At the Edge of Mysteries by Perera Shantha;

Author:Perera, Shantha;
Language: eng
Format: epub
Publisher: Hero

Chapter 21

THE BOY IN THE BUBBLE

What happens when the immune system is deficient in one or more of its components? What happens if antibodies cannot be generated or lymphocytes fail to mount immune responses? Up until the 1950s no one had any idea, because no case of immunodeficiency had been documented. That crucial discovery – that there were indeed individuals with deficient immune systems – came from America.

In 1952, Colonel Ogden Bruton, an American army paediatrician, described an eight-year-old male who presented with an unusual constellation of infections. The boy suffered from chills, a fever of 38.1°C and left-knee pain. History did not reveal any significant illnesses; his mother had had an uneventful pregnancy; the delivery was normal, and the boy’s developmental history was also unremarkable. The attending physician, suspecting rheumatic fever, prescribed aspirin and discharged the boy. However, there was no improvement, and within two hours his temperature had spiked up to 38.8°C, necessitating a return to the hospital. This time the boy was admitted. He was treated with penicillin for 28 days and discharged. But after a few weeks the boy was back, this time with an upper-respiratory-tract infection which had turned into pneumonia: his temperature had now gone up to 40°C. He was given sulphonamides and recovered some five days later. But within a week he returned, complaining of a painful jaw swelling. Again, he responded to treatment and was discharged, but a few weeks later was back in hospital, vomiting from a violent gastrointestinal upset and running a high fever. Once again he was treated with sulphonamides and sent home, only to return just a week later with fever and vomiting, which lasted for two weeks. He then developed severe middle-ear infections in both ears. Treated with penicillin in oil and beeswax, he made a good recovery, but his left eardrum had required incision. However, blood samples taken at the time had grown a bacterium, the pneumococcus that had caused the pneumonia. Alarmingly, the boy had a blood infection: he was septicaemic. Two months later he again developed pneumococcal middle-ear infections, but again responded to sulpha drugs.

This waxing and waning continued for several more months. Frequent infections were not uncommon in children, but Ogden Burton was troubled by the fact that the boy had suffered from clinical sepsis, a serious bloodstream infection, on six separate occasions with pneumococci isolated in three out of the six. Prophylactic antibiotic therapy was failing to stop these recurrent episodes and the boy was admitted for further investigation.

Because the initial episodes of sepsis involved the same type of pneumococcus, a vaccine was prepared from bacteria isolated from the patient. This was given over five months, but the boy failed to make any antibodies. As more types of pneumococci were being isolated, a vaccine containing six different types isolated from the boy was prepared and administered over a period of seven months. But, again, no antibodies were detected. Subsequent investigations found that the boy had not made any antibodies in response to his routine childhood immunizations for diphtheria, tetanus or typhoid.

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