Role of the Toll‐Like Receptor 4 Asp299Gly Polymorphism in Susceptibility toCandidaalbicansInfection
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Abstract
To the Editor-My colleagues and I appreciate the comments of Drs.DeVincenzo and Buckingham [1] on our recently published article [2].They question the lack of a relationship between the amount of virus shed and severity of illness in respiratory syncytial virus (RSV) disease.We created a carefully modulated illness score that included 16 ventilated patients.In addition to finding no relationship between the amount of virus shed and this summation of the severity of illness, we were struck by the highly variable virus load in both nasal and endotracheal secretions of the 16 ventilated patients.As Drs.DeVincenzo and Buckingham are aware [1], no therapeutic effect of RSV intravenous immune globulin could be demonstrated in the multicenter study from which these patients were drawn.The same was true in the subset of patients we studied at Vanderbilt University Medical Center (Nashville).Hence, we do not feel that this was a confounding variable.Perhaps neither their study [3] nor ours [2] provides a definitive answer to the presence of a modest effect of virus titer on illness severity, especially since neither study can address the peak titer of viral shedding that probably occurs before hospitalization.Both studies suggest that the effect, if any, of virus load on illness severity is modest and that we need to search elsewhere for a complete understanding of RSV pathogenesis.
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