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Suggest Remedies To Boost The Immune System Of An Acute CMV And EBV Patient
Question: Hello
Can you advise of treatment or other ways (apart from nutrition & rest) to boost my18 yr old daughter’s immunity after acute CMV & EBV with resistance to antibiotics developed including loss of memory cells (e.g. Hep A & Hep B antibodies) requiring further vaccination. Possibly like immune-globin injection?
She also showed some allergic reaction with inability to breathe from swelling and raised white skin bumps about 5 days after first going on penicillin (initially thought tonsillitis) and was then on amoxicillin for abt 5 days before +ve EBV result. Happened in middle of night so not observed by doctor. Told not allergy to penicillin but adverse reaction of virus to antibiotics. Daughter was born in US with strep B infection treated with antibiotics so advised penicillin later in life likely. Suspecting with recent (as above) this developing.What to do or test for here? How urgent is it if travelling shortly?
If not your area can you suggest what area I should consult on this website?
Can you advise of treatment or other ways (apart from nutrition & rest) to boost my18 yr old daughter’s immunity after acute CMV & EBV with resistance to antibiotics developed including loss of memory cells (e.g. Hep A & Hep B antibodies) requiring further vaccination. Possibly like immune-globin injection?
She also showed some allergic reaction with inability to breathe from swelling and raised white skin bumps about 5 days after first going on penicillin (initially thought tonsillitis) and was then on amoxicillin for abt 5 days before +ve EBV result. Happened in middle of night so not observed by doctor. Told not allergy to penicillin but adverse reaction of virus to antibiotics. Daughter was born in US with strep B infection treated with antibiotics so advised penicillin later in life likely. Suspecting with recent (as above) this developing.What to do or test for here? How urgent is it if travelling shortly?
If not your area can you suggest what area I should consult on this website?
Brief Answer:
First we need to establish whether she is immunodeficient.
Detailed Answer:
Dear Madam,
Thank you for posting your query on HCM.
Going through your history I don't see any significant signs of immunodeficiency, so we need to establish that first. I would suggest T cell and B cell count done by flow cytometry , IgG, IgM , IgA levels , CD4 ,CD8 count . If any of these are considerably deficient, then IVIg is considered like in cases of CVID .
Urgency of tests depend on whether she is having any current infection or not. If she is fine you can wait. That decision depends on you and her treating doctor.
Take care
Dr. Shruti
First we need to establish whether she is immunodeficient.
Detailed Answer:
Dear Madam,
Thank you for posting your query on HCM.
Going through your history I don't see any significant signs of immunodeficiency, so we need to establish that first. I would suggest T cell and B cell count done by flow cytometry , IgG, IgM , IgA levels , CD4 ,CD8 count . If any of these are considerably deficient, then IVIg is considered like in cases of CVID .
Urgency of tests depend on whether she is having any current infection or not. If she is fine you can wait. That decision depends on you and her treating doctor.
Take care
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Prasad
OK I'm confused as seen three dfferent doctors since daughter fell ill (time constraints) and latest didn't suggest investigations you mentioned. Numbered questions for clarity.Us mums worry about our kids.
1 I may've misunderstood but was told antibodies circulating in blood for various tests including one already done (e.g. to check Hep A & Hep B antibodies) are different to those in other parts of body e.g. lymphatic system so not really accurate tests. This confusing as I thought cells were similar whereever located and means initial antibody count tests unreliable. Not make sense to me as would also mean Hep B booster & Hep A vaccinations that redone shouldn't have been.
2 Also doctor not doing immunoglobulin injection or similar - but specific tests for rubella and varicella rosta (these vaccinations might need to be redone),liver function and Hep A & Hep B IcG, total antibody levels for immunoglobulins. This confusing as negates what told about the other tests being unreliable (no. 1). Are there different behaviours for different types of antibodies in cells?
3 Have been told to redo EBV tests for non specific reactivity possibility. What are they suspecting?
4 Is there no universal sero conversion test to see if antibody protection lost from illness (EBV, CMV & likely adverse drug reaction to virus?).
5 Told memory cells were lost and that she'd catch pretty much anything if that was so. Have I misunderstood this - How occur?
6 Should I consult specialist?
7 Should we retest after illness and drug reaction for kidney function e.g. urates?
Thanks XXXXXXX
1 I may've misunderstood but was told antibodies circulating in blood for various tests including one already done (e.g. to check Hep A & Hep B antibodies) are different to those in other parts of body e.g. lymphatic system so not really accurate tests. This confusing as I thought cells were similar whereever located and means initial antibody count tests unreliable. Not make sense to me as would also mean Hep B booster & Hep A vaccinations that redone shouldn't have been.
2 Also doctor not doing immunoglobulin injection or similar - but specific tests for rubella and varicella rosta (these vaccinations might need to be redone),liver function and Hep A & Hep B IcG, total antibody levels for immunoglobulins. This confusing as negates what told about the other tests being unreliable (no. 1). Are there different behaviours for different types of antibodies in cells?
3 Have been told to redo EBV tests for non specific reactivity possibility. What are they suspecting?
4 Is there no universal sero conversion test to see if antibody protection lost from illness (EBV, CMV & likely adverse drug reaction to virus?).
5 Told memory cells were lost and that she'd catch pretty much anything if that was so. Have I misunderstood this - How occur?
6 Should I consult specialist?
7 Should we retest after illness and drug reaction for kidney function e.g. urates?
Thanks XXXXXXX
Brief Answer:
Follows.
Detailed Answer:
Dear XXXXXXX ,
Thanks for reverting back.
Well , I told u in my last reply also that there are certain parameters that we need to look to see for immunodeficiency , without having those results how can we say she is immunodeficienct . Also the doctor is right in saying that different viruses , bacteria have different structures so accordingly body make specific structured cells to fight them which often turn up as memory cells so no one cell fight an organism , they are all different . For any vaccination to be repeated its titre for antibody can be done , if it's low it can be repeated , but response to one does not predict response to other , like one may be adequate other may be not .
Regarding EBV testing I don't know what cross reactivity they are testing . There is no single test for testing seroconversion . If possible see an immunologist , and I agree that she will catch up with memory cells because body heals themselves . You can consider repeating tests once her illness is over , that will be better but her treating Doctor should agree for the same .
Dr. Shruti
Follows.
Detailed Answer:
Dear XXXXXXX ,
Thanks for reverting back.
Well , I told u in my last reply also that there are certain parameters that we need to look to see for immunodeficiency , without having those results how can we say she is immunodeficienct . Also the doctor is right in saying that different viruses , bacteria have different structures so accordingly body make specific structured cells to fight them which often turn up as memory cells so no one cell fight an organism , they are all different . For any vaccination to be repeated its titre for antibody can be done , if it's low it can be repeated , but response to one does not predict response to other , like one may be adequate other may be not .
Regarding EBV testing I don't know what cross reactivity they are testing . There is no single test for testing seroconversion . If possible see an immunologist , and I agree that she will catch up with memory cells because body heals themselves . You can consider repeating tests once her illness is over , that will be better but her treating Doctor should agree for the same .
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello
Apologies if it seems I'm repeating myself or not listening to you. I’ve seen doctor but she didn’t prescribe tests for most of the antibody titres for vaccinations although same was requested. Possible financial considerations under public health system although I didn't indicate such concerns.She's trying to assist but isn't specialised in immunology so now booking to see one as you advised. Will revert later but need to wait two more weeks so 6 weeks after EBV/CMV) diagnosis. Doctor also has tight time constraints hence questions here for fuller explanations – and thinking over time also raised other questions as you understand better.
Thanks for clarifying re the different antibodies behaviour. Ties in also with immunology testing for the different bacteria properties of prior various illness and drug reaction.
Please explain in meantime how blood test can have negative result for antibodies even though they may be within body (i.e. in lymphathic system etc). Want to better understand this.
Rgds XXXXXXX
Apologies if it seems I'm repeating myself or not listening to you. I’ve seen doctor but she didn’t prescribe tests for most of the antibody titres for vaccinations although same was requested. Possible financial considerations under public health system although I didn't indicate such concerns.She's trying to assist but isn't specialised in immunology so now booking to see one as you advised. Will revert later but need to wait two more weeks so 6 weeks after EBV/CMV) diagnosis. Doctor also has tight time constraints hence questions here for fuller explanations – and thinking over time also raised other questions as you understand better.
Thanks for clarifying re the different antibodies behaviour. Ties in also with immunology testing for the different bacteria properties of prior various illness and drug reaction.
Please explain in meantime how blood test can have negative result for antibodies even though they may be within body (i.e. in lymphathic system etc). Want to better understand this.
Rgds XXXXXXX
Brief Answer:
Follow the advises.
Detailed Answer:
Dear XXXXXXX ,
See every test has a minimum value , so when the amount of antibodies crosses that value then only we can visualize it as positive . If they are present in lower thresholds then they may not be visible to us .
Since we are exposed to lot of bacteria and viruses we generally tend to have antibodies against them but since exposure is less they don't result in infection and hence we are not able to measure the titre .
I hope now it's clear to you..
Dr. Shruti
Follow the advises.
Detailed Answer:
Dear XXXXXXX ,
See every test has a minimum value , so when the amount of antibodies crosses that value then only we can visualize it as positive . If they are present in lower thresholds then they may not be visible to us .
Since we are exposed to lot of bacteria and viruses we generally tend to have antibodies against them but since exposure is less they don't result in infection and hence we are not able to measure the titre .
I hope now it's clear to you..
Dr. Shruti
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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