Abstract

Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.

Details

Title
Stem Cell Transplant in Immune-deficiency–associated Vaccine-derived Poliovirus
Author
Ranchod, Heena 1 ; Howard, Wayne 1 ; Roux, Adele 2 ; Walda van Zyl 3 ; Ekermans, Pieter 4 ; van den Berg, Sylvia 5 ; Seakamela, Lerato 1 ; Makua, Koketso 1 ; Yousif, Mukhlid 1 ; Sibiya, Rosinah 1 ; Heleen Du Plessis 1 ; Phalane, Emmanuel 1 ; McCarthy, Kerrigan 1 ; Moonsamy, Shelina 1 ; Reynders, David 6 ; Hincks, Jeffrey 7 ; Suchard, Melinda S 1 ; du Plessis, Nicolette M 6 

 Centre for Vaccines and Immunology, National Institute for Communicable Diseases , Johannesburg , South Africa 
 Dr Adéle Roux Practice, Life Groenkloof Hospital , Pretoria , South Africa 
 Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, National Health Laboratory Services—Tshwane Academic Division , Pretoria , South Africa 
 Department of Medical Microbiology, Ampath Laboratories , Pretoria , South Africa 
 Department of Immunology, Ampath Laboratories , Pretoria , South Africa 
 Department of Paediatrics, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa 
 ViroDefense , Chevy Chase, Maryland , USA 
Publication year
2024
Publication date
Feb 2024
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3171905143
Copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.