[Palivizumab for respiratory syncytial virus disease]. / Terapia con palivizumab nell'infezione da virus respiratorio sinciziale.

AIM: Palivizumab (Synagis, Abbott) is a humanized monoclonal antibody of IgG class currently used for prophylaxis of respiratory syncytial virus (RSV) infection. It neutralises the protein F of RSV, which allows the virus to penetrate inside the host cell and subsequently to form syncytia, causing clinical manifestations. Based on that, our aim was to assess if an early administration of palivizumab during RSV infection could positively modify the infection course, hence providing a therapeutic effect. METHODS: The study included eight infants hospitalized with a case history suggestive of severe RSV which made the use of oxygen therapy and, in five cases, mechanical ventilation necessary. The diagnosis was confirmed by the isolation of the virus in the nasopharyngeal aspirate; for all of them informed consent was obtained by the parents. All infants were treated with palivizumab (15 mg/kg i.m. in a single dose). RESULTS: All infants showed a significant clinical improvement and a fast recovery, with a consequent precocious dismissal. After 7 days, 6 infants had a negative nasopharyngeal aspirate. Palivizumab administration at the onset of RSV infection seems to work as a therapy. CONCLUSION: The limited number of the patients does not allow to formulate definitive conclusions but the present study suggests the usefulness of verifying these positive results through randomised controlled studies.

Screening patients affected by common variable immunodeficiency.

Chronic immunoglobulin administration decreases the incidence of bronchial and pulmonary infections in patients affected by chronic variable immunodeficiency (CVI). In this study, an ENT screening was carried out in 22 patients affected by chronic variable immunodeficiency and treated with chronic immunoglobulin administration. All the patients underwent ENT physical examination, nasal endoscopy by fiberoptics, mucociliary transport test (MTT), anterior rhinorheomanometry (RRM), nasal provocation test with cold water (ANPT), audiometry and impedentiometry, olfactory evaluation, and paranasal sinus X rays. Dysphagia was present in 91% of the patients, nasal secretion and obstruction in 77%, and hypoacusia, tinnitus, and otodinia in 57%. Rhinitis and pharyngitis were observed in 86% of the patients, and serous middle ear effusion in 50%. Confirmed maxillary sinusitis was observed in five patients. Hyposmia was observed in 50% of the patients. MTT was significantly longer in the patients than in the controls (18.0 +/- 10.5 vs. 11.2 +/- 2.4 min; p < .05). Nasal resistance was lower in patients than in controls (0.46 +/- 0.32 vs. 1.11 +/- 0.22 Pa/L.s-1; p < .001). ANPT was positive in 9 patients out of 25 versus 1 control out of 15 (p < .05). Finally, seven patients were affected by transmissive hypoacusia, and one patient by neurosensorial hypoacusia. Our results suggest that chronic immunoglobulin administration in CVI patients is not effective against ENT disorders, probably because of the important role played by nasal hyperreactivity. Frequent ENT examination and early treatment of ENT disorders are therefore suggested in order to prevent chronic disease.