Winston D J, Schiffman G, Wang D C, Feig S A, Lin C H, Marso E L, Ho W G, Young L S, Gale R P
Ann Intern Med. 1979 Dec;91(6):835-41. doi: 10.7326/0003-4819-91-6-835.
Seven of 26 long-term survivors (greater than 7 months post-transplant) of bone-marrow transplantation developed penicillin-sensitive pneumococcal infections more than 7 months after transplantation. One patient had two infections. Six of eight infections were associated with pneumococcal bacteremia, and Streptococcus pneumoniae type 6A was isolated in three cases. Two infections were fatal. All patients had normal nematopoietic function, and none was receiving immunosuppressive therapy. The development of pneumococcal infection was significantly associated with males and with abnormally low or high serum IGG and IgM levels but not with graft-versus-host disease. Serum opsonic activity for S. pneumoniae type 6A was decreased in six of the seven patients when compared to normal pooled serum in an in-vitro bactericidal assay. Four of the six patients with impaired opsonic activity had low serum antibody levels for S. pneumoniae type 6A capsular polysaccharide, while the other two patients had low serum CH100 complement activity. Bone-marrow transplant recipients have an increased susceptibility to pneumococcal infections and should be evaluated for prophylactic penicillin or pneumococcal vaccination.
26例骨髓移植长期存活者（移植后超过7个月）中有7例在移植7个月后发生了对青霉素敏感的肺炎球菌感染。1例患者发生了两次感染。8次感染中有6次与肺炎球菌菌血症相关，3例分离出6A 型肺炎链球菌。2次感染是致命的。所有患者的造血功能正常，且均未接受免疫抑制治疗。肺炎球菌感染的发生与男性以及血清IGG和IgM水平异常降低或升高显著相关，但与移植物抗宿主病无关。在体外杀菌试验中，与正常混合血清相比，7例患者中有6例针对6A 型肺炎链球菌的血清调理活性降低。6例调理活性受损的患者中有4例针对6A 型肺炎链球菌荚膜多糖的血清抗体水平较低，而另外2例患者的血清CH100补体活性较低。骨髓移植受者对肺炎球菌感染的易感性增加，应评估是否进行预防性青霉素治疗或接种肺炎球菌疫苗。
