Cristina Arslanian

Immunological evaluation of allergic respiratory children with recurrent sinusitis.

The objective of this study was to evaluate humoral immunity of allergic respiratory children with chronic/recurrent sinusitis. Twenty‐seven allergic respiratory (persistent mild/moderate asthma and persistent allergic rhinitis) children (7–15‐year old) with chronic or recurrent sinusitis were evaluated. Patients had symptoms and abnormal computer tomography scan even after two adequate treatments (long‐lasting antibiotics, decongestants, and short‐term oral corticosteroids). clinical examination, sweat test, total blood cell count, measurement of serum levels of: total and specific IgE, immunoglobulins (G, M, A), IgG subclasses, antibodies to Haemophilus influenza type b (IgG anti‐Ps Hib) and pneumococcal serotypes (IgG anti‐Ps 1, 3, 5, 6B, 9V, and 14) before and after active immunization (Act‐Hib® and Pneumo23®, Aventis Pasteur SA, Lyon, France), Rubella neutralizing antibody titers and human immunodeficiency virus antibodies. Specific IgE to inhalant allergens higher than class III were observed in 24/27 patients. One patient had IgA plus IgG2 deficiency and other an IgG3 deficiency. Eight and 12 of 27 patients had IgG2 and IgG3 serum levels below 2.5th percentile, respectively. Immunological responses to protein and polysaccharide antigens were normal in all patients. Although our patients have been appropriately treated of their allergic diseases, they persisted with chronic/recurrent sinusitis and 60% of them had a documented osteomeatal complex blockade. In spite of the diagnosis of IgA plus IgG2 deficiency and an isolated IgG3 deficiency, in all patients an adequate response to Ps antigens was observed. Primary and/or secondary humoral immunodeficiency seems not to be the main cause of chronic/recurrent sinusitis in patients with respiratory allergic disease.

Response to polysaccharide antigens in patients with ataxia-telangiectasia.

OBJECTIVE To analyze the production of antibodies to polysaccharide antigens in patients with ataxia-telangiectasia. PATIENTS AND METHODS We used the ELISA technique to measure the levels of IgG antibodies to serotypes 1, 3, 5, 6B, 9V and 14 of Streptococcus pneumoniae in 14 patients with ataxia-telangiectasia before and after immunization with 23-valent polysaccharide vaccine. Adequate response to individual polysaccharide can be defined as a postimmunization antibody titer equal to or greater than 1.3 microg/ml or as a minimum fourfold increase over the baseline (preimmunization) value. RESULTS Six (43%) patients showed an absent response to all serotypes analyzed. Four patients showed adequate response to only one serotype, one patient to two serotypes, two patients to three serotypes and only one patient to four out of six serotypes analyzed. No patient had adequate response to all serotypes tested. Postimmunization pneumococcus IgG levels were higher than preimmunization levels to all serotypes analyzed, except for serotype 3. In spite of this, the mean postimmunization levels were lower than 1.3 microg/ml in all serotypes, except for serotype 14. Mean increment was less than four in all serotypes analyzed. CONCLUSIONS Our results suggest that patients with ataxia-telangiectasia are at a high risk of having an impaired response to pneumococcus, which may be one of the causes of recurrent sinopulmonary infections in these patients.

Resposta a antígenos polissacarídicos em pacientes com ataxia-telangiectasia

OBJECTIVE: To analyze the production of antibodies to polysaccharide antigens in patients with ataxia-telangiectasia. PATIENTS AND METHODS: We used the ELISA technique to measure the levels of IgG antibodies to serotypes 1, 3, 5, 6B, 9V and 14 of Streptococcus pneumoniae in 14 patients with ataxia-telangiectasia before and after immunization with 23-valent polysaccharide vaccine. Adequate response to individual polysaccharide can be defined as a postimmunization antibody titer equal to or greater than 1.3 µg/ml or as a minimum fourfold increase over the baseline (preimmunization) value. RESULTS: Six (43%) patients showed an absent response to all serotypes analyzed. Four patients showed adequate response to only one serotype, one patient to two serotypes, two patients to three serotypes and only one patient to four out of six serotypes analyzed. No patient had adequate response to all serotypes tested. Postimmunization pneumococcus IgG levels were higher than preimmunization levels to all serotypes analyzed, except for serotype 3. In spite of this, the mean postimmunization levels were lower than 1.3 µg/ml in all serotypes, except for serotype 14. Mean increment was less than four in all serotypes analyzed. CONCLUSION: Our results suggest that patients with ataxia-telangiectasia are at a high risk of having an impaired response to pneumococcus, which may be one of the causes of recurrent sinopulmonary infections in these patients.

Brief report. Placental transfer of IgG antibodies against Haemophilus influenzae type b capsular polysaccharide in Brazilian term and preterm newborns

Placental transfer of antibodies to polysaccharide antigens is still a controversial subject. The incidence of invasive Haemophilus influenzae type b (Hib) infections is high in countries where the vaccine has not been included in routine immunization schedules. In the present work, we proposed to evaluate the natural immune response to Hib capsular polysaccharide in term and preterm Brazilian newborns and their respective mothers. Although the means, medians, and ranges of antibody titres in paired maternal and cord sera from preterm neonates were similar, the maternal levels were slightly higher than the cord levels and a poor correlation between these levels was verified. Term neonates showed similar antibody levels to those of their respective mothers and a very significant correlation between these levels was observed.

Evaluation of serum levels of IgG subclasses and anti-ribosyl-ribitolphosphate IgG and IgG2 in children with Haemophilus infleunzae b meningitis

In 40 children with Haemophilus influenzae b (Hib) meningitis, we determined serum levels (mg/dl) of IgG subclasses using the radial immunodiffusion method; 67.8 per cent of these children were less than 24 months old. In 14 children of the sample we measured serum IgG and IgG2 anti-ribosyl-ribitolphosphate (anti-PRP) (by enzyme-linked immunosorbent assay, ELISA) in the acute and convalescent phases of the disease. Lower IgG2 levels than those of the control group were obtained in all age ranges: 3-12 months, 1-2 years (p < 0.01), and 2-5 years (p < 0.001). IgG4 was also present in lower levels in patients of all age ranges (p < 0.05, p < 0.001, and p < 0.01 respectively). Serum levels of IgG anti-PRP and IgG2 anti-PRP measured were very low in the acute phase of the disease in all age ranges and there was no notable increase in levels during the convalescent phase of the disease. This result indicates that children less than 24 months old do not produce sufficient levels of IgG and IgG2 anti-PRP even after Hib meningitis.

IMMUNOGLOBULIN LEVELS OF NEONATES WITH RISK FACTORS FOR EARLY SEPSIS AT DIFFERENT GESTATIONAL AGES: COMPARATIVE ANALYSIS BETWEEN NEONATES WITH AND WITHOUT INFECTION. 1748

OBJECTIVE: The high mortality in early sepsis is related to the presence of risk factors and to the neonate immunological state. The objective of this study was to do a comparative analysis of the immunological state of neonates with or without infection, at different gestational ages.METHODS: A prospective study with 60 newborns presenting one or more risk factors for early infection: clinical amnionitis, prolonged rupture of membranes or urinary tract infection was done. The newborns were classified into three groups of gestational age. I: 20 newborns ≥ 37 weeks, II: 20 newborns between 34 and 36 6/7 weeks, III: 20 newborns < 34 weeks. Blood samples were obtained from all newborns at birth and at the fifth day of life after family consent. Diagnosis of sepsis was based upon clinical and laboratorial criteria. The immunologic state was studied and analisys comparative was done between newborns with or without infection, into each group of gestational age. Immunoglobulin levels: IgG, IgM, IgA and total complement, at birth and at the fifth day of life, were studied. Statistical tests done were: Kruskal Wallis, Wilcoxon, Fisher and quisquare.RESULTS: Serum IgG levels were directly related to gestational age and in this study were higher when compared to current literature in all the groups. In groups II and III average serum IgG levels at birth were significantly different between neonates with or without infection, being lower in the infected neonates. This difference remained statistically significant at the fifth day of life only in group III. Serum IgM levels at birth were not related to gestational age and were significantly different in groups II and III at birth and in fifth day of life between neonates with or without infection. Serum IgA levels were undetectable in 96% of these cases at birth and in 80,5% at the fifth day.CONCLUSIONS: The rate of infection in newborn infant with risk factors for early sepsis seems to be correlated to IgM and IgG levels.