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

[CIS-PIDD]

Carla:  Thank you for your e-mail.  The patient has experienced upper respiratory infections (URIs) not urinary tract infections (UTIs).  JC

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, September 10, 2015 12:55 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] 18yo M with antibody deficiency

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<mailto:gianellicarla at gmail.com>

2015-09-10 17:32 GMT+02:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto: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<tel:507-255-8464>
fax: 507-255-7767<tel:507-255-7767>


From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org<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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