Chapter 17 : Immunodeficiency and Invasive Pneumococcal Disease

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in

Immunodeficiency and Invasive Pneumococcal Disease, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816537/9781555812973_Chap17-1.gif /docserver/preview/fulltext/10.1128/9781555816537/9781555812973_Chap17-2.gif


This chapter focuses on the rates and clinical manifestations of invasive pneumococcal disease in patients at high risk, on proposed mechanisms of impaired defense, as well as on strategies for prevention of invasive pneumococcal disease in these groups. It describes how individual host defects may each contribute independently to the increased risk of invasive disease, and observes that the potential number of immunological risk factors is greatest and rates of invasive pneumococcal disease are highest among HIV type 1 (HIV-1). The extremely high rates of invasive pneumococcal disease in apparently otherwise healthy children suggest the presence of specific defects related to this class of organisms. HIV-1-associated immunodeficiency, rather than behavioral (e.g., smoking), medical (e.g., splenectomy, liver disease), environmental (e.g., seasonality), or bacteriological features (serotypes or colonization), appears to underlie the remarkable rates of disease in this population. Despite the many fold-increased rates of pneumonia and, particularly, invasive pneumococcal disease during HIV-1 infection, no specific overriding risk or target for intervention has been confirmed. The protection provided by both the 23-valent polysaccharide vaccine in adults and the 7-valent conjugate vaccine in children is most apparent and consistent against invasive pneumococcal disease. Specific immune defects can be identified for particular groups at higher risk of invasive pneumococcal infection, whereas more generalized deficiencies in immune and nonimmune defenses underlie bacteremia in others. The development of newer vaccines which are more universally immunogenic and which combat mucosal disease more effectively is an important goal in preventing pneumococcal disease in the immunocompromised host.

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17

Key Concept Ranking

Human immunodeficiency virus 1
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of FIGURE 1

Rates of invasive pneumococcal disease by risk group and age (all ages versus those in children <2 years of age [yo]). Some rates are approximated from several studies.

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 2

Association of case-fatality rates among 15,860 patients (ages 2 to 104 years) with invasive pneumococcal disease by age with and without U.S. Advisory Committee of Immunization Practices indications for pneumococcal vaccine in nine areas of the United States, 1995 to 1998. Overall case-fatality rates were 11.7% among those with indications (“Yes”) and 4.0% among those without indications (“No”) ( ).

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 3

Relative risk of death from invasive pneumococcal disease among 3,049 hospitalized patients with bacteremic pneumococcal pneumonia and specific underlying illnesses in nine cities in the United States and Canada. Overall case-fatality rates were 12% (range, 6 to 27%) ( ). Heme., hematologic; immunosupp., immunosuppressive; CHF, congestive heart failure.

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 4

Mechanisms which may impair killing of

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 5

Effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in adults >65 years of age (Seattle, Wash.) in a retrospective cohort study monitoring 127,180 patient years (84,203 after immunization), including 61 cases of invasive disease. Compromised patients (those with cancer, immunosuppressive therapy, chronic renal failure, and liver failure) comprised 19% of subjects and 26% of patients with invasive disease. Values for immunocompetent patients with chronic lung disease were unadjusted for influenza virus vaccine and other factors. #0.06 for protection compared with unimmunized adults in the same group ( ). COPD, chronic obstructive pulmonary disease.

Citation: Janoff E, Rubins J. 2004. Immunodeficiency and Invasive Pneumococcal Disease, p 252-280. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch17
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Abadi, J.,, J. Friedman,, R. A. Mageed,, R. Jefferis,, M. C. Rodriguez-Barradas,, and L. Pirofski. 1998. Human antibodies elicited by a pneumococcal vaccine express idiotypic determinants indicative of VH3 gene segment usage. J. Infect. Dis. 178:707716.
2. Abadi, J.,, Z. Zhong,, J. Dobroszycki,, and L.-A. Pirofski. 1997. FcγRIIa polymorphism in human immunodeficiency virus-infected children with invasive pneumococcal disease. Pediatr. Res. 42:259262.
3. Adderson, E. E.,, F. H. Azmi,, P. M. Wilson,, P. G. Shackelford,, and W. L. Carroll. 1993. The human VH3b gene subfamily is highly polymorphic. J. Immunol. 151:800809.
4. Ahmed, F.,, M. C. Steinhoff,, M. C. Rodriguez- Barradas,, R. G. Hamilton,, D. M. Musher,, and K. E. Nelson. 1996. Effect of human immunodeficiency virus type 1 infection on the antibody response to a glycoprotein conjugate pneumococcal vaccine: results from a randomized trial. J. Infect. Dis. 173:8390.
5. Aittoniemi, J.,, A. Miettinen,, S. Laine,, M. Sinisalo,, P. Laippala,, L. Vilpo,, and J. Vilpo. 1999. Opsonising immunoglobulins and mannanbinding lectin in chronic lymphocytic leukemia. Leuk. Lymphoma 34:381385.
6. Ambrosino, D. M.,, V. A. Barrus,, G. G. De- Lange,, and G. R. Siber. 1986. Correlation of the Km(1) immunoglobulin allotype with antipolysaccharide antibodies in Caucasian adults. J. Clin. Investig. 78:361365.
7. Ambrosino, D. M.,, G. Schiffman,, E. C. Gotschlich,, P. H. Schur,, G. A. Rosenberg,, G. G. DeLange,, E. vanLoghem,, and G. R. Siber. 1985. Correlation between G2M(n) immunoglobulin allotype and human antibody response and susceptibility to polysaccharide encapsulated bacteria. J. Clin. Investig. 75:19351942.
8. Amdahl, B. M.,, J. B. Rubins,, C. L. Daley,, C. F. Gilks,, P. C. Hopewell,, and E. N. Janoff. 1995. Impaired natural immunity to pneumolysin during human immunodeficiency virus infection in the United States and Africa. Am. J. Respir. Crit. Care Med. 152:20002004.
9. Amman, A. J.,, G. Schiffman,, D. Abrams,, P. Volberding,, J. Ziegler,, and M. Conant. 1984. B-cell immunodeficiency in acquired immune deficiency syndrome. JAMA 251:14471449.
10. Andiman, W. A.,, J. Mezger,, and E. Shapiro. 1994. Invasive bacterial infections in children born to women infected with human immunodeficiency virus type 1. J. Pediatr. 124:846852.
11. Austrian, R. 1986. Pneumococcal pneumonia: diagnostic, epidemiologic, therapeutic and prophylactic considerations. Chest 90:738743.
12. Austrian, R. 1981. Pneumococcus: the first hundred years. Rev. Infect. Dis. 3:183189.
13. Austrian, R.,, and J. Gold. 1964. Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann. Intern. Med. 60:759776.
14. Avanzini, M. A.,, A. M. Carra,, R. Maccario,, M. Zecca,, P. Pignatti,, M. Marconi,, P. Comoli,, F. Bonetti,, P. DeStefano,, and F. Locatelli. 1995. Antibody response to pneumococcal vaccine in children receiving bone marrow transplantation. J. Clin. Immunol. 15:137144.
15. Baccarani, M.,, M. Fiacchini,, P. Galieni,, F. Gherlinzoni,, R. Fanin,, G. Fasola,, P. Mazza,, and S. Tura. 1986. Meningitis and septicaemia in adults splenectomized for Hodgkin’s disease. Scand. J. Haematol. 36:492498.
16. Balakrishnan, I.,, P. Crook,, R. Morris,, and S. H. Gillespie. 2000. Early predictors of mortality in pneumococcal bacteraemia. J. Infect. 40:256261.
17. Baxendale, H. E.,, Z. Davis,, H. N. White,, M. B. Spellerberg,, F. K. Stevenson,, and D. Goldblatt. 2000. Immunogenetic analysis of the immune response to pneumococcal polysaccharide. Eur. J. Immunol. 30:12141223.
18. Bender, B. S.,, J. F. Bohnsack,, S. H. Sourlis,, M. M. Frank,, and T. C. Quinn. 1987. Demonstration of defective C3-receptor-mediated clearance by the reticuloendothelial system in patients with acquired immunodeficiency syndrome. J. Clin. Investig. 79:715720.
19. Bender, B. S.,, M. M. Frank,, T. J. Lawley,, W. J. Smith,, C. M. Brickman,, and T. C. Quinn. 1985. Defective reticuloendothelial system Fc-receptor function in patients with the acquired immunodeficiency syndrome. J. Infect. Dis. 152:409412.
20. Benin, A. L.,, K. L. O’Brien,, J. P. Watt,, R. Reid,, E. R. Zell,, S. Katz,, C. Donaldson,, A. Parkinson,, A. Schuchat,, M. Santosham,, and C. G. Whitney. 2003. Effectiveness of the 23- valent polysaccharide vaccine against invasive pneumococcal disease in Navajo adults. J. Infect. Dis. 188:8189.
21. Bennett, N. M.,, J. Buffington,, and F. M. La Force. 1992. Pneumococcal bacteremia in Monroe County, New York. Am. J. Public Health 82:15131516.
22. Berberian, L.,, J. Shukla,, R. Jefferis,, and J. Braun. 1994. Effects of HIV infection on VH3 (D12 idiotope) B cells in vivo. J. Acquir. Immune Defic. Syndr. 7:641646.
23. Berberian, L.,, Y. Valles-Ayoub,, N. Sun,, O. Martinez-Maza,, and J. Braun. 1991. A VH clonal deficit in human immunodeficiency virus-positive individuals reflects a B-cell maturational arrest. Blood 78:175179.
24. Berstein, L. J.,, B. Z. Krieger,, B. Novick,, M. J. Sicklick,, and A. Rubinstein. 1985. Bacterial infection in the acquired immunodeficiency syndrome of children. Pediatr. Infect. Dis. 4:472475.
25. Bishof, N. A.,, T. R. Welch,, and L. S. Beischel. 1990. C4B deficiency: a risk factor for bacteremia with encapsulated organisms. J. Infect. Dis. 162:248250.
26. Bjornson, A. B.,, and J. S. Lobel. 1987. Direct evidence that decreased serum opsonization of Streptococcus pneumoniae via the alternative complement pathway in sickle cell disease is related to antibody deficiency. J. Clin. Investig. 79:388398.
27. Bjornson, A. B.,, J. S. Lobel,, and K. S. Harr. 1985. Relation between serum opsonic activity for Streptococcus pneumoniae and complement function in sickle cell disease. J. Infect. Dis. 152: 701709.
28. Black, S.,, H. Shinefield,, B. Fireman,, E. Lewis,, P. Ray,, J. R. Hansen,, L. Elvin,, K. M. Ensor,, J. Hackell,, G. Siber,, F. Malinoski,, D. Madore,, I. Chang,, R. Kohberger,, W. Watson,, R. Austrian,, K. Edwards, and the Northern California Kaiser Permanente Vaccine Study Center Group. 2000. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr. Infect. Dis. J. 19:187195.
29. Black, S. B.,, H. R. Shinefield,, S. Ling,, J. Hansen,, B. Fireman,, D. Spring,, J. Noyes,, E. Lewis,, P. Ray,, J. Lee,, and J. Hackell. 2002. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr. Infect. Dis. J. 21:810815.
30. Bohnsack, J. F.,, and E. J. Brown. 1986. The role of the spleen in resistance to infection. Annu. Rev. Med. 37:4959.
31. Boschini, A.,, C. Smacchia,, M. Di Fine,, A. Schiesari,, P. Ballarini,, M. Arlotti,, C. Gabrielli,, G. Castellani,, M. Genova,, P. Pantani,, A. Cozzi Lepri,, and G. Rezza. 1996. Community-acquired pneumonia in a cohort of former injection drug users with and without human immunodeficiency virus infection: incidence, etiologies, and clinical aspects. Clin. Infect. Dis. 23:107113.
32. Breiman, R. F.,, D. W. Keller,, M. A. Phelan,, and D. H. Sniadack. 2000. Evaluation of effectiveness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. Arch. Intern. Med. 160:26332638.
33. Breiman, R. F.,, J. S. Spika,, V. J. Navarro,, P. M. Darden,, and C. P. Darby. 1990. Pneumococcal bacteremia in Charleston County, South Carolina: a decade later. Arch. Intern. Med. 150:14011405.
34. Brown, J. S.,, T. Hussell,, S. M. Gilliland,, D. W. Holden,, J. C. Paton,, M. R. Ehren- stein,, M. J. Walport,, and M. Botto. 2002. The classical pathway is the dominant complement pathway required for innate immunity to Streptococcus pneumoniae infection in mice. Proc. Natl. Acad. Sci. USA 99:1696916974.
35. Bruyn, G. A. W.,, J. W. M. vanderMeer,, J. Hermans,, and W. Knoppert. 1988. Pneumococcal bacteremia in adults over a 10-year period at University Hospital, Leiden. Rev. Infect. Dis. 10:446450.
36. Bruyn, G. A. W.,, B. J. M. Zegers,, and R. van Furth. 1992. Mechanisms of host defense against infection with Streptococcus pneumoniae. Clin. Infect. Dis. 14:251262.
37. Buchanan, G. R.,, S. J. Smith,, C. A. Holtkamp,, and J. P. Fuseler. 1983. Bacterial infection and splenic reticuloendothelial function in children with hemoglobin SC disease. Pediatrics 72:9398.
38. Bulnois, G. J.,, J. C. Paton,, T. J. Mitchell,, and P. W. Andrew. 1991. Structure and function of pneumolysin, the multifunctional thiolactivated toxin of Streptococcus pneumoniae. Mol. Microbiol. 5:26112616.
39. Burman, L. Å., R. Norrby, and B. Trollfors. 1985. Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. Rev. Infect. Dis. 7:133142.
40. Carson, P. J.,, K. L. Nichol,, J. O’Brien,, P. Hilo,, and E. N. Janoff. 2000. Immune function and vaccine responses in the healthy advanced elderly. Arch. Intern. Med. 160:20172024.
41. Carson, P. J.,, R. L. Schut,, M. L. Simpson,, J. O’Brien,, and E. N. Janoff. 1995. Antibody class and subclass responses to pneumococcal polysaccharides following immunization of human immunodeficiency virus-infected patients. J. Infect. Dis. 172:340345.
42. Carter, R. H.,, and D. T. Fearon. 1992. CD19: lowering the threshold for antigen receptor stimulation of B lymphocytes. Science 256:105106.
43. Casali, P.,, and A. L. Notkins. 1989. CD5+ lymphocytes and the human B cell repertoire. Immunol. Today 10:364368.
44.CentersforDiseaseControl. 1993. FDA approval of use of a new Haemophilus b conjugate vaccine and a combined diphtheria-tetanuspertussis and Haemophilus b conjugate vaccine for infants and children. Morb. Mortal. Wkly. Rep. 42:296298.
45.CentersforDiseaseControl. 1984. Update: pneumococcal polysaccharide vaccine usage— United States. Ann. Intern. Med. 101:348350.
46.CentersforDiseaseControland Prevention. 2000. Preventing pneumococcal disease among infants and young children. Morb. Mortal. Wkly. Rep. 49:135.
47.CentersforDiseaseControland Prevention. 1997. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb. Mortal. Wkly. Rep.(RR-8) 46:124.
48.CentersforDiseaseControland Prevention. 1999. USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Morb. Mortal. Wkly. Rep.(RR-10) 48:166.
49. Chang, Q.,, J. Abadi,, P. Alpert,, and L. Pirofski. 2000. A pneumococcal capsular polysaccharide vaccine induces a repertoire shift with increased VH3 expression in peripheral B cells from human immunodeficiency virus (HIV)- uninfected but not HIV-infected persons. J. Infect. Dis. 181:13131321.
50. Cheson, B. D.,, H. S. Walker,, M. E. Health,, R. J. Gobel,, and J. Janatova. 1984. Defective binding of the third component of complement (C3) to Streptococcus pneumoniae in multiple myeloma. Blood 63:949957.
51. Chou, M.,, A. E. Brown,, A. Blevins,, and D. Armstrong. 1983. Severe pneumococcal infection in patients with neoplastic disease. Cancer 51:15461550.
52. Chudwin, D. S.,, S. G. Artrip,, and G. Schiffman. 1987. Immunoglobulin G class and subclass antibodies to pneumococcal capsular polysaccharides. Clin. Immunol. Immunopathol. 44:114121.
53. Coccia, M. R.,, R. R. Facklam,, L. D. Saravolatz,, and O. Manzor. 1998. Recurrent pneumococcal bacteremia: 34 episodes in 15 patients. Clin. Infect. Dis. 26:982985.
54.CooperativeGroupfortheStudyofImmunoglobulininChronicLymphocytic Leukemia. 1988. Intravenous Immunoglobulin for the prevention of infection in chronic lymphocytic leukemia: a randomized, controlled trial. N. Engl. J. Med. 319:902907.
55. Corbett, E. L.,, G. J. Churchyard,, S. Charalambos,, B. Samb,, V. Moloi,, T. C. Clayton,, A. D. Grant,, J. Murray,, R. J. Hayes,, and K. M. De Cock. 2002. Morbidity and mortality in South African gold miners: impact of untreated disease due to human immunodeficiency virus. Clin. Infect. Dis. 34:12511258.
56. Cortese, M. M.,, M. Wolff,, J. Almeido-Hill,, R. Reid,, J. Ketcham,, and M. Santosham. 1992. High incidence rates of invasive pneumococcal disease in the White Mountain Apache population. Arch. Intern. Med. 152:22772282.
57. Crum, N. F.,, M. R. Wallace,, C. R. Lamb,, A. M. Conlin,, D. E. Amundson,, P. E. Ol- son,, M. A. Ryan,, T. J. Robinson,, G. C. Gray,, and K. C. Earhart. 2003. Halting a pneumococcal pneumonia outbreak among United States Marine Corps trainees. Am. J. Prev. Med. 25:107111.
58. Dagan, R.,, D. Engelhard,, and E. Piccard. 1992. Epidemiology of invasive childhood pneumococcal infections in Israel: the Israeli Pediatric Bacteremia and Meningitis Group. JAMA 268:33283332.
59. Dalmasso, A. P. 1986. Complement in the pathophysiology and diagnosis of human diseases. Crit. Rev. Clin. Lab. Sci. 24:123183.
60. Davidson, M.,, A. J. Parkinson,, L. R. Bulkow,, M. A. Fitzgerald,, H. V. Peters,, and D. J. Parks. 1994. The epidemiology of invasive pneumococcal disease in Alaska, 1986-90: ethnic differences and opportunities for prevention. J. Infect. Dis. 170:368376.
61. Davidson, M.,, C. D. Schraer,, A. J. Parkinson,, J. F. Campbell,, R. R. Facklam,, R. B. Wainwright,, A. P. Lanier,, and W. L. Heyward. 1989. Invasive pneumococcal disease in an Alaska native population, 1980 through 1986. JAMA 261:715718.
62. Dempsey, P. W.,, M. E. Allison,, S. Akkaraju,, C. C. Goodnow,, and D. T. Fearon. 1996. C3d of complement as a molecular adjuvant: bridging innate and acquired immunity. Science 271:348350.
63. DiPadova, F.,, M. Durig,, F. Harder,, C. Di- Padova,, and C. Zanussi. 1985. Impaired antipneumococcal antibody production in patients without spleens. Br. Med. J. Clin. Res. Educ. 290:1416.
64. Drew, P. A.,, G. K. Kiroff,, A. Ferrante,, and R. C. Cohen. 1984. Alterations in immunoglobulin synthesis by peripheral blood mononuclear cells from splenectomized patients with and without splenic regrowth. J. Immunol. 132:191196.
65. Dworkin, M. S.,, J. W. Ward,, D. L. Hanson,, J. L. Jones,, and J. E. Kaplan. 2001. Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. Clin. Infect. Dis. 32:794800.
66. Elkayam, O.,, D. Paran,, D. Caspi,, I. Litinsky,, M. Yaron,, D. Charboneau,, and J. B. Rubins. 2002. Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus. Clin. Infect. Dis. 34:147153.
67. Ellis, M.,, S. Gupta,, S. Galant,, S. Hakim,, C. VandeVen,, C. Toy,, and M. S. Cairo. 1988. Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation. J. Infect. Dis. 158:12681276.
68. Eskola, J.,, H. Käyhty,, A. K. Takala,, H. Peltola,, P.-R. Rönnberg,, E. Kela,, E. Pekkanen,, P. H. McVerry,, and P. H. Mäkelä. 1990. A randomized, prospective field trial of a conjugate vaccine in the protection of infants and young children against invasive Haemophilus influenzae type b disease. N. Engl. J. Med. 323:13811387.
69. Eskola, J.,, A. K. Takala,, E. Kela,, E. Pekkanen,, R. Kalliokoski,, and M. Leinonen. 1992. Epidemiology of invasive pneumococcal infections in children in Finland. JAMA 268:33233327.
70. Farley, J. J.,, J. C. King, Jr., P. Nair, S. E. Hines, R. L. Tressler, and P. E. Vink. 1994. Invasive pneumococcal disease among infected and uninfected children of mothers with human immunodeficiency virus infection. J. Pediatr. 124:853858.
71. Farr, B. M.,, L. Johnston,, D. K. Cobb,, M. J. Fisch,, T. P. Germanson,, K. A. Adal,, and A. M. Anglim. 1995. Preventing pneumococcal bacteremia in patients at risk. Arch. Intern. Med. 155:23362340.
72. Fearon, D. T. 1997. Seeking wisdom in innate immunity. Nature 388:323324.
73. Fearon, D. T.,, and R. M. Locksley. 1996. The instructive role of innate immunity in the acquired immune response. Science 272:5053.
74. Feikin, D. R.,, C. M. Elie,, M. B. Goetz,, J. L. Lennox,, G. M. Carlone,, S. Romero-Steiner,, P. F. Holder,, W. A. O’Brien,, C. G. Whitney,, J. C. Butler,, and R. F. Breiman. 2001. Randomized trial of the quantitative and functional antibody responses to a 7-valent pneumococcal conjugate vaccine and/or 23-valent polysaccharide vaccine among HIV-infected adults. Vaccine 20:545553.
75. Feikin, D. R.,, A. Schuchat,, M. Kolczak,, N. L. Barrett,, L. H. Harrison,, L. Lefkowitz,, A. McGeer,, M. M. Farley,, D. J. Vugia,, C. Lexau,, K. R. Stefonek,, J. E. Patterson,, and J. H. Jorgensen. 2000. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am. J. Public Health 90:223229.
76. Feldman, S.,, W. Malone,, R. Wilbur,, and G. Schiffman. 1985. Pneumococcal vaccination in children with acute lymphocytic leukemia. Med. Pediatr. Oncol. 13:6972.
77. Figueroa, J. E.,, and P. Densen. 1991. Infectious diseases associated with complement deficiencies. Clin. Microbiol. Rev. 4:359395.
78. Filice, G. A.,, C. P. Darby,, and D. W. Fraser. 1980. Pneumococcal bacteremia in Charleston County, South Carolina. Am. J. Epidemiol. 112:828835.
79. Forrester, H. L.,, D. W. Jahnigen,, and F. M. LaForce. 1987. Inefficacy of pneumococcal vaccine in a high-risk population. Am. J. Med. 83:425430.
80. Frankel, R. E.,, M. Virata,, C. Hardalo,, F. L. Altice,, and G. Friedland. 1996. Invasive pneumococcal disease: clinical features, serotypes, and antimicrobial resistance patterns in cases involving patients with and without human immunodeficiency virus infection. Clin. Infect. Dis. 23:577584.
81. Frederiksen, B.,, L. Specht,, J. Henrichsen,, F. K. Pedersen,, and J. Pedersen-Bjergaard. 1989. Antibody response to pneumococcal vaccine in patients with early stage Hodgkin’s disease. Eur. J. Haematol. 43:4549.
82. French, N.,, C. F. Gilks,, A. Mujugira,, C. Fasching,, J. O’Brien,, and E. N. Janoff. 1998. Pneumococcal vaccination in HIV-1-infected adults in Uganda: humoral response and two vaccine failures. AIDS 12:16831689.
83. French, N.,, J. Nakiyingi,, L. M. Carpenter,, E. Lugada,, C. Watera,, K. Moi,, M. Moore,, D. Antvelink,, D. Mulder,, E. N. Janoff,, J. Whitworth,, and C. F. Gilks. 2000. 23-valent pneumococcal polysaccharide vaccine in HIV-1- infected Ugandan adults: double-blind, randomised and placebo controlled trial. Lancet 355:21062111.
84. Frezzato, M.,, G. Castaman,, and F. Rodeghiero. 1993. Fulminant sepsis in adults splenectomized for Hodgkin’s disease. Haematologica 78(6 Suppl. 2):7377.
85. Fry, A. M.,, R. R. Facklam,, C. G. Whitney,, B. D. Plikaytis,, and A. Schuchat. 2003. Multistate evaluation of invasive pneumococcal diseases in adults with human immunodeficiency virus infection: serotype and antimicrobial resistance patterns in the United States. J. Infect. Dis. 188:643652.
86. Garin, E. H.,, and D. J. Barrett. 1988. Pneumococcal polysaccharide immunization in patients with active nephrotic syndrome. Nephron 50:383388.
87. Garred, P.,, J. Strom,, L. Quist,, E. Taaning,, and H. O. Madsen. 2003. Association of mannose- binding lectin polymorphisms with sepsis and fatal outcome, in patients with systemic inflammatory response syndrome. J. Infect. Dis. 188:13941403.
88. Gaston, M. H.,, J. I. Verter,, G. Woods,, C. Pegelow,, J. Kelleher,, G. Presbury,, H. Zarkowsky,, E. Vichinsky,, R. Iyer,, J. S. Lobel,, S. Diamond,, C. T. Holbrook,, F. M. Gill,, K. Ritchey,, and J. M. Falletta. 1986. Prophylaxis with oral penicillin in children with sickle cell anemia: a randomized trial. N. Engl. J. Med. 314:15931599.
89. Giebink, G. S.,, J. E. Foker,, Y. Kim,, and G. Schiffman. 1980. Serum antibody and opsonic responses to vaccination with pneumococcal capsular polysaccharide in normal and splenectomized children. J. Infect. Dis. 141:404412.
90. Giebink, G. S.,, P. I. Warkentin,, N. K. Ramsay,, and J. H. Kersey. 1986. Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine. J. Infect. Dis. 154:590596.
91. Gilks, C. F.,, L. S. Otieno,, R. J. Brindle,, R. S. Newnham,, G. N. Lule,, J. B. O. Were,, P. M. Simani,, S. M. Bhatt,, G. B. A. Okelo,, P. G. Waiyaki,, and D. A. Warrell. 1992. The presentation and outcome of HIV-related disease in Nairobi. Quarterly J. Med. 297:2532.
92. Gillespie, S. H. 1989. Aspects of pneumococcal infection including bacterial virulence, host response and vaccination. J. Med. Microbiol. 28:237248.
93. Glaser, R.,, J. K. Kiecolt-Glaser,, W. B. Malarkey,, and J. F. Sheridan. 1998. The influence of psychological stress on the immune response to vaccines. Ann. N. Y. Acad. Sci. 840:649655.
94. Glaser, R.,, J. Sheridan,, W. B. Malarkey,, R. C. MacCallum,, and J. K. Kiecolt-Glaser. 2000. Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosom. Med. 62:804807.
95. Glass, R. I.,, A.-M. Svennerholm,, B. J. Stoll,, M. R. Khan,, K. M. Hossain,, M. Imdadul Huq,, and J. Holmgren. 1983. Protection against cholera in breast-fed children by antibodies in breast milk. N. Engl. J. Med. 308: 13891392.
96. Gordon, S. B.,, M. Chaponda,, A. L. Walsh,, C. J. Whitty,, M. A. Gordon,, C. E. Machili,, C. F. Gilks,, M. J. Boeree,, S. Kampondeni,, R. C. Read,, and M. E. Molyneux. 2002. Pneumococcal disease in HIV-infected Malawian adults: acute mortality and long-term survival. AIDS 16:14091417.
97. Gransden, W. R.,, S. J. Eykyn,, and I. Phillips. 1985. Pneumococcal bacteremia: 325 episodes at St. Thomas’s hospital. Br. Med. J. 290:505508.
98. Griffioen, A. W.,, G. T. Rijkers,, P. Janssens- Korpela,, and B. J. M. Zegers. 1991. Pneumococcal polysaccharides complexed with C3d bind to human B lymphocytes via complement receptor type 2. Infect. Immun. 59:18391845.
99. Griffioen, A. W.,, E. A. Toebes,, B. J. Zegers,, and G. T. Rijkers. 1992. Role of CR2 in the human adult and neonatal in vitro antibody response to type 4 pneumococcal polysaccharide. Cell. Immunol. 143:1122.
100. Grimfors, G.,, M. Bjorkholm,, L. Hammarstrom,, J. Askergren,, C. I. Smith,, and G. Holm. 1989. Type-specific anti-pneumococcal antibody subclass response to vaccination after splenectomy with special reference to lymphoma patients. Eur. J. Haematol. 43:404410.
101. Gurrieri, C.,, P. McGuire,, H. Zan,, X. J. Yan,, A. Cerutti,, E. Albesiano,, S. L. Allen,, V. Vinciguerra,, K. R. Rai,, M. Ferrarini,, P. Casali,, and N. Chiorazzi. 2002. Chronic lymphocytic leukemia B cells can undergo somatic hypermutation and intraclonal immunoglobulin V(H)DJ(H) gene diversification. J. Exp. Med. 196:629639.
102. Haas, K. M.,, M. Hasegawa,, D. A. Steeber,, J. C. Poe,, M. D. Zabel,, C. B. Bock,, D. R. Karp,, D. E. Briles,, J. H. Weis,, and T. F. Tedder. 2002. Complement receptors CD21/35 link innate and protective immunity during Streptococcus pneumoniae infection by regulating IgG3 antibody responses. Immunity 17:713723.
103. Hammarström, V.,, K. Pauksen,, J. Azinge,, G. Oberg,, and P. Ljungman. 1993. Pneumococcal immunity and response to immunization with pneumococcal vaccine in bone marrow transplant patients: the influence of graft versus host reaction. Support Care Cancer 1:195199.
104. Hazelwood, M. A.,, D. S. Kumararatne,, A. D. Webster,, M. Goodall,, P. Bird,, and M. Daha. 1992. An association between homozygous C3 deficiency and low levels of anti-pneumococcal capsular polysaccharide antibodies. Clin. Exp. Immunol. 87:404409.
105. Hibbs, J. R.,, J. M. Douglas, Jr.,, F. N. Judson,, W. L. McGill,, C. A. M. Rietmeijer,, and E. N. Janoff. 1997. Prevalence of human immunodeficiency virus infection, mortality rate, and serogroup distribution among patients with pneumococcal bacteremia at Denver General Hospital, 1984-1994. Clin. Infect. Dis 25:195199.
106. Hirschtick, R. E.,, J. Glassroth,, M. C. Jordan,, T. C. Wilcosky,, J. M. Wallace,, P. A. Kvale,, N. Markowitz,, M. J. Rosen,, B. T. Mangura,, and P. C. Hopewell. 1995. Bacterial pneumonia in persons infected with the human immunodeficiency virus. N. Engl. J. Med. 333:845851.
107. Hoge, C. W.,, M. R. Reichler,, E. A. Dominguez,, J. C. Bremer,, T. D. Mastro,, K. A. Hendricks,, D. M. Musher,, J. A. Elliott,, R. R. Facklam,, and R. F. Breiman. 1994. An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail. N. Engl. J. Med. 331:643648.
108. Hopken, U. E.,, B. Lu,, N. P. Gerard,, and C. Gerard. 1996. The C5a chemoattractant receptor mediates mucosal defence to infection. Nature 383:8689.
109. Hornef, M. W.,, M. J. Wick,, M. Rhen,, and S. Normark. 2002. Bacterial strategies for overcoming host innate and adaptive immune responses. Nat. Immunol. 3:10331040.
110. Hostetter, M. K. 1986. Serotypic variations among virulent pneumococci in deposition and degradation of covalently bound C3b: implications for phagocytosis and antibody production. J. Infect. Dis. 153:682693.
111. Humbert, J. R.,, E. L. Winsor,, J. M. Githens,, and J. B. Schmitz. 1990. Neutrophil dysfunctions in sickle cell disease. Biomed. Pharmacother. 44:153158.
112. Itala, M.,, H. Helenius,, J. Nikoskelainen,, and K. Remes. 1992. Infections and serum IgG levels in patients with chronic lymphocytic leukemia. Eur. J. Haematol. 48:266270.
113. Jackson, L. A.,, K. M. Neuzil,, O. Yu,, P. Benson,, W. E. Barlow,, A. L. Adams,, C. A. Hanson,, L. D. Mahoney,, D. K. Shay,, W. W. Thompson, and the Vaccine Safety Datalink. 2003. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N. Engl. J. Med. 348:17471755.
114. Janoff, E. N.,, R. F. Breiman,, C. L. Daley,, and P. C. Hopewell. 1992. Pneumococcal disease during HIV infection. Epidemiologic, clinical, and immunologic perspectives. Ann. Intern. Med. 117:314324.
115. Janoff, E. N.,, J. M. Douglas,, M. Gabriel,, M. J. Blaser,, A. J. Davidson,, D. L. Cohn,, and F. N. Judson. 1988. Class-specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1. J. Infect. Dis. 158:983990.
116. Janoff, E. N.,, C. Fasching,, J. C. Ojoo,, J. O’Brien,, and C. F. Gilks. 1997. Responsiveness of human immunodeficiency virus type 1- infected Kenyan women with or without prior pneumococcal disease to pneumococcal vaccine. J. Infect. Dis. 175:975978.
117. Janoff, E. N.,, J. O’Brien,, P. Thompson,, J. Ehret,, G. Meiklejohn,, G. Duvall,, and J. M. Douglas, Jr. 1993. Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection. J. Infect. Dis. 167:4956.
118. Janoff, E. N.,, and J. B. Rubins. 2000. Invasive Pneumococcal Disease in Immunocompromised Patients. Mary Ann Liebert, Inc., Larchmont, N.Y..
119. Jetté, L. P.,, and F. Lamothe. 1989. Surveillance of invasive Streptococcus pneumoniae infection in Quebec, Canada, from 1984 to 1986: serotype distribution, antimicrobial susceptibility, and clinical characteristics. J. Clin. Microbiol. 27:15.
120. Johnson, C. A.,, P. Densen,, R. A. Wetsel,, F. S. Cole,, N. E. Goeken,, and H. R. Colten. 1992. Molecular heterogeneity of C2 deficiency. N. Engl. J. Med. 326:871874.
121. Kaplan, J.,, S. Sarnaik,, and G. Schiffman. 1986. Revaccination with polyvalent pneumococcal vaccine in children with sickle cell anemia. Am. J. Pediatr. 8:8082.
122. Karstaedt, A. S.,, M. Khoosal,, and H. H. Crewe-Brown. 2001. Pneumococcal bacteremia in adults in Soweto, South Africa, during the course of a decade. Clin. Infect. Dis. 33:610614.
123. Kiecolt-Glaser, J. K.,, R. Glaser,, S. Gravenstein,, W. B. Malarkey,, and J. Sheridan. 1996. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc. Natl. Acad. Sci. USA 93:30433047.
124. Kim, P. E.,, D. M. Musher,, W. P. Glezen,, M. C. Rodriguez-Barradas,, W. K. Nahm,, and C. E. Wright. 1996. Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses. Clin. Infect. Dis. 22:100106.
125. King, M. D.,, C. G. Whitney,, F. Parekh,, M. M. Farley, and Active Bacterial Core Surveillance Team/Emerging Infections Program Network. 2003. Recurrent invasive pneumococcal disease: a population-based assessment. Clin. Infect. Dis. 37:10291036.
126. Kiroff, G. K.,, A. N. Hodgen,, P. A. Drew,, and G. G. Jamieson. 1985. Lack of effect of splenic regrowth on the reduced antibody responses to pneumococcal polysaccharides in splenectomized patients. Clin. Exp. Immunol. 62:4856.
127. Klugman, K. P.,, S. A. Madhi,, R. E. Huebner,, R. Kohberger,, N. Mbelle,, N. Pierce, and the Vaccine Trialists Group. 2003. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N. Engl. J. Med. 349:13411348.
128. Koch, G.,, B. D. Lok,, A. van Oudenaren,, and R. Benner. 1982. The capacity and mechanism of bone marrow antibody formation by thymus-independent antigens. J. Immunol. 128:14971501.
129. Kohler, P. F.,, V. J. Rivera,, E. D. Eckert,, T. J. Bouchard, Jr., and L. L. Heston. 1985. Genetic regulation of immunoglobulin and specific antibody levels in twins reared apart. J. Clin. Investig. 75:883888.
130. Konradsen, H. B.,, and J. Henrichsen. 1991. Pneumococcal infections in splenectomized children are preventable. Acta Paediatr. Scand. 80:423427.
131. Konradsen, H. B.,, J. Henrichsen,, H. Wachmann,, and N. Holm. 1993. The influence of genetic factors on the immune response as judged by pneumococcal vaccination of mono- and dizygotic Caucasian twins. Clin. Exp. Immunol. 92:532536.
132. Konradsen, H. B.,, V. A. Oxelius,, M. Hahn-Zoric,, and L. A. Hanson. 1994. The importance of G1m and 2 allotypes for the IgG2 antibody levels and avidity against pneumococcal polysaccharide type 1 within mono- and dizygotic twin-pairs. Scand. J. Immunol. 40:251256.
133. Kontoyianis, D. P.,, E. J. Anaissie,, and G. P. Bodey. 1993. Infection in Chronic Lymphocytic Leukemia: a Reappraisal in Chronic Lymphocytic Leukemia Scientific Advances and Clinical Developments. Marcel Dekker, Inc., New York, N.Y..
134. Koziel, H.,, and M. J. Koziel. 1995. Pulmonary complications of diatetes mellitus. Pneumonia. Infect. Dis. Clin. N. Am. 9:6596.
135. Krasinski, K.,, W. Borkowsky,, S. Bonk,, R. Lawrence,, and S. Chandwani. 1988. Bacterial infections in human immunodeficiency virus-infected children. Pediatr. Infect. Dis. J. 7:323328.
136. Krivit, W. 1977. Overwhelming postsplenectomy infection. Am. J. Hematol. 2:193201.
137. Krumholz, H. M.,, M. A. Sande,, and B. Lo. 1989. Community-acquired bacteremia in patients with acquired immunodeficiency syndrome: clinical presentation, bacteriology and outcome. Am. J. Med. 86:776779.
138. Kuikka, A.,, J. Syrjanen,, O. V. Renkonen,, and V. V. Valtonen. 1992. Pneumococcal bacteraemia during a recent decade. J. Infect. 24:157168.
139. Kulkarni, S.,, R. Powles,, J. Treleaven,, U. Riley,, S. Singhal,, C. Horton,, B. Sirohi,, N. Bhagwati,, S. Meller,, R. Saso,, and J. Mehta. 2000. Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants. Blood 95:36833686.
140. Kumar, D.,, C. Rotstein,, G. Miyata,, D. Arlen,, and A. Humar. 2003. Randomized, double-blind, controlled trial of pneumococcal vaccination in renal transplant recipients. J. Infect. Dis. 187:16391645.
141. Lane, P. J. L.,, and I. C. M. Maclennan. 1986. Impaired IgG2 anti-pneumococcal antibody responses in patients with recurrent infection and normal IgG2 levels but no IgA. Clin. Exp. Immunol. 65:427433.
142. Linnemann, C. C., Jr., and M. R. First. 1979. Risk of pneumococcal infections in renal transplant patients. JAMA 241:26192621.
143. Lortan, J. E.,, A. S. Kaniuk,, and M. A. Monteil. 1993. Relationship of in vitro phagocytosis of serotype 14 Streptococcus pneumoniae to specific class and IgG subclass antibody levels in healthy adults. Clin. Exp. Immunol. 91:5457.
144. Madhi, S. A.,, K. Petersen,, A. Madhi,, M. Khoosal,, and K. P. Klugman. 2000. Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children. Clin. Infect. Dis. 31:170176.
145. Marfin, A. A.,, J. Sporrer,, P. S. Moore,, and A. D. Siefkin. 1995. Risk factors for adverse outcome in persons with pneumococcal pneumonia. Chest 107:457462.
146. Marrie, T. J. 1994. Pneumonia and carcinoma of the lung. J. Infect. 29:4552.
147. Martin, F.,, A. M. Oliver,, and J. F. Kearney. 2001. Marginal zone and B1 B cells unite in the early response against T-independent blood-borne particulate antigens. Immunity 14:617629.
148. McCashland, T. M.,, L. C. Preheim,, and M. J. Gentry. 2000. Pneumococcal vaccine response in cirrhosis and liver transplantation. J. Infect. Dis. 181:757760.
149. McEllistrem, M. C.,, A. B. Mendelsohn,, M. A. Pass,, J. A. Elliott,, C. G. Whitney,, J. A. Kolano,, and L. H. Harrison. 2002. Recurrent invasive pneumococcal disease in individuals with human immunodeficiency virus infection. J. Infect. Dis. 185:13641368.
150. Morgan, B. P.,, and M. J. Walport. 1991. Complement deficiency and disease. Immunol. Today 12:301306.
151. Müller, F.,, S. S. Frøland,, and P. Brandtzaeg. 1989. Altered IgG-subclass distribution in lymph node cells and serum of adults infected with human immunodeficiency virus (HIV). Clin. Exp. Immunol. 78:153158.
152. Mundy, L. M.,, P. G. Auwaerter,, D. Oldach,, M. L. Warner,, A. Burton,, E. Vance,, C. A. Gaydos,, J. M. Joseph,, R. Gopalan,, R. D. Moore,, T. C. Quinn,, P. Charache,, and J. G. Bartlett. 1995. Community- acquired pneumonia: impact of immune status. Am. J. Respir. Crit. Care Med. 152:13091315.
153. Murphy, P. M.,, H. C. Lane,, A. S. Fauci,, and J. I. Gallin. 1988. Impairment of neutrophil bactericidal capacity in patients with AIDS. J. Infect. Dis. 158:627630.
154. Murray, S. E.,, H. R. Lallman,, A. D. Heard,, M. B. Rittenberg,, and M. P. Stenzel-Poore. 2001. A genetic model of stress displays decreased lymphocytes and impaired antibody responses without altered susceptibility to Streptococcus pneumoniae. J. Immunol. 167:691698.
155. Musher, D. M.,, J. E. Groover,, M. R. Reichler,, F. X. Riedo,, B. Schwartz,, D. A. Watson,, R. E. Baughn,, and R. F. Breiman. 1997. Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization. Clin. Infect. Dis. 24:441446.
156. Musher, D. M.,, J. E. Groover,, D. A. Watson,, J. P. Pandey,, M. C. Rodriguez-Barradas,, R. E. Baughn,, M. S. Pollack,, E. A. Graviss,, M. de Andrade,, and C. I. Amos. 1997. Genetic regulation of the capacity to make immunoglobulin G to pneumococcal capsular polysaccharides. J. Investig. Med. 45:5768.
157. Neth, O.,, I. Hann,, M. W. Turner,, and N. J. Klein. 2001. Deficiency of mannose-binding lectin and burden of infection in children with malignancy: a prospective study. Lancet 358:614618.
158. Neth, O.,, D. L. Jack,, A. W. Dodds,, H. Holzel,, N. J. Klein,, and M. W. Turner. 2000. Mannose-binding lectin binds to a range of clinically relevant microorganisms and promotes complement deposition. Infect. Immun. 68:688693.
159. Newman, S. L.,, L. B. Vogler,, R. D. Feigin,, and R. B. Johnston, Jr. 1979. Recurrent septicemia associated with congenital deficiency of C2 and partial deficiency of factor B and the alternate complement pathway. N. Engl. J. Med. 299:290292.
160. Nuorti, J. P.,, J. C. Butler,, M. M. Farley,, L. H. Harrison,, A. McGeer,, M. S. Kolczak,, R. F. Breiman, and Active Bacterial Core Surveillance Team. 2000. Cigarette smoking and invasive pneumococcal disease. N. Engl. J. Med. 342:681689.
161. O’Brien, K. L.,, L. H. Moulton,, R. Reid,, R. Weatherholtz,, J. Oski,, L. Brown,, G. Kumar,, A. Parkinson,, D. Hu,, J. Hackell,, I. Chang,, R. Kohberger,, G. Siber,, and M. Santosham. 2003. Efficacy and safety of seven- valent conjugate pneumococcal vaccine in American Indian children: group randomised trial. Lancet 362:355361.
162. Oldfield, S.,, S. Jenkins,, H. Yeoman,, D. Gray,, and I. C. M. MacLennan. 1985. Class and subclass anti-pneumococcal antibody responses in splenectomized patients. Clin. Exp. Immunol. 61:664673.
163. O’Neal, B. J.,, and J. C. McDonald. 1981. The risk of sepsis in the asplenic adult. Ann. Surg. 194:775778.
164. Ortqvist, A.,, M. Kalin,, I. Julander,, and M. A. Mufson. 1993. Deaths in bacteremic pneumococcal pneumonia. A comparison of two populations—Huntington, WV and Stockholm, Sweden. Chest 103:710716.
165. Perlino, C. A.,, and D. Rimland. 1985. Alcoholism, leukopenia, and pneumococcal sepsis. Am. Rev. Respir. Dis. 132:757760.
166. Peset-Llopis, M. J.,, G. Harms,, M. J. Hardonk,, and W. Timens. 1996. Human immune response to pneumococcal polysaccharides: complement-mediated localization preferentially on CD21-positive splenic marginal zone B cells and follicular dendritic cells. J. Allergy Clin. Immunol. 97:10151024.
167. Peterslund, N. A.,, C. Koch,, J. C. Jensenius,, and S. Thiel. 2001. Association between deficiency of mannose-binding lectin and severe infections after chemotherapy. Lancet 358:637638.
168. Picard, C.,, A. Puel,, M. Bonnet,, C. L. Ku,, J. Bustamante,, K. Yang,, C. Soudais,, S. Dupuis,, J. Feinberg,, C. Fieschi,, C. Elbim,, R. Hitchcock,, D. Lammas,, G. Davies,, A. Al-Ghonaium,, H. Al-Rayes,, S. Al-Jumaah,, S. Al-Hajjar,, I. Z. Al-Mohsen,, H. H. Frayha,, R. Rucker,, T. R. Hawn,, A. Aderem,, H. Tufenkeji,, S. Haraguchi,, N. K. Day,, R. A. Good,, M. A. Gougerot- Pocidalo,, A. Ozinsky,, and J. L. Casanova. 2003. Pyogenic bacterial infections in humans with IRAK-4 deficiency. Science 299:20762079.
169. Polsky, B.,, J. W. M. Gold,, E. Wimbey,, J. Dryjansky,, A. E. Brown,, G. Schiffman,, D. Armstrong,, and T. C. Quinn. 1986. Bacterial pneumonia in patients with the acquired immune deficiency syndrome. Ann. Intern. Med. 104:3841.
170. Puppo, F.,, R. Ruzzenenti,, S. Brenci,, L. Lanza,, M. Scudeletti,, and F. Indiveri. 1991. Major histocompatibility gene products and human immunodeficiency virus infection. J. Lab. Clin. Med. 117:91100.
171. Rao, S. P.,, K. Rajkumar,, G. Schiffman,, N. Desai,, C. Unger,, and S. T. Miller. 1995. Anti-pneumococcal antibody levels three to seven years after first booster immunization in children with sickle cell disease, and after a second booster. J. Pediatr. 127:590592.
172. Rautonen, N.,, N. L. Martin,, J. Rautonen,, Y. Rooks,, W. C. Mentzer,, and D. W. Wara. 1992. Low number of antibody producing cells in patients with sickle cell anemia. Immunol. Lett. 34:201211.
173. Redd, S. C.,, G. W. Rutherford,, M. A. Sande,, A. R. Lifson,, W. K. Hadley,, R. R. Facklam,, and J. S. Spika. 1990. The role of human immunodeficiency virus in pneumococcal bacteremia in San Francisco residents. J. Infect. Dis. 162:10121017.
174. Reed, W. P.,, G. W. Drach,, and R. C. Williams, Jr. 1974. Antigens common to human and bacterial cells. IV. Studies of human pneumococcal disease. J. Lab. Clin. Med. 83:599610.
175. Reimer, C. B.,, C. M. Black,, R. C. Holman,, T. W. Wells,, R. M. Ramirez,, J. A. Sa-Ferreira,, J. K. Nicholson,, and J. S. Mc- Dougal. 1988. Hypergammaglobulinemia associated with human immunodeficiency virus infection. Monogr. Allergy 23:8396.
176. Reinert, R. R.,, A. Kaufhold,, O. Kuhnemund,, and R. Lutticken. 1994. Serum antibody responses to vaccination with 23-valent pneumococcal vaccine in splenectomized patients. Int. J. Med. Microbiol. Virol. Parasitol. Infect. Dis. 281:481490.
177. Robinson, K. A.,, W. Baughman,, G. Rothrock,, N. L. Barrett,, M. Pass,, C. Lexau,, B. Damaske,, K. Stefonek,, B. Barnes,, J. Patterson,, E. R. Zell,, A. Schuchat,, and C. G. Whitney. 2001. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: opportunities for prevention in the conjugate vaccine era. JAMA 285:17291735.
178. Rodriguez, M. E.,, W.-L. van der Pol,, L. A. M. Sanders,, and J. G. J. van de Winkel. 1999. Crucial role of FcγRIIa (CD32) in assessment of functional anti-Streptococcus pneumoniae antibody activity in human sera. J. Infect. Dis. 179:423433.
179. Rodriguez-Creixems, M.,, P. Munoz,, E. Miranda,, T. Pelaez,, and R. Alonso. 1996. Recurrent pneumococcal bacteremia. A warning of immunodeficiency. Arch. Intern. Med. 156:14291434.
180. Rodriquez-Barradas, M. C.,, D. M. Musher,, R. J. Hamill,, M. Dowell,, J. T. Bagwell,, and C. V. Sanders. 1992. Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited. Clin. Infect. Dis. 14:192199.
181. Romero-Steiner, S.,, D. M. Musher,, M. S. Cetron,, L. B. Pais,, J. E. Groover,, A. E. Fiore,, B. D. Plikaytis,, and G. M. Carlone. 1999. Reduction in functional antibody activity against Streptococcus pneumoniae in vaccinated elderly individuals highly correlates with decreased IgG antibody avidity. Clin. Infect. Dis. 29:281288.
182. Rosen, F. S.,, and C. A. Janeway. 1966. The gamma globulins. III: The antibody deficiency syndromes. N. Engl. J. Med. 275: 709715.
183. Ross, S. C.,, and P. Densen. 1984. Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency. Medicine (Baltimore) 63:243273.
184. Rowe, P. C.,, R. H. McLean,, R. A. Wood,, R. J. Leggiadro,, and J. A. Winkelstein. 1989. Association of homozygous C4B deficiency with bacterial meningitis. J. Infect. Dis. 160:448451.
185. Rubins, J. B.,, M. Alter,, J. Loch,, and E. N. Janoff. 1999. Determination of antibody responses of elderly adults to all 23 capsular polysaccharides after pneumococcal vaccination. Infect. Immun. 67:59795984.
186. Rubins, J. B.,, D. Charboneau,, J. C. Paton,, T. J. Mitchell,, P. W. Andrew,, and E. N. Janoff. 1995. Dual function of pneumolysin in the early pathogenesis of murine pneumococcal pneumonia. J. Clin. Investig. 95:142150.
187. Rubins, J. B.,, and E. N. Janoff. 2001. Pneumococcal disease in the elderly: what is preventing vaccine efficacy? Drugs Aging 18:305311.
188. Rubins, J. B.,, A. K. Puri,, J. Loch,, D. Charboneau,, R. MacDonald,, N. Opstad,, and E. N. Janoff. 1998. Magnitude, duration, quality, and function of pneumococcal vaccine responses in elderly adults. J. Infect. Dis. 178:431440.
189. Rynnel-Dagoo, B.,, A. Freijd,, L. Hammarström,, V. Oxelius,, and M. A. Persson. 1986. Pneumococcal antibodies of different immunoglobulin subclasses in normal and IgG subclass deficient individuals of various ages. Acta Oto-Laryngol. 101:146151.
190. Ryser, O.,, A. Morell,, and W. H. Hitzig. 1988. Primary immunodeficiencies in Switzerland: first report of the national registry in adults and children. J. Clin. Immunol. 8:479485.
191. Saeland, E.,, J. H. Leusen,, G. Vidarsson,, W. Kuis,, E. A. Sanders,, I. Jonsdottir,, and J. G. van de Winkel. 2003. Role of leukocyte immunoglobulin G receptors in vaccine-induced immunity to Streptococcus pneumoniae. J. Infect. Dis. 187:16861693.
192. Saeland, E.,, G. Vidarsson,, J. H. Leusen,, E. Van Garderen,, M. H. Nahm,, H. Vile- Weekhout,, V. Walraven,, A. M. Stemerding,, J. S. Verbeek,, G. T. Rijkers,, W. Kuis,, E. A. Sanders,, and J. G. Van De Winkel. 2003. Central role of complement in passive protection by human IgG1 and IgG2 anti-pneumococcal antibodies in mice. J. Immunol. 170:61586164.
193. Sarvas, H.,, N. Rautonen,, S. Sipinen,, and O. Mäkelä. 1989. IgG subclasses of pneumococcal antibodies—effect of allotype G2m(n). Scand. J. Immunol. 29:229237.
194. Sasso, E. H.,, J. H. Buckner,, and L. A. Suzuki. 1995. Ethnic differences of polymorphism of an immunoglobulin VH3 gene. J. Clin. Investig. 96:15911600.
195. Scamurra, R. W.,, D. J. Miller,, L. Dahl,, M. Abrahamsen,, V. Kapur,, S. M. Wahl,, E. C. Milner,, and E. N. Janoff. 2000. Impact of HIV-1 infection on VH3 gene repertoire of naive human B cells. J. Immunol. 164:54825491.
196. Schuchat, A.,, C. V. Broome,, A. Hightower,, S. J. Costa,, and W. Parkin. 1991. Use of surveillance for invasive pneumococcal disease to estimate the size of the immunosuppressed HIV-infected population. JAMA 265:32753279.
197. Schutze, G. E.,, E. O. Mason, Jr.,, E. R. Wald,, W. J. Barson,, J. S. Bradley,, T. Q. Tan,, K. S. Kim,, L. B. Givner,, R. Yogev,, and S. L. Kaplan. 2001. Pneumococcal infections in children after transplantation. Clin. Infect. Dis. 33:1621.
198. Selby, C.,, S. Hart,, P. Ispahani,, and P. J. Toghill. 1987. Bacteremia in adults after splenectomy or splenic irradiation. Q. J. Med. 63:523530.
199. Selwyn, P. A.,, P. Alcabes,, D. Hartel,, D. Buono,, E. E. Schoenbaum,, R. S. Klein,, K. Davenny,, and G. H. Friedland. 1992. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection. N. Engl. J. Med. 327:16971703.
200. Selwyn, P. A.,, A. R. Feingold,, D. Hartel,, E. E. Schoenbaum,, M. H. Alderman,, R. S. Klein,, and G. H. Friedland. 1988. Increased risk of bacterial pneumonia in HIV-infected intravenous drug users without AIDS. AIDS 2:267272.
201. Shah, T. P.,, and F. R. Sattler. 1987. Polymorphonuclear leukocyte-mediated, antibodydependent cellular cytotoxicity in patients with AIDS. J. Infect. Dis. 155:594595. (Letter.)
202. Shapiro, E. D.,, A. T. Berg,, R. Austrian,, D. Schroeder,, V. Parcells,, A. Margolis,, R. K. Adair,, and J. D. Clemens. 1991. The protec- tive efficacy of polyvalent pneumococcal polysaccharide vaccine. N. Engl. J. Med. 325:14531460.
203. Shapiro, E. D.,, and J. D. Clemens. 1984. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann. Intern. Med. 101:325330.
204. Siber, G. R.,, P. H. Schur,, A. C. Aisenberg,, S. A. Weitzman,, and G. Schiffman. 1980. Correlation between serum IgG2 concentrations and the antibody response to bacterial polysaccharide antigens. N. Engl. J. Med. 303:178182.
205. Sims, R. V.,, W. C. Steinmann,, J. H. Mc- Conville,, L. R. King,, W. C. Zwick,, and J. S. Schwartz. 1988. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann. Intern. Med. 108:653657.
206. Spika, J. S.,, N. A. Halsey,, C. T. Le,, A. J. Fish,, G. M. Lum,, B. A. Lauer,, G. Schiffman,, and G. S. Giebink. 1986. Decline of vaccine-induced antipneumococcal antibody in children with nephrotic syndrome. Am. J. Kidney Dis. 7:466470.
207. Spoulou, V.,, P. Victoratos,, J. P. Ioannidis,, and S. Grafakos. 2000. Kinetics of antibody concentration and avidity for the assessment of immune response to pneumococcal vaccine among children with bone marrow transplants. J. Infect. Dis. 182:965969.
208. Stiehm, E.,, T. Chin,, A. Haas,, and A. Peerless. 1986. Infectious complications of the primary immunodeficiencies. Clin. Immunol. Immunopathol. 40:6986.
209. Styrt, B. 1990. Infection associated with asplenia: risks, mechanisms, and prevention. Am. J. Med. 88:33N42N.
210. Sumiya, M.,, M. Super,, P. Tabona,, R. J. Levinsky,, T. Arai,, M. W. Turner,, and J. A. Summerfield. 1991. Molecular basis of opsonic defect in immunodeficient children. Lancet 337:15691570.
211. Summerfield, J. A.,, S. Ryder,, M. Sumiya,, M. Thursz,, A. Gorchein,, M. A. Monteil,, and M. W. Turner. 1995. Mannose binding protein gene mutations associated with unusual and severe infections in adults. Lancet 345:886889.
212. Super, M.,, S. Thiel,, J. Lu,, R. J. Levinsky,, and M. W. Turner. 1989. Association of low levels of mannan-binding protein with a common defect of opsonisation. Lancet ii:12361239.
213. Taborda, C. P.,, and A. Casadevall. 2002. CR3 (CD11b/CD18) and CR4 (CD11c/CD18) are involved in complement-independent antibody- mediated phagocytosis of Cryptococcus neoformans. Immunity 16:791802.
214. Tasker, S. A.,, M. R. Wallace,, J. B. Rubins,, W. B. Paxton,, J. O’Brien,, and E. N. Janoff. 2002. Reimmunization with 23-valent pneumococcal vaccine for patients infected with human immunodeficiency virus type 1: clinical, immunologic, and virologic responses. Clin. Infect. Dis. 34:813821.
215. Tausk, F. A.,, A. McCutchan,, P. Spechko,, R. D. Schreiber,, and I. Gigli. 1986. Altered erythrocyte C3b receptor expression, immune complexes, and complement activation in homosexual men in varying risk groups for acquired immune deficiency syndrome. J. Clin. Investig. 78:977982.
216. Traub, A.,, G. S. Giebink,, C. Smith,, C. C. Kuni,, M. L. Brekke,, D. Edlund,, and J. F. Perry. 1987. Splenic reticuloendothelial function after splenectomy, spleen repair, and spleen autotransplantation. N. Engl. J. Med. 317:15591564.
217. Twomey, J. T. 1973. Infections complicating multiple myeloma and chronic lymphocytic leukemia. Arch. Intern. Med. 132:562565.
218. Van Wyck, D. B. 1983. Overwhelming postsplenectomy infection (OPSI): the clinical syndrome. Lymphology 16:107114.
219. Vedhara, K.,, N. K. Cox,, G. K. Wilcock,, P. Perks,, M. Hunt,, S. Anderson,, S. L. Lightman,, and N. M. Shanks. 1999. Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination. Lancet 353:627631.
220. Walport, M. J. 2001. Complement. Second of two parts. N. Engl. J. Med. 344:11401144.
221. Ward, H. K.,, and J. F. Enders. 1933. An analysis of the opsonic and tropic action of normal and immune sera based on experiments with the pneumococcus. J. Exp. Med. 1933:527547.
222. Warmerdam, P. A. M.,, J. G. J. van de Winkel,, A. Vlug,, N. A. C. Westerdaal,, and P. J. A. Capel. 1991. A single amino acid in the second Ig-like domain of the human Fcγ receptor II is critical for human IgG2 binding. J. Immunol. 147:13381343.
223. Watanakunakorn, C.,, A. Greifenstein,, K. Stroh,, D. G. Jarjoura,, D. Blen