Screening for Humoral Immunodeficiency in Patients with Community‐Acquired Pneumonia

Abstract

BACKGROUND Immunodeficiency is an underrecognized risk factor for infections, such as community‐acquired pneumonia (CAP). OBJECTIVE We evaluated patients admitted with CAP for humoral immunodeficiency. DESIGN Prospective cohort study SETTING Inpatients PATIENTS, INTERVENTION, AND MEASUREMENTS We enrolled 100 consecutive patients admitted with a diagnosis of CAP from February 2017 to April 2017. Serum IgG, IgM, IgA, and IgE levels were obtained within the first 24 hours of admission. CURB‐65 score and length of hospital stay were calculated. The Wilcoxon rank‐sum test, Kruskal‐Wallis test, and simple linear regression analysis were used in data analysis. RESULTS The prevalence of hypogammaglobinemia in patients with CAP was 38% (95% CI: 28.47% to 48.25%). Twenty‐seven of 100 patients had IgG hypogammaglobinemia (median: 598 mg/dL, IQ range: 459‐654), 23 of 100 had IgM hypogammaglobinemia (median: 38 mg/dL, IQ range: 25‐43), and 6 of 100 had IgA hypogammaglobinemia (median: 36 mg/dL, IQ range: 18‐50). The median hospital length of stay for patients with IgG hypogammaglobinemia was significantly higher when compared to patients with normal IgG levels (five days, IQ range [3‐10] vs three days, IQ range [2‐5], P = .0085). Fourteen patients underwent further immune evaluation, resulting in one diagnosis of multiple myeloma, three patients diagnosed with specific antibody deficiency, and one patient diagnosed with selective IgA deficiency. CONCLUSION There is a high prevalence of hypogammaglobinemia in patients hospitalized with CAP, with IgG and IgM being the most commonly affected classes. IgG hypogammaglobinemia was associated with an increased length of hospitalization. Screening immunoglobulin levels in CAP patients may also uncover underlying humoral immunodeficiency or immunoproliferative disorders.

COVID-related psychological distress fully mediates the association from social impact to sleep disturbance among patients with chronic schizophrenia

“…It can also have a multi-dimensional effect on patients with schizophrenia. Regarding the significant risks of pneumonia among patients with schizophrenia 1 , it can also compromise immune function, increasing the risk of developing a respiratory infection 2 . In addition, up to 70% of schizophrenia patients have one or more medical comorbidities 3 , and these clinical conditions can increase risk of infection 4 and mortality rates for COVID-19 5 .…”

Schizophrenia and COVID-19: risks and recommendations

“…Although community-acquired pneumonia is nontransmissible, it could indicate immunodeficiency. 3,4 Thus, our search indicated that this population could be at higher risk of developing respiratory infections, especially when comorbid medical conditions and lifestyle risk factors are involved.…”

Aging and therapy‐related hypogammaglobulinemia causing pneumonia: An overlooked curable entity in the chaotic COVID‐19 pandemic

“…Streptococcus pneumoniae or Haemophilus influenzae infections in more than one-third of the patients. 12 Valdamalai et al 13 reported a 38% prevalence of hypogammaglobinemia in patients with communityacquired pneumonia. 13 Interestingly, Cowan et al 14 in a retrospective cohort of invasive pneumococcal disease patients, found that 72.2% of those with an underlying hematological malignancy (CLL, lymphoma, and MM) had hypogammaglobulinemia.…”

“…12 Valdamalai et al 13 reported a 38% prevalence of hypogammaglobinemia in patients with communityacquired pneumonia. 13 Interestingly, Cowan et al 14 in a retrospective cohort of invasive pneumococcal disease patients, found that 72.2% of those with an underlying hematological malignancy (CLL, lymphoma, and MM) had hypogammaglobulinemia. Timely diagnosis before the development of a serious infection is the key to reducing infection burden and is dependent on appropriate screening and recognition of risk factors.…”