Alonso Carolyn D, Papamichael Konstantinos, Sprague Rebecca, Barrett Caitlin, Gonzales-Luna Anne J, Daugherty Kaitlyn, Garey Kevin W, Villafuerte-Gálvez Javier, Xu Hua, Lin Qianyun, Wang Lamei, Chen Xinhua, Pollock Nira R, Kelly Ciarán P
Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2021 Jun 1;8(7):ofab286. doi: 10.1093/ofid/ofab286. eCollection 2021 Jul.
The humoral immune response to toxins in infection (CDI) is incompletely characterized in immunocompromised hosts (ICHs).
We conducted a prospective study of hospitalized adults with CDI, with and without immunosuppression (hematologic malignancy, active solid tumor, solid organ or stem cell transplant, inflammatory bowel disease, autoimmune disease, congenital or acquired immunodeficiency, asplenia, chronic receipt of high-dose steroids, or receipt of immunosuppressing medications within 12 months). Serum and stool antibody concentrations of immunoglobulin (Ig)M, IgG, and IgA to toxins A and B at treatment days 0, 3, and 10-14 were compared.
Ninety-eight subjects (47 ICH; 51 non-ICH) were enrolled. Baseline serum antitoxin A and B antibody levels were similar. At day 3, ICHs demonstrated lower serum levels of antitoxin A IgG, antitoxin A IgA, and antitoxin B IgA (all < .05). At day 10-14, lower antitoxin A IgG concentrations were observed in ICHs (ICH, 21 enzyme-linked immunosorbent assay [ELISA] units; interquartile range [IQR], 16.4-44.6) compared with non-ICH subjects (49.0 ELISA units; IQR, 21.5-103; = .045). In stool, we observed lower concentrations of antitoxin B IgA antibodies at baseline and at day 3 for ICH subjects, with a notable difference in concentrations of antitoxin B IgA at day 3 (ICH, 6.7 ELISA units [IQR, 1.9-13.9] compared with non-ICH, 18.1 ELISA units [IQR, 4.9-31.7]; = .003).
The ICHs with CDI demonstrated lower levels of antitoxin antibodies in serum and stool during early CDI therapy compared with non-ICHs. These data provide insight into the humoral response to CDI in ICHs.
免疫功能低下宿主（ICHs）对艰难梭菌感染（CDI）毒素的体液免疫反应尚未完全明确。
我们对住院的成年CDI患者进行了一项前瞻性研究，这些患者有或没有免疫抑制（血液系统恶性肿瘤、活动性实体瘤、实体器官或干细胞移植、炎症性肠病、自身免疫性疾病、先天性或获得性免疫缺陷、无脾、长期接受高剂量类固醇治疗或在12个月内接受免疫抑制药物治疗）。比较了治疗第0、3和10 - 14天血清和粪便中免疫球蛋白（Ig）M、IgG和IgA针对毒素A和B的抗体浓度。
共纳入98名受试者（47名ICH；51名非ICH）。基线血清抗毒素A和B抗体水平相似。在第3天，ICHs的血清抗毒素A IgG、抗毒素A IgA和抗毒素B IgA水平较低（均P <.05）。在第10 - 14天，与非ICH受试者（49.0酶联免疫吸附测定[ELISA]单位；四分位间距[IQR]，21.5 - 103）相比，ICHs中抗毒素A IgG浓度较低（ICH，21 ELISA单位；IQR，16.4 - 44.6；P =.045）。在粪便中，我们观察到ICH受试者在基线和第3天抗毒素B IgA抗体浓度较低，第3天抗毒素B IgA浓度有显著差异（ICH，6.7 ELISA单位[IQR，1.9 - 13.9]，非ICH为18.1 ELISA单位[IQR，4.9 - 31.7]；P =.003）。
与非ICHs相比，患有CDI的ICHs在早期CDI治疗期间血清和粪便中的抗毒素抗体水平较低。这些数据为了解ICHs对CDI的体液反应提供了依据。
