Age: 71.0
Sex: F
Vaccine: PPV
Symptoms: Pneumonia, Sputum culture
Clinical narrative: Information has been received from a published literature article, concerning a 71 year old female pediatric nurse with frequent upper respiratory tract infections, chronic cough, COPD exacerbation and had a history of acute pneumonia, shortness of breath of 3 years duration, smoker (also reported as 40 pack year smoking history) and hospitalisation, In the early 1990's, the pt was vaccinated with pneumococcal 23v polysaccharide vaccine (details not reported). In June 2002, the pt was vaccinated with the second dose of pneumococcal 23v polysaccharide vaccine. In July 2002, the pt developed bronchitis. I June 2003, the pt developed multifocal pneumonia and was hospitalized. In August 2003, the pt was vaccinated with the third dose of pneumococcal 23v polysaccharide vaccine. In December 2003, the pt developed influenza A. In Nov 2004, the pt developed Haemophilus influenza. At the time of this report, the pt was recovering from the events. The published literature article reads as follows, the pt reported that she had been given pneumococcal vaccine in the early 1990's but those details were not available. She was given a dose of 23 valent pneumococcal polysaccharide vaccine in June 2002, after her treatment for acute pneumonia was completed. At that time she was receiving a prednisone taper, dating to her hospital stay. Her dose was reduced from 10 mg/d on the day of vaccination to 5mg/d for 1 week and then 5 mg every other day for a week. Three additional episodes of bronchitis occurred between July 2002 and March 2003, each of which was treated with oral antibiotics. She was hospitalized in June 2003 with multifocal of pneumonia, again with an S pneumoniae positive sputum culture. Immunoglobulin levels (IgG 1.470 mg/dl, IgA 187 mg/dl and IgM 88 ml/dl), but specified antipneumococcal antibody levels, although greater then 1.0 ug/ml in all 12 stereotypes tested, showed little increase between pre vaccination and post vaccination titers obtained 1 month after administration of her second 23 valent pneumococcal 23v polysaccharide vaccine. An RTI in Dec 2003, diagnosed as influenza A, slowly resolved in 1 month despite the use of oseltamivir. No Nov 2004 she developed pneumonia again, confirmed by a chest radiography, and was hospitalized. Sputum Gram stain and culture showed many white blood cells and small gram neg bacilli identified with Haemophilus influenzae. In Feb 2005, the pt started monthly IV IgG replacement therapy 25g of 350 mg/kg per dose. She was without infection and did not require antibiotic therapy for any reason until May 2006, 15 months after starting replacement therapy. At that time, she was given a single outpatient antibiotic course for a mild increase in symptoms and yellow sputum. She completed that course with a prompt response to therapy and remains free of infection as of July 2006. This was the first article describing the successful use of IgG replacement therapy in an adult with documented recurrent RTI's with polysaccharide encapsulated organisms and apparent insufficient response to pneumococcal 23v polysaccharide vaccine. No further information is available.