Combined immune deficiency, autoantibody formation, and mucocutaneous candidiasis

Effect of hair growth cycles on experimental cutaneous candidiasis in mice

Experimental cutaneous Candida albicans infections were produced in mice by inoculating the organisms onto areas of shaved flank skin where the hair follicles were in either the anagen (growing) or telogen (resting) phase of the growth cycle. Infection with Candida occurred in a majority of animals inoculated on either anagen or telogen skin, and the rate of clearance of the organisms was equivalent for infections on the 2 types of skin. Some of the animals inoculated on anagen skin developed foci of Candida infection in the well-developed hair follicles, below the skin surface. Deep foci of infection were not found after inoculation of the telogen areas. The infections resulted in increases in epidermal thickness and sensitization of the animals to Candida antigens, but these responses were not different between animals inoculated on the 2 types of skin. The results of these experiments indicate that although Candida albicans can infect skin containing either active or resting hair follicles, foci of infection below the skin surface occur only when well-developed hair follicles are present. These findings may have relevance to the consequences of human cutaneous candidiasis.

Host-parasite relationship in opportunistic mycoses

Aspergillosis and mucormycosis are opportunistic fungal infections that share several unique features. The etiologic agents of aspergillosis and mucormycosis are ubiquitous in the environment, but are opportunistic organisms and usually infect only patients predisposed by some underlying disease or treatment. These infections are typically characterized by hyphal tissue invasion and a predilection of the organism for blood vessel invasion with hemorrhage, necrosis, and infarction. Also, these organisms are not dimorphic, like the true pathogenic dimorphic fungi, as they grow both in the environment and within the host in hyphal forms. However, the host must contend with several forms to successfully eliminate them. Each form displays different antigenic and surface features and elicits different host responses. Finally, if germination and hyphal growth occur, the host must compete with a rapidly growing organism that is too large to be ingested by a single cell and so must be handled by extracellular defense mechanisms.

Evaluation of auto-antibodies in chronic mucocutaneous candidiasis without endocrinopathy

Six patients with chronic mucocutaneous candidiasis (CMCC) were investigated for the presence of auto-antibodies during the course of the infection. Sera were tested for antibodies to native DNA (dsDNA) and denatured DNA (ssDNA), mitochondrial and microsomal antigens, smooth muscle, gastric parietal cells, basal membrane and skin intercellular substance, parathyroid glands, thyroglobulin and microsomal antigen, immunoglobulins and for anti-nuclear antibodies. Auto-antibodies were detected by radioimmunoassay, immunofluorescence, hemagglutination and other routine methods. Tests were performed at the end of the observation period, with the same batches of antigens and at the same time for all patients. Organ-specific antibodies (gastric parietal cells and intercellular substance) were found at low titers in five patients. Anti-smooth muscle antibodies were increased in two patients. In four patients antibodies to ssDNA were elevated. Moreover high titers of anti-ssDNA antibodies correlated well with disease activity after treatment with Ketoconazole in four tested patients. The possibility that C. albicans infection may induce auto-antibodies should be considered in assessing their disease activity significance in other chronic infected patients. The mechanisms of appearance of auto-antibodies and their immunopathological significance in CMCC are discussed.

Enhanced antibody responses induced by Candida albicans in mice

Candida albicans may immunopotentiate antibody responses in mice to antigens unrelated to the fungus. This effect occurred best with cell-associated, rather than soluble, antigens. When dead yeasts, cell walls, or a water-soluble candidal polysaccharide were used, immunopotentiation was most dramatic when the antigen and fungal materials were given concomitantly via an intraperitoneal injection. However, mice infected with viable yeasts several days before antigen administration also developed heightened responses to the antigen. The mechanism of the C. albicans-induced adjuvanticity was not defined, but the effect seemed to correlate with induction of inflammation. The presence of C. albicans or other inflammatory agents in the peritoneal cavity caused a more rapid uptake of particulate antigen by the liver. The relationship between this event and immunopotentiation is not known. These studies demonstrate that C. albicans may have profound effects on host immune responses. Because immunological aberrations are commonly found in patients with candidiasis it may be important to determine whether some of these aberrations result from, rather than precede candidiasis.

Murine defense mechanism against Candida albicans infection. I. Collaboration of cell-mediated and humoral immunities in protection against systemic C. albicans infection

Mice immunized with viable C. albicans cells demonstrated a high incidence of cell-mediated and a low incidence of humoral immune response. There was good agreement between the final survival rate of C. albicans infected mice and the rate of simultaneous cell-mediated and humoral immune response acquisition. Immunized mice with positive delayed hypersensitivity (DTH) against C. albicans crude antigen showed significant protection against intravenous challenge with C. albicans. Furthermore, the transfer of immunoglobulins from rabbit anti-C. albicans serum to DTH-positive mice enhanced protection, while it did not protect control mice against a subsequent challenge with C. albicans. These results suggest that cell-mediated immunity plays a major role and humoral immunity a side role in the defense mechanism(s) of C. albicans infected mice.

Chronic mucocutaneous candidiasis. Immunologic studies of three generations of a single family

A family consisting of eight members in three generations (age 10 months to 53 years) affected with chronic mucocutaneous candidiasis was studied along with three unaffected relatives. Dermatophytosis, loss of teeth and recurrent viral infections were present in some members. Results of tests for endocrinologic, muscle or liver disease, thymoma, iron deficiency, antitissue antibodies and malabsorption were normal in all patients. Antibody function and levels, B cell counts, serum complement, leukocyte enzymes, chemotaxis, phagocytosis and adherence were normal in all members. Plasma inhibitors to lymphocyte transformation and leukocyte inhibitory factor were not found. No unique HLA haplotype or antigen segregated in this family. Evaluation of cell-mediated immunity revealed total cutaneous anergy in three of eight whereas four of the other five had negative lymphocyte transformation and skin tests to Candida but responded normally to other antigens. Leukocyte inhibitory factor was not produced to Candida antigen in all four patients tested. T cell counts were within normal limits in all. Extensive evaluation of all limbs of the immune system in this family revealed a defect in cell-mediated immunity to Candida that appeared to be inherited as a dominant characteristic.

[Defective polymorphonuclear leukocyte function in chronic granulomatous muco-cutaneous candidiasis (author's transl)]

Chronic granulomatous muco-cutaneous candidiasis is reported in a 12-year-old boy who died of pulmonal cryptococcosis. Chemotactic and phagocytic functions of the neutrophilic polymorphonuclear leukocytes were deficient while the cell mediated immunity was not disturbed and no decrease of immunoglobulins and complement factors--especially C3 and C5--was found in the serum. The possibility is considered that the disturbance of lymphocyte mediated immune response is the normal, but not only fundamental aetiological factor of chronic muco-cutaneous candidiasis.