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

[CIS-PIDD]

Hi Joe,

Prevnar is not the best to elicit a polysaccharide response.  Consider giving him a Pneumovax then retesting for pneumococcal response in 3 weeks.

Stan

Stanley J. Naides, M.D., F.A.C.P., F.A.C.R.
Medical Director, Immunology R&D | Interim Scientific Director, Immunology R&D
Quest Diagnostics | Action from Insight | 33608 Ortega Highway| San Juan Capistrano, CA 92675| phone: 949-728-4578| fax: 949-728-7852
stanley.j.naides at QuestDiagnostics.com<mailto:stanley.j.naides at QuestDiagnostics.com>
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From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, September 10, 2015 7:05 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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