Antibody-dependent enhancement of bacterial disease: Prevalence, mechanisms and treatment.

ABSTRACT

Antibody-dependent enhancement (ADE) of viral disease has been demonstrated for infections caused by flaviviruses and influenza viruses, however antibodies that enhance bacterial disease are relatively unknown. Over recent years, a few studies have directly linked antibody in exacerbating bacterial disease. This ADE of bacterial disease has been observed in mouse models and human patients with bacterial infections. This antibody-mediated enhancement of bacterial infection is driven by various mechanisms and are disparate from those found in viral ADE. This review aims to highlight and discuss historic evidence, potential molecular mechanisms and current therapies for ADE of bacterial infection. Based on specific case studies, we report how plasmapheresis has been successfully used in patients to ameliorate infection related symptomatology associated with bacterial ADE. A greater understanding and appreciation of bacterial ADE of infection and disease could lead to better management of infections and inform current vaccine development efforts.