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A Warning of Immunodeficiency

Marta Rodríguez-Créixems, MD; Patricia Muñoz, MD; Eugenia Miranda, MD; Teresa Peláez, PharmD, PhD; Roberto Alonso, BD, PhD; Emilio Bouza, MD, PhD

Arch Intern Med. 1996;156(13):1429-1434.

Abstract
Background
Recurrent pneumococcal infections are known to occur occasionally in patients with profound immune defects. We performed a case-control analysis of recurrent pneumococcal bacteremias.

Patients and Methods
The 547 episodes of Streptococcus pneumoniae bacteremia detected from January 1, 1985, to December 31, 1994, were reviewed. We selected all cases with more than 1 episode separated by 30 days or more ("cases") and compared each of them with 2 controls (patients with single episodes of pneumococcal bacteremia).

Results
Fifteen patients (2.8%) had 31 episodes of pneumococcal bacteremia. Except for multiple myeloma (P<.02), the underlying disease was remarkably similar among patients with single and recurrent episodes of pneumococcal bacteremia. However, among patients positive for human immunodeficiency virus infection, those who had recurrences were at a more advanced stage of their disease than those who did not. The presence of an ultimately fatal underlying condition was more frequent in case patients (P<.001). Overall, 47% of the patients with recurrences died during their second episode of pneumococcal bacteremia.

Conclusions
Our data suggest that recurrence is more than anecdotal in patients with bacteremic infections caused by S pneumoniae (2.8%). We believe that recurrence is a warning sign of immunodeficiency. Patients with multiple myeloma, human immunodeficiency virus infection, solid organ tumors, and chronic liver disease with bacteremic pneumococcal infections should be offered antipneumococcal vaccine and other potentially preventive measures, despite doubts about their efficacy. This is justified by the high mortality rate associated with recurrent episodes (47%).

Arch Intern Med. 1996;156:1429-1434

Author Affiliations
From the Division of Clinical Microbiology and Infectious Diseases—HIV, "Gregorio Marañón" General Hospital, University of Madrid (Spain).

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