The probability of antibody production deficiency in patients with a history of otitis media was 20%, 26% in those with low IgG2 subclass levels, and 58% in those with both a history of otitis media and low IgG2 subclass levels.Īntibody production deficiency with normal IgG levels may be associated with bronchiectasis, making it advisable to evaluate the antibody response to both the H influenzae and pneumococcal vaccines in patients with bronchiectasis of unknown etiology, particularly in those with a history of otitis media, low IgG2 subclass levels, and low levels of baseline specific antibodies.īackground: Intravenous immunoglobulin therapy has been proposed as an adjuvant treatment for sepsis. A significantly higher incidence of otitis media, lower serum IgG2 subclass levels, and lower preimmunization antibody levels to Streptococcus pneumoniae and H influenzae type b were observed in patients with antibody production deficiency. Antibody production deficiency was diagnosed in 12 patients (11%). One hundred seven patients were included in the study (mean age, 46.3 years). Antibody production deficiency was defined as a failure to respond to either vaccine. Serum-specific antibodies were measured by enzyme-linked immunosorbent assay, and the results were compared with those obtained in a healthy adult control group. To ascertain whether antibody production deficiency with normal total serum IgG levels is associated with bronchiectasis.Īntibody response to a pneumococcal unconjugate vaccine and an Haemophilus influenzae type b conjugate vaccine was prospectively studied in all consecutive adult patients with bronchiectasis of unknown etiology who were assessed in our chest outpatient clinic from January 1994 to October 2001. Bronchiectasis is a common long-term complication in patients with primary hypogammaglobulinemia. No defined cause of bronchiectasis is currently found in approximately 50% of cases. In this review we outline the biology and clinical relevance of the IgG subclasses and summarize current rational treatment approaches. Careful patient investigation can identify such deficiencies and suggest appropriate clinical management. A failure to produce the appropriate specific antibody response may result in recurrent upper and/or lower respiratory tract infection. This is particularly apparent for responses to certain bacterial carbohydrate antigens that are normally of IgG2 isotype. An inability to produce antibody of the optimally protective isotype can result in a selective immunodeficiency state. This results in antibody responses to certain antigens being predominantly or exclusively of a single IgG subclass. The quantitative response within each IgG subclass varies with the nature of the antigen, its route of entry and, presumably, the form in which it is presented to the immune system. Studies in this large population are needed to explore whether prompt correction of may impact these outcomes.Įach of the four human IgG subclasses exhibits a unique profile of effector functions relevant to the clearance and elimination of infecting microorganisms. Hyponatremia is common among hospitalized patients with pneumonia and is associated with worsened clinical and economic outcomes. After adjusting for confounders, hyponatremia was associated with an increased risk of ICU (OR 1.58, 95% CI 1.20-2.08), MV (OR 1.75 95% CI 1.13-2.69), and hospital death (OR 1.3, 95% CI 0.90-1.87) and with increases of 0.8 day to ICU and 0.3 day to hospital LOS, and over $1,300 to total hospital costs. 7.0 +/- 5.2 days, p < 0.001) and a trend toward increased hospital mortality (5.4% vs. Hyponatremia was associated with an increased ICU (6.3 +/- 5.6 vs. 2.3%, p = 0.01) in the first 48 hours of hospitalization than patients with normal sodium. Of 7,965 patients with pneumonia, 649 (8.1%) with hyponatremia were older (72.4 +/- 15.7 vs. Hyponatremia was defined as at least two < 135 mEq/L within 24 hours of admission value. To explore how hyponatremia is associated with outcomes in hospitalized patients with pneumonia, we analyzed a large administrative database with laboratory component from January 2004 to December 2005. Hyponatremia, occurring in >1/4 of patients with CAP, is associated with greater disease severity and worsened outcomes. Community-acquired (CAP) and nosocomial pneumonias contribute substantially to morbidity and hospital resource utilization.
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