ANTIBODY FORMATION IN CASES OF LOBAR PNEUMONIA TREATED WITH SULFAPYRIDINE
Authors: Yale Kneeland, Barbara Mulliken
Journal: Journal of Clinical Investigation (1940)

Early in 1940'we published a report (1) on antibody formation in cases of lobar pneumonia treated with sulfapyridine. In nineteen treated cases of pneumococcus pneumonia repeatedly studied during  acute phase of  disease and during convalescence, an excess of type-specific antibody was only demonstrated in  serum of four. In  past it has often been shown that spontaneous recovery from lobar pneumonia is associated, in  great majority of instances, with  appearance of an excess of antibody in  patient's serum, and this phenomenon has been generally regarded as an essential part of  mechanism of spontaneously occurring crisis. Our failure to demonstrate antibodies in fifteen out of nineteen cases suggested to us that sulfapyridine had supplanted, at least to some degree, this portion of  immune process. We did not believe that antibody-production ceased to exist in treated cases, but rather that it proceeded at a lower rate, probably because  stimulus to antibody formation was lessened as a result of  action of  drug on  invading organism. Our technique for  demonstration of excess antibody throughout  series studied was  precipitin reaction with type-specific polysaccharide. While this paper was in press, two similar studies were published. Wood and Long (2) reported  appearance of mouse-protective antibodies in  serum of ten out of eleven treated patients recovering from lobar pneumonia but pointed out that in seven of these cases antibody appeared after  time of  essential recovery. Subsequently, Finland and his associates (3) reported a large series of cases of pneumococcus pneumonia in which mouse-protective antibodies and agglutinins were sought. They concluded as a result of these studies that the antibody response of patients with pneumococcic pneumonia treated with sulfapyridine, as far as could be determined, was comparable in every respect to that resulting from spontaneous recovery. It will be observed that these results were not in accord with our findings. None of these investigators, however, used  same technique as we did-to wit,  precipitin reaction. It is our belief that  precipitin reaction, as Heidelberger and Kendall (4) have pointed out, is probably less sensitive than  other methods, but that it is more clear-cut and more specific. Unfortunately, at  time our paper was written, we had no control series of our own in which untreated patients were studied by  same technique, although such was present in  literature (5). As will be observed,  results which we obtained in patients treated with sulfathiazole, as opposed to sulfapyridine, using precisely  same technique, were almost diametrically different, and therefore constitute a very satisfactory control of  method. Before sulfathiazole was introduced, eleven additional sulfapyridine-treated cases were studied in  same manner as those reported in  original paper. Including one doubtful reaction, only four of these showed precipitins during convalescence. Adding these to  original series, we have then a total of thirty cases of pneumococcus pneumonia treated with sulfapyridine; of these twenty-two, or nearly seventy-five per cent, recovered from  disease without  appearance of an excess of antibody in  blood serum as demonstrated by  precipitin reaction. The chief purpose of  present communication is to describe  results which we obtained when an exactly similar study was made of patients treated with sulfathiazole.