Primary immunodeficiency masks: A clinical case of vaccine-associated paralytic poliomyelitis

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Abstract

Human inborn immune-related errors comprise a heterogeneous group of rare genetically determined diseases of the immune system caused by loss or gain of function mutations altering relevant protein functions. The 2019 International Union of Immunological Societies recently proposed the classification for such pathologies now comprising 406 distinct disorders with 430 different gene defects. Predominantly antibody deficiencies represent most common group of human inborn immune-related errors, which diagnostics poses uneasy challenge for general practitioner due to a broad range of their clinical manifestations, such as infection, allergy, autoimmunity and malignancy. In addition, patients with human immune-related inborn errors may develop a vaccine-associated disease after administering live vaccines in accordance with the Russia-wide National Vaccine Schedule. Most common among vaccine-associated diseases are vaccine-associated paralytic poliomyelitis, vaccine-associated encephalitis (1 case per 1 000 000 doses of measles, rubella, varicella vaccine), vaccine-associated meningitis (1 case per 250 000 – 500 000 doses of mumps vaccine) as well as adverse effects related to BCG immunization: local (infiltration, cold abscess – 8.6 case per 100,000 vaccinated patients) and disseminated complications (BCG lymphadenitis – 15.5 case per 100 000 vaccinated patients, BCG osteitis – 3.5 case per 100 000 vaccinated patients). Vaccine-associated paralytic poliomyelitis in vaccinated patients occurs after the first, second and rarely third oral polio vaccine dose inoculation. Incidence rate for vaccineassociated paralytic polio after 1 and 3 oral vaccine inoculation ranges from 1 case per 700 000 vaccine doses to 1 case per 3 500 000, respectively. Vaccine-associated paralytic poliomyelitis mainly emerges due to inborn mutations related to humoral immunity after primary vaccination with oral polio vaccine or close contact of unvaccinated patients with subjects vaccinated with oral polio vaccine. Here, we describe a clinical case of vaccine-associated paralytic poliomyelitis in patient with primary immunodeficiency. Our is aimed at emphasizing importance of immunological alertness with regard to detecting primary immunodeficiencies and timely apply a replacement therapy prior to verifying type of immunodeficiency.

About the authors

T. V. Savin

First St. Petersburg State I. Pavlov Medical University; St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: savintihon@gmail.com

Savin Tikhon V. - Senior Laboratory Assistant, Department of Immunology; Resident, I. Vorontsov Department of Childhood Diseases

194017, St. Petrsburg, Torez ave., 102, bldg 5, apt 40

Phone: 7 (911) 288-39-74

Russian Federation

R. N. Kuznetsova

First St. Petersburg State I. Pavlov Medical University; St. Petersburg Pasteur Institute

Email: fake@neicon.ru

PhD (Medicine), Associate Professor, Department of Immunology; Allergist-Immunologist, Medical Centre

St. Petersburg

Russian Federation

A. A. Kuznetsova

St. Petersburg State Pediatric Medical University

Email: fake@neicon.ru

PhD, MD (Medicine), Professor, Department of Faculty Pediatrics

St. Petersburg

Russian Federation

Areg A. Totolian

First St. Petersburg State I. Pavlov Medical University; St. Petersburg Pasteur Institute

Email: fake@neicon.ru

PhD, MD (Medicine), Professor, Full Member, Russian Academy of Sciences, Head, Department of Immunology; Director

St. Petersburg

Russian Federation

References

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Copyright (c) 2020 Savin T.V., Kuznetsova R.N., Kuznetsova A.A., Totolian A.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
Свидетельство о регистрации СМИ ПИ № 77 - 11525 от 04.01.2002 выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).


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