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PLASMA INFUSION CORRECTION OF OPSONIZATION FOR PNEUMOCOCCAL MENINGITIS

It is well appreciated that children with sickle cell disease (SCD) experience a strikingly increased susceptibility to pneumo-coccal meningitis and septicemia. One factor of major etiologic importance appears to be a defect in serum components which enhance phagocytosis (opsonins).A new assay employing acridine orange as a vital stain for bacteria to examine phagocytosis and bactericidal capacity of neutrophils was used to evaluate a SCD patient with type 14 pneumococcal meningitis which remained culture positive for 8 days into penicillin therapy. The patient subsequently received infusions of fresh frozen plasma from donors with type 14 pneumococcal antibody. Results were as follows:These assays of neutrophil phagocytosis and bactericidal capacity, specific for the pneumococcus infecting the patient, revealed a deficiency of serum opsonization which could be corrected with infusions of fresh frozen plasma. These data therefore support the need for large controlled clinical trials of plasma infusions for treating pneumococcal meningitis and sepsis in patients with SCD. Studies of this nature are in progress.