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Respiratory Syncytial Virus Pneumonia-Reply

Lawrence R. Crane, MD; Voravit Ratanatharathorn, MD
JAMA. 1982;247(14):1937. doi:10.1001/jama.1982.03320390021018.
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In Reply.—  The role of the immune system in the pathogenesis of and recovery from RSV infection is not clear. Passive maternal antibody does not protect infants from fatal disease. Killed vaccine that stimulates high titers of neutralizing antibody does not prevent vaccinees from natural infection, and subsequent infection may be serious.1 In contrast, the appearance of RSV-specific nasal IgA correlates with decreased nasal virus shedding and clinical recovery.2 Cellular immune mechanisms appear both to enhance disease and mediate recovery.1,3Our patient's immune deficient state was complex. He had received total lymphoid irradiation and chemotherapy three years earlier. Before induction chemotherapy there was impaired lymphocyte response to alloantigens of unrelated lymphocytes in cultures. Despite a fatal, overwhelming RSV pneumonia, he had a poor antibody response. Total lymphoid irradiation is highly immunosuppressive, to the point of allograft tolerance.4,5 Mixed lymphocyte reactions are severely impaired for as long


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