[CIS PIDD] [cis-pidd] Suspected vaccine-acquired rotavirus infection in X-HIGM

[Cowan, Mort]

I agree with Joe.  We've had limited success with oral IVIG for rotavirus. Frankly, we've not seen it clear without correction of the T cell defect at least in SCID patients and it's probably true for X-HIGM.  Mort

Morton J. Cowan, M.D.
Professor of Pediatrics
Chief, Allergy, Immunology, and Blood and Marrow Transplant Division
UCSF Children's Hospital, Room M659
505 Parnassus Ave
San Francisco, CA 94143-1278

Phone: 415-476-2188
FAX: 415-502-4867

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From: Church, Joseph [mailto:JChurch at chla.usc.edu]
Sent: Friday, January 11, 2013 9:47 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] Suspected vaccine-acquired rotavirus infection in X-HIGM


To my knowledge there is no specific therapy for chronic rotavirus.  However, after discussions with a number of investigators I found out a couple of things:

·         Antibody is likely required to clear rotavirus

·         There is substantial rotavirus antibodies in IVIG.



Consider combination high-dose IVIG (trough levels ~1,000) and a course of oral IVIG.  There are a few references but no controlled trials (e.g. Guarino et al Pediatr Infect Dis J 1991;10:612-4).



Here is one protocol:

·         IVIG ~500mg/kg/day, divided TID for 7 days (IVIG has excellent palatability)

·         Give IVIG  at least 1 hour before and 2 hours after a meal.

·         Administer an antacid immediately prior to each dose.



Good luck.



Joe Church

Children's Hospital Los Angeles





-----Original Message-----
From: Laia Alsina Manrique de Lara [mailto:lalsina at hsjdbcn.org]
Sent: Friday, January 11, 2013 1:54 AM
To: CIS-PIDD
Subject: [cis-pidd] Suspected vaccine-acquired rotavirus infection in X-HIGM





Dear all,



I am attending a 7 month old patient with X-linked hyperIgM syndrome, to whom Rotateq was administered before the diagnosis of PID was made.

He has a protracted watery diarrhoea with recurrent severe dehidration and metabolic acidosis, which is becoming uncontrollable.

We are pending studies for Cryptosporidium, Microsporidium and Rotavirus (vaccine strain).

In case we confirm Cryptosporidium or Microsporidium, any suggestions besides nitazoxanide (100 mgr BID for 14 days)? Would you also combine azithromycin?

In case we confirm a Rotavirus vaccine strain, can anyone suggest any specific treatment?





Thank you in advance,





Dra. Laia Alsina

Sección de Alergia e Inmunología Clínica Hospital Sant Joan de Déu Passeig Sant Joan de Déu nº2

08950 Esplugues de Llobregat, Barcelona

+34932804000 ext 3330

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