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84 - Evaluation of suspected immunodeficiency
- from Part XI - The susceptible host
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- By Thomas A. Fleisher, Immunology Service National Institutes of Health
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 545-550
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- Chapter
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Summary
The need to evaluate immunologic function has become a part of the standard practice of clinical medicine, resulting at least in part from the secondary immunodeficiency produced by human immunodeficiency virus (HIV) infection. In addition, since the early 1990s the molecular basis of primary immunodeficiency disorders has evolved, with now more than 200 genetic defects identified impacting host defense and an expanded range of clinical phenotypes associated with the resulting immune dysfunction. This chapter presents the general methods available to assess immune function, linking these to the clinical infectious history that is suggestive of specific types of immunodeficiency.
The primary clinical problem that sets the stage for initiating an immunologic evaluation is a history of increased susceptibility to infection. In general, the specific characteristics of the recurrent and/or chronic infections, including organism(s), site(s), frequency, and response to therapy provide critical insights into the most likely type or category of immunodeficiency.
The primary clinical problem that sets the stage for initiating an immunologic evaluation is a history of increased susceptibility to infection. In general, the specific characteristics of the recurrent and/or chronic infections, including organism(s), site(s), frequency, and response to therapy provide critical insights into the most likely type or category of immunodeficiency.
Defects in adaptive immunity involving anti-body production (humoral immunity) most typically lead to recurrent infections with high-grade encapsulated extracellular bacteria such as Haemophilus influenzae (often untypeable) and Streptococcus pneumoniae usually affecting the sinopulmonary tract.
83 - Evaluation of Suspected Immunodeficiency
- from Part XI - The Susceptible Host
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- By Thomas A. Fleisher, National Institutes of Health
- Edited by David Schlossberg
-
- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 587-592
-
- Chapter
- Export citation
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Summary
The need to evaluate immunologic function has become a part of the standard practice of clinical medicine, resulting at least in part from the secondary immunodeficiency produced by human immunodeficiency virus (HIV) infection. In addition, since the early 1990s the molecular basis of primary immunodeficiency disorders has evolved, with now more than 120 genetic defects identified and an expanded range of clinical phenotypes associated with immune dysfunction. This chapter presents the general methods available to assess immune function linking these to the clinical infection scenaria that suggest specific types of immunodeficiency.
The primary clinical problem that sets the stage for initiating an immunologic evaluation is a history of increased susceptibility to infection. In general, the specific characteristics of the recurrent and/or chronic infections, including organism(s), sites, and response to therapy, provide critical insights into the most likely source of the immunodeficiency.
Defects in adaptive immunity involving antibody production (humoral immunity) lead to recurrent infections with high-grade encapsulated extracellular bacteria such as Haemophilus influenzae and Streptococcus pneumoniae usually affecting the sinopulmonary tract. The protective immune response depends on the production of antibodies against the capsular carbohydrate antigens present on these organisms. In contrast, the clinical picture of patients with defective T-cell (cellular) immunity typically consists of recurrent infections with opportunistic organisms, including Pneumocystis jiroveci (formerly Pneumocystis carinii), Candida species, and cytomegalovirus. This demonstrates that functional T cells are required to prevent or clear infection with these opportunistic intracellular micro organisms.
Measles Immunity in a Population of Healthcare Workers
- Mary E. Willy, Deloris E. Koziol, Thomas Fleisher, Sylvia Koo, Henry McFarland, James Schmitt, Robert Wesley, Eugene S. Hurwitz, David K. Henderson
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 1 / January 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 12-17
- Print publication:
- January 1994
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- Article
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Objectives:
To evaluate measles seroprev-among cohorts of new employees and to evaluate vaccine responses of susceptible adult healthcare workers.
Design:New employees were screened for measles susceptibility as part of employee evaluations. Anti-IgG measles antibody tests were completed on 2,473 workers. Demographic, measles history, and measles vaccination information was collected using a short questionnaire. Susceptible workers were vaccinated and screened for vaccine responses following vaccination.
Results:Ninety-three workers (4%) were seronegative, and 56 (2%) were equivocal. Individuals in the youngest cohort (born after 1956) were significantly more likely to be susceptible than those in the middle cohort (born 1951 to 1956) and those in the oldest cohort (born before 1951) (P<0.01). The middle cohort included eight (5%) of the 149 seronegative or equivocal workers. Among the members of the youngest cohort, those from the United States were more likely to be susceptible (P<0.01) than those from outside the United States.
Of the 106 vaccinated susceptible workers whose follow-up serologies were determined, 90 (85%) developed positive IgG serologies, six had equivocal results, and 10 were seronegative. Eleven of the 16 non- or hyporesponders were revaccinated and re-evaluated; nine developed low positive IgG antimeasles levels, one exhibited an equivocal response, and one failed to respond.
Conclusions:A small but important proportion of healthcare workers are susceptible to measles. Whenever feasible, measles immunity programs for healthcare workers should include workers born before 1957. Of workers born after 1956, those from outside the United States are more likely to be immune than workers from inside the United States. Using the currently available vaccine, revaccination of initial non- or hyporesponders appears to be effective.