Avaliação da resposta clínica dos pacientes com imunodeficiência comum variável submetidos à vacinação com antígenos proteicos e polissacarídicos
Clinical evaluation of patients with common variable immunodeficiency before and after immunization with polysaccharide and protein antigens
Ana Karolina B.B. Marinho; Maíra Pedreschi; Andrea Cohon; Jorge Kalil; Myrthes T. Barros; Cristina M. Kokron
Resumo
Objetivo: Avaliar a resposta clínica a imunização com antígenos proteicos e polissacarídicos após administração de vacinas de antígenos específicos (Pneumococo e Influenza H2N3 e H1N1) em pacientes com imunodeficiência comum variável (ICV) acompanhados no ambulatório de Imunodeficiências Primárias do Serviço de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Métodos: Os pacientes foram diagnosticados segundo critérios da OMS, PAGID e ESID. Os pacientes foram vacinados contra Influenza H2N3, Influenza H1N1 e Pneumococo. A avaliação clínica foi realizada a partir de um escore clínico no qual os parâmetros considerados foram: pneumonias, sinusites, otite média aguda, infecções de vias aéreas superiores virais (IVAS), amigdalite, diarreia, bronquiectasias, hospitalizações, uso de antibiótico terapêutico, uso de antibiótico profilático, sepse e meningite. Avaliação do escore clínico foi realizada durante o ano que precedeu a vacinação e um ano após a administração das vacinas. Resultados: Participaram do estudo 45 pacientes (51% mulheres), com idade entre 20 a 78 anos (média 36,3 anos). Observamos mediana de 7 anos de retardo no diagnóstico dos pacientes com ICV. IVAS, pneumonias e sinusites foram as manifestações infecciosas mais frequentes em mulheres (80%, 78% e 55% respectivamente). IVAS, sinusites e pneumonias foram os achados mais frequentes em homens (78%, 65% e 35% respectivamente). Houve redução significativa do escore clínico em relação ao número de sinusites e IVAS após a administração das vacinas (p < 0,001). Conclusões: Observamos redução do número de infecções, especialmente sinusites e IVAS no ano posterior à vacinação. Esta observação reforça o benefício da vacina
Palavras-chave
Abstract
Objective: To evaluate clinical response to immunization with polysaccharide and protein antigens following administration of specific antigen vaccines (Pneumococcus and Influenza H2N3 and H1N1) in patients with common variable immunodeficiency (CVID) treated at the Primary Immunodeficiency Outpatient Clinic of the Division of Clinical Immunology and Allergy at the Clinical Hospital of the School of Medicine of University of São Paulo (HC-FMUSP). Methods: Patients were diagnosed according to WHO, PAGID, and ESID criteria. Patients were vaccinated against Influenza H2N3, Influenza H1N1, and Pneumococcus. Clinical evaluation was performed using clinical scores for the following parameters: pneumonia, sinusitis, acute otitis media, viral upper respiratory tract infections (URI), tonsillitis, diarrhea, bronchiectasis, hospitalizations, antibiotic therapy, antibiotic prophylaxis, sepsis, and meningitis. Evaluation focused on one year prior to immunization and one year after the administration of vaccines. Results: A total of 45 patients (51% women), aged 20 to 78 years (mean 36.3 years), were evaluated. A median delay of 7 years was observed in the diagnosis of patients with CVID. URI, pneumonia, and sinusitis were the most frequent infectious conditions found in women (80%, 78%, and 55%, respectively); URI, sinusitis, and pneumonia were the most frequent findings in men (78%, 65%, and 35%, respectively). There was a significant reduction in the clinical scores assigned to the number of sinusitis and URI episodes following administration of the vaccines (p < 0.001). Conclusions: A reduction was observed in the number of infections, particularly sinusitis and URI, in the year following immunization. This finding reinforces the benefit of vaccination and suggests modifications to current recommendations for vaccines in patients with CVID.
Keywords
References
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Submitted date:
02/05/2013
Accepted date:
04/08/2013
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