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Ma WW, Wang LC, Zhao DA, Wei N, Cui JW, Li SJ. Analysis of T-lymphocyte subsets and risk factors in children with tuberculosis. Tuberculosis (Edinb) 2024; 146:102496. [PMID: 38401266 DOI: 10.1016/j.tube.2024.102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Tuberculosis (TB) is not only related to infection but also involves immune factors. This study explores the changes in T-lymphocyte subsets in children with TB who are human immunodeficiency virus (HIV)-negative and examines their relationship using chest computed tomography (CT) scans. Additionally, the study identifies risk factors for severe TB (STB) in children and establishes relevant risk prediction models. METHODS We recruited 235 participants between 2018 and 2022, comprising 176 paediatric patients with TB who were HIV-negative and 59 age-matched children with bacterial community-acquired pneumonia (CAP). We quantitatively analysed and compared T-lymphocyte subsets between the two groups and among different types of TB infection. Both univariate and multivariate analyses of clinical and laboratory characteristics were conducted to identify independent risk factors for STB in children and to establish a risk prediction model. RESULTS The absolute counts of CD3, CD4 and CD8 T-cells in children with TB infection decreased significantly compared with bacterial CAP. The percentage of CD8 T-cells increased, whereas the percentage of CD4 T-cells did not change significantly. The absolute count of CD3, CD4 and CD8 T-cells in extrapulmonary TB (EPTB) was significantly higher than in extra-respiratory TB, with unchanged subset percentages. According to chest CT lesion classification, CD4 T-cell counts decreased significantly in S3 compared with S1 or S2, with no significant change in CD3 and CD8 T-cell counts and percentages. No significant differences were observed in lymphocyte subset counts and percentages between S1 and S2. Univariate analyses indicated that factors such as age, symptom duration, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate, prealbumin level, albumin level, globulin level, albumin/globulin (A/G) ratio, high-sensitivity C-reactive protein (Hs-CRP) level and CD4 and CD8 T-cell counts are associated with STB. Multivariate logistic regression analysis revealed that age, Hs-CRP level, NLR, symptom duration and A/G ratio are independent risk factors for STB in children. Increased age, Hs-CRP levels and NLR, along with decreased A/G, correlate with increased susceptibility to STB. A nomogram model, based on these independent risk factors, demonstrated an area under the receiver operating characteristics curve of 0.867 (95% CI: 0.813-0.921). Internal verification confirmed the model's accuracy, with the calibration curve approaching the ideal and the Hosmer-Lemeshow goodness-of-fit test showing consistent results (χ2 = 12.212, p = 0.142). CONCLUSION In paediatric patients with TB, the absolute counts of all lymphocyte subsets were considerably reduced compared with those in patients with bacterial CAP. Clinicians should consider the possibility of EPTB infection in addition to respiratory infections in children with TB who have higher CD3, CD4 and CD8 T-cell counts than the ERTB group. Furthermore, CD4 T-cell counts correlated closely with the severity of chest CT lesions. Age, symptom duration, A/G ratio, Hs-CRP level and NLR were established as independent risk factors for STB. The nomogram model, based on these factors, offers effective discrimination and calibration in predicting STB in children.
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Affiliation(s)
- Wei-Wei Ma
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Ling-Chao Wang
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - De-An Zhao
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Na Wei
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Jun-Wei Cui
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China
| | - Shu-Jun Li
- The First Clinical College of Xinxiang Medical University, Henan, Xinxiang, 453000, China.
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Zanon IDB, Meves R, Klautau GB. The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated
*. Rev Bras Ortop 2023; 58:92-100. [PMID: 36969768 PMCID: PMC10038726 DOI: 10.1055/s-0042-1756638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/18/2022] [Indexed: 03/26/2023] Open
Abstract
Objective
To describe the clinico-epidemiological, laboratory, and radiological characteristics of tuberculous spondylodiscitis in the Brazilian population, and to assess whether there are differences between patients in whom the etiological agent in Pott disease was isolated or not.
Methods
Patients diagnosed with tuberculosis (TB) of the spine (Pott disease) underwent follow-up between 2009 and 2019 at a quaternary hospital and were divided into 2 groups: successful isolation (SI) of the etiological agent (through bacilloscopy, culture, or positive molecular rapid test) and unsuccessful isolation (UI) of the etiological agent.
Results
From a total of 26 patients diagnosed with TB of the spine, 21 (80.7%) were male, with a mean age of 40 ± 22.5 years. The average lymphocyte counts were higher in the UI group (25.35 ± 13.08;
p
= 0.025) compared to the SI group (14.18 ± 7.48). Moreover, the monocyte/lymphocyte ratio was lower in the UI group (0.39 ± 0.22;
p
= 0.009) than in the SI group (0.89 ± 0.65). Relative lymphocyte counts higher than or equal to 16.7 had a sensitivity of 76.9% and specificity of 62.5% in the UI group. Values higher than or equal to 0.58 for the monocyte/lymphocyte ratio showed a sensitivity of 84.6% and specificity of 75.0% in the UI group.
Conclusion
No differences were observed regarding the clinico-epidemiological and radiological characteristics of the two experimental groups. However, the UI group had higher lymphocyte counts and a lower monocyte/lymphocyte ratio.
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Affiliation(s)
- Igor de Barcellos Zanon
- Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Endereço para correspondência Igor de Barcellos Zanon, MD, MSc Rua Doutor Cesário Motta Júnior112, Vila Buarque, São Paulo, SPBrasil
| | - Robert Meves
- Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Giselle Burlamaqui Klautau
- Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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Scioscia G, Lacedonia D, Giuffreda E, Caccavo I, Quarato CMI, Soccio P, Tondo P, Sassani EV, Pescatore D, Foschino Barbaro MP. Adaptive immunity in different CT patterns of active tuberculosis and possible variability according to patients' geographic provenience. Front Med (Lausanne) 2022; 9:890609. [PMID: 36160177 PMCID: PMC9489992 DOI: 10.3389/fmed.2022.890609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIt is still unclear if low lymphocyte levels are directly related to immunological modifications induced by the TB infection or if they depend on the general pre-existing health impairment of affected patients. Our aim was to detect eventual differences in the immunological status of patients with pulmonary TB compared to an age and sex-matched group of hospitalized patients with other bacterial community-acquired pneumonia (CAP). In addition, we tried to assess an association between alterations in the peripheral lymphocyte subsets and the development of different CT patterns of active TB and to discover differences in the immunological status and in the radiological patterns of TB presentation between patients of different geographic proveniences.MethodsThis observational study included 48 patients with TB and 48 sex- and age-matched patients affected by other bacterial CAP. The presence of HIV/AIDS, other immunocompromising conditions, and confounding chronic pulmonary comorbidities was excluded. Flow cytometry was performed on all the enrolled subjects at admission, before starting the appropriate antibiotic therapy. Patients with TB also underwent a computed tomography (CT) scan.ResultsPatients with TB showed a decrease in the absolute count of all the lymphocyte subsets compared to the CAP group. Only the reduction in the percentage of CD4+ T-lymphocytes was significant, while the percentage of CD8+ T-lymphocytes was significantly increased. Patients presenting exudative forms with atypical locations of TB showed a significant reduction in the absolute count and percentage of CD19+ B-lymphocytes compared to those affected by productive TB forms with the typical location. Despite being younger, our black Sub-Saharan Africans showed a significant reduction in the CD4+ T-lymphocytes compartment and a higher prevalence of atypical and exudative forms of TB compared with white Europeans.ConclusionTuberculosis itself may alter peripheral blood lymphocyte subsets compared to other CAP. An impaired CD19+ B-lymphocyte compartment may result in an abnormal exudative response in atypical locations and a suboptimal bacterial control. Other constitutive or environmental causes may influence immunological differences found in patients with TB, particularly in case of different geographic origins. Anyhow, flow cytometry may be of great value in evaluating the immune function of these patients.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy
| | - Ernesto Giuffreda
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy
| | - Incoronata Caccavo
- Internistic Department, Institute of Respiratory Disease, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy
- *Correspondence: Carla Maria Irene Quarato
| | - Piera Soccio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Dalila Pescatore
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy
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Comparing Current and Next-generation Humanized Mouse Models for Advancing HIV and HIV/Mtb Co-infection Studies. Viruses 2022; 14:v14091927. [PMID: 36146734 PMCID: PMC9500899 DOI: 10.3390/v14091927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
In people living with HIV, Mycobacterium tuberculosis (Mtb) is the major cause of death. Due to the increased morbidity/mortality in co-infection, further research is urgently required. A limiting factor to research in HIV and HIV/Mtb co-infection is the lack of accessible in vivo models. Next-generation humanized mice expressing HLA transgenes report improved human immune reconstitution and functionality, which may better recapitulate human disease. This study compares well-established huNRG mice and next-generation HLA I/II-transgenic (huDRAG-A2) mice for immune reconstitution, disease course, and pathology in HIV and TB. HuDRAG-A2 mice have improved engraftment of key immune cell types involved in HIV and TB disease. Upon intravaginal HIV-1 infection, both models developed significant HIV target cell depletion in the blood and tissues. Upon intranasal Mtb infection, both models sustained high bacterial load within the lungs and tissue dissemination. Some huDRAG-A2 granulomas appeared more classically organized, characterized by focal central necrosis, multinucleated giant cells, and foamy macrophages surrounded by a halo of CD4+ T cells. HIV/Mtb co-infection in huNRG mice trended towards worsened TB pathology and showed potential for modeling co-infection. Both huNRG and huDRAG-A2 mice are viable options for investigating HIV and TB, but the huDRAG-A2 model may offer advantages.
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5
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Baluku JB, Musaazi J, Mulwana R, Mugabo AR, Bongomin F, Katagira W. Prevalence and Predictors of CD4+ T-Lymphocytopenia Among HIV-Negative Tuberculosis Patients in Uganda. Res Rep Trop Med 2020; 11:45-51. [PMID: 32612406 PMCID: PMC7323690 DOI: 10.2147/rrtm.s252550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose CD4+ T-lymphocytopenia is a risk for tuberculosis (TB) infection, reactivation and severe disease. We sought to determine the prevalence and predictors of CD4 T-lymphocytopenia among HIV-negative patients with bacteriologically confirmed TB in Uganda. Patients and Methods Eligible participants were adult HIV-negative patients with bacteriologically confirmed TB at the National TB Treatment Centre in Uganda. CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry. We defined CD4+ T-lymphocytopenia as a CD4+ T-lymphocyte count of <418 cells/mm3 as per the population estimate for Ugandans. We performed logistic regression analysis to determine predictors of CD4+ T-lymphocytopenia. Results We enrolled 216 participants whose mean age (standard deviation (±SD)) was 32.5 (±12.1) years, of whom 146 (67.6%) were males. The prevalence of CD4+ T-lymphocytopenia was 25% (54/216) (95% confidence interval (CI): 19.6-31.2%). Patients with anaemia (adjusted odds ratio (aOR): 3.83, 95% CI: 1.59-9.23, p = 0.003), weight loss (aOR: 3.61, 95% CI: 1.07-12.23, p = 0.039) and a low CD8+ T-cell count (aOR: 6.10, 95% CI: 2.68-13.89, p < 0.001) were more likely to have CD4+ T-lymphocytopenia while those with monocytosis (aOR: 0.35, 95% CI: 0.14-0.89, p = 0.028) were less likely to have CD4+ T-lymphocytopenia. Conclusion There was a high prevalence of CD4+ T-lymphocytopenia among HIV-negative TB patients. Patients with weight loss, anaemia and a low CD8+ count were more likely to have CD4+ T-lymphocytopenia while those with monocytosis were less likely to have CD4+ lymphocytopenia. The findings suggest that CD4+ lymphocytopenia is indicative of severe disease and globally impaired cell-mediated immune responses against TB.
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Affiliation(s)
- Joseph Baruch Baluku
- Mulago National Referral Hospital, Pulmonology Division, Kampala, Uganda.,Mildmay Uganda, Kampala, Uganda.,Makerere University Lung Institute, Kampala, Uganda
| | - Joseph Musaazi
- Makerere University Infectious Disease Institute, Kampala, Uganda
| | - Rose Mulwana
- Mulago National Referral Hospital, Pulmonology Division, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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6
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Li K, Ran R, Jiang Z, Fan C, Li T, Yin Z. Changes in T-lymphocyte subsets and risk factors in human immunodeficiency virus-negative patients with active tuberculosis. Infection 2020; 48:585-595. [PMID: 32472529 PMCID: PMC7395032 DOI: 10.1007/s15010-020-01451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/21/2020] [Indexed: 11/08/2022]
Abstract
Purpose Immune function imbalance is closely associated with the occurrence and development of infectious diseases. We studied the characteristics of changes in T-lymphocyte subsets and their risk factors in HIV-negative patients with active tuberculosis (ATB). Methods T-lymphocyte subsets in 275 HIV-negative ATB patients were quantitatively analyzed and compared with an Mycobacteriumtuberculosis-free control group. Single-factor and multifactor analyses of clinical and laboratory characteristics of patients were also conducted. Results In ATB patients, CD4 and CD8 T-cell counts decreased, and the levels were positively interrelated (r = 0.655, P < 0.0001). After 4 weeks of antituberculosis treatment, CD4 and CD8 T-cell counts increased significantly but remained lower than in the control group. CD4 and CD8 cell counts were negatively associated with the extent of lesions detected in the chest by computed tomography (all P < 0.05). Although not reflected in the CD4/CD8 ratio, CD4 and CD8 cell counts differed between drug-resistant TB patients and drug-susceptible TB patients (P = 0.030). The multivariate analysis showed prealbumin, alpha-1 globulin, body mass index, and platelet count were independent risk factors for decreased CD4 cell count (all P < 0.05), while age and platelet count were independent risk factors for decreased CD8 cell count (all P < 0.05). Conclusion CD4 and CD8 T-cell counts showed the evident value in predicting ATB severity. An increase in the CD4/CD8 ratio may be a critical clue of drug resistance in ATB. Although the factors influencing CD4 and CD8 are not identical, our results indicated the importance of serum protein and platelets to ATB patients’ immune function. Electronic supplementary material The online version of this article (10.1007/s15010-020-01451-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kui Li
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, Shaanxi, China.,Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Hubei, China
| | - Renyu Ran
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, Shaanxi, China
| | - Zicheng Jiang
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, Shaanxi, China.,Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Hubei, China
| | - Chuanqi Fan
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, Shaanxi, China
| | - Tao Li
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, Shaanxi, China
| | - Zhiguo Yin
- Department of Pharmacy, Ankang Central Hospital, No. 85, South Jinzhou Road, Hanbin District, Ankang, 725000, Shaanxi, China.
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7
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T lymphocyte subpopulations and intestinal helminthes profile among tuberculosis patients co-infected with HIV before and after anti tubercular treatment at University of Gondar Hospital, Northwest Ethiopia. BMC Infect Dis 2020; 20:109. [PMID: 32033581 PMCID: PMC7006099 DOI: 10.1186/s12879-020-4845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis continues to be a health problem of both developed and developing countries, and its incidence has currently increased due to HIV induced immune suppression. HIV-co-infection decreases the total number of CD4+ T cells since the virus preferentially replicates with in activated CD4+ T cells and macrophages, resulting in the disruption of granuloma to contain M. tuberculosis. In this study, we investigated the change in T lymphocyte subpopulations before and after anti-tubercular treatment and the effect of intestinal parasites on the cell populations of tuberculosis patients before the initiation of anti TB treatment. Method A prospective cohort study was conducted in the outpatient TB Clinic, University of Gondar hospital between January 2014 and August 2015. Blood samples were collected from 80 newly diagnosed TB patients with and without HIV co-infection. The mean CD4+ and CD8+ T lymphocyte counts of the patients were assessed before and after the course of anti-TB treatment. The mean values of T lymphocytes of TB, TB/HIV co-infected patients and of the control groups were compared. Data was analyzed by SPSS version 16 and the graph pad prism software. Results A total of 80 tuberculosis patients 40 of whom were co-infected with HIV participated in our study. The mean CD4 + T lymphocytes counts of the TB/HIV cohort were 354.45 ± 138cell/μl, and the mean CD8+ cell counts were 926.82 ± 384cell/μl. There were significant changes in the mean CD4+ and CD8+ T cell counts after the course of anti-TB treatment in both groups of patients(p < 0.05). However, no statistically significant differences were observed in the mean CD4 + and CD8+ T cell counts of helminthes infected and non-infected patients (P > 0.05). Conclusion We found significantly lower CD4+ T cell counts among TB infected HIV negative patients compared with controls who showed that TB was the cause of non–HIV-associated declination of circulating CD4 counts, and the reduction was reversible with anti-tubercular treatment in both HIV-negative and ART naïve TB-HIV co-infected patients.
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8
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Venturini E, Lodi L, Francolino I, Ricci S, Chiappini E, de Martino M, Galli L. CD3, CD4, CD8, CD19 and CD16/CD56 positive cells in tuberculosis infection and disease: Peculiar features in children. Int J Immunopathol Pharmacol 2019; 33:2058738419840241. [PMID: 30957643 PMCID: PMC6454648 DOI: 10.1177/2058738419840241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pathogenesis of mycobacterial infection has been extensively studied determining
the fundamental role of host immunocompetence in disease progression. Cellular
adaptive immunity, in particular CD4+ cells, has shown to be crucial in the host
defence. A role of cytotoxic lymphocytes and humoral immunity has also been
established. However, few studies have been performed in low endemic countries
on immunological correlates of tuberculosis in paediatric patients. The present
study aims to fill this gap analysing the distribution and the absolute values
of the main lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+ and CD16+/CD56+)
in the different stages of tubercular infection in human immunodeficiency
virus–negative children living in low tubercular endemic countries. Results
obtained in children with latent tuberculosis, active tuberculosis and healthy
controls were compared. Moreover, quantitative analysis of interferon-γ levels
of mitogen-induced response was carried out within the different study groups.
The aim of this analysis was to enforce the comprehension of immune
modifications subsequent to Mycobacterium tuberculosis
infection. The major finding of our study was CD3+ and CD4+ absolute and
percentage depletion in children with active tuberculosis versus healthy
controls. Moreover, severe forms of active tuberculosis showed a marked
reduction in the CD4+ percentage in the context of a systemic impairment which
affects globally the absolute count of all peripheral lymphocyte subsets tested.
A relative increase of natural killer cells was proved in infected patients,
whereas no differences in B cells among the study groups were detected.
Mitogen-induced interferon-γ levels were significantly higher in children with
latent tuberculosis when compared to active tuberculosis and healthy controls,
demonstrating effective immune activation in those patients able to control the
infection.
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Affiliation(s)
| | | | | | | | | | - Maurizio de Martino
- Maurizio de Martino, Department of Health
Sciences and Anna Meyer Children’s University Hospital, University of Florence,
viale Pieraccini 24, 50139 Florence, Italy.
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Díaz A, Bongiovanni B, D’Attilio L, Santucci N, Dídoli G, Fernández RDV, Kovalevski L, Lioi S, Gardeñez W, Brandan N, Nannini LJ, Besedovsky H, del Rey A, Bottasso O, Bay ML. The clinical recovery of tuberculosis patients undergoing specific treatment is associated with changes in the immune and neuroendocrine responses. Pathog Dis 2017; 75:4033034. [DOI: 10.1093/femspd/ftx087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ariana Díaz
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Luciano D’Attilio
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Natalia Santucci
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Griselda Dídoli
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Rocío del Valle Fernández
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Leandro Kovalevski
- Facultad de Ciencias Económicas y Estadística, UNR, Escuela de Estadística, 2000 Rosario, Santa Fe, Argentina
| | - Susana Lioi
- Laboratorio Central Rosario, Hospital Provincial del Centenario, 2000 Rosario, Santa Fe, Argentina
| | - Walter Gardeñez
- Servicio de Neumonología, Hospital Provincial del Centenario, 2000 Rosario, Santa Fe, Argentina
| | - Nadia Brandan
- Servicio de Neumonología, Hospital Escuela Eva Perón, 2152 Granadero Baigorria, Santa Fe, Argentina
| | - Luis J Nannini
- Servicio de Neumonología, Hospital Escuela Eva Perón, 2152 Granadero Baigorria, Santa Fe, Argentina
| | - Hugo Besedovsky
- Institute of Physiology and Pathophysiology, Philipps University, Faculty of Medicine, 35037 Marburg, Germany
| | - Adriana del Rey
- Institute of Physiology and Pathophysiology, Philipps University, Faculty of Medicine, 35037 Marburg, Germany
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - María Luisa Bay
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
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Hussain T, Kulshreshtha KK, Yadav VS, Katoch K. CD4+, CD8+, CD3+ cell counts and CD4+/CD8+ ratio among patients with mycobacterial diseases (leprosy, tuberculosis), HIV infections, and normal healthy adults: a comparative analysis of studies in different regions of India. J Immunoassay Immunochem 2015; 36:420-43. [PMID: 25350657 DOI: 10.1080/15321819.2014.978082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In this study, we estimated the CD4+, CD8+, CD3+ cell counts and the CD4/CD8 ratio among normal healthy controls (adults and children), leprosy patients (without any complications and during reactional states), TB patients (with and without HIV), and HIV-positive patients (early infection and full-blown AIDS) and correlated the changes with disease progression. In our study, it was observed that among adults, CD4+ cell counts ranged from 518-1098, CD8+ from 312-952, whereas CD4/CD8 ratio from 0.75-2.30. Among children, both CD4+ and CD8+ cells were more and the CD4/CD8 ratio varied from 0.91-3.17. With regard to leprosy patients, we observed that CD4+ and CD8+ cell counts were lower among PB (pauci-bacillary) and MB (multi-bacillary) patients. CD4/CD8 ratio was 0.99 ± 0.28 among PB patients while the ratio was lower, 0.78 ± 0.20, among MB patients. CD4+ cell counts were raised during RR (reversal reactions) and ENL (erythema nodosum leprosum) among the PB and MB patients whereas the CD8+ cell counts were lower among PB and MB patients. CD4/CD8 ratio doubled during reactional episodes of RR and ENL. Among the HIV-negative tuberculosis (TB) patients, both the CD4+ and CD8+ cell counts were found to be less and the CD4/CD8 ratio varied between 0.53-1.75. Among the HIV-positive TB patients and HIV-positive patients, both the CD4+ and CD8+ cells were very less and ratio drops significantly. In the initial stages of infection, as CD4+ counts drop, an increase in the CD8+ cell counts was observed and the ratio declines. In full-blown cases, CD4+ cell counts were very low, 3-4 to 54 cells, CD8+ cells from 12-211 and the ratio drops too low. This study is the first of its kind in this region of the country and assumes importance since no other study has reported the values of CD4+ and CD8+ T-lymphocyte counts among patients with mycobacterial diseases (leprosy and TB), HIV infections along with normal healthy individuals of the region, and correlation with clinical presentations of patients.
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Affiliation(s)
- Tahziba Hussain
- a HIV/AIDS Unit, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, (Indian Council of Medical Research) , Tajganj , Agra , India
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Atomsa D, Abebe G, Sewunet T. Immunological markers and hematological parameters among newly diagnosed tuberculosis patients at Jimma University Specialized Hospital. Ethiop J Health Sci 2015; 24:311-8. [PMID: 25489195 PMCID: PMC4248030 DOI: 10.4314/ejhs.v24i4.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Tuberculosis (TB) is a cause of 1.2–1.5 million deaths worldwide, including deaths from TB among HIV positive people. Determining the extent of immune cells belonging to cell mediated immunity and haematological parameters is critical to maximize the potential benefit of anti-tubercular treatment and case management. Materials and Methods Comparative cross sectional study was conducted to determine the white blood cell (WBC) count, CD4, CD8, haemoglobin (Hgb), red blood cell (RBC) count, mean corpuscular haemoglobin (MCHC), mean corpuscular volume (MCV) between newly diagnosed TB patients and apparently healthy controls (HCs). Results From consecutively enrolled 108 TB patients, pulmonary TB (PTB) accounted for 48(44.4%), TB lymphadenitis accounted for 48(44.4%), and disseminated/miliary TB accounted for 12(11.1%). Analysis of variance revealed that mean ± SD of CD4 count of male TB patients (650 ± 224cells/µl) was significantly lower than male control group (883 ± 256 cells/µl) (p= 0.001). In a similar manner, the mean CD4 count of female TB patients (793 ± 332cells/µl) was lower than female control group (975 ± 300 cells/µl) (p=0.001). There was no statistically significant difference in CD8 counts between cases and controls for both genders. Forty (37.0%) TB patients had developed anaemia of whom 22(55%) were among PTB, 13(32.5%) from tuberculous lymphadenitis and 5(20%) from disseminated TB. Morphologically, from all anaemia among TB patients, normocytic normochromic anaemia accounted for 15(37.5%) followed by normocytic hypochromic anaemia 13(30.4%). Conclusion CD4 lymphopenia was significant among TB patients. Granulocyte count was increased. Mild anaemia was found major haematological abnormality among newly diagnosed TB patients.
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Affiliation(s)
- Dereje Atomsa
- Department of Medical Laboratory Science and Pathology, Jimma University, Ethiopia
| | - Gemeda Abebe
- Department of Medical Laboratory Science and Pathology, Jimma University, Ethiopia
| | - Tsegaye Sewunet
- Department of Medical Laboratory Science and Pathology, Jimma University, Ethiopia
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Kapoor N, Pawar S, Sirakova TD, Deb C, Warren WL, Kolattukudy PE. Human granuloma in vitro model, for TB dormancy and resuscitation. PLoS One 2013; 8:e53657. [PMID: 23308269 PMCID: PMC3538642 DOI: 10.1371/journal.pone.0053657] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 12/04/2012] [Indexed: 12/04/2022] Open
Abstract
Tuberculosis (TB) is responsible for death of nearly two million people in the world annually. Upon infection, Mycobacterium tuberculosis (Mtb) causes formation of granuloma where the pathogen goes into dormant state and can live for decades before resuscitation to develop active disease when the immune system of the host is weakened and/or suppressed. In an attempt to better understand host-pathogen interactions, several groups have been developing in vitro models of human tuberculosis granuloma. However, to date, an in vitro granuloma model in which Mtb goes into dormancy and can subsequently resuscitate under conditions that mimic weakening of the immune system has not been reported. We describe the development of a biomimetic in vitro model of human tuberculosis granuloma using human primary leukocytes, in which the Mtb exhibited characteristics of dormant mycobacteria as demonstrated by (1) loss of acid-fastness, (2) accumulation of lipid bodies (3) development of rifampicin-tolerance and (4) gene expression changes. Further, when these micro granulomas were treated with immunosuppressant anti-tumor necrosis factor-alpha monoclonal antibodies (anti-TNFα mAbs), resuscitation of Mtb was observed as has been found in humans. In this human in vitro granuloma model triacylglycerol synthase 1deletion mutant (Δtgs1) with impaired ability to accumulate triacylglycerides (TG), but not the complemented mutant, could not go into dormancy. Deletion mutant of lipY, with compromised ability to mobilize the stored TG, but not the complemented mutant, was unable to come out of dormancy upon treatment with anti-TNFα mAbs. In conclusion, we have developed an in vitro human tuberculosis granuloma model that largely exhibits functional features of dormancy and resuscitation observed in human tuberculosis.
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Affiliation(s)
- Nidhi Kapoor
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Santosh Pawar
- Sanofi Pasteur, VaxDesign Campus, Orlando, Florida, United States of America
| | - Tatiana D. Sirakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Chirajyoti Deb
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - William L. Warren
- Sanofi Pasteur, VaxDesign Campus, Orlando, Florida, United States of America
| | - Pappachan E. Kolattukudy
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
- * E-mail:
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Mhmoud NA, Fahal AH, van de Sande WWJ. CD4+ T-lymphocytopenia in HIV-negative tuberculosis patients in Sudan. J Infect 2012; 65:370-2. [PMID: 22728173 DOI: 10.1016/j.jinf.2012.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 11/30/2022]
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14
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ICOS, SLAM and PD-1 expression and regulation on T lymphocytes reflect the immune dysregulation in patients with HIV-related illness with pulmonary tuberculosis. J Int AIDS Soc 2012; 15:17428. [PMID: 22713261 PMCID: PMC3499801 DOI: 10.7448/ias.15.2.17428] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 05/15/2012] [Accepted: 03/15/2012] [Indexed: 12/11/2022] Open
Abstract
Background Tuberculosis (TB) continues to be the most frequent cause of illness and death from an infectious agent globally, and its interaction with HIV is having devastating effects. To investigate how HIV alters the immune response to Mycobacterium tuberculosis (Mtb), we assessed basal and Mtb-induced proliferation, cytokine production, and expression of signalling lymphocytic activation molecule (SLAM), inducible costimulator (ICOS) and programmed death-1 (PD-1) on T lymphocytes from HIV-positive individuals coinfected with TB, HIV-positive subjects, TB patients and healthy donors (HD). Findings HIV-TB patients showed increased ICOS, SLAM and PD-1 basal levels on T lymphocytes, whereas HIV-positive individuals displayed elevated levels of SLAM and PD-1, TB patients high levels of SLAM, and HD low levels of the three proteins. Mtb-stimulation enhanced ICOS expression in the four groups, but only TB and HD increased SLAM and PD-1 levels. Conclusions These data show the immune deregulation that takes place during the immune response against TB in different study populations.
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15
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Régent A, Kluger N, Bérezné A, Lassoued K, Mouthon L. [Lymphocytopenia: aetiology and diagnosis, when to think about idiopathic CD4(+) lymphocytopenia?]. Rev Med Interne 2012; 33:628-34. [PMID: 22658164 PMCID: PMC7115373 DOI: 10.1016/j.revmed.2012.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/24/2012] [Indexed: 11/16/2022]
Abstract
Une lymphopénie est définie par un nombre de lymphocytes circulants inférieur à 1500/mm3 chez l’adulte et 4500/mm3 chez l’enfant avant huit mois. La lymphopénie peut être globale ou sélective, affectant une population lymphocytaire particulière. Le diagnostic étiologique doit tenir compte de l’âge, du contexte, des manifestations clinicobiologiques associées et des thérapeutiques reçues. Les lymphopénies de l’adulte peuvent être liées schématiquement à : (1) une insuffisance de production (carence en zinc, corticothérapie, déficits immunitaires primitifs…), (2) un excès de catabolisme (radiothérapie, chimiothérapie, traitements immunosuppresseurs, infection par le VIH ou lupus systémique, etc.), (3) une modification de la répartition des lymphocytes (infections virales, choc septique, brûlures étendues, hypersplénisme, granulomatoses, etc.), (4) les étiologies multifactorielles ou non identifiées (insuffisance rénale chronique, certaines hémopathies lymphoïdes, tumeur solide, causes ethniques, etc.). Chez l’enfant, à ces étiologies s’ajoutent d’autres déficits immunitaires primitifs d’expression sévère (défaut des précurseurs thymiques, déficit cytokinique, défaut de synthèse des récepteurs des lymphocytes B et T et défaut de la transduction du signal ou des interactions cellulaires). La lymphopénie CD4+ idiopathique de l’adulte est un diagnostic d’élimination. Cette affection rare se définit par une lymphopénie T CD4+ inférieure ou égale à 300/mm3 ou inférieure ou égale à 20 % des lymphocytes totaux, persistante en l’absence de diagnostic alternatif. Elle peut être asymptomatique, s’associer à des infections à germes opportunistes, ou se compliquer de symptômes auto-immuns (en particulier cytopénies) ainsi que de néoplasies. Le traitement, calqué sur la prise en charge des patients infectés par le VIH, peut nécessiter le recours à une immunothérapie spécifique dont le bénéfice clinique reste à évaluer.
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Affiliation(s)
- A Régent
- Université Paris Descartes, 12, rue de l'École de médecine, 75270 Paris cedex 06, France
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Natural killer cell activation distinguishes Mycobacterium tuberculosis-mediated immune reconstitution syndrome from chronic HIV and HIV/MTB coinfection. J Acquir Immune Defic Syndr 2011; 58:309-18. [PMID: 21826013 DOI: 10.1097/qai.0b013e31822e0d15] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND With increased access to antiretroviral treatment (ART), immune reconstitution inflammatory syndrome (IRIS) in Mycobacterium tuberculosis (MTB)-infected populations remains a clinical challenge. We studied a cross-sectional cohort of HIV-infected subjects in Johannesburg (South Africa) to help define the immune correlates that best distinguish IRIS from ongoing MTB cases. METHODS We studied HIV+ subjects developing MTB-related unmasking tuberculosis-related immune reconstitution inflammatory syndrome (uTB-IRIS) after ART initiation; control groups were subjects with HIV and HIV/tuberculosis-coinfected subjects with comparable ART treatment. Testing was conducted with whole blood-based 4-color flow cytometry and plasma-based Luminex cytokine assessment. RESULTS Natural killer cell activation, C-reactive protein, and interleukin 8 serum concentration were significantly higher in uTB-IRIS subjects compared with both control groups. In addition, all MTB-coinfected subjects, independent of clinical presentation, had higher neutrophils and T-cell activation, together with lower lymphocytes, CD4⁺ T-cell, and myeloid dendritic cell counts. Using conditional inference tree analysis, we show that elevated natural killer cell activation in combination with lymphocyte count characterizes the immunological profile of uTB-IRIS. CONCLUSION Our results support a role for innate immune effectors in the immunopathogenesis of unmasking MTB-related IRIS and identify new immune parameters defining this pathology.
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Al-Aska A, Al-Anazi AR, Al-Subaei SS, Al-Hedaithy MA, Barry MA, Somily AM, Buba F, Yusuf U, Al Anazi NA. CD4+ T-lymphopenia in HIV negative tuberculous patients at King Khalid University Hospital in Riyadh, Saudi Arabia. Eur J Med Res 2011; 16:285-8. [PMID: 21810564 PMCID: PMC3353405 DOI: 10.1186/2047-783x-16-6-285] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/16/2011] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis (Tb) is a chronic infectious disease in which the cellular immunity (specifically CD4+ and CD8 lymphocytes) provides the most important defense in controlling infection. CD4 lymphopenia is a well-defined risk factor for the development of active tuberculosis in patients infected with Human Immunodeficiency Virus. In HIV - negative patients, CD4 and CD8 cell count suppression has been associated with Tb infection. Our study was designed to determine the baseline and post-treatment values of CD4 and CD8 in HIV negative patients diagnosed with active Tb in Saudi Arabian patients. We recruited twenty-eight, non-HIV patients with tuberculosis for the study group comprising 16 males and 12 females with either disseminated or localized active Tb infection. Two control groups were selected one of twenty-one matched healthy controls and the second of forty-two subjects from pool of controls of an ongoing study in same population for normal CD4 and CD8 counts. The baseline pre-treatment CD4 and CD8 counts in the study group were significantly lower than either control group. Specifically the mean ± SD of CD4 counts were 556.79 ± 298.81 in the study group vs 1,132.38 ± 259.90 in control group 1 and 1,424.38 ± 870.98 in control group 2 (p 0.000). Likewise the CD8 counts in the study group were 1,136.00 ± 512.06 vs. 1,461.90 ± 367.02 in control group 1 and 1,495.90 ± 565.32 in control group 2 (p 0.000) respectively. After treatment of tuberculosis, the study patients experienced a significant increase in their mean ± SD CD4 and CD8 cell counts, from 556.79 ± 297.81 to 954.29 ± 210.90 for CD4 cells (p 0.005) and 1136.00 ± 512.06 to 1,316.54 ± 286.17 for CD8 cells (p 0.002). Analysis of study patients with disseminated disease found significantly lower CD4 cells (but not lower CD8 cells) compared to study patients with localized disease, both at baseline and after treatment. The mean ± SD baseline CD4 cells were 247.60 ± 187.80 with disseminated vs 728.56 ± 186.32 for localized disease (p = 0.000) which rose to 842.30 ± 93.55 vs 1016.50 ± 233.51 (p = 0.033) respectively. We conclude that tuberculosis may be associated with CD4 and CD8 lymphopenia even in patients without human immunodeficiency virus infection, there was the tendency of recovery towards normality especially of the CD4 and CD8 counts after treatment, and that disseminated disease is associated specifically with profound CD4 lymphopenia.
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Affiliation(s)
- Abdulkarim Al-Aska
- Department of Medicine, College of Medicine and King Khalid University Hospital,King Saud Hospital, Riyadh, Saudi Arabia.
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18
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Janols H, Bredberg A, Thuvesson I, Janciauskiene S, Grip O, Wullt M. Lymphocyte and monocyte flow cytometry immunophenotyping as a diagnostic tool in uncharacteristic inflammatory disorders. BMC Infect Dis 2010; 10:205. [PMID: 20626864 PMCID: PMC2912311 DOI: 10.1186/1471-2334-10-205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/13/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with uncharacteristic inflammatory symptoms such as long-standing fatigue or pain, or a prolonged fever, constitute a diagnostic and therapeutic challenge. The aim of the present study was to determine if an extended immunophenotyping of lymphocytes and monocytes including activation markers can define disease-specific patterns, and thus provide valuable diagnostic information for these patients. METHODS Whole blood from patients with gram-negative bacteraemia, neuroborreliosis, tuberculosis, acute mononucleosis, influenza or a mixed connective tissue disorders, as diagnosed by routine culture and serology techniques was analysed for lymphocyte and monocyte cell surface markers using a no-wash, no-lyse protocol for multi-colour flow cytometry method. The immunophenotyping included the activation markers HLA-DR and CD40. Plasma levels of soluble TNF alpha receptors were analysed by ELISA. RESULTS An informative pattern was obtained by combining two of the analysed parameters: (i), the fractions of HLA-DR-expressing CD4+ T cells and CD8+ T cells, respectively, and (ii), the level of CD40 on CD14+ CD16- monocytes. Patients infected with gram-negative bacteria or EBV showed a marked increase in monocyte CD40, while this effect was less pronounced for tuberculosis, borrelia and influenza. The bacterial agents could be distinguished from the viral agents by the T cell result; CD4+ T cells reacting in bacterial infection, and the CD8+ T cells dominating for the viruses. Patients with mixed connective tissue disorders also showed increased activation, but with similar engagement of CD4+ and CD8+ T cells. Analysis of soluble TNF alpha receptors was less informative due to a large inter-individual variation. CONCLUSION Immunophenotyping including the combination of the fractions of HLA-DR expressing T cell subpopulations with the level of CD40 on monocytes produces an informative pattern, differentiating between infections of bacterial and viral origin. Furthermore, a quantitative analysis of these parameters revealed the novel finding of characteristic patterns indicating a subacute bacterial infection, such as borreliosis or tuberculosis, or a mixed connective tissue disorder. The employed flow cytometric method is suitable for clinical diagnostic laboratories, and may help in the assessment of patients with uncharacteristic inflammatory symptoms.
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Affiliation(s)
- Helena Janols
- Department of Infectious Diseases, Skane University Hospital, Lund University, 20502 Malmo, Sweden
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Hernandez J, Velazquez C, Valenzuela O, Robles-Zepeda R, Ruiz-Bustos E, Navarro M, Garibay-Escobar A. Low Number of Peripheral Blood B Lymphocytes in Patients with Pulmonary Tuberculosis. Immunol Invest 2010; 39:197-205. [DOI: 10.3109/08820130903586346] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Nikolaeva LG, Maystat TV, Pylypchuk VS, Volyanskii YL, Masyuk LA, Kutsyna GA. Effect of oral immunomodulator Dzherelo in TB/HIV co-infected patients receiving anti-tuberculosis therapy under DOTS. Int Immunopharmacol 2008; 8:845-51. [PMID: 18442788 DOI: 10.1016/j.intimp.2008.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 01/31/2008] [Accepted: 01/31/2008] [Indexed: 11/29/2022]
Abstract
Open-label, phase II clinical trial was conducted in 40 HIV/TB dually infected patients to evaluate the effect of oral immunomodulator Dzherelo on immune and viral parameters. The anti-retroviral therapy naïve patients were randomized into two equal groups to be given anti-tuberculosis therapy (ATT) under DOTS. The arm A, which served as a control, received Isoniazid (H); Rimfapicin (R); Pyrazinamide (Z); Streptomycin (S); and Ethambutol (E), and arm B received 50 drops of Dzherelo twice per day in addition to the daily dose of HRZSE. After 2months the total CD3+ lymphocytes increased from 728 to 921cells/microl (P=0.025) in Dzherelo recipients, whereas in the control group they decreased from 651 to 585 cells (P=0.25). The population of CD4 T-cells expanded in Dzherelo arm (174 to 283; P=0.00003) but declined in ATT group (182 to 174; P=0.34). The CD8 cells fluctuated slightly upward in both groups: 159>180 (P=0.17) and 159>183 (P=0.13). The ratio between CD4/CD8 cells deteriorated in arm A (1.213>0.943; P=0.002) but improved in arm B (1.244>1.536; P=0.007). The percent of CD3+HLA-DR+ activated lymphocytes had fallen in ATT group (22.6>20.5; P=0.004), but rose in Dzherelo recipients (21.5>30.5; P=0.0001). The changes in CD20+ B lymphocytes were insignificant in both arms (28.4%>28.6%; P=0.4) and (27.2%>26.7%; P=0.38). No difference was seen in the amount of CD3-CD16+CD56+ natural killer (NK) cells in arm A (21.3%>22.6%; P=0.1), while in Dzherelo recipients they declined significantly (19.9%>14.5%; P=0.0026). The viral load, measured by plasma RNA-PCR, decreased in Dzherelo group (2174>1558; P=0.002), but increased in ATT group (1907>2076 copies/ml; P=0.03). Dzherelo has a favorable effect on the immune status and viral burden in HIV/TB patients when given as the immunomodulating adjunct to ATT.
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Affiliation(s)
- Lyudmila G Nikolaeva
- Kharkov Regional AIDS Prophylaxis and Prevention Center, Kharkov Medical Academy of Postgraduate Education, 6 Bor'by street, Kharkov 61044, Ukraine
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Deveci F, Akbulut HH, Celik I, Muz MH, İlhan F. Lymphocyte subpopulations in pulmonary tuberculosis patients. Mediators Inflamm 2007; 2006:89070. [PMID: 16883069 PMCID: PMC1592589 DOI: 10.1155/mi/2006/89070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Protection against Mycobacterium
tuberculosis is based on cell-mediated immunity, most importantly
involving CD4+ and CD8+ T-cell subsets.
The aim of this study was to evaluate CD4+
and CD8+ T-cell profiles and CD19+ and
CD3−CD(16+56)+ populations in patients with pulmonary
tuberculosis. CD4+ and CD8+ T cells,
B-lymphocytes, and natural killer (NK) cells were evaluated in 75
active (APTB) and 25 inactive (IPTB) pulmonary tuberculosis cases
and 20 healthy subjects (HCs). The results were compared at
different stages of antituberculosis treatment in the APTB
patients and also according to X-ray findings in the newly
diagnosed APTB patients. The percentages of
CD4+ T cells were significantly lower (P < .01) and those of
CD3−CD(16 + 56)+ cells were significantly higher (P < .01)
in APTB patients than in HCs. CD8+ T cells were significantly
decreased (P < .05), and CD3−CD(16+56)+ cells were significantly increased (P < .01), in IPTB patients compared to
HCs. The percentages of CD4+, CD8+,
CD3−CD19+,
and CD3−CD(16+56)+ cells showed no differences at
different times of the antituberculosis regimen, and different
stages of newly diagnosed APTB patients. APTB
patients have a reduced percentage of circulating CD4+ T
cells and an increased percentage of NK cells compared with
healthy individuals. These cells could play important roles in the
immune response to M tuberculosis infection.
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Affiliation(s)
- Figen Deveci
- Department of Chest Diseases, Faculty of Medicine, Firat University, Elazig 23119, Turkey
- *Figen Deveci:
| | - H. Handan Akbulut
- Department of Immunology, Faculty of Medicine, Firat University, Elazig 23119, Turkey
| | - Ilhami Celik
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine,
Firat University, Elazig 23119, Turkey
| | - M. Hamdi Muz
- Department of Chest Diseases, Faculty of Medicine, Firat University, Elazig 23119, Turkey
| | - Fulya İlhan
- Department of Immunology, Faculty of Medicine, Firat University, Elazig 23119, Turkey
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Bocsi J, Lenz D, Mittag A, Varga VS, Molnar B, Tulassay Z, Sack U, Tárnok A. Automated four-color analysis of leukocytes by scanning fluorescence microscopy using quantum dots. Cytometry A 2006; 69:131-4. [PMID: 16479596 DOI: 10.1002/cyto.a.20217] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Scanning fluorescence microscope (SFM) is a new technique for automated motorized microscopes to measure multiple fluorochrome labeled cells (Bocsi et al., Cytometry A 2004, 61:1-8). AIMS We developed a four-color staining protocol (DNA, CD3, CD4, and CD8) for the lymphocyte phenotyping by SFM. METHODS Organic (Alexa488, FITC, PE-Alexa610, CyChrom, APC) and inorganic (quantum dot (QD) 605 or 655) fluorochromes were used and compared in different combinations. Measurements were performed in suspension by flow cytometer (FCM) and on slide by SFM. RESULTS Both QDs were detectable by the appropriate Axioplan-2 and FCM filters and the AxioCam BW-camera. CD4/CD8 ratios were highly correlated (P = 0.01) between the SFM and FCM. CONCLUSION Automated SFM is an applicable tool for CD4/CD8 ratio determination in peripheral blood samples with QDs.
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Affiliation(s)
- József Bocsi
- Department of Pediatric Cardiology, Heart Center, University Leipzig, Leipzig, Germany.
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Abstract
Lymphopenia is defined as a peripheral lymphocyte count lower than 1500/mm3 in adults and 4500/mm3 in children younger than eight months of age. We propose a classification of lymphopenia according to the mechanism involved: lymphocyte production defects, including primary immune deficiencies and immune deficiencies secondary to malnutrition or zinc deprivation; excess catabolism, due to causes including radiotherapy, chemotherapy, immunosuppressive therapy, HIV infection, and systemic lupus erythematosus; abnormal lymphocyte trapping, including mainly splenomegaly, certain viral infections, septic shock, extended burns, systemic granulomatosis, and corticosteroids; other causes of lymphocytopenia, with mechanisms that remain poorly understood: ethnicity (Ethiopians), lymphoma, renal insufficiency, and idiopathic CD4 lymphocytopenia.
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Affiliation(s)
| | | | | | - Luc Mouthon
- Service de médecine interne, Hôpital Cochin, AP-HP, université Paris-Descartes, faculté de médecine, Paris (75)
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Bunders M, Thorne C, Newell ML. Maternal and infant factors and lymphocyte, CD4 and CD8 cell counts in uninfected children of HIV-1-infected mothers. AIDS 2005; 19:1071-9. [PMID: 15958839 DOI: 10.1097/01.aids.0000174454.63250.22] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effects of antiretroviral treatment (ART) for mother-to-child transmission of HIV and infant/maternal characteristics on total lymphocytes (TLC) and lymphocyte subsets in uninfected children of HIV-1-infected mothers. DESIGN The European Collaborative Study followed 1663 uninfected children from birth until at least 8 years of age using a standard protocol. METHODS Smoothers (running medians) illustrated patterns of immune markers over age by ART exposure and race. Associations between lymphocyte parameters and maternal/infant characteristics were quantified in linear regression analyses using z-scores obtained after modelling log10-transformed TLC, CD4 and CD8 cell counts using the LMS method. Cox proportional hazard models assessed time to TLC, CD4 and CD8 cell counts below the defined cut-off. Covariates included prematurity, gender, race, drug withdrawal and ART exposure. RESULTS Overall, black children had lower TLC, CD4 and CD8 cell counts than white children, and an increased risk of TLC, CD4 and CD8 cell counts below the cut-off. ART exposure was associated with TLC levels (but not with TLC below the cut-off for lymphopenia), with reduced CD4 cell counts in the first year of life, and with reduced CD8 cell counts until at least 8 years of age. Duration and intensity of ART exposure was associated with TLC levels. CONCLUSION The effect of ART exposure in fetal and early life on TLC and CD8 cell counts was prolonged until at least 8 years. These results add to the growing list of adverse effects associated with ART used as prevention of mother-to-child transmission of HIV.
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