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DOI: 10.1055/s-2008-1077527
© Georg Thieme Verlag KG Stuttgart · New York
Juvenile Larynxpapillomatose – Impfung mit dem polyvalenten Spaltimpfstoff Gardasil®
Juvenile Laryngeal Papillomatosis – Immunisation with the Polyvalent Vaccine Gardasil®Publication History
eingereicht 21. April 2008
akzeptiert 16. Juli 2008
Publication Date:
29 August 2008 (online)
![](https://www.thieme-connect.de/media/lro/200811/lookinside/thumbnails/10.1055-s-2008-1077527-1.jpg)
Zusammenfassung
Die juvenile Larynxpapillomatose ist eine seltene, durch humane Papillomaviren (HPV) verursachte Erkrankung. Bei aggressiven Verlaufsformen sind bleibende Stimm- und Atemstörungen durch eine Vielzahl notwendiger Papillomabtragungen bisher kaum zu vermeiden. Um die Rezidivrate bei schwerer Verlaufsform zu senken, werden heute die Immunstimulation mit Interferon alpha oder die lokale Applikation von Cidofovir empfohlen. Auch Mumps-Impfungen und eine fotodynamische Therapie werden angewendet. Im vorliegenden Fall wurde versucht, durch Immunisierung mit dem quadrivalenten HPV-Spaltimpfstoff Gardasil® den Krankheitsverlauf bei einem zweijährigen Jungen, der seit 9 Monaten erkrankt war, positiv zu beeinflussen. Durch chromogene In-situ-Hybridisierung und Polymerase-Kettenreaktion (PCR) an Läsionsgewebe war eine simultane HPV-Infektion durch HPV-Typ 6 und 11 nachgewiesen. Nach der dritten Impfung stabilisierte sich der Krankheitsverlauf. In den bisher zehn Monaten nach der letzten Impfung war kein erneuter Progress erkennbar. Aufgrund des geringen Risikos dieser Form der adjuvanten Behandlung halten wir eine multizentrische Studie zur Klärung der Wirksamkeit für gerechtfertigt, auch wenn eine vollständige Viruselimination mit diesem Impfstoff nicht wahrscheinlich ist.
Abstract
Juvenile laryngeal papillomatosis is a rare condition caused by human papilloma virus (HPV). In cases with rapid recurrences permanent impairments of voice and breathing are almost inevitable due to the frequent need of debulking surgeries. Efforts to lower the recurrence rate comprise the adjuvant use of interferon alpha, local cidofovir, photodynamic therapy or mumps vaccination.
In the present case we tried to positively influence the aggressive course of disease in a two year old boy by immunisation with the quadrivalent HPV vaccine Gardasil®. Chromogenic in-situ hybridisation analysis and polymerase chain reaction (PCR) of lesion tissue showed simultaneous infection with the HPV-Types 6 and 11. After the third immunisation the disease became stable. No further surgery was necessary for the last ten months.
The risk profile of this adjuvant treatment is low. We think it worth to initiate a multicentre trial to prove a benefit of this treatment even if no complete virus elimination can be achieved.
Schlüsselwörter
Larynx - HPV - Papillomavirus - Gardasil - Larynxpapillomatose - Fallbericht
Key words
larynx - papillomavirus - HPV - Gardasil - laryngeal papillomatosis - case report
Literatur
- 1 Derkay C S. Task force on recurrent respiratory papillomas. A preliminary report. Arch Otolaryngol Head Neck Surg. 1995; 121 1386-1391
- 2 Alberico S, Pinzano R, Comar M. et al . Maternal-fetal transmission of human papillomavirus. Minerva Ginecol. 1996; 48 199-204
- 3 Terry R M, Lewis F A, Griffiths S, Wells M, Bird C C. Demonstration of human papillomavirus types 6 and 11 in juvenile laryngeal papillomatosis by in-situ DNA hybridization. J Pathol. 1987; 153 245-248
- 4 Mounts P, Shah K V, Kashima H. Viral etiology of juvenile- and adult-onset squamous papilloma of the larynx. Proc Natl Acad Sci USA. 1982; 79 5425-5429
- 5 Reeves W C, Ruparelia S S, Swanson K I. et al . National registry for juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg. 2003; 129 976-982
- 6 Ruparelia S, Unger E R, Nisenbaum R, Derkay C S, Reeves W C. Predictors of remission in juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg. 2003; 129 1275-1278
- 7 Kimberlin D W. Current status of antiviral therapy for juvenile-onset recurrent respiratory papillomatosis. Antiviral Res. 2004; 63 141-151
- 8 Gerein V, Rastorguev E, Gerein J, Draf W, Schirren J. Incidence, age at onset, and potential reasons of malignant transformation in recurrent respiratory papillomatosis patients: 20 years experience. Otolaryngol Head Neck Surg. 2005; 132 392-394
- 9 Aaltonen L M, Rihkanen H, Vaheri A. Human papillomavirus in larynx. Laryngoscope. 2002; 112 700-707
- 10 Stamataki S, Nikolopoulos T P, Korres S. et al . Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management. Head Neck. 2007; 29 155-162
- 11 Gerein V, Rastorguev E, Gerein J, Jecker P, Pfister H. Use of interferon-alpha in recurrent respiratory papillomatosis: 20-year follow-up. Ann Otol Rhinol Laryngol. 2005; 114 463-471
- 12 Pudszuhn A, Welzel C, Bloching M, Neumann K. Intralesional Cidofovir application in recurrent laryngeal papillomatosis. Eur Arch Otorhinolaryngol. 2007; 264 63-70
- 13 Neumann K, Pudszuhn A, Welzel C, Bartel-Friedrich S, Passmann M. Intralesional cidofovir injections for recurrent laryngeal papillomatosis: first results. Laryngo-Rhino-Otol. 2003; 82 700-706
- 14 Shikowitz M J, Abramson A L, Steinberg B M. et al . Clinical trial of photodynamic therapy with meso-tetra (hydroxyphenyl) chlorin for respiratory papillomatosis. Arch Otolaryngol Head Neck Surg. 2005; 131 99-105
- 15 Pashley N R. Can mumps vaccine induce remission in recurrent respiratory papilloma?. Arch Otolaryngol Head Neck Surg. 2002; 128 783-786
- 16 Villa L L, Costa R L, Petta C A. et al . High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006; 95 1459-1466
- 17 Glastetter E, Kaufmann A M. Humoral and cellular immune response in HPV vaccination. Hautarzt. 2007; 58 493-500
- 18 Garland S M, Hernandez-Avila M, Wheeler C M. et al . Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007; 356 1928-1943
- 19 Maloney E M, Unger E R, Tucker R A. et al . Longitudinal measures of human papillomavirus 6 and 11 viral loads and antibody response in children with recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg. 2006; 132 711-715
- 20 Chen B B, Zhao K N, Liu X S. et al . The detection and significance of human papilloma virus 11b virus like particles and its serum antibody in juvenile larynx papilloma. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2003; 38 417-420
- 21 Roda Husman A-M, Walboomers J MM, Brule A JC, Meijer C JLM, Snijders P JF. The use of geneal primers PG5 and PG6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol. 1995; 76 1057-1062
- 22 Hallez S, Simon P, Maudoux F. et al . Phase I/II trial of immunogenicity of a human papillomavirus (HPV) type 16 E7 protein-based vaccine in women with oncogenic HPV-positive cervical intraepithelial neoplasia. Cancer Immunol Immunother. 2004; 53 642-650
- 23 Waterboer T, Sehr P, Michael K M. et al . Multiplex Human Papillomavirus Serology Based on in Situ-Purified Glutathione S-Transferase Fusion Proteins. Clin Chem. 2005; 51 1845-1853
Dr. med. Gerhard Förster
Klinik für HNO-Heilkunde/Plastische Operationen
SRH Wald-Klinikum Gera
Straße des Friedens 122
07548 Gera
Email: gerhard.foerster@wkg.srh.de