point) for  

> serious bacterial infections.

>

> It would be interesting to see how the patient responds to PhiX neoantigen.

>

> Best Wishes,

>

> Nick

>

> Nicholas L. Rider, D.O.

> Clinic for Special Children

> 535 Bunker Hill Road

> Strasburg, PA 17579

> Ph:  717-687-9407

> Fx:   717-687-9237

> nrider at clinicforspecialchildren.org

>

>

>

> On Jul 16, 2009, at 2:49 PM, Howard M Lederman wrote:

>

>> I have a fascinating  12 yr old male patient with a history of  

>> recurrent infections (mostly upper and lower respiratory tract).   

>> No individual infection has been overwhelmingly severe, but the sum  

>> of all infections leads to a significant number of school absences.

>>

>> He has low IgG and IgM levels with normal IgA levels.  He makes  

>> normal IgG antibody responses to a wide variety of vaccines, but  

>> does not seem to be able to maintain long-term immunity.  (See  

>> attached spreadsheet.  Sheet 1 tabulates the antibody and  

>> immunglobulin levels; sheet 2 lists the immunizations.)

>>

>> Is this a pattern that others have seen?    I am open to any ideas  

>> for further evaluation.  Would anyone offer this child gamma  

>> globulin?

>>

>> Howard

>> Howard M. Lederman, M.D., Ph.D.

>> Professor of Pediatrics, Medicine and Pathology

>> Division of Pediatric Allergy and Immunology

>> Johns Hopkins Hospital - CMSC 1102

>> 600 N. Wolfe Street

>> Baltimore, MD 21287-3923

>> Phone: 410-955-5883

>> Fax: 410-955-0229

>> Email: Hlederm1 at jhem.jhmi.edu

>>

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>>

>>

>>

>> <Hodinko, Samuel.xls>

>

>




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