1/10. IgG2 immunodeficiency: association to pediatric patients with bacterial meningoencephalitis.An IgG subclass deficiency is often associated with bacterial infections. We studied four pediatric patients suffering from meningoencephalitis, two of them due to streptococcus pneumoniae and two due to haemophilus influenzae type b. Simultaneous diagnostic serum and cerebrospinal fluid samples were taken during income. The four subclasses of IgG and albumin were quantified in both biologic fluids by radial immunodiffusion. Very low levels of seric IgG2 with non detectable cerebrospinal fluid IgG2 were found in the patients. No intrathecal IgG subclass synthesis was found in two patients. One patient with S. pneumoniae had IgG3 intrathecal synthesis. Intrathecal IgG1, IgG3 and IgG4 synthesis was found in one patient suffering from H. influenzae according with reibergrams. Substitutive therapy with intravenous gammaglobulin was given to the patients as part of the treatment.- - - - - - - - - - ranking = 1keywords = pneumoniae (Clic here for more details about this article) |
2/10. Localization of extrapulmonary tuberculosis in the synovial membrane, skin, and meninges in a patient with systemic lupus erythematosus and igg deficiency.We report on a 31-year-old female patient with systemic lupus erythematosus (SLE) for 24 years who had a past history of skin tuberculosis (lupus vulgaris), long-term corticosteroid therapy, and igg deficiency. She presented with monoarthritis and concomitant meningitis from skin tuberculosis after 5 years. The diagnosis of joint and meningeal tuberculosis was defined with clinical symptoms--signs and typical histopathological findings of involved synovium. Clinical improvement was achieved with antituberculous therapy. Cutaneous, articular, and cerebral manifestations of tuberculosis might have been confused with some of the lupus manifestations or lupus activation. It should be kept in mind that tuberculosis may be encountered in SLE due to the nature of the underlying disease and/or its therapy. It is also worth mentioning that, in this patient, tissues involved with extrapulmonary tuberculosis were the primary areas of involvement with SLE.- - - - - - - - - - ranking = 0.57263500695473keywords = meningitis (Clic here for more details about this article) |
3/10. Antibody deficiency with hyper IgM--a case report.A 20-month-old Indian boy presented with recurrent pyogenic infections and failure to thrive. His IgG and IgA levels were low, but his IgM was elevated. He also had undetectable isohaemagglutinin titre and neutropenia, both parameters being poor prognostic indicators in this very rare primary immunodeficiency state--antibody deficiency with hyper IgM. Our patient subsequently succumbed to pseudomonas aeruginosa septicaemia and meningitis inspite of aggressive antibiotic and intravenous gammaglobulin therapy. To the best of our knowledge, this is the first such case to be documented in malaysia.- - - - - - - - - - ranking = 0.57263500695473keywords = meningitis (Clic here for more details about this article) |
4/10. Coexistent yellow nail syndrome and selective antibody deficiency.BACKGROUND: yellow nail syndrome (YNS) is a rare, often underdiagnosed condition of unknown origin. The clinical features of the syndrome include yellow nails, chronic sinusitis, bronchiectasis, pleural effusion, and lymphoedema. Despite the frequent occurrence of upper and lower respiratory tract infections in patients with YNS, comprehensive analysis of their humoral immunity has not been previously reported. OBJECTIVE: To present the case of a patient with YNS whose recurrent upper and lower respiratory tract infections may have been caused by an underlying selective antibody deficiency that manifests as impaired IgG antibody response to polysaccharide antigens. methods: The patient underwent cultures of purulent sputum for streptococcus pneumoniae and Haemophilus influenzae, bronchial washings for H. influenzae, and nail scrapings for fungi. Her serum levels of IgG, IgA, IgM, IgG subclasses, and serum titers of IgG antitetanus toxoid, anti-H. influenzae, and anti-S. pneumoniae antibodies were measured. RESULTS: Cultures of purulent sputum were positive on multiple occasions for S. pneumoniae and H. influenzae and bronchial washings were positive for H. influenzae. Nail scrapings were consistently negative for fungi. She had no reductions in serum levels of IgG, IgA, IgM, or IgG subclasses and had normal serum titers of IgG antitetanus toxoid antibodies. However, she demonstrated impaired IgG antibody responses following immunization with Pneumovax and an H. influenza B vaccine. CONCLUSIONS: This case report describes the first comprehensive analysis of humoral immune function in a patient with YNS. The finding of a selective antibody deficiency in our patient provides a potential explanation for the occurrence of respiratory infections in YNS. Accordingly, we recommend that functional antibody determinations and quantitative serum immunoglobulins be evaluated in patients diagnosed as having this unusual, enigmatic syndrome.- - - - - - - - - - ranking = 1.5keywords = pneumoniae (Clic here for more details about this article) |
5/10. Iatrogenic IgG2 deficiency in a leukaemic child. A case report.A girl with acute non-lymphoblastic leukaemia was treated with immunosuppressive chemotherapy. After cessation of therapy she had three consecutive episodes of infection due to streptococcus pneumoniae from which she recovered and was shown to have developed a combined deficiency of both IgG2 and IgG4. The patient eventually relapsed and died 3 years after the initial diagnosis. The importance of measuring IgG subclasses in patients treated with immunosuppressive chemotherapy is discussed.- - - - - - - - - - ranking = 0.5keywords = pneumoniae (Clic here for more details about this article) |
6/10. IgG subclasses in childhood infections.Selective IgG subclass (IgGSc) deficiencies are frequently found in association with recurrent infections in childhood. IgG1 deficiency is the most severe and is associated with features typical of panhypogammaglobulinaemia. Immunoglobulin replacement therapy is usually required. IgG2 deficiency is associated with recurrent infections with encapsulated bacteria such as Haemophilus influenzae and streptococcus pneumoniae. IgG2 deficiency may be transient in children under five years of age and patients improve with antibiotics and immunisation. IgG3 and IgG4 deficiency are commonly found in children with recurrent infections and may indicate a disordered immune system since absence of these antibodies alone appears insufficient to cause symptoms. Children may also have selective IgGSc deficiencies in the absence of recurrent infections. This is explained by compensatory factors in other parts of the immune system. Measurement of IgGSc levels should be based on highly specific polyclonal antisera which show no IgGSc cross-reactivity. Most monoclonal antibodies are unsatisfactory since allotypes are detected variably, leading to excess reporting of IgGSc deficiencies and Mabs cannot be used for nephelometric or turbidimetric methods.- - - - - - - - - - ranking = 0.5keywords = pneumoniae (Clic here for more details about this article) |
7/10. Recurrent pneumococcal meningitis in a patient with transient IgG subclass deficiency.We report the case of a 3 year old boy who exhibited recurrent serious infections with a transient imbalance of IgG subclass in the second year of life. He suffered from pneumococcal meningitis at 3 months, hepatitis at 9 months, and purulent arthritis at 11 months of age. The second episode of pneumococcal meningitis occurred at 14 months. serum IgG level was normal for age. Low level of IgG2, undetectable level of IgG4 and negligible level of pneumococcus-specific IgG1-G2 antibodies were found. No other primary immunodeficiency was apparent. serum IgG2-G4 levels but not pneumococcus-specific IgG1-G2 titers increased by the age of 30 months. At that time, he was inoculated with a polyvalent pneumococcal vaccine along with acellular diphtheria-pertussis-tetanus vaccine. He acquired the immunity against these agents, and had no episodic infections in the following 2 years. This observation stresses the existence of transient IgG subclass deficiency associated with delayed development of the anti-polysaccharide antibody response.- - - - - - - - - - ranking = 3.4358100417284keywords = meningitis (Clic here for more details about this article) |
8/10. Haemophilus influenzae type D infection and IgG2 deficiency in a patient with chronic mucocutaneous candidiasis.A 14 year old boy with chronic mucocutaneous candidiasis and persistent pulmonary infection caused by Haemophilus influenzae and streptococcus pneumoniae is reported. Initial bacterial culture studies showed H. influenzae type B and S. pneumoniae as causative agents. H. influenzae type D was constantly isolated from the patient's sputum. Abnormally low levels of serum immunoglobulin G2 (IgG2) found in the patient may have contributed to the pulmonary infection and H. influenzae type D may be an important causative agent in immunodeficient patients.- - - - - - - - - - ranking = 1keywords = pneumoniae (Clic here for more details about this article) |
9/10. Recurrent lymphocytic meningitis associated with hereditary isolated IgG subclass 3 deficiency.We report the case of an otherwise healthy young adult woman who has suffered three episodes of lymphocytic meningitis of possible enteroviral aetiology during a 5 year period. Analysis of immunoglobulin subclasses has revealed a sustained reduction of IgG3 to below the fifth percentile. In addition, the patient's father and brother have a similar degree of IgG3 deficiency. Isolated IgG3 deficiency has previously been described in association with recurrent upper respiratory tract infections, asthma, obstructive lung disease and enteral infections. However, our patient did not have any of these and there was no other identifiable immune defect to account for the recurrent meningitis. Although a mere chance association is possible, the case is interesting as antibody responses involving IgG3 tend to be triggered by protein antigens such as viral envelopes, while humoral immunity is known to be important in the clearance of enteroviral infection.- - - - - - - - - - ranking = 3.4358100417284keywords = meningitis (Clic here for more details about this article) |
10/10. IgA and IgG2 deficiency associated with zonisamide therapy: a case report.PURPOSE: To report a previously undescribed adverse effect, IgA/IgG subclass deficiency associated with zonisamide (ZNS) therapy. methods: serum IgA and IgG subclass levels were determined by the turbidimetric immunoassay and enzyme-linked immunosorbent assay, respectively, in a 2-year-old boy with postmeningitis sequelae who was treated by ZNS. RESULTS: Four months after initiation of ZNS, combined deficiency of IgA and IgG2 was noted. After cessation of ZNS, serum IgA level was promptly increased. IgG2 level was gradually increased, but remained subnormal after 7 months. CONCLUSIONS: This case documents, for the first time, the action of ZNS on IgG immune system as well as IgA system. If patients with ZNS therapy showed iga deficiency and recurrent infections, it is preferable to check serum IgG subclass concentrations as well.- - - - - - - - - - ranking = 0.57263500695473keywords = meningitis (Clic here for more details about this article) |
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