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Prevention of infections in patients with T cell defects
1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105.
Abstract:
Although no specific infection is limited entirely to hosts with T-lymphocyte defects, certain microbial organisms have an affinity for such individuals. Effective, safe, and feasible methods are available for the prevention of two of the major life-threatening infections in patients with T-lymphocyte defects, although none of these methods is ideal. Trimethoprim-sulfamethoxazole administered orally daily or thrice weekly is highly effective for the prevention of Pneumocystis carinii pneumonia. For patients who cannot tolerate this drug combination, monthly inhalation of aerosolized pentamidine is an alternative prophylactic approach. Additional drugs in clinical or preclinical trials offer promise for use in preventing this pneumonitis. Varicella is one of the most frequent serious viral infections in patients with cancer, especially children. Varicella-zoster immune globulin (VZIG) has proven effective in reducing the frequency of infection in exposed susceptible individuals; however, breakthrough infections are not uncommon. Of 358 children with acute lymphoblastic leukemia, 62 received VZIG following exposure to varicella, and 16 (26%) of these had breakthrough varicella. A live attenuated varicella-zoster virus vaccine offers promise, especially for the universal immunization of individuals before immunocompromise occurs.
Insights
Preventing serious infections in T-lymphocyte deficient patients is crucial. Trimethoprim-sulfamethoxazole is effective for Pneumocystis pneumonia, while Varicella-zoster immune globulin offers protection against varicella, though breakthrough cases occur.
Area of Science:
- Immunology
- Infectious Diseases
- Oncology
Background:
- Patients with T-lymphocyte defects are susceptible to specific life-threatening infections.
- While no infection is exclusive to these hosts, certain microbes show an affinity for them.
- Effective preventive strategies are available but not universally ideal.
Purpose of the Study:
- To review current and emerging methods for preventing major infections in T-lymphocyte deficient individuals.
- To assess the efficacy and limitations of prophylactic treatments for Pneumocystis pneumonia and varicella.
Main Methods:
- Review of existing literature on infection prevention in T-lymphocyte defects.
- Analysis of data on Trimethoprim-sulfamethoxazole and aerosolized pentamidine for Pneumocystis pneumonia prophylaxis.
- Evaluation of Varicella-zoster immune globulin (VZIG) efficacy and breakthrough infections in at-risk populations, including children with acute lymphoblastic leukemia.
Main Results:
- Trimethoprim-sulfamethoxazole is highly effective for Pneumocystis carinii pneumonia prevention; aerosolized pentamidine is an alternative.
- VZIG reduces varicella frequency but breakthrough infections are common (26% in one study of leukemia patients).
- Newer drugs and a live attenuated varicella-zoster virus vaccine show promise for future prevention.
Conclusions:
- Prophylaxis against Pneumocystis pneumonia and varicella is essential for T-lymphocyte deficient patients.
- Current preventive methods have limitations, highlighting the need for improved strategies.
- Vaccination before immunocompromise presents a promising avenue for long-term protection.