1
|
Interleukin-13 overexpressing mice represent an advanced pre-clinical model for detecting the distribution of anti-mycobacterial drugs within centrally necrotizing granulomas. Antimicrob Agents Chemother 2021; 66:e0158821. [PMID: 34871095 PMCID: PMC9211424 DOI: 10.1128/aac.01588-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Mycobacterium tuberculosis-harboring granuloma with a necrotic center surrounded by a fibrous capsule is the hallmark of tuberculosis (TB). For a successful treatment, antibiotics need to penetrate these complex structures to reach their bacterial targets. Hence, animal models reflecting the pulmonary pathology of TB patients are of particular importance to improve the preclinical validation of novel drug candidates. M. tuberculosis-infected interleukin-13-overexpressing (IL-13tg) mice develop a TB pathology very similar to patients and, in contrast to other mouse models, also share pathogenetic mechanisms. Accordingly, IL-13tg animals represent an ideal model for analyzing the penetration of novel anti-TB drugs into various compartments of necrotic granulomas by matrix-assisted laser desorption/ionization–mass spectrometry imaging (MALDI-MS imaging). In the present study, we evaluated the suitability of BALB/c IL-13tg mice for determining the antibiotic distribution within necrotizing lesions. To this end, we established a workflow based on the inactivation of M. tuberculosis by gamma irradiation while preserving lung tissue integrity and drug distribution, which is essential for correlating drug penetration with lesion pathology. MALDI-MS imaging analysis of clofazimine, pyrazinamide, and rifampicin revealed a drug-specific distribution within different lesion types, including cellular granulomas, developing in BALB/c wild-type mice, and necrotic granulomas in BALB/c IL-13tg animals, emphasizing the necessity of preclinical models reflecting human pathology. Most importantly, our study demonstrates that BALB/c IL-13tg mice recapitulate the penetration of antibiotics into human lesions. Therefore, our workflow in combination with the IL-13tg mouse model provides an improved and accelerated evaluation of novel anti-TB drugs and new regimens in the preclinical stage.
Collapse
|
2
|
[Histopathology of pulmonary tuberculosis]. DER PATHOLOGE 2021; 42:71-77. [PMID: 33475810 DOI: 10.1007/s00292-021-00910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Although typical histological findings of tuberculosis are well known, the diagnosis of nonmicrobiologically proven tuberculosis with the instruments available to pathology is challenging. Indeed, necrotizing epithelioid cell granulomatosis is typical for tuberculosis, but it is also seen in a number of different infectious or noninfectious lung diseases. The tools of microscopy and molecular pathology are suitable for confirming the diagnosis or paving the way to a differential diagnosis, but molecular pathology applied to formalin-fixated and paraffin-embedded material is limited. This should be openly communicated to the referring clinician. After interdisciplinary re-evaluation of the findings, an alternative solution to confirm the diagnosis must therefore be found if the additional examinations are negative.
Collapse
|
3
|
Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020; 56:446-454. [PMID: 35373756 DOI: 10.1016/j.arbr.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 06/14/2023]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
Collapse
Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| |
Collapse
|
4
|
Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, Cresswell F, Miró JM, García-Basteiro AL. Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out. Arch Bronconeumol 2020. [PMID: 31932150 DOI: 10.1016/j.arbres.2019.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.
Collapse
Affiliation(s)
- Emilio Letang
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain.
| | - Jayne Ellis
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Hospital for Tropical Diseases, University College London, London, UK
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Esther C Casas
- Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
| | - Paquita Sánchez
- Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | - Fiona Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| |
Collapse
|
5
|
Wang Y, Wu Q, Zhang W, Zhang N. Tuberculosis and HIV Coinfection–the Challenge in the Prevention, Detection and Treatment of Tuberculosis. Curr Bioinform 2019. [DOI: 10.2174/1574893613666180621153734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Tuberculosis (TB) is still a major public health concern world-wide. The
increasing global burden of TB is linked to HIV infection. HIV-TB coinfection has also
conditioned clinical aspects of the TB. Since the HIV is beginning in the 1980s, the HIV infection
poses a significant challenge in global TB control.
Objective:
In this review we focused on the challenges of epidemiological and clinical feature of
tuberculosis presented by the HIV coinfection.
Method:
The article consists of a summary of the most important effects presented by the HIV
coinfection on epidemiological and clinical feature of tuberculosis. The article analyzes and
summary the causes for these challenges.
Results:
The major challenges to strategy of TB control and clinical feature of TB-HIV coinfection
are presented in this paper.
Conclusion:
HIV/TB co-infection is synergic, interactive and reciprocal with significant impact.
The infection of HIV and Mtb affect each other and the breakdown the immune function in
TB/HIV coinfected individual. HIV infection has changed the strategy of TB control, however
HIV increases global burden of TB, the reduction in the TB incidence rate is far from sufficient.
Atypically clinical manifestations in TB/HIV co-infected patients and increased MDR-TB and
XDR-TB contribute to the challenges in the diagnosis and treatment. Increased complexity of
managing patients requires expertise in the clinical m knowledge. The focused efforts to control
HIV-related TB are of great urgency. These findings will provide insight into the prevention,
detection and treatment of tuberculosis and will guide advances towards tuberculosis control.
Collapse
Affiliation(s)
- Yiyi Wang
- TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, China
| | - Qi Wu
- TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, China
| | - Wei Zhang
- Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University, 100015, Peiking, China
| | - Ning Zhang
- Department of Biomedical Engineering, Tianjin Key Lab of Biomedical Engineering Measurement, Tianjin University, Tianjin, China
| |
Collapse
|
6
|
Gati S, Chetty R, Wilson D, Achkar JM. Utilization and Clinical Value of Diagnostic Modalities for Tuberculosis in a High HIV Prevalence Setting. Am J Trop Med Hyg 2018; 99:317-322. [PMID: 29893198 DOI: 10.4269/ajtmh.17-0965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is a major risk factor for the development of active tuberculosis (TB), one of the deadliest infectious diseases globally. The high mortality associated with the disease can be reduced by early diagnosis and prompt antituberculous treatment initiation. Facilities in TB-endemic regions are increasing the use of nucleic acid amplification (e.g., GeneXpert), which provides rapid results but may have suboptimal sensitivity in HIV-associated TB. Our objective was to evaluate the current practices for TB diagnosis at Edendale Hospital, a large regional hospital in KwaZulu-Natal, South Africa-a TB-endemic region with high HIV prevalence. In this cross-sectional study, all adult inpatients newly started on TB treatment at Edendale were identified over a 6-week period. Demographics, clinical information, diagnostic test results, and outcomes were documented. Pulmonary TB (PTB), extrapulmonary TB (EXTB), and PTB + EXTB were defined as disease evidence in the lungs, other organs, or both, respectively. Ninety-four cases were identified, of which 83% were HIV-associated. Only 30% of all TB patients were microbiologically confirmed, consisting of 7/16 (44%) HIV-uninfected and 21/78 (27%) HIV-infected TB patients. Smear microscopy and mycobacterial culture were seldom ordered. Ultrasound was performed in about one-third of suspected EXTB cases and was valuable in identifying abdominal TB. In this clinical setting with a high incidence of HIV-associated TB, TB diagnosis was more commonly based on clinical assessment and imaging results than on mycobacterial gold standard test confirmation.
Collapse
Affiliation(s)
| | - Rhoda Chetty
- Department of Medicine, Edendale Hospital, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Douglas Wilson
- Department of Medicine, Edendale Hospital, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Jacqueline M Achkar
- Department of Immunology, Albert Einstein College of Medicine, Bronx, New York.,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.,Department of Microbiology, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
7
|
Diedrich CR, O'Hern J, Gutierrez MG, Allie N, Papier P, Meintjes G, Coussens AK, Wainwright H, Wilkinson RJ. Relationship Between HIV Coinfection, Interleukin 10 Production, and Mycobacterium tuberculosis in Human Lymph Node Granulomas. J Infect Dis 2016; 214:1309-1318. [PMID: 27462092 PMCID: PMC5079364 DOI: 10.1093/infdis/jiw313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV)-infected persons are more susceptible to tuberculosis than HIV-uninfected persons. Low peripheral CD4+ T-cell count is not the sole cause of higher susceptibility, because HIV-infected persons with a high peripheral CD4+ T-cell count and those prescribed successful antiretroviral therapy (ART) remain more prone to active tuberculosis than HIV-uninfected persons. We hypothesized that the increase in susceptibility is caused by the ability of HIV to manipulate Mycobacterium tuberculosis-associated granulomas. METHODS We examined 71 excised cervical lymph nodes (LNs) from persons with HIV and M. tuberculosis coinfection, those with HIV monoinfection, and those with M. tuberculosis monoinfection with a spectrum of peripheral CD4+ T-cell counts and ART statuses. We quantified differences in M. tuberculosis levels, HIV p24 levels, cellular response, and cytokine presence within granulomas. RESULTS HIV increased M. tuberculosis numbers and reduced CD4+ T-cell counts within granulomas. Peripheral CD4+ T-cell depletion correlated with granulomas that contained fewer CD4+ and CD8+ T cells, less interferon γ, more neutrophils, more interleukin 10 (IL-10), and increased M. tuberculosis numbers. M. tuberculosis numbers correlated positively with IL-10 and interferon α levels and fewer CD4+ and CD8+ T cells. ART reduced IL-10 production. CONCLUSIONS Peripheral CD4+ T-cell depletion correlated with increased M. tuberculosis presence, increased IL-10 production, and other phenotypic changes within granulomas, demonstrating the HIV infection progressively changes these granulomas.
Collapse
Affiliation(s)
- Collin R Diedrich
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Jennifer O'Hern
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | | | | | | | - Graeme Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Helen Wainwright
- Division of Anatomical Pathology
- Department of Medicine, University of Cape Town, South Africa
| | - Robert J Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
- Francis Crick Institute Mill Hill Laboratory
- Department of Medicine, Imperial College London, United Kingdom
| |
Collapse
|
8
|
Walter ND, de Jong BC, Garcia BJ, Dolganov GM, Worodria W, Byanyima P, Musisi E, Huang L, Chan ED, Van TT, Antonio M, Ayorinde A, Kato-Maeda M, Nahid P, Leung AM, Yen A, Fingerlin TE, Kechris K, Strong M, Voskuil MI, Davis JL, Schoolnik GK. Adaptation of Mycobacterium tuberculosis to Impaired Host Immunity in HIV-Infected Patients. J Infect Dis 2016; 214:1205-11. [PMID: 27534685 DOI: 10.1093/infdis/jiw364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is unknown whether immunosuppression influences the physiologic state of Mycobacterium tuberculosis in vivo. We evaluated the impact of host immunity by comparing M. tuberculosis and human gene transcription in sputum between human immunodeficiency virus (HIV)-infected and uninfected patients with tuberculosis. METHODS We collected sputum specimens before treatment from Gambians and Ugandans with pulmonary tuberculosis, revealed by positive results of acid-fast bacillus smears. We quantified expression of 2179 M. tuberculosis genes and 234 human immune genes via quantitative reverse transcription-polymerase chain reaction. We summarized genes from key functional categories with significantly increased or decreased expression. RESULTS A total of 24 of 65 patients with tuberculosis were HIV infected. M. tuberculosis DosR regulon genes were less highly expressed among HIV-infected patients with tuberculosis than among HIV-uninfected patients with tuberculosis (Gambia, P < .0001; Uganda, P = .037). In profiling of human genes from the same sputa, HIV-infected patients had 3.4-fold lower expression of IFNG (P = .005), 4.9-fold higher expression of ARG1 (P = .0006), and 3.4-fold higher expression of IL10 (P = .0002) than in HIV-uninfected patients with tuberculosis. CONCLUSIONS M. tuberculosis in HIV-infected patients had lower expression of the DosR regulon, a critical metabolic and immunomodulatory switch induced by NO, carbon monoxide, and hypoxia. Our human data suggest that decreased DosR expression may result from alternative pathway activation of macrophages, with consequent decreased NO expression and/or by poor granuloma formation with consequent decreased hypoxic stress.
Collapse
Affiliation(s)
- Nicholas D Walter
- Pulmonary Section, Denver Veterans Affairs Medical Center Integrated Center for Genes, Environment, and Health Division of Pulmonary Sciences and Critical Care Medicine
| | - Bouke C de Jong
- New York University, New York Institute of Tropical Medicine, Antwerp, Belgium Medical Research Council Laboratories, Serrekunda, Gambia
| | - Benjamin J Garcia
- Integrated Center for Genes, Environment, and Health Computational Bioscience Program
| | | | - William Worodria
- Makerere University-UCSF Research Collaboration, Kampala, Uganda
| | - Patrick Byanyima
- Makerere University-UCSF Research Collaboration, Kampala, Uganda
| | - Emmanuel Musisi
- Makerere University-UCSF Research Collaboration, Kampala, Uganda
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine HIV/AIDS Division, University of California-San Francisco (UCSF)
| | - Edward D Chan
- Pulmonary Section, Denver Veterans Affairs Medical Center Department of Academic Affairs and Medicine, National Jewish Health, Denver Division of Pulmonary Sciences and Critical Care Medicine
| | - Tran T Van
- Department of Microbiology and Immunology
| | - Martin Antonio
- Medical Research Council Laboratories, Serrekunda, Gambia
| | | | | | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine
| | - Ann M Leung
- Department of Radiology, Stanford University Medical Center
| | - Andrew Yen
- Department of Radiology, University of California-San Diego
| | | | - Katerina Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Michael Strong
- Integrated Center for Genes, Environment, and Health Computational Bioscience Program
| | - Martin I Voskuil
- Department of Immunology and Microbiology, University of Colorado-Denver Anschutz Medical Campus
| | - J Lucian Davis
- Department of Epidemiology of Microbial Diseases Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
9
|
Diedrich CR, O'Hern J, Wilkinson RJ. HIV-1 and the Mycobacterium tuberculosis granuloma: A systematic review and meta-analysis. Tuberculosis (Edinb) 2016; 98:62-76. [PMID: 27156620 DOI: 10.1016/j.tube.2016.02.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 12/17/2022]
Abstract
Infection with HIV-1 greatly increases the risk of active tuberculosis (TB). Although hypotheses suggest HIV-1 disrupts Mycobacterium tuberculosis (Mtb) granuloma function, few studies have examined this directly. The objective of this study was to determine what evidence exists about the effect HIV-1 co-infection has upon Mtb granulomas. A systematic search of PubMed, Web of Science, and Medline up to 20 March 2015 was conducted, to identify studies comparing Mtb-infected tissue from HIV-1 infected and uninfected persons, or HIV-1 infected persons with stratified peripheral CD4 T cell (pCD4) counts. We summarized findings that focused on how HIV-1 changes granuloma formation, bacterial presence, cellular composition, and cytokine production. Nineteen studies with a combined sample size of 899 persons were included. Although studies frequently were limited by variable or inadequately described definitions of outcomes and analytical methods, HIV-1 was found to be associated with increased bacillary load within Mtb-infected tissue. Reductions in pCD4 counts within co-infected persons associated with both poorer granuloma formation and higher bacterial load. The high degree of heterogeneity among studies combined with experimental limitations made it difficult to conclusively support previously published and prevalent hypotheses about HIV-1/Mtb co-infection granulomas. To elucidate the validity of these hypotheses we have described areas that can be improved in future studies in order to clarify the influence HIV-1 co-infection has upon the Mtb granuloma.
Collapse
Affiliation(s)
- C R Diedrich
- Clinical Infectious Diseases Research Initiative Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
| | - J O'Hern
- Clinical Infectious Diseases Research Initiative Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Royal Hobart Hospital, Tasmania, Australia
| | - R J Wilkinson
- Clinical Infectious Diseases Research Initiative Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Department of Medicine, University of Cape Town, South Africa; Francis Crick Institute Mill Hill Laboratory, London, United Kingdom; Department of Medicine, Imperial College London, W21PG, United Kingdom
| |
Collapse
|
10
|
HIV/AIDS Related Respiratory Diseases. RADIOLOGY OF HIV/AIDS 2014. [PMCID: PMC7121050 DOI: 10.1007/978-94-007-7823-8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lungs are the most commonly involved organ by HIV/AIDS related diseases, and pulmonary infections are the main reasons for the increasing death rate from AIDS. Pathogens of HIV related pulmonary infections include parasites, fungi, mycobacteria, viruses, bacteria and toxoplasma gondii. According to international reports, pathogens have different geographical distribution, which is also closely related to the socioeconomic status of the region to produce varied AIDS related diseases spectra. For instance, in the United States, pneumocystis carnii pneumonia (PCP), tuberculosis and recurrent bacterial pneumonia (at least twice within 1 year) occur frequently in HIV infected patients. An international report published 10 years ago indicated that PCP is the most common and serious pulmonary opportunistic infections in HIV infected patients. Now its incidence has dropped with the application of antiretroviral treatment and preventive measures. PCP will continue to occur initially in patients who are aware of their HIV infection. In addition, HIV related viral and parasitic infections have been reported both domestically and internationally. In this section, the clinical manifestations and imaging findings of HIV related pulmonary infections are analyzed and discussed, which provide effective diagnosis basis, so as to reduce the incidence of HIV-related pulmonary infections.
Collapse
|
11
|
Achkar JM, Casadevall A. Antibody-mediated immunity against tuberculosis: implications for vaccine development. Cell Host Microbe 2013; 13:250-62. [PMID: 23498951 DOI: 10.1016/j.chom.2013.02.009] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is an urgent need for new and better vaccines against tuberculosis (TB). Current vaccine design strategies are generally focused on the enhancement of cell-mediated immunity. Antibody-based approaches are not being considered, mostly due to the paradigm that humoral immunity plays little role in the protection against intracellular pathogens. Here, we reappraise and update the increasing evidence for antibody-mediated immunity against Mycobacterium tuberculosis, discuss the complexity of antibody responses to mycobacteria, and address mechanism of protection. Based on these findings and discussions, we challenge the common belief that immunity against M. tuberculosis relies solely on cellular defense mechanisms, and posit that induction of antibody-mediated immunity should be included in TB vaccine development strategies.
Collapse
Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | | |
Collapse
|
12
|
Wiggill TM, Mayne ES, Willem P. Challenges in lymphoma diagnosis in HIV positive patients in the South African setting. Transfus Apher Sci 2013; 49:157-62. [PMID: 23981653 DOI: 10.1016/j.transci.2013.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
An increase in high grade B-cell lymphomas has been noted in HIV infection. Sub-Saharan Africa is the epicentre of the epidemic and in Gauteng, South Africa >90% of patients with high grade lymphoma tested positive for HIV infection. The diagnosis of lymphoma may be challenging in HIV because of reactive conditions which mimic lymphomas, the atypical clinical presentation and the atypical histological findings. The WHO classification divides lymphomas into discrete categories. Despite this, tumours in HIV positive patients commonly show atypical morphological, immunophenotypic, molecular and cytogenetic features, making exact classification difficult. This has lead to an increase in the diagnosis of the highly aggressive B-cell lymphoma, unclassifiable with features intermediate between DLBCL and BL. It appears likely that HIV-associated lymphomas represent a continuum of disease.
Collapse
Affiliation(s)
- T M Wiggill
- Department of Molecular Medicine and Haematology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.
| | | | | |
Collapse
|
13
|
Abdulahad WH, De Souza AWS, Kallenberg CGM. L3. Are mononuclear cells predominant actors of endothelial damage in vasculitis? Presse Med 2013; 42:499-503. [PMID: 23477715 DOI: 10.1016/j.lpm.2013.02.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Wayel H Abdulahad
- University of Groningen, University Medical Center Groningen, Department of Rheumatology, Groningen, Netherlands.
| | | | | |
Collapse
|
14
|
Achkar JM, Jenny-Avital ER. Incipient and subclinical tuberculosis: defining early disease states in the context of host immune response. J Infect Dis 2011; 204 Suppl 4:S1179-86. [PMID: 21996700 DOI: 10.1093/infdis/jir451] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Latent Mycobacterium tuberculosis infection (LTBI) and active tuberculosis (TB) are 2 ends of a spectrum of states ranging from asymptomatic infection to overt disease. While progressing from LTBI to TB, patients often undergo asymptomatic states with detectable manifestations indicative of disease. Such asymptomatic disease states frequently remain undiagnosed, and their manifestations and duration are mostly dependent on host immune response. Various terms referring to such states are used in the literature, often interchangeably and without explicit definitions. Defining these intermediate states in concrete terms is important for pragmatic reasons, as they might impact upon the diagnostic performance of TB biomarkers and could also present targets for therapeutic interventions. We here propose definitions for 2 commonly used terms, "incipient" and "subclinical" TB, to describe asymptomatic disease states occurring at opposite ends of the host response spectrum. We propose using the term "incipient TB" when referring to early, contained disease in asymptomatic, relatively immunocompetent persons. In contrast, we propose using the term "subclinical TB" to refer to disease in asymptomatic, immunocompromised individuals in whom it is largely associated with loss of effective containment. The rationale for this article is to facilitate the discussion of such early disease states, especially in relation to their impact on TB biomarker discovery and assessment of new diagnostics, and with regard to treatment decisions and ultimately outcome.
Collapse
Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
| | | |
Collapse
|
15
|
Lepse N, Abdulahad WH, Kallenberg CG, Heeringa P. Immune regulatory mechanisms in ANCA-associated vasculitides. Autoimmun Rev 2011; 11:77-83. [PMID: 21856453 DOI: 10.1016/j.autrev.2011.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/05/2011] [Indexed: 01/09/2023]
|
16
|
Pigs as an experimental model for systemic Mycobacterium avium infectious disease. Comp Immunol Microbiol Infect Dis 2011; 34:455-64. [DOI: 10.1016/j.cimid.2011.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 11/19/2022]
|
17
|
Achkar JM, Lawn SD, Moosa MYS, Wright CA, Kasprowicz VO. Adjunctive tests for diagnosis of tuberculosis: serology, ELISPOT for site-specific lymphocytes, urinary lipoarabinomannan, string test, and fine needle aspiration. J Infect Dis 2011; 204 Suppl 4:S1130-41. [PMID: 21996695 PMCID: PMC3192548 DOI: 10.1093/infdis/jir450] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The diagnostic gold standard for active tuberculosis (TB) is the detection of Mycobacterium tuberculosis (MTB) by culture or molecular methods. However, despite its limited sensitivity, sputum smear microscopy is still the mainstay of TB diagnosis in resource-limited settings. Consequently, diagnosis of smear-negative pulmonary and extrapulmonary TB remains challenging in such settings. A number of novel or alternative techniques could provide adjunctive diagnostic use in the context of difficult-to-diagnose TB. These may be especially useful in certain patient groups such as persons infected with human immunodeficiency virus (HIV) and children, who are disproportionably affected by smear-negative and extrapulmonary disease and who are also most adversely affected by delays in TB diagnosis and treatment. We review a selection of these methods that are independent of nucleic acid amplification techniques and could largely be implemented in resource-limited settings in current or adapted versions. Specifically, we discuss the diagnostic use and potential of serologic tests based on detection of antibodies to MTB antigens; interferon gamma release assays using site-specific lymphocytes; detection of lipoarabinomannan, a glycolipid of MTB, in urine; the string test, a novel technique to retrieve lower respiratory tract samples; and fine needle aspiration biopsy of lymph nodes.
Collapse
Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
| | | | | | | | | |
Collapse
|
18
|
Abdulahad WH, Lamprecht P, Kallenberg CGM. T-helper cells as new players in ANCA-associated vasculitides. Arthritis Res Ther 2011; 13:236. [PMID: 21888687 PMCID: PMC3239339 DOI: 10.1186/ar3362] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In anti-neutrophil cytoplasmic autoantibody-associated vasculitides (AAV), several observations support a key role of T-helper cells (CD4(+) T cells) in disease pathophysiology. An expanded population of effector memory CD4(+) T cells in AAV patients may contribute to tissue injury and disease progression. In addition, functional impairment of regulatory T cells (T(Regs)) is reported in AAV patients. A fraction of T(Regs) have the capacity to differentiate into Th17 cells in the context of a proinflammatory environment. Therefore, nonfunctionality of T(Regs) described in AAV patients may be caused by their conversion into IL-17-producing cells that may contribute to granulomatous vasculitis. Further investigations directed at the plasticity of T(Regs) in AAV patients are warranted.
Collapse
Affiliation(s)
- Wayel H Abdulahad
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | | | | |
Collapse
|
19
|
Vani J, Bansal K, Kazatchkine MD, Kaveri SV, Bayry J. Immunointervention for patients with HIV and tuberculosis. THE LANCET. INFECTIOUS DISEASES 2009; 9:332-3. [PMID: 19467470 DOI: 10.1016/s1473-3099(09)70127-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
20
|
ABDULAHAD WAYELH, STEGEMAN COENA, KALLENBERG CEESGM. Review article: The role of CD4+T cells in ANCA-associated systemic vasculitis. Nephrology (Carlton) 2009; 14:26-32. [DOI: 10.1111/j.1440-1797.2008.01069.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Rao PVR, Murthy MK, Basirudeen S, Sharma P, Swaminathan S, Raja A. Improved diagnosis of tuberculosis in HIV-positive patients using RD1-encoded antigen CFP-10. Int J Infect Dis 2008; 13:613-22. [PMID: 19119038 DOI: 10.1016/j.ijid.2008.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/12/2008] [Accepted: 09/27/2008] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The present study was aimed at determining the serodiagnostic potential of 38-kDa (Rv0934, Mycobacterium tuberculosis complex-specific antigen) and CFP-10 (Rv3874, RD1 antigen) antigens among HIV-positive and HIV-negative patients with pulmonary TB. METHODS The diagnostic potential of native 38-kDa (n38-kDa) and recombinant CFP-10 (rCFP-10) antigens was ascertained in terms of sensitivity and specificity using an indirect ELISA. The study included 508 HIV-seronegative TB patients (TB), 54 HIV-seropositive TB patients (HIV-TB), 30 HIV-positive patients without TB (HIV), and 256 controls. RESULTS In HIV-TB, the sensitivities for individual antigens ranged from 14.8% to 31.5% and the specificity was >98% for IgG. When IgA results were added to IgG, the sensitivity increased to 25.9% for 38-kDa and 57.4% for CFP-10; specificity changed to 97.5% for 38-kDa and 98.1% for CFP-10. The combined results of both the antigens gave 59.3% sensitivity and 95.6% specificity. In TB, the sensitivity was 82.8% when the antigen results were combined. None of the HIV-infected controls showed positivity for IgG to either of the two antigens. CONCLUSION Use of CFP-10 enhances the sensitivity of 38-kDa, and therefore the 38-kDa and CFP-10 antigen combination can be a diagnostic marker in HIV-TB.
Collapse
Affiliation(s)
- Parasa V Ramana Rao
- Department of Immunology, Tuberculosis Research Centre (ICMR), Mayor V. R. Ramanathan Road, Chetput, Chennai 600031, India
| | | | | | | | | | | |
Collapse
|
22
|
Cowley D, Govender D, February B, Wolfe M, Steyn L, Evans J, Wilkinson RJ, Nicol MP. Recent and rapid emergence of W-Beijing strains of Mycobacterium tuberculosis in Cape Town, South Africa. Clin Infect Dis 2008; 47:1252-9. [PMID: 18834315 DOI: 10.1086/592575] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is increasing evidence of a strain-related variation in the virulence in Mycobacterium tuberculosis that may afford a selective advantage to certain strains. The W-Beijing strain family is globally distributed, highly virulent in animal models, associated with human immunodeficiency virus infection and drug resistance, and may be an emerging strain family. Our goal was to determine whether W-Beijing strains are expanding in a region of South Africa where rates of tuberculosis are among the highest in the world. METHODS We used spoligotyping and single nucleotide polymorphism analysis to genotype all strains of tuberculosis from children presenting to the major pediatric referral hospital in Cape Town, South Africa over a period of 4 years and strains present in 352 archived histological samples from over a 76-year period. RESULTS The proportion of W-Beijing strains from children increased from 13% to 33% from 2000 to 2003 (P= .026). With regard to the histological samples, W-Beijing strains were absent in the samples from the period 1930-1965 and rare in the samples from the period 1966-1995 (2.8% of samples), but they were increasingly common in samples from the period 1996-2005 (20% of samples; P= .001). CONCLUSIONS The rapid expansion of W-Beijing strains in a region with a very high background incidence of tuberculosis suggests that these strains have a significant selective advantage. The biological reasons for this observation remain unclear but warrant further study. The rapid spread of this virulent strain lineage is likely to present additional challenges for tuberculosis control.
Collapse
Affiliation(s)
- Donna Cowley
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Hammond AS, McConkey SJ, Hill PC, Crozier S, Klein MR, Adegbola RA, Rowland-Jones S, Brookes RH, Whittle H, Jaye A. Mycobacterial T cell responses in HIV-infected patients with advanced immunosuppression. J Infect Dis 2008; 197:295-9. [PMID: 18194089 DOI: 10.1086/524685] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Antimycobacterial T cell reactivity at different stages of HIV infection was investigated. Subjects were screened with purified protein derivative (PPD), early secreted antigenic target (ESAT)-6, and culture filtrate protein (CFP)-10 antigens for interferon (IFN)-gamma-producing effector T cell responses by direct ex vivo enzyme-linked immunospot (ELISpot) assay. The proportion of responders to PPD tuberculin decreased with a reduction in CD4 T cell count, whereas the proportion of responder to ESAT-6 and CFP-10 did not. The main sources of IFN-gamma secretion were CD4 cells, and the relative responses to ESAT-6 and CFP-10 significantly increased in HIV-infected patients with decreasing CD4 cell count. This may reflect early signs of reactivation, reinfection, or a restricted, inefficient immune response to Mycobacterium tuberculosis.
Collapse
Affiliation(s)
- Abdulrahman S Hammond
- Bacterial and Viral Diseases Programme, Medical Research Council Laboratories, Fajara, Banjul, The Gambia, West Africa.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Abdulahad WH, Stegeman CA, Limburg PC, Kallenberg CGM. CD4-Positive Effector Memory T Cells Participate in Disease Expression in ANCA-Associated Vasculitis. Ann N Y Acad Sci 2007; 1107:22-31. [PMID: 17804529 DOI: 10.1196/annals.1381.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the cause of ANCA-associated vasculitis (AAV) remains undetermined, the presence of lymphocytic infiltrates in inflammatory lesions of patients suggests that vascular damage is immune mediated. Studies over the past decade have implicated a role for T cells in the pathogenesis of AAV as altered T cell phenotype has been observed in this disorder. The distribution of T cell subpopulations has been analyzed most intensely in Wegener's granulomatosis (WG), where an expanded population of circulating CD4(+) effector memory T cells (CD4(+)T(EM)) was demonstrated. CD4(+)T(EM) cells play a major role in the pathogenesis of several autoimmune diseases. Specific suppression of CD4(+)T(EM) cells inhibits delayed-type hypersensitivity (DTH) and has therapeutic potential in autoimmune disease. Thus, CD4(+)T(EM) cells may act as inducers of tissue injury and participate in the development of AAV. Therapies that target CD4(+)T(EM), without impairing the activity of other lymphocyte subsets, may hold therapeutic promise for AAV.
Collapse
Affiliation(s)
- Wayel H Abdulahad
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | | | | | | |
Collapse
|
26
|
Abstract
The authors argue that understanding and countering general bacterial mechanisms of phenotypic antibiotic resistance may hold the key to reducing the duration of treatment of all recalcitrant bacterial infections, including tuberculosis.
Collapse
|
27
|
Abdulahad WH, van der Geld YM, Stegeman CA, Kallenberg CGM. Persistent expansion of CD4+ effector memory T cells in Wegener's granulomatosis. Kidney Int 2006; 70:938-47. [PMID: 16837919 DOI: 10.1038/sj.ki.5001670] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In order to test the hypothesis that Wegener's granulomatosis (WG) is associated with an ongoing immune effector response, even in remission, we examined the distribution of peripheral naive and memory T-lymphocytes in this disease, and analyzed the function-related phenotypes of the memory T-cell population. Peripheral blood mononuclear cells (PBMCs) were freshly isolated from WG-patients in remission (R-WG, n=40), active WG-patients (A-WG, n=17), and age-matched healthy controls (HCs, n=21). Expression of CD4, CD8, CD45RO, CCR7, interleukin (IL)-18Ralpha, ST2L, and FoxP3 were determined by four-color flow cytometric analysis. CD45RO and CCR7 were used for distinction between naive and memory T cells, IL-18Ralpha, ST2L, and FoxP3 for the assessment of Type1, Type2, and regulatory T-cells, respectively. In R-WG, the CD4+CD45RO+CCR7- effector memory T-cell subpopulation (TEM) was relatively increased, whereas the CD4+CD45RO-CCR7+ naive T-cell population (TNaive) was decreased as compared to HC. The distribution of naive and memory CD8+T cells did not differ between R-WG, A-WG, and HC, nor did CD4+CD45RO+CCR7+ central memory T cells (TCM). In contrast to HC, the percentage of CD4+TNaive cells in R-WG correlated negatively with age, whereas CD4+TEM cells showed a positive correlation. In R-WG, a skewing towards Type2 T cells was observed in CD4+TEM cells. No differences were detected in FoxP3+CD4+TEM cells between R-WG and A-WG, whereas the FoxP3-CD4+TEM cells were increased in R-WG and decreased in A-WG as compared to HC. Collectively, peripheral blood homeostasis of CD4+T cells is disturbed in R-WG with the persistent expansion of non-regulatory CD4+TEM cells. These cells might be involved in relapse and may constitute a target for therapy.
Collapse
Affiliation(s)
- W H Abdulahad
- Department of Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | |
Collapse
|
28
|
Carranza C, Juárez E, Torres M, Ellner JJ, Sada E, Schwander SK. Mycobacterium tuberculosis growth control by lung macrophages and CD8 cells from patient contacts. Am J Respir Crit Care Med 2005; 173:238-45. [PMID: 16210664 PMCID: PMC2662991 DOI: 10.1164/rccm.200503-411oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Healthy household contacts (HHCs) of patients with active pulmonary tuberculosis are exposed aerogenically to Mycobacterium tuberculosis (Mtb), thus permitting the study of protective local immunity. OBJECTIVES To assess alveolar macrophage (AM) and autologous blood CD4 and CD8 T-cell-mediated Mtb growth control in HHCs and healthy, unexposed community control subjects (CCs). METHODS AMs were infected with Mtb strains H(37)Ra and H(37)Rv at multiplicities of infection 0.1 and 1. Mtb colony-forming units were evaluated on Days 1, 4, and 7. MAIN RESULTS CD8 T cells from HHCs in 1:1 cocultures with AMs significantly (p < 0.05) increased Mtb growth control by AMs. In CCs, no detectable contribution of CD8 T cells to Mtb growth control was observed. CD4 T cells did not increase Mtb growth control in HHCs or in CCs. IFN-gamma, nitric oxide, and tumor necrosis factor were determined as potential mediators of Mtb growth control in AMs and AM/CD8 and AM/CD4 cocultures. IFN-gamma production in AM/CD4 was twofold higher than that in AM/CD8 cocultures in both HHCs and CCs (p < 0.05). Nitric oxide production from AMs of HHCs increased on Days 4 and 7 and was undetectable in AMs from CCs. IFN-gamma and nitric acid concentrations and Mtb growth control were not correlated. Tumor necrosis factor levels were significantly increased in AM/CD8 cocultures from HHCs compared with AM/CD8 cocultures from CCs (p < 0.05). CONCLUSION Aerogenic exposure to Mtb in HHCs leads to expansion of Mtb-specific effector CD8 T cells that limit Mtb growth in autologous AMs.
Collapse
Affiliation(s)
- Claudia Carranza
- University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, MSB I-503, Newark, NJ 07103, USA
| | | | | | | | | | | |
Collapse
|
29
|
Ramalingam B, Uma Devi KR, Raja A. Isotype-specific anti-38 and 27 kDa (mpt 51) response in pulmonary tuberculosis with human immunodeficiency virus coinfection. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 35:234-9. [PMID: 12839150 DOI: 10.1080/00365540310000292] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is a need for rapid diagnostic methods to identify tuberculosis among human immunodeficiency virus-positive cases (HIV-TB). This study evaluated the serodiagnostic potential of the native 38 kDa and recombinant 27 kDa (mpt 51) antigens of Mycobacterium tuberculosis purified in the laboratory, when applied to HIV-TB patients. The antibody response was studied using enzyme-linked immunosorbent assays (ELISA). In the HIV-TB group, anti-38 kDa antibody of the immunoglobulin G (IgG), IgA and IgM isotypes was found in 38%, 43% and 7%, of patients, respectively. Antibodies to the 27 kDa antigen occurred in 50%, 31%, and 1%, for IgG, IgA and IgM, respectively. The sensitivity increased upon combination of the results of IgG and IgA isotypes for each of the antigens, without compromising specificity. When the results were analysed based on the smear positivity, 71-78% and 54-69% were positive among smear-positive and smear-negative HIV-TB cases, respectively. A higher sensitivity (71% and 69%) was obtained using the 27 kDa antigen. The use of both antigens offered a sensitivity of 82% in smear-positive and 69% in smear-negative cases. There was no difference in antibody response among the HIV-TB cases, related to CD4 counts. Thus, the combination of the 38 and 27 kDa (mpt 51) antigens proved to be of diagnostic utility in HIV-TB, irrespective of the severity of immunosuppression, in smear-positive and smear-negative TB.
Collapse
Affiliation(s)
- B Ramalingam
- Department of Immunology, Tuberculosis Research Centre (ICMR), Chetput, Chennai, India
| | | | | |
Collapse
|
30
|
Ehlers S, Benini J, Held HD, Roeck C, Alber G, Uhlig S. Alphabeta T cell receptor-positive cells and interferon-gamma, but not inducible nitric oxide synthase, are critical for granuloma necrosis in a mouse model of mycobacteria-induced pulmonary immunopathology. J Exp Med 2001; 194:1847-59. [PMID: 11748285 PMCID: PMC2193571 DOI: 10.1084/jem.194.12.1847] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The immunological basis of tuberculin-induced necrosis, known for more than a century as "Koch's phenomenon," remains poorly understood. Aerosol infection in mice with the highly virulent Mycobacterium avium strain TMC724 causes progressive pulmonary pathology strongly resembling caseating necrosis in human patients with tuberculosis. To identify the cellular and molecular mediators causing this pathology, we infected C57BL/6 mice and mice selectively deficient in recombinase activating gene (RAG)-1, alphabeta T cell receptor (TCR), gammadelta TCR, CD4, CD8, beta2-microglobulin, interferon (IFN)-gamma, interleukin (IL)-10, IL-12p35, IL-12p35/p40, or iNOS with M. avium by aerosol and compared bacterial multiplication, histopathology, and respiratory physiology in these mice. The bacterial load in the lung was similarly high in all mouse groups. Pulmonary compliance, as a surrogate marker for granulomatous infiltrations in the lung, deteriorated to a similar extent in all groups of mice, except in alphabeta TCR-knockout (KO) and IL-12-KO mice in which compliance was higher, and in IFN-gamma and inducible nitric oxide synthase-KO mice in which compliance was reduced faster. Progressive caseation of pulmonary granulomas never occurred in alphabeta TCR-KO, IL-12-KO, and IFN-gamma-KO mice and was reduced in CD4-KO mice. In summary, alphabeta TCR(+) cells and IFN-gamma are essential for the development of mycobacteria-induced pulmonary caseous necrosis. In contrast, high mycobacterial load and extensive granulomatous infiltration per se are not sufficient to cause caseation, nor is granuloma necrosis linked to the induction of nitric oxide.
Collapse
MESH Headings
- Animals
- Cytotoxicity, Immunologic
- Gene Expression Regulation/immunology
- Granuloma/immunology
- Granuloma/pathology
- Humans
- Interferon-gamma/genetics
- Interferon-gamma/immunology
- Mice
- Mice, Knockout
- Mycobacterium avium/immunology
- Necrosis
- Nitric Oxide Synthase/genetics
- Nitric Oxide Synthase/immunology
- Nitric Oxide Synthase Type II
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- T-Lymphocyte Subsets/immunology
- Tuberculosis, Pulmonary/genetics
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/pathology
Collapse
Affiliation(s)
- S Ehlers
- Division of Molecular Infection Biology, Research Center Borstel, Center for Medicine and Biosciences, D-23845 Borstel, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Johnson JL, Okwera A, Hom DL, Mayanja H, Mutuluuza Kityo C, Nsubuga P, Nakibali JG, Loughlin AM, Yun H, Mugyenyi PN, Vernon A, Mugerwa RD, Ellner JJ, Whalen CC. Duration of efficacy of treatment of latent tuberculosis infection in HIV-infected adults. AIDS 2001; 15:2137-47. [PMID: 11684933 DOI: 10.1097/00002030-200111090-00009] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment of latent infection is needed to protect HIV-infected individuals against tuberculosis. A previous report addressed short-term efficacy of three regimens in HIV-infected adults. We now report on long-term efficacy of the study regimens. METHODS Three daily self-administered regimens were compared in a randomized placebo-controlled trial in 2736 purified protein derivative (PPD)-positive and anergic HIV-infected adults. PPD-positive subjects were treated with isoniazid (INH) for 6 months (6H), INH plus rifampicin for 3 months (3HR), INH plus rifampicin and pyrazinamide for 3 months (3HRZ), or placebo for 6 months. Anergic subjects were randomized to 6H or placebo. RESULTS 6H initially protected against tuberculosis in PPD-positive individuals; however, benefit was lost within the first year of treatment. Sustained benefit was observed in persons receiving 3HR and 3HRZ. In a Cox regression analysis, the adjusted relative risk for tuberculosis compared with placebo was 0.67 [95% confidence interval (CI), 0.42-1.07] for 6H, 0.49 (95% CI, 0.29-0.82) for 3HR, and 0.41 (95% CI, 0.22-0.76) for 3HRZ. When the rifampicin-containing regimens were combined, the adjusted relative risk for tuberculosis compared with placebo was 0.46 (95% CI, 0.29-0.71). Among anergic subjects, a modest degree of protection with 6H was present (adjusted relative risk, 0.61; 95% CI, 0.32-1.16). Treatment of latent tuberculosis infection had no effect on mortality. CONCLUSION Six months of INH provided short-term protection against tuberculosis in PPD-positive HIV-infected adults. Three month regimens including INH plus rifampicin or INH, rifampicin and pyrazinamide provided sustained protection for up to 3 years.
Collapse
Affiliation(s)
- J L Johnson
- Division of Infectious Diseases, Department of Medicine, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio 44106-4984, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
The goals of the present study were twofold: (i) to compare the repertoires of antigens in culture filtrates of in vitro-grown Mycobacterium tuberculosis that are recognized by antibodies from noncavitary and cavitary tuberculosis (TB) patients and (ii) to determine the extent of variation that exists between the antigen profiles recognized by individual TB patients. Lipoarabinomannan-free culture filtrate proteins of M. tuberculosis were fractionated by one-dimensional (1-D) and 2-D polyacrylamide gel electrophoresis, and the Western blots were probed with sera from non-human immunodeficiency virus (non-HIV)-infected cavitary and noncavitary TB patients and from HIV-infected, noncavitary TB patients. In contrast to earlier studies based on recombinant antigens of M. tuberculosis which suggested that antibody responses in TB patients were heterogeneous (K. Lyashchenko et al., 1998, Infect. Immun. 66:3936-3940, 1998), our studies with native culture filtrate proteins show that the antibody responses in TB patients show significant homogeneity in being directed against a well-defined subset of antigens. Thus, there is a well-defined subset of culture filtrate antigens that elicits antibodies during noncavitary and cavitary disease. In addition, another set of antigens is recognized primarily by cavitary TB patients. The mapping with individual patient sera presented here suggests that serodiagnostic tests based on the subset of antigens recognized during both noncavitary and cavitary TB will enhance the sensitivity of antibody detection in TB patients, especially in difficult-to-diagnose, smear-negative, noncavitary TB patients.
Collapse
Affiliation(s)
- K Samanich
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA
| | | | | |
Collapse
|
33
|
|
34
|
Pennycook A, Openshaw P, Hussell T. Partners in crime: co-infections in the developing world. Clin Exp Immunol 2000; 122:296-9. [PMID: 11122231 PMCID: PMC1905791 DOI: 10.1046/j.1365-2249.2000.01407.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2000] [Indexed: 11/20/2022] Open
|
35
|
Scanga CA, Mohan V, Yu K, Joseph H, Tanaka K, Chan J, Flynn JL. Depletion of CD4(+) T cells causes reactivation of murine persistent tuberculosis despite continued expression of interferon gamma and nitric oxide synthase 2. J Exp Med 2000; 192:347-58. [PMID: 10934223 PMCID: PMC2193220 DOI: 10.1084/jem.192.3.347] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Tuberculosis is a major cause of death in much of the world. Current estimates are that one-third of the world's population is infected with Mycobacterium tuberculosis. Most infected persons control the infection but in many cases may not eliminate the organism. Reactivation of this clinically latent infection is responsible for a large proportion of active tuberculosis cases. A major risk factor for reactivation of latent tuberculosis is HIV infection, suggesting a role for the CD4(+) T cell subset in maintaining the latent persistent infection. In this study, we tested the requirement for CD4(+) T cells in preventing reactivation in a murine model of latent tuberculosis. Antibody-mediated depletion of CD4(+) T cells resulted in rapid reactivation of a persistent infection, with dramatically increased bacterial numbers in the organs, increased pathology in the lungs, and decreased survival. Although CD4(+) T cells are believed to be a major source of interferon (IFN)-gamma, expression of the gene for IFN-gamma in the lungs of CD4(+) T cell-depleted mice was similar to that in control mice. In addition, inducible nitric oxide synthase production and activity was unimpaired after CD4(+) T cell depletion, indicating that macrophage activation was present even during CD4(+) T cell deficiency. These data indicate that CD4(+) T cells are necessary to prevent reactivation but may have roles in addition to IFN-gamma production and macrophage activation in controlling a persistent tuberculous infection.
Collapse
Affiliation(s)
- Charles A. Scanga
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
| | - V.P. Mohan
- Department of Medicine, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Microbiology and Immunology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
| | - Keming Yu
- Department of Medicine, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Microbiology and Immunology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
| | - Heather Joseph
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
| | - Kathryn Tanaka
- Department of Pathology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
| | - John Chan
- Department of Medicine, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Microbiology and Immunology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, New York 10461
| | - JoAnne L. Flynn
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
| |
Collapse
|
36
|
Takemura T, Akiyama O, Yanagawa T, Ikushima S, Ando T, Oritsu M. Pulmonary tuberculosis with unusual cystic change in an immunocompromised host. Pathol Int 2000; 50:672-7. [PMID: 10972868 DOI: 10.1046/j.1440-1827.2000.01086.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a rare case of upper zone cystic change of the lung with disseminated tuberculosis of a non-smoking 30-year-old immunocompromised male. He suffered from repeated pneumothorax. The basic pathological feature of video-assisted thoracoscopic lung biopsy revealed granulomatous involvement in the respiratory bronchioles with poorly developed epithelioid cells and disruption of elastic fibers. Electron microscopy demonstrated a decrease in elastic fibers and disruption of the epithelial basement membrane of the respiratory bronchiole and no Langerhans cells in the lesion. Autopsy of the lung revealed centroacinar distribution of multiple cystic lesions in the bilateral upper lobe. Almost all cystic walls showed loss of elastic fibers and cysts frequently involved the respiratory and terminal bronchioles, alveolar ducts and, occasionally, alveoli. Some larger cystic lesions revealed communication to the bronchi. The cystic changes in this case of pulmonary tuberculosis may be caused by a check-valve mechanism due to granulomatous involvement of the bronchioles and also by excavation of caseous necrotic material by draining bronchi.
Collapse
Affiliation(s)
- T Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
37
|
Samanich KM, Keen MA, Vissa VD, Harder JD, Spencer JS, Belisle JT, Zolla-Pazner S, Laal S. Serodiagnostic potential of culture filtrate antigens of Mycobacterium tuberculosis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2000; 7:662-8. [PMID: 10882669 PMCID: PMC95931 DOI: 10.1128/cdli.7.4.662-668.2000] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our studies of the humoral responses of tuberculosis (TB) patients have defined the repertoire of culture filtrate antigens of Mycobacterium tuberculosis that are recognized by antibodies from cavitary and noncavitary TB patients and demonstrated that the profile of antigens recognized changes with disease progression (K. Samanich et al., J. Infect. Dis. 178:1534-1538, 1998). We have identified several antigens with strong serodiagnostic potential. In the present study we have evaluated the reactivity of cohorts of human immunodeficiency virus (HIV)-negative, smear-positive; HIV-negative, smear-negative; and HIV-infected TB patients, with three of the candidate antigens, an 88-kDa protein, antigen (Ag) 85C, and MPT32, and compared the reactivity of the same patient cohort with the 38-kDa antigen and Ag 85A. We have also compared the reactivity of native Ag 85C and MPT32 with their recombinant counterparts. The evaluation of the reactivity was done by a modified enzyme-linked immunosorbent assay described earlier (S. Laal et al., Clin. Diag. Lab. Immunol. 4:49-56, 1997), in which all sera are preadsorbed against Escherichia coli lysates to reduce the levels of cross-reactive antibodies. Our results demonstrate that (i) antigens identified on the basis of their reactivity with TB patients' sera provide high sensitivities for serodiagnosis, (ii) recombinant Ag 85C and MPT32, expressed in E. coli, show reduced reactivity with human TB sera, and (iii) of the panel of antigens tested, the 88-kDa protein is the most promising candidate for serodiagnosis of TB in HIV-infected individuals. Moreover, these results reaffirm that both the extent of the disease and the bacterial load may play a role in determining the antigen profile recognized by antibodies.
Collapse
Affiliation(s)
- K M Samanich
- Department of Pathology, New York University Medical Center, New York, New York 10016, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Bonora S, Concia E, Allegranzi B, Biglino A, Di Perri G. Mycobacterium tuberculosis transmission and HIV status. Lancet 2000; 355:2077; author reply 2078. [PMID: 10885383 DOI: 10.1016/s0140-6736(05)73534-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
39
|
Actor JK, Olsen M, Jagannath C, Hunter RL. Relationship of survival, organism containment, and granuloma formation in acute murine tuberculosis. J Interferon Cytokine Res 1999; 19:1183-93. [PMID: 10547159 DOI: 10.1089/107999099313136] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The relationship among organism growth, immunopathology, and survival was studied in C57BL/6 and A/J mice acutely infected with Mycobacterium tuberculosis (MTB) (Erdman). Although organisms grew at similar rates in the lungs of both mouse strains, A/J mice died prior to 14 days after infection, whereas C57BL/6 mice survived twice as long. The lungs of A/J mice exhibited necrotizing interstitial inflammation and widely distributed acid-fast bacilli without granuloma formation. In contrast, the lungs of C57BL/6 mice had relatively mild interstitial inflammation, which was replaced by focal granulomas, and acid-fast bacilli were primarily within granulomas. MTB induced similar granulomas for A/J and C57BL/6 mice in spleen and liver. In the lung, the A/J mice produced only transient messages for interferon-y (IFN-y), interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-10, and inducible nitric oxide synthase (iNOS). The C57BL/6 mice, in contrast, produced a delayed but sustained response in the lung correlating with granuloma onset and characterized by high induction of IL-6, IFN-gamma, IL-1beta, IL-10, and TNF-alpha. Responses in the liver and spleen were also evaluated. These results demonstrate that histopathology and cytokine response to MTB infection varies among organs in mice. Increased survival during acute infection may, therefore, depend on the ability to contain organisms within granulomas in the lung.
Collapse
Affiliation(s)
- J K Actor
- Department of Pathology and Laboratory Medicine, University of Texas, Houston Medical School, 77030, USA.
| | | | | | | |
Collapse
|
40
|
Benini J, Ehlers EM, Ehlers S. Different types of pulmonary granuloma necrosis in immunocompetent vs. TNFRp55-gene-deficient mice aerogenically infected with highly virulent Mycobacterium avium. J Pathol 1999; 189:127-37. [PMID: 10451499 DOI: 10.1002/(sici)1096-9896(199909)189:1<127::aid-path398>3.0.co;2-s] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The immunopathogenesis of mycobacterial infections frequently involves the formation of caseating granulomas which cause tissue destruction and, in the case of tuberculosis (TB), may lead to cavity formation. Both intravenous and aerosol models of Mycobacterium tuberculosis infection in mice do not reflect the pulmonary lesions characteristic of TB patients. Using both low-dose (10(2) colony-forming units, cfu) and high-dose (10(5) cfu) aerosol infection with a highly virulent strain of Mycobacterium avium (TMC724) in C57BL/6 mice, it is now shown that these mice are capable of developing centrally caseating necrosis in lung granulomas after approximately 4 months of infection. In contrast, mice infected intravenously with the high dose never developed this type of lesion, although bacterial counts in their lungs reached levels comparable to those attained by aerosol-infected mice (10(10) cfu). To study the relevance of events signalled by tumour necrosis factor (TNF) in this model, TNFRp55 gene-deficient and syngeneic C57BL/6 immunocompetent mice were infected with 10(5) cfu M. avium via aerosol. In gene-deficient mice, newly formed pulmonary granulomas acutely disintegrated, showing signs of apoptotic cell death and neutrophil influx, and TNFRp55 knock-out mice all succumbed to infection just beyond the stage of granuloma initiation. Aerogenic infection with M. avium in mice is a suitable model to study the immunopathogenesis of granuloma necrosis because it closely mimicks the histopathology of mycobacterial infections in humans, including TB. Furthermore, the use of TNFRp55 gene-deficient mice in this model establishes a role for TNF in maintaining the integrity of a developing pulmonary granuloma.
Collapse
MESH Headings
- Aerosols
- Animals
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Disease Models, Animal
- Injections, Intravenous
- Interferon-gamma/blood
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Mycobacterium avium
- Necrosis
- Receptors, Tumor Necrosis Factor/genetics
- Receptors, Tumor Necrosis Factor/metabolism
- Receptors, Tumor Necrosis Factor, Type I
- Statistics, Nonparametric
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/pathology
- Tumor Necrosis Factor-alpha/analysis
Collapse
Affiliation(s)
- J Benini
- Molecular Infection Biology, Research Center Borstel, Center for Medicine and Biosciences, Parkallee 22, D-23845 Borstel, Germany
| | | | | |
Collapse
|
41
|
Ledru E, Ledru S, Zoubga A. Granuloma formation and tuberculosis transmission in HIV-infected patients. IMMUNOLOGY TODAY 1999; 20:336-7. [PMID: 10379053 DOI: 10.1016/s0167-5699(98)01436-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
42
|
Di Perri G, Bonora S, Allegranzi B, Concia E. Granulomatous inflammation and transmission of infectious disease. IMMUNOLOGY TODAY 1999; 20:337-8. [PMID: 10379054 DOI: 10.1016/s0167-5699(99)01459-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
43
|
Di Perri G, Bonora S, Vento S, Allegranzi B, Concia E. M tuberculosis drug resistance in AIDS. Lancet 1997; 349:60-1; author reply 61-2. [PMID: 8988143 DOI: 10.1016/s0140-6736(05)62200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
44
|
Horsburgh CR. Tuberculosis without tubercles. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1996; 77:197-8. [PMID: 8758100 DOI: 10.1016/s0962-8479(96)90000-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|