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Volume 44, Number 2, April 2011

Lymphocyte subsets, immunoglobulin levels, complement activity CH50, and phagocytic peroxide production in 19 Iranian patients with first episode of bacterial meningitis


Zahra Ahmadinejad, Hamideh Bagherian, Lida Atarord, Abdolreza Soodbakhsh, Ghazal Saheli


Received: September 9, 2009    Revised: December 21, 2009    Accepted: February 24, 2010   

 

Corresponding author:

Department of Infectious Diseases, Imam Khomeini Hospital Complex, Keshavarz Boulevard, Tehran, Iran.
E-mail address: ahmadiz@tums.ac.ir (Z. Ahmadinejad).



 

Background and purpose: 

Despite the availability of potent antimicrobial drugs, bacterial meningitis remains a serious infection with significant morbidity and mortality. In many studies, pyogenic meningitis is reported in patients with immunoglobulin (Ig) and complement deficiencies. In the present study, a broad range of immunological tests were performed to determine the relative importance of primary immunodeficiency as a predisposing cause of first episode of pyogenic meningitis without any evidence of other major infections in past medical history.



 

Methods:

We studied 19 patients with bacterial meningitis confirmed by smear, culture, and cerebrospinal fluid parameters. Immunological tests were performed within 1 to 21 days of diagnosis. Twenty healthy adults served as controls. Serum Ig levels (IgA, IgG, IgM, IgE) and total hemolytic complement (CH5O) as screening tests were done. Lymphocytes, neutrophils, and T-cells were enumerated. Nitroblue tetrazolium test was used for the assessment of neutrophil function.



 

Results:

Thirteen patients were male and six were female. The mean age of the patients was 27.8±19 years (range 5–73 years). One patient had subnormal IgA levels; five patients had subnormal IgE levels; one patient had lymphopenia and low CD4, CD3, and CD19; and one patient had subnormal IgM and IgE levels with lymphopenia and low CD4, CD3, CD8, and CD19 counts. All patients had normal complement components (C3 and C4), CH50, and nitroblue tetrazolium test.



 

Conclusion:

The most common immunodeficiency in our study was Ig deficiency. Our results support the recommendation that immunological evaluation, especially Ig assay, should be used in patients with bacterial meningitis even in the first episode.



 

Key words:

Bacterial meningitis, Immunodeficiency, Immunologic tests