Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?

• Published in: Clinical immunology (Orlando, Fla.) Fla.), 2017-07, Vol.180, p.111-119
• Main Authors: van de Vosse, Esther, van Ostaijen-ten Dam, Monique M, Vermaire, René, Verhard, Els M, Waaijer, Jacqueline L, Bakker, Jaap A, Bernards, Sandra T, Eibel, Hermann, van Tol, Maarten J, van Dissel, Jaap T, Haverkamp, Margje H
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aging - blood; Aging - genetics; Aging - immunology; Allergy and Immunology; B-cell activating factor; B-Cell Activation Factor Receptor - genetics; B-Cell Activation Factor Receptor - immunology; Cell Differentiation; Complement Pathway, Alternative; Complement Pathway, Classical; Complement System Proteins - analysis; Elderly; Female; Humans; Immunodeficiency; Immunoglobulins - blood; Immunologic Deficiency Syndromes - blood; Immunologic Deficiency Syndromes - genetics; Immunologic Deficiency Syndromes - immunology; Late onset; Lymphocytes - cytology; Lymphocytes - immunology; Male; Mannose binding lectin; Mannose-Binding Lectin - blood; Mannose-Binding Lectin - deficiency; Mannose-Binding Lectin - genetics; Mannose-Binding Lectin - immunology; Metabolism, Inborn Errors - blood; Metabolism, Inborn Errors - genetics; Metabolism, Inborn Errors - immunology; Middle Aged; Pneumococcal Vaccines - therapeutic use; Recurrence; Respiratory tract infection; Respiratory Tract Infections - blood; Respiratory Tract Infections - genetics; Respiratory Tract Infections - immunology; Specific anti-polysaccharide deficiency; Vaccination
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2017.05.008

Abstract Elderly with late-onset recurrent respiratory tract infections (RRTI) often have specific anti-polysaccharide antibody deficiency (SPAD). We hypothesized that late-onset RRTI is caused by mild immunodeficiencies, such as SPAD, that remain hidden through adult life. We analyzed seventeen elderly RRTI patients and matched controls. We determined lymphocyte subsets, expression of BAFF receptors, serum immunoglobulins, complement pathways, Pneumovax-23 vaccination response and genetic variations in BAFFR and MBL2 . Twelve patients (71%) and ten controls (59%) had SPAD. IgA was lower in patients than in controls, but other parameters did not differ. However, a high percentage of both patients (53%) and controls (65%) were MBL deficient, much more than in the general population. Often, MBL2 secretor genotypes did not match functional deficiency, suggesting that functional MBL deficiency can be an acquired condition. In conclusion, we found SPAD and MBL deficiency in many elderly, and conjecture that at least the latter arises with age.