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Pneumococcal Infection Reveals Underlying Immunosuppressive Conditions for Low-Risk Adults
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Investigators say basic immunodeficiency screening should be completed in full for this patient population.
A growing body of research is emerging about the prevalence of newly diagnosed immunosuppressive conditions following an invasive pneumococcal infection for adults who were previously considered low-risk. Therefore, investigators have concluded that individuals who experience invasive pneumococcal disease (IPD) and who are assumed at low risk for it should be considered for immunosuppressive conditions.
Pneumococcal, Low-Risk, Multiple Myeloma | Image Credit: © Minerva Studio | stock.adobe.com
Currently, there is no guidance on whether adult patients without predisposing risk factors should be screened for immunodeficiency following IPD, which is a prevalent infection for those who are at high-risk. IPD is rare in low-risk groups; however, there has been interest in whether an infection in low-risk groups could indicate underlying factors. The investigators of the study reported the prevalence and types of newly diagnosed immunodeficiencies following an IPD for patients who were at low baseline risk. The study authors also discussed immunodeficiency screening practices and future interventions.
The study included a respective cohort from a university hospital with 1200 beds and a care population of approximately 450,000 patients. IPD was defined as a confirmed Streptococcus pneumoniae infection and cases were identified between January 2016 and December 2022. Patients that met the criteria for low risk were included, defined as individuals 18 to 60 years old who did not have previous immunization against pneumococcal disease and did not have an immunocompromising condition that met the criteria for vaccination against pneumococcal disease. Follow-up was conducted with electronic medical records and centralized medical record repository in all public health care in the Community of Madrid, Spain. Any newly diagnosed immunosuppression, including congenital or acquired, were recorded.
Investigators identified a total of 352 patients with IPD, with 88.9% excluded. A total of 39 patients were included in the analysis, with a median age of 41 years. Pneumonia was the main infection, and only 8 patients required admission to the intensive care unit. Only 1 patient had a previous severe infection, and 1 patient died. The patient death was not confirmed by immunosuppression, according to the study investigators. Follow up lasted approximately 3.4 years, with 4 individuals being diagnosed with an immunosuppressive condition and 3 diagnosed with multiple myeloma. For those diagnosed with multiple myeloma, diagnosis was received after 2.7 months, 3.3 months, and 1.1 years after hospital discharge. There was no presence of end-organ damage, renal failure, hypercalcemia, or recorded bone pain within their medical records. The other patient was diagnosed with stage IV lung adenocarcinoma after 741 days after discharge.
The study authors noted that none of the patients received basic immunodeficiency screening, but HIV testing and serum immunoglobin levels were the most common study test performed at 59% and 30.8%, respectively. Additionally, serum protein gap was available for 39 patients, which was found to be elevated for all 3 patients that were diagnosed with multiple myeloma, according to the study results
The investigators concluded that earlier testing for multiple myeloma should be initiated after a low-risk adult is first diagnosed with IPD. They state that multiple myeloma is the most common immunosuppressive revealed after low baseline risk, and that basic immunodeficiency screening should be completed in full for this patient population.
