Pneumococcal Infections After Human Bone-Marrow Transplantation

Abstract

Of 25 long-term survivors (> 7 mo. post-transplant) of bone-marrow transplantation, 7 developed penicillin-sensitive pneumococcal infections more than 7 mo. after transplantation. One patient had 2 infections. Of eight infections, 6 were associated with pneumococcal bacteremia and Streptococcus pneumoniae type 6A was isolated in 3 cases. Two infections were fatal. All patients had normal hematopoietic function, and none was receiving immunosuppressive therapy. The development of pneumococcal infection was significantly associated with males and with abnormally low or high serum Ig[immunoglobulin]G and IgM levels but not with graft-vs.-host disease. Serum opsonic activity for S. pneumoniae type 6A was decreased in 6 of the 7 patients when compared to normal pooled serum in an in vitro bactericidal assay. Of the 6 patients with impaired opsonic activity, 4 had low serum antibody levels for S. pneumoniae type 6A capsular polysaccharide while the other 2 patients had low serum CH100 (total complement activity). Bone-marrow transplant recipients have an increased susceptibility to pneumococcal infections and should be evaluated for prophylactic penicillin or pneumococcal vaccination.