Die prognostische Bedeutung von Lymphozytensubpopulationen und Makrophagen im peripheren Blut und in der bronchoalveolären Lavage bei AIDS-Patienten mit Verdacht auf Pneumocystis-carinii-Pneumonie

Abstract

In 36 HIV seropositive patients with the clinical manifestation of AIDS and a suspected Pneumocystis carinii infection, lymphocyte subpopulations were analyzed in the peripheral blood (PBL) and compared with the results of the bronchoalveolar lavage (BAL). Of those 36 patients, 29 showed a highly abnormal CD4/CD8 ratio in both the PBL and the BAL. The clinical course of these 29 patients was unpredictable. In seven patients, however, the CD4/CD8 ratio in the BAL was normal or only slightly altered, despite a highly abnormal CD4/CD8 ratio in the PBL. Five of these seven patients improved greatly during the clinical course. The positive outcome of the clinical course was even more strongly correlated with the number of macrophages in the BAL. Twelve of the 36 patients showed normal or only slightly changed numbers of macrophages in the BAL. Eleven of these twelve patients (92%) improved rapidly during antibiotic therapy, while the clinical course was unpredictable in patients with markedly reduced macrophage counts in the BAL.

Correlation of Organism Burden and Alveolar Macrophage Counts during Infection withPneumocystis cariniiand Recovery

“…Fleury et al (7) further showed that alveolar macrophages are 69.5% of the total cell population in bronchoalveolar lavage (BAL) fluids from immunocompromised patients without PCP but are only 38.8% of the total cell population in BAL fluids from PCP patients with AIDS. The reduction in alveolar macrophage number was found in both human immunodeficiency virus-positive and -negative patients with PCP but was not observed in either human immunodeficiency virus-positive or -negative patients without PCP (7,11). A similar observation was reported by Sadaghdar et al (28), i.e., that alveolar macrophages account for 64% of total cells in BAL fluids from AIDS patients without PCP and only 45% in BAL fluids from AIDS patients with PCP.…”

“…Several studies in the 1980s and 1990s showed that the number of alveolar macrophages in BAL fluid from AIDS patients with PCP was reduced relative to other cell types (7, 8, 11,42,44). It was unknown whether this change is due to a decrease in the number of alveolar macrophages or an increase in other cell types.…”

“…145:A246, 1992), surfactant proteins A and D (22,26) and the adhesion proteins vitronectin and fibronectin (19). Pneumocystis infection also causes increases in the production of the cytokines tumor necrosis factor alpha (11,24,37), interleukin-8 (IL-8), IL-10, IL-12 (2,39), and gamma interferon (39); the growth factor granulocytemacrophage colony-stimulating factor (24); and the chemokine monocyte chemotactic protein 1 (2) but down-regulates the expression of the host transcription factor GATA-2 (33). An inflammatory response (41,43) that changes alveolar macrophage and polymorphonuclear cell populations (7,42,44) is also observed during pneumocystis infection.…”

Changes in Alveolar Macrophage Number are Early Events in Pneumocystis carinii Infection

“…Pneumocystis carinii ( P. carinii ) remains a major cause of pneumonia in patients with AIDS as well as other immunocompromised patients [3,5]‐ Alveolar macrophages are important for the clearance of P. carinii. Previous reports state that alveolar macrophage number in bronchoalveolar lavage (BAL) fluid, relative to other cell types, decreases during P. carinii pneumonia in immunosuppressed individuals [2,4,6]. Alveolar macrophages in immunosuppressed humans and animals are exposed to an altered immune environment, affecting their response to infectious agents.…”