RESUMO
BACKGROUND: The relationship between pneumococcal conjugate vaccine-induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed. METHODS AND FINDINGS: This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15-18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization-defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28-30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: -1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases. CONCLUSIONS: Efficacy was demonstrated against a broad range of pneumococcal diseases commonly encountered in young children in clinical practice. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT00466947.
Assuntos
Proteínas de Bactérias/imunologia , Proteínas de Transporte/imunologia , Haemophilus influenzae/imunologia , Imunoglobulina D/imunologia , Lipoproteínas/imunologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Vacinação , Vacinas Conjugadas/imunologia , Anticorpos Antibacterianos/sangue , Pré-Escolar , Método Duplo-Cego , Infecções por Haemophilus/microbiologia , Humanos , Imunização Secundária , Lactente , Análise de Intenção de Tratamento , América Latina , Otite Média/imunologia , Otite Média/microbiologia , Otite Média/prevenção & controle , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/microbiologia , Resultado do TratamentoRESUMO
Introducción: Streptococus pneumoniae es la principal causa de otitis media aguda (OMA). La vacuna antineumocócica 10 valente (PCV-10) fue introducida al Programa Nacional de Inmunizaciones (PNI) el año 2011. No existen estudios que midan la incidencia de infecciones por S. pneumoniae desde la implementación de esta vacuna en el PNI. Objetivo: Determinar la incidencia de OMA en niños <24 meses que consulten en el Hospital Dr. Sótero del Río (HSR) de Santiago antes y después de la implementación de PCV-10 en el PNI. Material y método: Estudio retrospectivo, observacional, en HSR entre 2007-2012. Se estudiaron niños <24 meses con diagnóstico de egreso de OMA atendidos en el Servicio de Urgencia (SU) del HSR. Se calculó incidencia de OMA en períodos pre y posvacuna y se compararon ambos períodos. Resultados: El promedio de niños <24 meses con diagnóstico de OMA por año en el período pre y posvacuna fue de 290 versus 239 (P >0,05) con un número de consultas totales anuales en niños de la misma edad que se mantuvo constante en el tiempo. La incidencia de OMA en el periodo prevacuna fue de 0,94% y en periodo posvacuna de 0,76%, P>0,05. Conclusiones: Nuestro estudio no mostró una diferencia en la incidencia de OMA en niños <24 meses que consultaron en el Servicio de Urgencia (SU) del Hospital Sótero del Río (HSR) antes y después de la implementación de vacuna antineumocócica en el PNI de Chile. Se requiere mantener la vigilancia y una evaluación a más largo plazo para evaluar el real efecto que esta vacuna podría tener en esta patología.
Introduction: Streptococcus pneumoniae is the leading cause of acute otitis media (AOM). The 10-valent pneumococcal vaccine (PCV-10) was introduced into the national immunization program (NIP) in 2011. There are no studies that measure the incidence of infections due to S. pneumonie from the implementation of this vaccine in the NIP. Aim: To determine the incidence of AOM in children <24 months attending the Sotero del Rio Hospital (HSR) of Santiago, Chile, before and after the implementation of PCV-10 in the NIP. Material and method: Retrospective, observational study in HSR, between 20072012. Children <24 months with discharge diagnosis of AOM treated at the Emergency Room (ER) of the HSR were included. We compared the incidence of AOM in pre and post vaccine periods. Results: Retrospective, observational study in HSR, between 2007-2012. Children <24 months with discharge diagnosis of AOM treated at the Emergency Room (ER) of the HSR were included. We compared the incidence of AOM in pre and post vaccine periods. Conclusions: Our study showed no difference in the incidence of AOM in children <24 months who visited the ER of SDR Hospital before and after implementation of pneumococcal vaccine in the NIP in Chile. Prospective surveillance is required to assess the longer term effect of the implementation of this vaccine in the incidence of AOM.
Assuntos
Humanos , Criança , Otite Média/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Otite Média/imunologia , Chile/epidemiologia , Doença Aguda , Incidência , Estudos Retrospectivos , Estudo ObservacionalRESUMO
Descrever a importância imunológica da IgG2 e de anticorpos específicos nas otites médias agudas de repetição na infância, através de revisão sistemática de trabalhos de literatura. Foi realizada uma busca eletrônica nas bases de dados MEDLINE, LILACS e Cochrane, no período de 1980 a 2005, no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro...
Relate the immunological status of IgG2 and specific antibodies in recurrent acute otitis media in childhood, throut academic review of medical papers. An eletronic research was performed on MEDLINE, LILACS, and Cochrane databases, in a period between 1980 and 2005 at Clementino Fraga Filho University Hospital from Rio de Janeiro Federal University...
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Deficiência de IgG/imunologia , Otite Média/imunologia , Recidiva/prevenção & controle , CriançaRESUMO
OBJECTIVE: To assess changes in the prevalence of otitis media, associated with the use of highly active antiretroviral therapy, in Brazilian human immunodeficiency virus (HIV) infected children. SETTING: Division of otorhinolaryngology, Hospital das Clínicas, Sao Paulo University Medical School, Brazil. PATIENTS: A cohort of 459 HIV-infected children aged below 13 years. MAIN OUTCOME MEASURES: The prevalence of otitis media and the serum cluster of differentiation four glycoprotein T lymphocyte count were compared for children receiving highly active antiretroviral therapy (with protease inhibitors) and those receiving standard antiretroviral therapy (without protease inhibitors). RESULTS: Otitis media was present in 33.1 per cent of the children. Children aged from zero years to five years 11 months receiving highly active antiretroviral therapy had a higher prevalence of acute otitis media (p=0.02) and a lower prevalence of chronic otitis media (p=0.02). Children who were receiving highly active antiretroviral therapy had a mean serum cluster of differentiation four glycoprotein T lymphocyte count greater than that of those who were receiving standard antiretroviral therapy (p<0.001). CONCLUSIONS: The use of highly active antiretroviral therapy in Brazilian HIV-infected children was associated with a lower prevalence of chronic otitis media.
Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Otite Média/epidemiologia , Antirretrovirais/uso terapêutico , Brasil/epidemiologia , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Otite Média/classificação , Otite Média/imunologia , Prevalência , Estudos RetrospectivosRESUMO
UNLABELLED: The advent of new antiretroviral drugs such as protease inhibitors has generated sensible changes in morbity and mortality in HIV-infected patients. OBJECTIVES: To evaluate the impact of Highly Active Antiretroviral Therapy (HAART) on the prevalence of chronic otitis media in HIV-infected pediatric population. METHODS: We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection from an Ambulatory of ENT and AIDS. Children were divided according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months and classified as having chronic otitis media based on history, physical examination, audiologic and tympanometric data. Prevalence of chronic otitis media, as well as CD4+ lymphocyte count were compared between groups in use of HAART and the group without HAART. RESULTS: Out of 459 children, 65 (14.2%) had chronic otitis media. We observed that in children aged 0 to 5 years and 11 months who were taking HAART there was significant lower prevalence of chronic otitis media (p=0.02). The use of HAART was associated to higher mean CD4+ lymphocyte count (p<0.001). CONCLUSION: The use of HAART was associated to reduction in prevalence of chronic otitis media in HIV infected children, probably due to increase in mean CD4+ lymphocyte count.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Otite Média/epidemiologia , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Feminino , Infecções por HIV/complicações , Infecções por HIV/imunologia , Humanos , Lactente , Recém-Nascido , Masculino , Otite Média/etiologia , Otite Média/imunologia , Prevalência , Estudos RetrospectivosRESUMO
O advento de novas drogas anti-retrovirais como os inibidores de protease provocou mudanças sensíveis na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto das novas drogas anti-retrovirais (Highly Active Anti-retroviral Therapy - HAART) na prevalência de otite média crônica em população pediátrica infectada pelo HIV. MÉTODOS: Analisamos os prontuários de 471 crianças com idade entre zero e 12 anos e 11 meses portadoras de HIV atendidas no ambulatório de AIDS de Clínica Otorrinolaringológica do HCFMUSP. As crianças foram divididas em dois grupos, de acordo com a faixa etária: 0 a 5 anos e 11 meses e 6 a 12 anos e 11 meses, e classificadas como portadoras de otite média crônica, baseadas em achados de anamnese, otoscopia, audiometria e imitanciometria. As prevalências de otite média crônica apresentadas e as contagens de linfócitos T CD4+ foram comparadas entre as crianças em uso ou não de HAART. RESULTADOS: Das 459 crianças atendidas, 65 (14,2 por cento) apresentavam otite média crônica. Observamos, nas crianças de 0 a 5 anos e 11 meses que o uso de HAART esteve associado a significante menor prevalência de otite média crônica (p = 0,02), e maior contagem de linfócitos T CD4+ (p < 0,001). CONCLUSÃO: O uso de HAART esteve associado à menor prevalência da forma crônica de otite média entre crianças menores de 6 anos infectadas pelo HIV, provavelmente como conseqüência do aumento promovido na contagem de linfócitos T CD4+.
The advent of new antiretroviral drugs such as protease inhibitors has generated sensible changes in morbity and mortality in HIV-infected patients. OBJECTIVES: To evaluate the impact of Highly Active Antiretroviral Therapy (HAART) on the prevalence of chronic otitis media in HIV-infected pediatric population. METHODS: We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection from an Ambulatory of ENT and AIDS. Children were divided according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months and classified as having chronic otitis media based on history, physical examination, audiologic and tympanometric data. Prevalence of chronic otitis media, as well as CD4+ lymphocyte count were compared between groups in use of HAART and the group without HAART. RESULTS: Out of 459 children, 65 (14.2 percent) had chronic otitis media. We observed that in children aged 0 to 5 years and 11 months who were taking HAART there was significant lower prevalence of chronic otitis media (p = 0.02). The use of HAART was associated to higher mean CD4+ lymphocyte count (p < 0.001). CONCLUSION: The use of HAART was associated to reduction in prevalence of chronic otitis media in HIV infected children, probably due to increase in mean CD4+ lymphocyte count.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Terapia Antirretroviral de Alta Atividade , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Otite Média/epidemiologia , Fatores Etários , Brasil/epidemiologia , Doença Crônica , Infecções por HIV/complicações , Infecções por HIV/imunologia , Otite Média/etiologia , Otite Média/imunologia , Prevalência , Estudos RetrospectivosRESUMO
OBJECTIVE: To characterize the immunodeficiency in ataxia-telangiectasia (A-T) and to determine whether the immunodeficiency is progressive and associated with increased susceptibility to infections. STUDY DESIGN: Records of 100 consecutive patients with A-T from the Johns Hopkins Ataxia-Telangiectasia Clinical Center (ATCC) were reviewed. RESULTS: Immunoglobulin (Ig) deficiencies are common, affecting IgG4 in 65% of patients, IgA in 63%, IgG2 in 48%, IgE in 23%, and IgG in 18%. Lymphopenia affected 71% of patients, with reduced B-lymphocyte number in 75%, CD4 T lymphocytes in 69%, and CD8 T lymphocytes in 51%. There was no trend for increased frequency or severity of immune abnormalities with age. Recurrent upper and lower respiratory tract infections were frequent: otitis media in 46% of patients, sinusitis in 27%, bronchitis in 19%, and pneumonia in 15%. Sepsis occurred in 5 patients, in 2 patients concurrent with cancer chemotherapy. Warts affected 17% of patients, herpes simplex 8%, molluscum contagiosum 5%, candidal esophagitis 3%, and herpes zoster 2%. Uncomplicated varicella infection occurred in 44% of patients; 2 patients had more than one clinical episode. No patient had Pneumocystis jerovici pneumonia or a complication of live viral vaccine. CONCLUSIONS: In spite of the high prevalence of laboratory immunologic abnormalities, systemic bacterial, severe viral, and opportunistic infections are uncommon in A-T. Cross-sectional analysis suggests that the immune defect is rarely progressive.
Assuntos
Ataxia Telangiectasia/complicações , Ataxia Telangiectasia/imunologia , Imunoglobulinas/deficiência , Infecções Respiratórias/imunologia , Adolescente , Adulto , Fatores Etários , Ataxia Telangiectasia/tratamento farmacológico , Ataxia Telangiectasia/mortalidade , Varicela/complicações , Varicela/imunologia , Criança , Pré-Escolar , Esofagite/complicações , Esofagite/imunologia , Esofagite/microbiologia , Feminino , Herpes Zoster/complicações , Herpes Zoster/imunologia , Humanos , Imunoglobulinas/sangue , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Células Matadoras Naturais/metabolismo , Leucopenia/imunologia , Contagem de Linfócitos , Linfopenia/imunologia , Masculino , Otite Média/complicações , Otite Média/imunologia , Infecções Respiratórias/complicações , Sepse/complicações , Sepse/imunologia , Dermatopatias Virais/complicações , Dermatopatias Virais/imunologiaRESUMO
Nontypeable Haemophilus influenzae (NTHi) is a leading etiologic agent of otitis media in children and recurrent respiratory infections in patients with chronic obstructive pulmonary disease. The highly conserved outer membrane protein P6 constitutes a promising vaccine candidate antigen. However, the small amount of P6 produced by this fastidious microorganism renders large-scale production difficult. Controversial data also exist concerning the suitability of recombinant P6 (rP6) as a vaccine antigen. Therefore, we performed a comparative evaluation of the immunogenicity and efficacy of native P6 and rP6 in mice intranasally vaccinated with adamantylamide dipeptide (AdDP) as an adjuvant. High titers of P6-specific serum antibodies were elicited in mice vaccinated with either native P6 or rP6, which cross-recognized both antigens. However, rP6 stimulated stronger mucosal responses. Mice vaccinated with rP6 were protected against both pulmonary and middle-ear infections (P<.01). This demonstrates that rP6 plus AdDP constitutes a promising vaccine formulation against the most relevant forms of disease caused by NTHi.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Amantadina/análogos & derivados , Amantadina/administração & dosagem , Proteínas da Membrana Bacteriana Externa/imunologia , Dipeptídeos/administração & dosagem , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/imunologia , Haemophilus influenzae/imunologia , Pneumopatias/prevenção & controle , Otite Média/prevenção & controle , Administração Intranasal , Animais , Anticorpos Antibacterianos/sangue , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Infecções por Haemophilus/imunologia , Infecções por Haemophilus/microbiologia , Vacinas Anti-Haemophilus/administração & dosagem , Imunização/métodos , Pneumopatias/imunologia , Pneumopatias/microbiologia , Camundongos , Camundongos Endogâmicos BALB C , Otite Média/imunologia , Otite Média/microbiologia , Proteínas Recombinantes/imunologia , Saliva/microbiologia , Vagina/microbiologiaRESUMO
Os autores fazem revisäo sobre otite média recorrente, na infância, abordando aspectos clinicoepidemiógicos, seus principais agentes etiológicos, alterações imunológicas envolvidas e enfocam a necessidade de adequada propedêutica diagnóstica, propondo os principais exames complementares necessários
Assuntos
Humanos , Criança , Antibacterianos/uso terapêutico , Otite Média/epidemiologia , Otite Média/diagnóstico , Otite Média/etiologia , Otite Média/imunologia , RecidivaRESUMO
Seventy-seven children with recurrent otitis media took part in the study at the Department of Otorhinolaryngology and Pediatrics of the University of São Paulo from February 1992 to March 1995. They were administered serum immunoglobulins and the relationship between recurrent otitis media and immunodeficiency was evaluated. No total IgG and IgM values were detected below the normal level; however, seven children with low levels of subclasses of IgG were detected and a below normal IgA value was detected in a child.
Assuntos
Imunoglobulinas/sangue , Otite Média/imunologia , Doença Aguda , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Otite Média/sangue , Otite Média/prevenção & controle , RecidivaRESUMO
A otite média aguda de repetiçao (OMAR), se constitui em um problema de grande importância devido a sua grande prevalência e a gravidade do quadro, representada por eventuais complicaçoes infecciosas. Além disso, a hipoacusia condutiva, que se estabelece nos períodos de crise, pode apresentar impacto negativo sobre as habilidades auditivas e lingüísticas. Com o intuito de contribuir para o estudo clínico das OMAR, analisamos prontuários de 84 crianças com diagnóstico de otite média aguda de repetiçao (OMAR), procurando identificar os fatores etiológicos principais e discutir as opçoes terapêuticas básicas. Em nossa casuística 40,5 por cento das crianças apresentaram diagnóstico clínico de alergia respiratória, 23,8 por cento apresentaram alteraçao imunológica, 10,7 por cento disfunçao tubária isolada, 28,57 por cento associaçao de fatores e em 14,3 por cento dos casos nao foi possível determinar o fator etiológico. Como linhas básicas de tratamento poderíamos citar que: a) A melhor opçao nos casos de disfunçao tubária permanente, associados ou nao a alergia, é a colocaçao do tubo de ventilaçao. b) Nos casos de alergia, como causa principal ou adjuvante, o uso de corticosteróides, seguido por anti-histamínicos, está indicado; c) Nos casos em que exista nítida prevalência dos fatores imunológicos, a antibioticoterapia (terapêutica e profilática) terá espaço justificado.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Otite Média/etiologia , Otite Média/terapia , Doença Aguda , Otite Média/imunologia , Estudos RetrospectivosRESUMO
Factor I deficiency causes a permanent, uncontrolled activation of the alternative pathway resulting in an increased turnover of C3 and consumption of factor B, factor H and properdin. Factor I deficiency is clinically associated with recurrent bacterial infections already in early infancy, mainly affecting the upper and lower respiratory tract, or presenting as meningitis or septicemia. We here report on a Brazilian family (n = 9) with known consanguinity, where in 3/7 children, suffering from chronic otitis, meningitis, and respiratory infections, a complete factor I deficiency was recognized. One of the patients died after fulminant sepsis. Hemolytic activity of the alternative pathway was not detectable in the patients' sera due to decreased plasma concentrations of C3, factor B and properdin. As a consequence of factor I deficiency, C3b could not be metabolized with the result that no C3-derived split products (C3dg/C3d) were detectable in the patients' sera. In vitro reconstitution with purified factor I restored the regulatory function in the patients' sera with the subsequent cleavage of C3b to C3c and C3dg. Factor H levels were decreased in all patients' sera and found to be tightly complexed with C3b resulting in a modified electrophoretic mobility. Upon factor I reconstitution, factor H was released from C3b regaining its beta 1 electrophoretic mobility. Complement-mediated biological functions like opsonization of bacteria, chemotactic activity and phagocytosis in these patients were impaired. The parents (cousins, 2nd degree) and 3/4 siblings had significantly reduced factor I plasma levels without further alteration in their complement profile. 3 of these obviously heterozygously deficient family members suffered from recurrent bacterial infections of different frequency and severity.
Assuntos
Infecções Bacterianas/imunologia , Fator I do Complemento/deficiência , Meningites Bacterianas/imunologia , Otite Média/imunologia , Infecções Respiratórias/imunologia , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Ativação do Complemento/imunologia , Complemento C3/imunologia , Complemento C3/metabolismo , Fator B do Complemento/imunologia , Fator B do Complemento/metabolismo , Fator H do Complemento/imunologia , Fator H do Complemento/metabolismo , Fator I do Complemento/imunologia , Consanguinidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Properdina/imunologia , Properdina/metabolismo , Sepse/imunologiaRESUMO
Sixty-eight children fed human milk were followed prospectively from birth to 12 months of age to assess the effect of milk antibody on nasopharyngeal colonization. Human milk secretory IgA antibody to P6, a highly conserved outer membrane protein of nontypeable Haemophilus influenzae, was measured with the use of an enzyme-linked immunosorbent assay. Nasopharyngeal colonization with nontypeable H. influenzae and the occurrence of otitis media were determined. Nasopharyngeal colonization was found in 22 children (32%), and 39 children (57%) had otitis media. Frequency of isolation of nontypeable H. influenzae was directly related to episodes of otitis media (r = 0.35; p = 0.001). The level of human milk anti-P6 secretory IgA antibody was inversely related to frequency of isolation of the organism (r = -0.27; p = 0.026). The average antibody level, expressed as nanograms per 0.1 mg total secretory IgA, in human milk fed to children with no colonization of nontypeable H. influenzae was significantly higher than in milk fed to children in whom colonization occurred on multiple occasions (156 +/- 120 vs 69 +/- 50; p = 0.013). Prevention of colonization was most evident during breast-feeding. These data suggest that the protective effects of human milk against otitis media may be due in part to inhibition of nasopharyngeal colonization with nontypeable H. influenzae by specific secretory IgA antibody.
Assuntos
Anticorpos Antibacterianos/análise , Haemophilus influenzae/imunologia , Haemophilus influenzae/isolamento & purificação , Imunoglobulina A Secretora/análise , Leite Humano/imunologia , Nasofaringe/microbiologia , Doença Aguda , Proteínas da Membrana Bacteriana Externa/imunologia , Feminino , Humanos , Recém-Nascido , Masculino , Otite Média/imunologia , Otite Média/microbiologia , Estudos ProspectivosRESUMO
We evaluated the prevention of recurrences of acute otitis media (AOM) by bacterial polysaccharide immune globulin (BPIG), a hyperimmune human immune globulin prepared by immunizing donors with bacterial polysaccharide vaccines. We used a randomized, stratified, double-blind, placebo-controlled design. Children < or = 24 months of age with 1 to 3 prior episodes of AOM received BPIG, 0.5 ml/kg, or saline placebo intramuscularly at entry and 30 days later. During the 120-day follow-up period, AOM was diagnosed by using clinical criteria and was confirmed with tympanocentesis and culture of the middle ear exudates. Eighty-eight episodes of AOM were observed in 76 patients who completed the study. The incidence of AOM during the entire 120-day study period was similar in BPIG and placebo recipients. Pneumococcal AOM was significantly less frequent in BPIG recipients (0.21 episode per patient) than in placebo recipients (0.45 episode per patient; p = 0.05). Time spent free of AOM was significantly prolonged in recipients of BPIG, in comparison with placebo recipients (51 vs 35 days; p = 0.034). This study demonstrated that circulating antibody, even without stimulation of specific local immunity, may prevent infection of the middle ear. The use of immune globulin preparations for longer periods or at a higher dosage might decrease the incidence of recurrent AOM in otitis-prone children, and deserves further evaluation.
Assuntos
Vacinas Anti-Haemophilus/uso terapêutico , Imunoglobulinas/uso terapêutico , Otite Média/prevenção & controle , Doença Aguda , Adolescente , Anticorpos Antibacterianos/análise , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Vacinas Anti-Haemophilus/imunologia , Humanos , Imunoglobulinas/imunologia , Lactente , Masculino , Otite Média/imunologia , Otite Média/microbiologia , Infecções Pneumocócicas/complicações , Recidiva , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/imunologiaRESUMO
We studied humoral immune function in 267 children with recurrent respiratory infections referred to our immunology clinic to determine the most appropriate immunologic studies for evaluating recurrent infections in children. Of this highly selected population, 58% had a partial deficiency in one or more of the major immunoglobulin isotypes or IgG subclasses (defined as at least 2 SD below the normal age-adjusted mean). In none of the patients was there a total absence of an immunoglobulin isotype. The most common abnormality was partial IgA deficiency, which was found in one third of the patients. Twenty-six patients had only partial IgG subclass deficiencies, of which 20 were deficiencies of a single subclass. IgG1 was an isolated partial defect in three patients, IgG3 in five patients, and IgG2 and IgG4 were selective partial defects in six patients each. Tetanus toxoid and pneumopolysaccharide type 3 were the most immunogenic of the immunogens tested; hyporesponsiveness to pneumococcal polysaccharide types 7, 9, and 14 was common. Nineteen percent of the patients with normal immunoglobulin concentrations who were tested had lower-than-expected antibody titers; 42% of those tested with partial isotype deficiencies had deficient antibody responses. Of 25 patients with selective partial IgG subclass deficiencies or combined IgG subclass deficiencies, eight had antibody deficiencies. Our findings indicate that a high proportion of children referred to immunology clinics for recurrent infection have a demonstrable immunologic abnormality. Selective IgG subclass deficiency or a combined IgG subclass deficiency without an associated deficiency in a major immunoglobulin isotype is unusual. Identification of such patients is not predictive of the capacity to form antibodies to the antigens tested in this study and, in our opinion, adds little to the initial evaluation of immune function in such children.
Assuntos
Anticorpos/sangue , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Otite Média/imunologia , Infecções Respiratórias/imunologia , Adolescente , Formação de Anticorpos , Criança , Pré-Escolar , Disgamaglobulinemia , Feminino , Humanos , Deficiência de IgA , Deficiência de IgG , Imunoglobulina M/deficiência , Lactente , Masculino , RecidivaRESUMO
Total IgG and subclasses IgG1, IgG2, IgG3, and IgG4 were measured in 89 subjects with recurrent otitis media. There was no significant difference between the groups with respect to the arithmetic or geometric mean levels for total IgG or subclasses IgG1, IgG2, IgG3, or IgG4.
Assuntos
Imunoglobulina G/sangue , Otite Média/imunologia , Amoxicilina/uso terapêutico , Pré-Escolar , Feminino , Humanos , Deficiência de IgG , Imunoglobulina G/classificação , Lactente , Masculino , Otite Média/prevenção & controle , RecidivaRESUMO
We studied the relationship of serum levels of IgA and IgE to allergic manifestations and otitis media in a cohort of 179 Icelandic children, aged 18 to 23 months. Only one of the infants had IgA deficiency (less than 50 micrograms/ml); all the others had IgA levels that were normal for their age. The children were divided into three groups according to their IgA levels (lowest 25%, intermediate 50%, highest 25%) and the clinical findings analyzed accordingly. The cumulative incidence of definite allergic manifestations was 37%. Asthma and otitis media were significantly more common among the infants with low normal IgA levels than among those with intermediate to high IgA levels. There was also a significant association between the severity of allergic manifestations and low IgA levels (p = 0.002). Children with detectable IgE (greater than or equal to 0.23 kilounit/L) had a higher incidence of atopic manifestations than did children in whom IgE was not detectable, but only a weak correlation was found between the occurrence and extent of allergic symptoms and increasing amounts of IgE beyond the 0.23 kilounit/L level. These findings suggest that atopic manifestations in infants may be more dependent on delayed maturation of IgA production than on overproduction of IgE.