Disseminated cryptococcal infection in a patient with hypogammaglobulinemia and normal T cell functions

Gupta, Sudhir; Ellis, M N; Cesario, Thomas C.; Ruhling, Merilee; Vayuvegula, Bharathi

doi:10.1016/0002-9343(87)90388-3

Cited by 46 publications

(28 citation statements)

References 12 publications

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“…An increased risk for cryptococcosis has been noted in patients with hypogammaglobulinemia, and immunoglobulin defects have been noted in patients with X-linked immunodeficiency, hyperimmunoglobulin M (hyperIgM), and common variable immunodeficiency syndromes (33,36,37,52,61,65). Although these syndromes are characterized by defects in acquired, T-cell-dependent antibody responses, they are complex disorders that also feature a central defect in the memory B-cell repertoire (3,4).…”

Section: The Central Importance Of Intact Cd4mentioning

confidence: 99%

Cryptococcus neoformans -Reactive and Total Immunoglobulin Profiles of Human Immunodeficiency Virus-Infected and Uninfected Ugandans

Subramaniam¹,

French

Pirofski

2005

Clin Vaccine Immunol

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We determined total and Cryptococcus neoformans glucuronoxylomannan (GXM)-reactive antibody repertoires of human immunodeficiency virus (HIV)-infected and HIV-uninfectedThe results showed that HIV-infected subjects had significantly lower levels of IgM to GXM but higher levels of total immunoglobulin and IgG and IgA to GXM than those of HIV-uninfected subjects. HIV-infected subjects with a history of pneumonia had higher levels, and those with a history of herpes zoster had lower levels of GXM-binding antibodies than subjects with no history of either disease. Minimal to no cross-reactivity was demonstrated between antibodies to GXM and polysaccharides in a pneumococcal vaccine. No significant differences between the antibody repertoires of HIV ؉ CM ؉ and HIV ؉ CM ؊ subjects were identified, but among subjects without a history of pneumonia, there was a trend towards lower V H 3-positive antibody levels among HIV ؉ CM ؉ than among HIV ؉ CM ؊ subjects. Our findings demonstrate an association between previous infectious diseases and differences in the total and GXM-reactive antibody repertoires of HIV-infected subjects and suggest the question of whether certain microbes modulate subsequent antibody responses to GXM deserves further study.

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Section: The Central Importance Of Intact Cd4mentioning

confidence: 99%

Cryptococcus neoformans -Reactive and Total Immunoglobulin Profiles of Human Immunodeficiency Virus-Infected and Uninfected Ugandans

Subramaniam¹,

French

Pirofski

2005

Clin Vaccine Immunol

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“…The increased incidence of infection with encapsulated bacterial pathogens in HIV infection has been attributed to impaired de novo anti-polysaccharide antibody responses, including responses to conjugate vaccination [31][32][33][34]. B cell defects have been reported in patients with CM [35,36]. Since B cell defects due to HIV infection may obviate de novo anti-GXM antibody responses, anti-GXM antibodies detected in HIV+ sera were most probably present before HIV infection, and may be the product of pre-existing B cells [37,38].…”

Section: Bsa Bindingmentioning

confidence: 99%

Antibodies to theCryptococcus neoformanscapsular glucuronoxylomannan are ubiquitous in serum from HIV+ and HIV− individuals

DeShaw

Pirofski

1995

Clinical and Experimental Immunology

104

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SUMMARYMurine MoAbs to the Cryptococcus neoformans capsular glucuronoxylomannan (GXM) polysaccharide are protective in mice in vivo and in vitro. The prevalence of protective anti-GXM antibodies in human serum is unknown. To provide further insight into the human antibody response to C. neoformans we determined the prevalence, isotype, and IgG subclass utilization of human anti-GXM antibodies in HIV+ and HIV-sera by a sensitive antigen capture ELISA assay. One hundred and twenty-three sera from the Bronx Municipal Hospital Centre serum bank were studied retrospectively. Seventy were from HIV+ individuals, 10 with a history of cryptococcal meningitis (CM), and 53 were from HIV-individuals. Serum GXM determinations were also performed on 61 HIV+ sera. Our results demonstrated that anti-GXM IgG, IgA, and IgM are ubiquitous in both HIV+ (including those with CM), and HIV-sera. Anti-GXM IgA titres and total serum IgA concentration were elevated in HIV+ sera. Anti-GXM IgG antibodies were almost exclusively isotype-restricted to the IgG2 subclass. Our data also demonstrated elevations of antibovine serum albumin (BSA) titres in HIV+ sera. Taken together, our findings confirm hypergammaglobulinaemia and expansion of anti-protein (BSA) antibodies in HIV+ individuals and isotype restriction of human anti-carbohydrate (GXM) antibodies to the IgG2 subclass. Our report of ubiquitous anti-GXM antibodies of the IgG and IgA isotypes suggests that anti-GXM antibodies exist before HIV infection.

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“…Cryptococcosis can result from reactivation of a latent infection (14,39) or a newly acquired infection (33) but occurs predominantly in immunocompromised patients (discussed in reference 8). Recent studies suggest that 20 to 60% of cases of cryptococcosis in patients who do not have human immunodeficiency virus (HIV) or AIDS occur in solidorgan transplant recipients (16). The incidence of cryptococcosis in this patient group is 1% to 5% (18,20), with reported mortality rates from 20 to 42% (18).…”

mentioning

confidence: 99%

Antibody Response to Cryptococcus neoformans Capsular Polysaccharide Glucuronoxylomannan in Patients after Solid-Organ Transplantation

Jalali

Singh

et al. 2006

Clin Vaccine Immunol

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Cryptococcosis is an important complication of solid-organ transplantation, but the risk factors for disease are poorly understood. The goal of this study was to investigate whether specific or nonspecific serum immunoglobulin levels determined in samples obtained before and after solid-organ transplantation differed in patients who did or did not develop cryptococcosis after transplantation. We analyzed pretransplantation sera from 25 subjects, 15 who subsequently developed cryptococcosis and 10 who did not, and posttransplantation sera from 24 subjects, 13 who developed cryptococcosis and 11 who did not. All subjects received a tacrolimus-based immunosuppressive regimen. Total immunoglobulin levels were measured by immunodiffusion, and Cryptococcus neoformans capsular polysaccharide glucuronoxylomannan (GXM)-specific serum antibody levels were determined by enzyme-linked immunosorbent assays. The results showed that solid-organ transplantation had a significant effect on total immunoglobulin and GXM-reactive antibody levels. GXMreactive antibody levels differed in subjects who did and did not develop cryptococcosis. In pretransplant serum samples, the levels of GXM-reactive immunoglobulin M (IgM) were significantly lower in subjects who developed cryptococcosis after transplantation than in those who did not. For posttransplant serum samples, the levels of GXM-reactive IgM and IgG were significantly higher among the subjects who developed cryptococcosis than among those who did not. These findings suggest that perturbations in the preexisting antibody or B-cell repertoire and/or related to treatment of rejection, transplantation, or immunosuppressive therapy could translate into an increased risk for transplant-associated cryptococcosis.

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Disseminated cryptococcal infection in a patient with hypogammaglobulinemia and normal T cell functions

Cited by 46 publications

References 12 publications

Cryptococcus neoformans -Reactive and Total Immunoglobulin Profiles of Human Immunodeficiency Virus-Infected and Uninfected Ugandans

Cryptococcus neoformans -Reactive and Total Immunoglobulin Profiles of Human Immunodeficiency Virus-Infected and Uninfected Ugandans

Antibodies to theCryptococcus neoformanscapsular glucuronoxylomannan are ubiquitous in serum from HIV+ and HIV− individuals

Antibody Response to Cryptococcus neoformans Capsular Polysaccharide Glucuronoxylomannan in Patients after Solid-Organ Transplantation

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