[CIS PIDD] [cis-pidd] Haemophilus influenza in CVID

[Susana Lopes da Silva]

Dear colleagues

 

We have been following a cohort of patients with CVID in our centre, in
Lisbon. The first patients we included are now followed for almost 20 years. We
are currently dealing in some of these individuals with repeated respiratory acutizations
due to recurrent infections/colonization with Haemophilus influenza. Most of these patients have chronic
rhinosinusitis and bronchiectasis, and despite maintaining IgG levels above
1000 – 1100mg/dL  (with intravenous or
subcutaneous treatment), they become highly symptomatic (productive cough,
bronchorrea, fever) and with high CRP 2 days after stopping high dose
antibiotics (amoxycilin 1g 6/6h; amoxycilin / clavulanic 1500 / 125 8/8h for
periods as long as 21 days). We ask for sputum culture routinely before
antibiotics and after some months Haemophilus starts to be resistant and in
clinics we do notice progressive decline in response to treatment. We have
optimized ENT care, bronchodilators and mucolytics in our patients.

We would like to hear your opinion on strategies you use to improve efficacy
in preventing biofilm production and resistances… Also we would like to have
your comments on the possible roles of prophylactic antibiotics in these
patients (and which schemes), and / or immunotherapy with bacterial extracts /
inactivated bacteria. Concerning this last strategy we have been balancing the potential
benefits of T-cell / innate immunity stimulation vs the risks of immune
activation / lymphoid proliferation in some patients.

 

Thanks in advance for all your inputs.

Best regards,

Susana

 

Susana Lopes da Silva, MD

Centro de Imunodeficiências
Primárias 

Hospital de Santa Maria,  / Faculdade de Medicina Universidade de Lisboa
/ Instituto de Medicina Molecular 

Lisboa,

Portugal

 		 	   		  
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