[CIS-PAGID] Pneumococcal sepsis

[Nelson, Robert P Jr]

Also may consider mannose binding lectin def

Robert P. Nelson Jr., MD
Professor of Medicine and Pediatrics
Divisions of Hematology/Oncology
535 Barnhill Dr. Ste 473
Indianapolis, IN  46202
Telephone: 317-948-1186
E-mail: ronelson at iupui.edu<mailto:ronelson at iupui.edu>
pager:  317-312-1773

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Elie Haddad
Sent: Monday, December 19, 2011 5:03 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Pneumococcal sepsis

In addition to TLR, since CH50 is low, it could be a C2 deficiency.
Also, normal spleen on US does not rule out a fonctional asplenia and if this diagnosis has been evoked, you should test for Auer-Jolly bodies on red cells.
All the best
Elie Haddad



Elie Haddad, MD, PhD,
Professor of Pediatrics, University of Montreal,
Head, Pediatric Immunology and Rheumatology Division,
CHU Sainte-Justine, 3175 Cote Sainte-Catherine
Montreal, QC, H3T 1C5, Canada
Ph: 1 514 345 4713
fax: 1 514 345 4897
e-mail: elie.haddad at umontreal.ca<mailto:elie.haddad at umontreal.ca>





Le 2011-12-19 à 12:14, Patel, Niraj C a écrit :



Dear All,
I am recently out of fellowship and need more experienced folks for input.

A colleague shared with me a previously healthy 4 yo Vietnamese girl who presented with Streptococcus pneumoniae bacteremia, sepsis, and empyema.  She had received Prevnar (does not contain serotype 3) x 3 doses, and then PCV13 (does contain serotype 3) x 1 dose as part of her routine childhood immunizations.   At presentation she had pancytopenia which resolved over her course of illness.  An ultrasound showed the presence of a spleen.  An HIV test was negative.  The initial labs soon after admission are as follows:
IgG 480 (468-1,328)
IgA 80 (33-187)
IgM 31 (31-184)
CH50 16 (22-60)
Tetanus 0.52
Haemophilus B 0.85
Diptheria 0.14

She was subsequently immunized with Pneumovax about 3 weeks into her illness, and post pneumococcal titers were assessed 4 weeks after immunization (or 7 weeks after symptoms began) and shown below.

Pneumococcal Antibodies:
Serotype          PrePneumovax             Post Pneumovax
                        (Acute Illness)
1                                             5.01                        20.87
3                0.31                              0.95
4                0.40                              11.11
8                0.25                              17.02
9                0.26                              5.66
12               <0.38                            4.90
14               1.07                              >6.02
19               0.76                              16.65
23               0.40                              >2.79
26               1.40                              31.14
51               1.02                              23.33
56               0.42                              7.96
57               1.07                              27.90
68               0.59                              12.25

The causative Streptococcus pneumoniae bacteria was identified as serotype 3.  She had excellent responses to all serotypes after immunization except to serotype 3.  Poor response after one dose of PCV 13 (containing serotype 3) has been reported.  But after immunization with pneumovax following natural infection with serotype 3, the titer for serotype 3 did not make much sense to me.  She completed 3 weeks of ceftriaxone and is doing well.  Should I be concerned about an immunodeficiency?      Would you pursue any additional evaluation?
Thank you in advance for your assistance.

Niraj


Niraj Patel, MD MS

Department of Pediatrics
Infectious Diseases and Immunology

Levine Children's Hospital
Carolinas Medical Center
Charlotte, NC 28232-2861



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