Septicemia and Shock: Pathogenesis and Novel Therapeutic Strategies
(2003, NS 124)
Anna Norrby-Teglund, Staffan Normark, Ragnar Norrby, Malak Kotb, Thierry Calandra, Terje Espevik
May 15 - 17
Nobel Forum, Karolinska Institutet, Stockholm, Sweden
Proceedings: Scandinavian Journal of Infectious Diseases, Vol. 35, No. 9, 2003, Stockholm.

 

Intravenous Immonuglobulin Adjunctive Therapy in Sepsis with Special Emphasis on Severe Invasive Group A Streptococcal Infections
Anna Norrby-Teglund, Nahla Ihendyane and Jessica Darenberg
Center for Infectious Medicine, Dept. of Medicine, Karolinska Institutet, Huddinge University Hospital, Sweden

Immunotherapy targeted against microbial toxins and host mediators has been studied in many pre-clinical investigations and clinical trials and sepsis during the past 20 years. Intravenous immunoglobulin, including both monoclonal and polyclonal antibodies, represents one such immunotherapeutic strategy. Monoclonal antibodies directed against endotoxin or TNF-a have been tested quite extensively in clinical trials, but have so far failed to reveal a significant effect on mortality rates. Several studies have assessed the efficacy of polyclonal inravenous immunoglobulin (IVIG) in sepsis with varying results. Although there is not conclusive data available to date to support the use of IVIG- therapy in all sepsis cases, there are strong indications that certain defined septic subgroups, such as streptococcal toxic shock syndrome caused by group A streptococcus, will benefit from its use. In this review we will give a brief summary of the clinical trials on IVIG-therapy in sepsis, and we will describe in more detail the mechanistic actions of IVIG and the clinical data that support the use of IVIG as adjunctive therapy in severe invasive group A streptococcal infections.