Specific antibody deficiency to pneumococcal polysaccharide in a young adult with recurrent respiratory infections: a case report

Submitted: October 10, 2022
Accepted: November 11, 2022
Published: November 16, 2022
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Specific antibody deficiency against pneumococcal serotypes was detected in a patient with recurrent episodes of fever. A 21-year-old man presented with a two-month history of recurrent episodes of fever and shaking chills. He was diagnosed with recurrent episodes of pneumonia caused by Streptococcus pneumoniae serotype 19A and treated with amoxicillin. Serotype-specific antibodies were not produced against most of the serotypes, which were consistent with moderate specific antibody deficiency. After pneumococcal 13-valent conjugate vaccination and pneumococcal polysaccharide vaccination, he adequately responded to the infecting serotype with an antibody titer of 1.1 µg/mL. There were eventually no recurrent episodes of fever with pneumonia.



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Lanks CW, Musani AI, Hsia DW. Community-acquired Pneumonia and hospital-acquired pneumonia. Med Clin North Am 2019;103:487-501. DOI: https://doi.org/10.1016/j.mcna.2018.12.008
Balmer P, Cant AJ, Borrow R. Anti-pneumococcal antibody titre measurement: what useful information does it yield? J Clin Pathol 2007;60:345-50. DOI: https://doi.org/10.1136/jcp.2006.041210
Hyams C, Camberlein E, Cohen JM, et al. The Streptococcus pneumoniae capsule inhibits complement activity and neutrophil phagocytosis by multiple mechanisms. Infect Immun 2010;78:704-15. DOI: https://doi.org/10.1128/IAI.00881-09
Kadioglu A, Weiser JN, Paton JC, Andrew PW. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol 2008;6:288-301. DOI: https://doi.org/10.1038/nrmicro1871
Johnson SE, Rubin L, Romero-Steiner S, et al. Correlation of opsonophagocytosis and passive protection assays using human anticapsular antibodies in an infant mouse model of bacteremia for Streptococcus pneumoniae. J Infect Dis 1999;180:133-40. DOI: https://doi.org/10.1086/314845
Musher DM, Groover JE, Reichler MR, et al. Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization. Clin Infect Dis 1997;24:441-6. DOI: https://doi.org/10.1093/clinids/24.3.441
Slotved H-C, Kaltoft M, Skovsted I, et al. Simple, rapid latex agglutination test for serotyping of pneumococci (Pneumotest-Latex). J Clin Microbiol 2004;42:2518-22. DOI: https://doi.org/10.1128/JCM.42.6.2518-2522.2004
Vergison A, Tuerlinckx D, Verhaegen J, Malfroot A. Epidemiologic features of invasive pneumococcal disease in Belgian children: passive surveillance is not enough. Pediatrics 2006;118:e801-9. DOI: https://doi.org/10.1542/peds.2005-3195
Shindo Y, Ito R, Kobayashi D, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013;188:985-95. DOI: https://doi.org/10.1164/rccm.201301-0079OC
Pavliakova D, Giardina PC, Moghazeh S, et al. Development and validation of 13-plex Luminex-based assay for measuring human serum antibodies to Streptococcus pneumoniae capsular polysaccharides. mSphere 2018;3:e00128-18. DOI: https://doi.org/10.1128/mSphere.00128-18
Plotkin SA. Correlates of protection induced by vaccination. Clin Vaccine Immunol 2010;17:1055-65. DOI: https://doi.org/10.1128/CVI.00131-10
Bonilla FA, Khan DA, Ballas ZK, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol 2015;136:1186-205 e1-78.
Wall LA, Dimitriades VR, Sorensen RU. Specific antibody deficiencies. Immunol Allergy Clin North Am 2015;35:659-70. DOI: https://doi.org/10.1016/j.iac.2015.07.003
Lopez B, Boucher A, Bahuaud M, et al. Specific polysaccharide antibody deficiency revealed by severe bacterial infections in adulthood: A report on 11 cases. Clin Infect Dis 2017;65:328-31. DOI: https://doi.org/10.1093/cid/cix284
Gupta R, Wong CS, Fonacier L. Pneumococcal 13-valent conjugate vaccine administration after inferior response to pneumococcal vaccine. Allergy Asthma Proc 2017;38:365-9. DOI: https://doi.org/10.2500/aap.2017.38.4070
Siber GR, Chang I, Baker S, et al. Estimating the protective concentration of anti-pneumococcal capsular polysaccharide antibodies. Vaccine 2007;25:3816-26. DOI: https://doi.org/10.1016/j.vaccine.2007.01.119
Kaur R, Pham M, Pichichero M. Serum antibody levels to pneumococcal polysaccharides 22F, 33F, 19A and 6A that correlate with protection from colonization and acute otitis media in children. Vaccine 2021;39:3900-6. DOI: https://doi.org/10.1016/j.vaccine.2021.05.089
Andrews NJ, Waight PA, Burbidge P, et al. Serotype-specific effectiveness and correlates of protection for the 13-valent pneumococcal conjugate vaccine: a postlicensure indirect cohort study. Lancet Infect Dis 2014;14:839-46. DOI: https://doi.org/10.1016/S1473-3099(14)70822-9
Mungall BA, Hoet B, Nieto Guevara J, Soumahoro L. A systematic review of invasive pneumococcal disease vaccine failures and breakthrough with higher-valency pneumococcal conjugate vaccines in children. Expert Rev Vaccines 2022;21:201-14. DOI: https://doi.org/10.1080/14760584.2022.2012455
Dagan R, Givon-Lavi N, Greenberg D, et al. Nasopharyngeal carriage of Streptococcus pneumoniae shortly before vaccination with a pneumococcal conjugate vaccine causes serotype-specific hyporesponsiveness in early infancy. J Infect Dis 2010;201:1570-9. DOI: https://doi.org/10.1086/652006
Borrow R, Stanford E, Waight P, et al. Serotype-specific immune unresponsiveness to pneumococcal conjugate vaccine following invasive pneumococcal disease. Infect Immun 2008;76:5305-9. DOI: https://doi.org/10.1128/IAI.00796-08
Corcoran M, Mereckiene J, Cotter S, et al. Using genomics to examine the persistence of Streptococcus pneumoniae serotype 19A in Ireland and the emergence of a sub-clade associated with vaccine failures. Vaccine 2021;39:5064-73. DOI: https://doi.org/10.1016/j.vaccine.2021.06.017
Sorensen RU, Edgar D. Specific antibody deficiencies in clinical practice. J Allergy Clin Immunol Pract 2019;7:801-8. DOI: https://doi.org/10.1016/j.jaip.2019.01.024

How to Cite

Ishimaru, Naoto, Yohei Kanzawa, Takahiro Nakajima, Kayoko Okamura, Eiichiro Sando, Isao Ito, Saori Kinami, and Hisashi Ohnishi. 2022. “Specific Antibody Deficiency to Pneumococcal Polysaccharide in a Young Adult With Recurrent Respiratory Infections: A Case Report”. Monaldi Archives for Chest Disease 93 (3). https://doi.org/10.4081/monaldi.2022.2454.