Immunological Studies in Patients With Pneumococcus Type Iii Pneumonia Treated With Sul-Fanilamide and Serum

Abstract

During the past season (November 1937 to May 1938 we had an opportunity to study the immune reactions of a group of patients with Pneumococcus Type III pneumonia before and during treatment with sulfanilamide and typespecific antipneumococcal rabbit serums used separately or in combination. Observations were also made on the effect of these substances, in zitro, on the bactericidal action of the blood of the patients taken before treatment. In this paper we present the results of these tests and attempt to correlate them with the course of the disease. Clinical results are reported in a separate communication ( 1 ).The irregular and atypical response of animals to immunization with Type III pneumococci has been reported by a number of workers (2). The antibody response of human beings to Type III pneumococcal pneumonia (3) or to immunization with the specific carbohydrate of this type (4) is quite similar to that of other common pneumococcal types (3, 4). The blood of many normal adults and children has bactericidal properties against the Type III pneumococcus (5). This bactericidal power is inhibited by the type-specific capsular polysaccharide and is enhanced by specific antiserum (5a, 6). The latter can also neutralize the antibactericidal action of the specific carbohydrate when used in proper concentrations (6).Robertson and his coworkers (7) studied the pneumococcidal-promoting action of the serum of 3 patients during the course of Type III pneumonia. There was some activity on the first or second day in each instance. One patient had a negative blood culture throughout the course of the disease and recovered. A second patient with less pneumococcidal-promoting activity in the serum had a positive blood culture on the first and second days.Subsequent blood cultures were sterile; there was an increase in the pneumococcidal-promoting action of the serum and recovery. The third patient had a high titer of the pneumococcidal-prpmoting antibody and a sterile blood culture at 48 hours, but beginning the following day the blood culture became and remained positive and the antibody was no longer demonstrable, the bacteremia increased and the patient died.Sulfanilamide has been shown to have bacteriostatic and bactericidal action on Type III pneumococci in titro (8). Experimental infections with this organism in rats and mice have been successfully treated with the drug (9). Favorable clinical results in small groups of cases of Type III pneumococcal pneumonia have been reported (10). There were no successfully treated bacteremic cases except 3 recorded by Bullowa (11). MATERIALS AND METHODSThe patients chosen for study each had clinical and x-ray or pathological evidence of pneumonia and Type III pneumococci were identified in one or more specimens of sputum by the Neufeld method (12) and/or isolated after mouse inoculation. Some had typical lobar pneumonia while in others the pulmonary consolidation was atypical in distribution (bronchopneumonia). The non-pneumonic subjects were either laboratory workers or hosp...

Immunological Studies of Pneumococcal Pneumonia in Patients Treated With Penicillin 1

“…The inferior response of the type 3 and 8 cases conforms with previous observations (1,6,18). The results are likewise in accord with those of Heidelberger and Anderson (8).…”

“…The data presented in this paper indicate that the antibody response (agglutinins and mouse protective antibodies) of patients with pneumococcal pneumonia treated with penicillin is comparable to that of similar patients treated without specific therapy (17)(18)(19)(20) or treated with sulfonamides (1)(2)(3)(4)(5)(6)(7)(8). The inferior response of the type 3 and 8 cases conforms with previous observations (1,6,18).…”

“…Agglutination tests were done using a 0.3 per cent 1 This investigation was supported in part through the Mouse protection tests were performed us'ng strains of pneumococci maintained by daily mouse passage. Mouse virulent strains 2 were available for all types except type 33.…”

“…of pneumococcal infections in both man (1)(2)(3)(4)(5)(6)(7)(8) and animals (9)(10)(11)(12)(13) have shown that the development of specific antibodies is not affected by early therapy with sulfonamide drugs. In contrast, early penicillin therapy of rabbits and mice (14) and of rats (15) infected with pneumococci has been observed to suppress or decrease the antibody response of these animals.…”

“…The present study was undertaken (1) to examine the immunological response of patients with pneumococcal pneumonia treated with penicillin and (2) to determine the effect of early penicillin therapy on the immune response.…”