Association between Severe Pandemic 2009 Influenza A (H1N1) Virus Infection and Immunoglobulin G<sub>2</sub>Subclass Deficiency

Gordon, Claire L.; Johnson, Paul D R; Permezel, Michael; Holmes, Natasha E; Gutteridge, Geoffrey A; McDonald, C.F.; Eisen, Damon P.; Stewardson, Andrew J.; Edington, John; Charles, Patrick G P; Crinis, Nick; Black, Mary Jane; Torresi, Joseph; Grayson, M Lindsay

doi:10.1086/650462

Cited by 78 publications

(99 citation statements)

References 23 publications

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“…Diminished interferon production may result in higher viral titers and increased production of CC-chemokines in vivo, resulting in more inflammation and increased morbidity. Pregnant women have also been shown to have decreased IgG subclass 2 production during influenza infection, which has been associated with severe disease and cytokine dysregulation (44)(45)(46). Thus, our detection of elevated percentages of MIP-1β-producing NK cells, CD4 + T cells, and CD8 + T cells in pregnant women in response to influenza A viruses, and pH1N1 virus in particular, but not nonspecific stimulation with PMA/I, suggests a possible mechanism for increased disease severity in pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Kay¹,

Fukuyama²,

Aziz

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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Pregnant women experience increased morbidity and mortality after influenza infection, for reasons that are not understood. Although some data suggest that natural killer (NK)-and T-cell responses are suppressed during pregnancy, influenza-specific responses have not been previously evaluated. Thus, we analyzed the responses of women that were pregnant (n = 21) versus those that were not (n = 29) immediately before inactivated influenza vaccination (IIV), 7 d after vaccination, and 6 wk postpartum. Expression of CD107a (a marker of cytolysis) and production of IFN-γ and macrophage inflammatory protein (MIP) 1β were assessed by flow cytometry. Pregnant women had a significantly increased percentage of NK cells producing a MIP-1β response to pH1N1 virus compared with nonpregnant women pre-IIV [median, 6.66 vs. 0.90% (P = 0.0149)] and 7 d post-IIV [median, 11.23 vs. 2.81% (P = 0.004)], indicating a heightened chemokine response in pregnant women that was further enhanced by the vaccination. Pregnant women also exhibited significantly increased T-cell production of MIP-1β and polyfunctionality in NK and T cells to pH1N1 virus pre-and post-IIV. NK-and T-cell polyfunctionality was also enhanced in pregnant women in response to the H3N2 viral strain. In contrast, pregnant women had significantly reduced NK-and T-cell responses to phorbol 12-myristate 13-acetate and ionomycin. This type of stimulation led to the conclusion that NK-and T-cell responses during pregnancy are suppressed, but clearly this conclusion is not correct relative to the more biologically relevant assays described here. Robust cellular immune responses to influenza during pregnancy could drive pulmonary inflammation, explaining increased morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Kay¹,

Fukuyama²,

Aziz

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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“…Repeat nose and throat swabs taken on day four of treatment returned negative results for H1N1 influenza. His serum total IgG level was low at 2.8 g/l, but he did not have specific IgG2 subclass deficiency which has previously been identified in severe cases of H1N1 influenza [6].…”

mentioning

confidence: 56%

Liver transplantation in a patient acutely infected with pandemic Influenza A H1N1

2012

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“…Although little data regarding the immunological effect of the novel influenza A H1N1 virus is available, we would highlight the key points of the reported case presenting some peculiar clinical findings. The patient with B-lymphocyte leukemia and splenectomy had presented with: a) reduction of the number of natural killer cells and a low level of total immunoglobulins and IgG, which may explain the development of severe pneumonia, the prolonged course of the illness and the poor effect of the antiviral treatment [12,13]; b) neutropenia which may be associated with the development of the coinfection (MRSA), but is not strictly associated with virus infection; c) lymphopenia, which was strictly linked to direct virus action and is considered a marker of swine influenza (H1N1) in adults [14,15]. Finally, the use of prolonged low-dose of corticosteroids in influenza A virus H1N1 associated acute lung injury seems to be associated with a reduction of pulmonary inflammation and fibrosis and with elevation of glucocorticoid reception expression in the lung [12,18].…”

Section: Discussionmentioning

confidence: 99%

Influenza A H1N1 pneumonia in a patient with hairy-cell leukemia

Nicolini

Perazzo

2016

Monaldi Arch Chest Dis

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Severe pandemic influenza A virus (H1N1) infection is associated with risk factors such as pregnancy, obesity and immunosuppression. Immunocompromised patients are at increased risk of more severe or prolonged infection. We report a case of a hairy cell leukemia patient with H1N1 pneumonia which caused severe and prolonged illness. H1N1 virus pneumonia with meticillin-resistant Staphilococcus Aerues (MRSA) coinfection causing Acute Lung Injury (ALI) was treated with a double-dose of osentamyvir, a high dose of teicoplanin and a low dose of corticosteroids. Haematological findings included leucopenia, neutropenia, lymphopenia, reduction of γ-globulins and natural killer (NK) cells. Reduction of NK and γ-globulins may explain the development of severe illness and the prolonged illness Neutropenia may explain the MRSA co-infection. Lymphopenia is directly associated with virus action and is considered to be a marker of the swine influenza in adults.

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Association between Severe Pandemic 2009 Influenza A (H1N1) Virus Infection and Immunoglobulin G₂Subclass Deficiency

Cited by 78 publications

References 23 publications

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Liver transplantation in a patient acutely infected with pandemic Influenza A H1N1

Influenza A H1N1 pneumonia in a patient with hairy-cell leukemia

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Association between Severe Pandemic 2009 Influenza A (H1N1) Virus Infection and Immunoglobulin G2Subclass Deficiency

Cited by 78 publications

References 23 publications

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy

Liver transplantation in a patient acutely infected with pandemic Influenza A H1N1

Influenza A H1N1 pneumonia in a patient with hairy-cell leukemia

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Resources

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Association between Severe Pandemic 2009 Influenza A (H1N1) Virus Infection and Immunoglobulin G₂Subclass Deficiency