Immunoglobulin therapy is becoming an important modality for the prevention and treatment of bacterial and viral infection. Standard intravenous immunoglobulin (IVIG) is made from large pools of plasma obtained from normal blood donors. However, lot-to-lot variation in titers of antibody to specific microbial pathogens may diminish therapeutic efficacy. Since group B Streptococcus (GBS) is an important neonatal pathogen, a preparation with high titers of activity against GBS was prepared and studied. Plasma was obtained from volunteers immunized with a polyvalent GBS vaccine and was processed by the Swiss Red Cross for intravenous infusion. This high-titered GBS intravenous immunoglobulin (GBS-IVIG) was shown to be superior both in vitro and in vivo to standard IVIG. GBS-IVIG provided protection when therapy was delayed for up to 24 hours after infection. Standard IVIG did not protect animals against all GBS strains. However, GBS-IVIG enhanced survival from infection with all strains tested, even when the challenge dose of GBS was increased by 2 log units. Specific hyperimmune globulins to pathogens such as Haemophilus influenzae and Streptococcus pneumoniae have also been studied. Immunization of adult volunteers as a means of obtaining hyperimmune globulin appears to be an effective method of producing high-titered pathogen-specific preparations of IVIG.

Adult↗

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Infections due to Stomatococcus mucilaginosus: 10 cases and review.

We describe 10 new cases of bacteremia due to Stomatococcus mucilaginosus and review eight other cases that have been described in the literature. The most common clinical presentations were endocarditis, catheter-related infection, and septicemia. Commonly associated risk factors were intravenous drug abuse, cardiac valve disease, the presence of foreign bodies (especially indwelling vascular catheters), and immunocompromised states. S. mucilaginosus bacteremia is readily treatable with antibiotics. This organism is of low virulence, but appears to be an emerging pathogen. Infection due to S. mucilaginosus is likely to be underreported because the organism may be easily misidentified and information on it is not included in the databases of many automated microbiologic identification systems.

Adolescent↗

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Neonatal herpes simplex infection.

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Female↗

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Intravenous immunoglobulin in the treatment of neonatal sepsis: therapeutic strategies and laboratory studies.

IGIV appears to have a promising future in treating and perhaps preventing neonatal bacterial infections. However, all IGIV lots do not contain equal amounts of pathogen-specific IgG with functional opsonic activity. To ensure effective therapy it will be important to inform physicians that the IGIV lots available for use contain functional antibacterial antibody to the responsible pathogens. To optimize therapy IGIV may need to be given early in the infection and doses may need to be repeated if pathogen-specific antibody is rapidly depleted. Further, clinical studies will be necessary to determine if IGIV will be a valuable adjunct to antibiotic therapy in neonatal GBS infections.

Animals↗

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Pharmacokinetics of intravenous immunoglobulin (Sandoglobulin) in neonates.

Sandoglobulin administration to neonates was safe at a dose of 500 mg/kg. GBS-specific IgG was significantly elevated for 14 days postinfusion. Pharmacokinetic studies suggest a two-compartment model with a redistribution phase and terminal elimination phase. A half-life of 11.3 days for the initial phase and 30.7 days for the terminal phase was observed. Further, studies will be necessary to determine if IGIV therapy will be effective in preventing or treating GBS infections in neonates.

Antibodies, Bacterial↗

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Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis.

Early-onset group B streptococci (GBS-EOS) sepsis may be prevented by intrapartum antibiotics administered for GBS maternal colonization, premature labor, or prolonged rupture of membranes. We sought to identify cases of neonatal GBS sepsis after apparent failure of intrapartum chemotherapy and to determine the factors associated with failure of intrapartum antibiotics in these cases. We identified 96 GBS blood culture-positive infants at five military medical centers from 1987 to 1990. Eighteen (18.7%) of these infants had mothers who had received intrapartum antibiotics; 16 of 18 cases were early-onset disease, 15 of which initially had symptoms at less than 1 hour of age. Two infants had late-onset disease develop at 3 weeks of age. At least one perinatal risk factor (prematurity, prolonged rupture of membranes > 12 hours, maternal fever) was present in each of the 16 cases. Indications for intrapartum antibiotics were suspected chorioamnionitis (13 cases), GBS colonization and prolonged rupture of membranes or prematurity (3), and GBS colonization alone (2). Maternal antibiotics included ampicillin (14 cases), cephadyl (1), vancomycin (1), clindamycin (1), and gentamicin alone (1). The median number of doses of ampicillin before delivery was 1 (range, 1 to 21), which was administered at a median of 4 hours (range, 1 to 84) before birth. The mean dose of ampicillin was 1.8 gm/dose (range, 1 to 2 gm/dose). Two of 16 (12.5%) infants with GBS-EOS died as a result of GBS sepsis. In our population of neonates with GBS-EOS, 18.4% (16 of 87) of the infants had positive blood cultures despite intrapartum antibiotics. Intrapartum antibiotics may fail to prevent GBS sepsis in a number of infants born to mothers colonized with GBS or to those with acute chorioamnionitis.

Ampicillin↗