AUTHOR=Mohanty Madhu Chhanda , Madkaikar Manisha Ranjan , Desai Mukesh , Aluri Jahnavi , Varose Swapnil Yashwant , Taur Prasad , Sharma Deepa Kailash , Nalavade Uma Prajwal , Rane Sneha Vijay , Gupta Maya , Shabarish Snehal , Dalvi Aparna , Deshpande Jagadish Mohanrao 

TITLE=Natural Clearance of Prolonged VDPV Infection in a Child With Primary Immunodeficiency Disorder

JOURNAL=Frontiers in Immunology

VOLUME=Volume 10 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.01567

DOI=10.3389/fimmu.2019.01567

ISSN=1664-3224

ABSTRACT=The emergence of immunodeficiency associated vaccine-derived polioviruses (iVDPV) from the children with primary immunodeficiency disorders poses a threat to the eradication program. Herein we report a patient with severe combined immunodeficiency (SCID), identified as a prolonged serotype 3 VDPV (VDPV3) excreter with thirteen VDPV3 isolates and maximum of 10.33% nucleotide divergence, who abruptly cleared infection after a period of two years. Occurrence of an episode of Norovirus diarrhea associated with increased activated oligoclonal cytotoxic T cells, inverse CD4:CD8 ratio, significantly elevated pro-inflammatory cytokines and subsequent clearance of the poliovirus suggests a possible link between inflammatory diarrheal illness and clearance of iVDPV.  Our findings suggest that in the absence of B cells and sufficiently activated T/NK cells, macrophages and other T cells may produce auto-inflammatory conditions by TLR/RLR ligands expressed by previous/ ongoing bacterial or viral infections to clear VDPV infection. The study highlights the need of screening all the patients with combined immunodeficiency for poliovirus excretion and intermittent follow-up of their immune parameters if found positive, in order to manage the risk of iVDPV excretion in the polio eradication endgame strategy.