Use of irradiated lymphocytes from immune donors for treatment of disseminated varicella.

Four children with acute lymphocytic leukemia who had disseminated varicella were treated with infusions of apheresed, irradiated lymphocytes from healthy donors who had recently recovered from infection with varicella-zoster virus. Each patient had cessation of new lesion formation and umbilication of old lesions within 24 hours of the first lymphocyte transfusion. There were no side effects attributable to the infusions. A controlled trial of infusions of irradiated lymphocytes should be considered for treatment of disseminated infection with varicella-zoster virus in immunocompromised hosts.

Successful treatment with an unrelated-donor bone marrow transplant in an HLA-deficient patient with severe combined immune deficiency ("bare lymphocyte syndrome").

An 8-month-old white female infant with Pneumocystis carinii pneumonia had a normal blastogenic response to mitogens but no response to a variety of antigens, as well as a poor response to allogeneic cells in one-way mixed lymphocyte culture assays. The patient's mononuclear cells had defective class I (HLA-A, -B, -C) and absent class II (HLA-D) antigen expression on their surface, thus establishing the diagnosis of HLA-deficient severe combined immune deficiency (bare lymphocyte syndrome). Family HLA typing, in vitro stimulation of patient mononuclear cells, and sequence-specific oligonucleotide probe hybridization allowed the patients HLA phenotype to be determined. An unrelated bone marrow donor whose phenotype matched at all but a single A locus was found. The patient was conditioned with busulfan and cyclophosphamide, followed by infusion of T-cell-depleted bone marrow cells. The patient has been infection free with a successful marrow graft documented by HLA typing and chromosomal analysis. Sequence-specific oligonucleotide probe hybridization allows determination of the HLA phenotype in patients with HLA-deficient severe combined immune deficiency which, in turn, makes marrow transplantation an option for the reconstitution of these patients' immune system.

Brucellosis: an unusual cause of a child's fever of unknown origin.

A 3-year-old Wisconsin native with the symptoms of chronic fever, hepatosplenomegaly, and inability to walk, was found to have an elevated anti-Brucella titer. Blood and bone marrow cultures grew Brucella melitensis, biotype 3. This infection was likely acquired during a trip to Mexico several months earlier during which the child had ingested raw milk. The patient's father was also discovered to have brucellosis. Both were successfully treated with antibiotic therapy. Although brucellosis has been almost totally eradicated in the United States, in the appropriate setting it should be considered as a possible cause of fever of unknown origin in a child.