HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by van Kessel, D. A. Articles by Rijkers, G. T. Search for Related Content PubMed PubMed Citation Articles by van Kessel, D. A. Articles by Rijkers, G. T.

Impaired pneumococcal antibody response in bronchiectasis of unknown aetiology

Depts of ¹ Pulmonology and ² Medical Microbiology & Immunology, Sint Antonius Hospital, Nieuwegein, and ³ Dept of Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands

CORRESPONDENCE: G. T. Rijkers, Dept of Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB Utrecht, The Netherlands. Fax: 31 302505311. E-mail: grijkers@wkz.azu.nl

Keywords: Antibody response, bronchiectasis, high-resolution computed tomography scan, IgA, IgG2, pneumococcal polysaccharide

Received: June 17, 2004
Accepted October 12, 2004

As a defective anti-polysaccharide response can exist in the absence of an immunoglobulin deficiency, a series of 26 patients with bronchiectasis of unknown aetiology was vaccinated with a 23-valent pneumococcal polysaccharide vaccine. All patients suffered from recurrent respiratory tract infections.

When measuring total antibody levels to pneumococcal serotypes 3, 4 and 9, a normal polysaccharide antibody response was found in 22 patients. However, only 11 of these subjects showed a normal pneumococcal antibody response within the IgA and/or IgG2 subclass, and thus could be classified as true responders, while 15 patients did not respond in either the IgA class or in the IgG2 subclass.

When analysing differences between the responder (n = 11) and nonresponder (n = 15) groups, the latter demonstrated higher frequencies of respiratory tract infections and more severe lung pathology, as revealed by the presence of more bronchi visualised in the peripheral third of the lung by high-resolution computed tomography scanning. Moreover, nonresponders needed extensive lung surgery more often in order to control their disease (number of resected segments eight versus five).

In conclusion, an important fraction of patients presenting with idiopathic bronchiectasis is associated with a selective anti-polysaccharide response deficiency and this subgroup appears to represent a more severe clinical phenotype. Therefore, it can be regarded as a separate clinical entity with possible therapeutic targets.

In order to identify IgA and IgG2 anti-polysaccharide nonresponders, all patients presenting with bronchiectasis of unkown aetiology should be immunised with a pneumococcal polysaccharide vaccine, and IgA and IgG2 isotype responses should be evaluated as well as the total antibody response.

This article has been cited by other articles:

				M. Miravitlles, M. Vendrell, and J. de Gracia Antibody deficiency in bronchiectasis Eur. Respir. J., July 1, 2005; 26(1): 178 - 180. [Full Text] [PDF]