RalphJ. Wedgwood

Immune response after splenectomy.

The immune response to intravenously administered bacteriophage phiX 174 and subcutaneously administered tridecavalent pneumococcal polysaccharide vaccine was studied in 31 patients with anatomical or functional asplenia. Antibody responses to primary immunisation with phiX 174 were significantly decreased while clearance was normal. Secondary responses were quantitatively normal; however, production of antibody did not switch from IgM to IgG as seen in controls. All groups of asplenic patients accept those patients with Hodgkins disease demonstrated significant seroconversions in response to pneumococcal polysaccharide antigens. One patient with Hodgkins disease, treated with local irradiation only, demonstrated normal responses to pneumococcal capsular antigens. 10 of the 12 capsular antigens for which antibody was measured stimulated threefold increases in antibody in the 26 asplenic patients without Hodgkins disease, which is similar to that observed in controls. Since the majority of cases of overwhelming postsplenectomy infection are caused by Streptococcus pneumoniae, all patients with either anatomical or functional asplenia should receive pneumococcal polysaccharide vaccine.

BACTERIAL L-FORMS IN RELAPSING URINARY-TRACT INFECTION

Abstract A patient with a relapsing Proteus mirabilis urinary-tract infection is described. Each relapse followed a seemingly adequate course of antibiotics, and no anatomical genitourinary malformation was found to explain the repeated infections. Bacterial L-forms were isolated from the patients urine during a course of ampicillin therapy. Further therapy designed to eliminate these L-forms was associated with eradication of the infection. Bacterial L-forms may play a role in some cases of relapsing urinary tract infections and antibiotic therapy aimed at their eradication may successfully terminate such infections.

TREATMENT OF CHILDHOOD COMBINED EPSTEIN-BARR VIRUS/CYTOMEGALOVIRUS INFECTION WITH ORAL BOVINE TRANSFER FACTOR

An illness lasting for two years, with recurrent fever, rash, abdominal pain, and arthralgia, developed in a four year old boy. He was found to have a combined Epstein-Barr virus and cytomegalovirus (CMV) infection. His symptoms, CMV in his urine, and an absent in vitro lymphocyte response to CMV antigen persisted for two years. After treatment with orally administered bovine transfer factor clinical symptoms and viruria disappeared and specific immunity to CMV developed. Evaluation of this treatment in chronic virus infections is warranted.

The Pharmacokinetics of Total Igg, Igg Subclasses, and Type Specific Antibodies in Immunodeficient Patients

The advent of immunoglobulin concentrates suitable for intravenous administration has greatly improved the clinical management of patients with a primary immunodeficiency syndrome. However, proper treatment requires understanding of the pharmacokinetics of the infused IgG and its components. We review here the work that has been conducted in this area. In particular, two studies have shown that these concentrates have adequate catabolic properties with regards to total IgG, IgG subclasses, and specific antibodies. We conclude that careful evaluation of the pharmacokinetics of a given IgG preparation is necessary in order to determine an appropriate treatment regimen.