Changes in immunoregulatory lymphocyte populations in patients with histoplasmosis

Payan, Donald G.; Wheat, L. Joseph; Brahmi, Z; Ip, SH; Hansen, W.; Hoffman, R. A.; Healey, K; Rubin, Robert H.

doi:10.1007/bf00915042

Cited by 33 publications

(9 citation statements)

References 41 publications

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“…Prior infection provides partial imnmnity against reinfection. Similarly, outbreaks at the fringe of the endemic areas of histoplasmosis are likely to result in higher attack rates, since a larger non-immune population is exposed (13)(14)(15)22 (26)(27)(28)(29)(30). T suppressor cells appear to be responsible for this suppression.…”

Section: Historymentioning

confidence: 95%

See 1 more Smart Citation

Diagnosis and management of Histoplasmosis

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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Histoplasmosis occurs throughout the world but is more common within the endemic areas of North America, particularly in fertile river valleys. Disease manifestations range from asymptomatic infection in the normal host with low-inoculum exposure to rapidly fatal, disseminated infection in the severely immunocompromised host, emphasizing the importance of cellular immunity in defense against Histoplasma capsulatum. Diagnosis depends on a high index of suspicion, knowledge of the clinical and epidemiologic features of the infection, and a thorough understanding of the uses and limitations of fungal cultural and serological laboratory procedures. Recently, a method has been developed for rapid diagnosis based on detection of a polysaccharide antigen in body fluids of patients with histoplasmosis. Amphotericin B remains the preferred treatment for more severe forms of histoplasmosis, particularly in the immunocompromised host, but oral treatment with ketoconazole or newer imidozoles appears to be effective in less severe infections in non-immunocompromised individuals.

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Section: Historymentioning

confidence: 95%

“…Alternately, ltistoplasma capsulatum may impair cellular immunity through complex suppressor Tcell mechanisms (29).…”

Section: Disseminated Histoplasmosis Progressive Disseminatedmentioning

confidence: 99%

Diagnosis and management of Histoplasmosis

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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“…It is known that disseminated his toplasmosis can give rise to major alterations in the T lymphocyte subpopulations both in human and in an imal models [8,10]. Immunosuppression is not rare in the disease, and fungal products might act to elevate the Ty8 subpopulation of cells at a time when the host is anergic.…”

Section: Discussionmentioning

confidence: 99%

Novel Abnormality in Subpopulations of Circulating Lymphocytes

Lehmann

Sawyer²,

Donabedian³

1989

Int Arch Allergy Immunol

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A patient, who had developed anergy after disseminated histoplasmosis and who had gone on to develop a cardiomyopathy, demonstrated an unusually large proportion of T lymphocytes bearing the γ and δ chains of the T cell resceptor (TCR-γ/δ). These γδ⁺ cells composed over half of the circulating lymphocytes and were clearly divisible into two subgroups based on the level of expression of the γ and δ chains and their ability to bind one of the monoclonal antibodies reactive with the TCR-δ chain. In addition, the patient showed an abnormally high proportion of circulating lymphocytes having the CD2^––, 3⁺, 4^––, 8^–– phenotype which has been only recently described. The pattern of lymphocyte subpopulations changed over the 9 years that the patient was followed since his original infection and appears to characterize a novel abnormality.

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“…Fungal diseases as histoplasmosis, cryptococcosis and coccidiomycosis are known to be associated with reduced levels of CD4+ T cells [10]. Low CD4+ cell counts and low CD4+/CD8+ ratios have been described in patients with chronic complications of histoplasmosis [23]. But this reduction in CD4+ T cells normally is transient and reflects sequestration of CD4+ T cells in the lymph nodes and the reticuloendothelial system, suggesting that the low CD4+ count in our patient was the cause and not the consequence of histoplasma infection.…”

Section: Discussionmentioning

confidence: 99%

Pleural Effusion due to <i>Histoplasma capsulatum</i> and Idiopathic CD4 Lymphocytopenia

Kortsik¹,

Elmer

Tamm

2003

Respiration

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Acute histoplasmosis is usually a benign, self-limited infection in endemic areas. Since protection against Histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g. due to HIV infection. We report here for the first time a case of pleural effusion due to H. capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL). A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss. Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate. Histologic examination of pleural biopsies identified H. capsulatum. Laboratory tests revealed lymphocytopenia with low CD4+ T cell counts (<100/µl) and a decreased CD4/CD8 ratio. Serology, including HIV, was repeatedly negative. The diagnosis of pleural effusion due to H. capsulatum infection in a patient with idiophatic ICL was established. There was no evidence of any other opportunistic infection. Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment. Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes. In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection. Treatment with itraconazole was given for 12 months. Because of persistent CD4+ T cell counts below 100/µl, prophylactic antibiotic treatment is continued.

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Changes in immunoregulatory lymphocyte populations in patients with histoplasmosis

Cited by 33 publications

References 41 publications

Diagnosis and management of Histoplasmosis

Diagnosis and management of Histoplasmosis

Novel Abnormality in Subpopulations of Circulating Lymphocytes

Pleural Effusion due to <i>Histoplasma capsulatum</i> and Idiopathic CD4 Lymphocytopenia

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