[CIS PIDD] [cis-pidd] 18yo M with antibody deficiency

[CIS-PIDD]

Hello,

- Urine culture with antibiogram  to assess resistance to Antibiotics

I agree to follow up his immunological  status with the addition of:
- All the Igs including IgG subclasses,
-evolution of Titers of specific Antibodies,  adding also,  in the future,
 and  if it could be possible: the response against other polysaccharide
antigen as  typhoid-Vi antigen following typhoid vaccine  and against
protein tetanus antigen  following Tetanus-difteria vaccine administration.


If over time these infections persist despite of  Antibiotics or the
patient depend on them  and/or  infections return more severe, consider
subcutaneous/intravenous  Immunoglobulin replacement  therapy   that could
help to eradicate the urinary tract infection, which is now the first clear
goal.
Then,  depending on  his clinical, microbiological  &
 immunological parameters  outcomes,  you can stop and see  or continue
 the  treatment.

Kind regards,

Carla Gianelli
Clinical Immunologist.
Madrid.
gianellicarla at gmail.com

2015-09-10 17:32 GMT+02:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org>:

> Hi Joe,
>
>
>
> Concomitant Menactra and Prevnar administration are contraindicated due to
> interference with immunogenicity of the latter when administered at the
> same time as Menactra.  It is recommended that Menactra be given a minimum
> of 4 weeks after all PCV-13 doses.
>
>
>
> MMWR 2013;62(RR2):1-28.
>
>
>
> Tom
>
>
>
>
>
> Thomas G. Boyce, MD, MPH
> Pediatric Infectious Diseases and Immunology
> Mayo Clinic
> Rochester, MN 55905
> phone: 507-255-8464
> fax: 507-255-7767
>
>
>
>
>
> *From:* CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
> *Sent:* Thursday, September 10, 2015 9:05 AM
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] 18yo M with antibody deficiency
>
>
>
> Colleagues:
>
>
>
> I have followed an 18yo male who had a history of recurrent URIs
> associated with IgA deficiency and poor antibody responses to pneumococcal
> polysaccharide antigens (Pneumovax).
>
>
>
> He has had no significant infections for at least 5 years.
>
>
>
> His primary MD wanted to check his immune status prior to the young man
> going to college.  The patient received Menactra (conjugated *N. men* A,
> C, Y, W-135 polysaccharides) and Prevnar (conjugated 13 serotypes of *S.
> pneumo *polysaccharides) on July 28.
>
>
>
> Labs drawn on September 1 showed:
>
> -       Positive antibodies to *N. men* A only
>
> -       Positive antibodies to ONE serotype of *S. pneumo*
>
> -       Normal IgG and Ig M levels.
>
>
>
> The lack of response to conjugated polysaccharide vaccines is of concern
> to me.
>
>
>
> Would you suggest:
>
> -       Continue observation and urgent use of antibiotics for febrile
> episodes?
>
> -       Antibiotic prophylaxis?
>
> -       Immunoglobulin replacement?
>
> -       Other?
>
> -
>
> Thank you for your consideration.
>
>
>
> Joe Church
>
> Children’s Hospital Los Angeles
>
>
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