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Justice
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A 33-year-old woman was hospitalized following her third episode of meningococcal meningitis in the last 20 years. She responded promptly to intravenous ceftriaxone and had no sequelae. During the acute phase of her illness and again 2 weeks after recovery, her total hemolytic complement (CH5O) values were in the mid-normal range.
Which of the following diagnostic studies should be ordered next?
A. No additional studies are needed
B. Measurement of alternative pathway complement components
C. Measurement of individual serum C5, 6, 7, and 8 levels
D. Serum lgG subset quantification
E. T-cell subset quantification
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| peter90036
Forum Elite
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i just saw this Medical Mysteries on the discovery channel,
but it was a young girl who had 3 episodes of meningitis (but normal immuno labs), they did CT of the head and found a tiny fracture in one of the bones leading to the sinuses
so i pick
F. CT of the head.
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| DrVirgo
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C. Measurement of individual serum C5, 6, 7, and 8 levels
Deficiency of C8 is associated with recurrent mengococcal meningitis.
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| CocaCola
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need to measure her levels of MAC - membrane attack complex... if i remeber correctly MAC is what is needed to fight encapulated bacteria
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| Markus2009
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It definetely sounds as a MAC deficiency but C doesn't include factor 9 anyways will go with C.
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| Justice
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I will put correct answers on Friday so more people could test their knowledge/learn from this Qn... Meantime, I want to remind my colleagues to vote on the top of the page...
Thank you
  
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| Justice
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The correct answer is B
Complement component deficiencies of the alternative pathway components properdin and factor D are associated with susceptibility to meningococcal disease but not with low levels of total hemolytic complement (OH 50). This is also true of C9 deficiency, and, if given as a choice, determination of the serum C9 level would have been an acceptable answer. Because the likelihood of a complement abnormality increases substantially after each neisserial infection, most experts would order additional diagnostic studies of alternative pathway complement components.
Determination of individual C5, 6, 7, and 8 levels is not needed because if any of these complement components had been low or absent, the CH5O value would have been significantly lower than normal for the laboratory where the test was done. Serum lgG subset quantification and T-cell subset quantification are incorrect because defects in lgG or T-cell subsets are not known to lead to increased susceptibility to neisserial infections.
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| DrVirgo
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According to this article:
http://cpj.sagepub.com/cgi/content/abstract/22/9/...
Relapsing Neisseria meningitidis Infection Associated with C8 Deficiency
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| Justice
Forum Fanatic
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I see where your confusion comes from but let me cite the answer once again:
"...Determination of individual C5, 6, 7, and 8 levels is not needed because if any of these complement components had been low or absent, the CH5O value would have been significantly lower than normal for the laboratory where the test was done..."
As all of us could imagine, the immunodeficiency story is quite complex one by itself due to numerous factors involved, and we heed to learn how to bring all this stuff together on a functional level... I am still learner... 
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