Natural Clearance of Prolonged VDPV Infection in a Child With Primary Immunodeficiency Disorder.

Abstract

The emergence of immunodeficiency-associated vaccine-derived polioviruses (iVDPV) from children with primary immunodeficiency disorders poses a threat to the eradication program. Herein, we report a patient with severe combined immunodeficiency (SCID), identified as a prolonged serotype 3 iVDPV (iVDPV3) excreter with 13 VDPV3 isolates and a maximum of 10.33% nucleotide divergence, who abruptly cleared infection after a period of 2 years. Occurrence of an episode of norovirus diarrhea associated with increased activated oligoclonal cytotoxic T cells, inverse CD4:CD8 ratio, significantly elevated pro-inflammatory cytokines, and subsequent clearance of the poliovirus suggests a possible link between inflammatory diarrheal illness and clearance of iVDPV. Our findings suggest that in the absence of B cells and sufficiently activated T/NK cells, macrophages and other T cells may produce auto-inflammatory conditions by TLR/RLR ligands expressed by previous/ongoing bacterial or viral infections to clear VDPV infection. The study highlights the need to screen all the patients with combined immunodeficiency for poliovirus excretion and intermittent follow-up of their immune parameters if found positive, in order to manage the risk of iVDPV excretion in the polio eradication endgame strategy.

• Authors: Madhu Chhanda Mohanty, Manisha Ranjan Madkaikar, Mukesh Desai, Jahnavi Aluri, Swapnil Yashwant Varose, Prasad Taur, Deepa Kailash Sharma, Uma Prajwal Nalavade, Sneha Vijay Rane, Maya Gupta, Snehal Shabarish, Aparna Dalvi, Jagadish Mohanrao Deshpande
• Journal: Frontiers in immunology (Front Immunol) Vol. 10 Pg. 1567 ( 2019) ISSN: 1664-3224 [Electronic] Switzerland
• PMID: 31396204 (Publication Type: Case Reports, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Neutralizing
• Antibodies, Viral
• Cytokines
• Immunoglobulins
• Poliovirus Vaccine, Oral

Topics

• Age Factors
• Antibodies, Neutralizing (blood, immunology)
• Antibodies, Viral (blood, immunology)
• B-Lymphocytes (immunology, metabolism)
• Child, Preschool
• Cytokines (blood)
• Humans
• Immunoglobulins (blood)
• Male
• Poliovirus (genetics, immunology)
• Poliovirus Vaccine, Oral (adverse effects, immunology)
• Primary Immunodeficiency Diseases (blood, diagnosis, etiology, therapy)
• Serologic Tests
• Symptom Assessment
• T-Lymphocytes (immunology, metabolism)
• Vaccination (adverse effects)