Department of Medicine, The Ottawa Hospital and University of Ottawa.
Ottawa Hospital Research Institute.
Clin Infect Dis. 2018 Feb 1;66(4):564-569. doi: 10.1093/cid/cix836.
Patients with humoral immune deficiency are susceptible to invasive pneumococcal disease (IPD). This study estimates the prevalence of underlying hypogammaglobulinemia in admitted IPD cases and examines whether IPD cases had received preventative treatment.
All adult IPD cases (Streptococcus pneumoniae in blood or cerebrospinal fluid) admitted to The Ottawa Hospital (TOH) from January 2013 to December 2015 were identified through the Eastern Ontario Regional Laboratory. Documented clinical demographics, S. pneumoniae serotype, serum immunoglobulins measured previously or in convalescence, and vaccination status of the cases were collected retrospectively for descriptive analyses.
There were 134 IPD in 133 patients (47.4% male; mean age 63, standard deviation [SD] = 15.6 years) during a 3-year observation period. All-cause mortality rate was 22.6% over a mean follow-up time of 362, SD = 345 days. Fifty-seven patients (42.9%) had serum immunoglobulin levels measured. Eighteen were either found to have hypogammaglobulinemia in convalescence (8/18) or previously known to have hypogammaglobulinemia (10/18). None of the known hypogammaglobulinemic patients had received antibiotic prophylaxis and/or immunoglobulin replacement therapy within 4 months prior to IPD. The high and low estimates of prevalence of hypogammaglobulinemia were 31.6% (of all measured) and 13.5% (of all cases). Among 18 patients with hematological malignancies in our cohort, 13 had hypogammaglobulinemia. Many isolates were vaccine serotypes; however, only 8 had documented previous pneumococcal vaccination.
IPD has high mortality, and hypogammaglobulinemia was present in at least 13.5% of IPD cases. Secondary hypogammaglobulinemia is especially common in cases with hematological malignancy and IPD.
体液免疫缺陷的患者易发生侵袭性肺炎球菌病（IPD）。本研究旨在评估住院 IPD 患者潜在低丙种球蛋白血症的患病率，并探讨 IPD 患者是否接受过预防治疗。
通过东安大略地区实验室，确定了 2013 年 1 月至 2015 年 12 月期间在渥太华医院（TOH）住院的所有成人 IPD 病例（血或脑脊液中的肺炎链球菌）。回顾性收集了记录的临床人口统计学资料、肺炎链球菌血清型、之前或恢复期测量的血清免疫球蛋白以及病例的疫苗接种情况，进行描述性分析。
在 3 年的观察期内，共有 133 例患者的 134 例 IPD（47.4%为男性；平均年龄 63 岁，标准差[SD] = 15.6 岁）。在平均随访 362 天，SD = 345 天的过程中，所有病因的死亡率为 22.6%。57 例患者（42.9%）测量了血清免疫球蛋白水平。18 例患者恢复期发现低丙种球蛋白血症（8/18）或之前已知低丙种球蛋白血症（10/18）。在发生 IPD 之前的 4 个月内，没有已知低丙种球蛋白血症患者接受抗生素预防和/或免疫球蛋白替代治疗。低丙种球蛋白血症的患病率高值和低值估计分别为 31.6%（所有测量）和 13.5%（所有病例）。在我们的队列中，18 例患有血液恶性肿瘤的患者中，有 13 例存在低丙种球蛋白血症。许多分离株是疫苗血清型；然而，只有 8 例有记录的既往肺炎球菌疫苗接种。
IPD 死亡率高，至少 13.5%的 IPD 病例存在低丙种球蛋白血症。继发性低丙种球蛋白血症在血液恶性肿瘤和 IPD 患者中尤为常见。
