In vitroandin vivoCellular Immunity in Anergic Miliary Tuberculosis^1–3

Abstract

_A patient with cutaneous anergy and miliary tuberculosis was studied with serial determinations in vivo of skin test responsiveness to natural antigens and to vesicant doses of dinitrochlorbenzene, and in vitro with buffy coat migration inhibition, indirect migration inhibition factor production, and lymphocyte transformation during the acute phase of the disease and during convalescence. During the anergic phase, the patient maintained good lymphocyte transformation to phytohemagglutinin and purified protein derivative of tuberculin and showed strong buffy coat migration inhibition that was partially dependent on autologous serum but not complement; however, indirect migration inhibition factor production to purified protein derivative was not demonstrable. The results suggest that the defect in anergic tuberculosis resides at least partially in the nonimmunologic inflammatory response and that lymphocyte function is at least partially intact.

Advances in the diagnosis of tuberculosis

“…A recent meta‐analysis stated that the overall sensitivity of the TST for active tuberculosis is 77%; 191 however, the sensitivity of the test can be dramatically impaired, for example, in infants and toddlers 192 as well as in elderly persons, 193 in individuals with congenital or acquired immunodeficiencies (e.g. those with HIV infection 194–196 ), patients being treated with corticosteroids 197 or other immunosuppressive drugs, 198 patients with chronic renal failure, 199,200 malnutrition, 201,202 cancer 203 or overt forms of tuberculosis 204,205 . The specificity of the TST is dependent on the BCG vaccination status 206 and the immune status of the individual who is tested 191 .…”

“…those with HIV infection [194][195][196] ), patients being treated with corticosteroids 197 or other immunosuppressive drugs, 198 patients with chronic renal failure, 199,200 malnutrition, 201,202 cancer 203 or overt forms of tuberculosis. 204,205 The specificity of the TST is dependent on the BCG vaccination status 206 and the immune status of the individual who is tested. 191 Cross-reactivity of antigens may result in a positive TST reaction after exposure to NTM 207 or following M. bovis BCG vaccination.…”

Cellular Immunity in Rheumatic Diseases I. Rheumatoid Arthritis

“…It is known that other measures of lymphocyte function such as migration inhibition factor production or antigen-induced transformation may be normal despite cutaneous anergy (23,26). In some instances this is clearly related to the inability of the patient to mount an inflammatory response (26).…”

“…T h e discrepancy between normal lymphocyte response to mitogen and absent skin-test reactivity is not easily explained, but it is not unique to RA (23)(24)(25). It is known that other measures of lymphocyte function such as migration inhibition factor production or antigen-induced transformation may be normal despite cutaneous anergy (23,26). In some instances this is clearly related to the inability of the patient to mount an inflammatory response (26).…”

“…It is known that other measures of lymphocyte function such as migration inhibition factor production or antigen-induced transformation may be normal despite cutaneous anergy (23,26). In some instances this is clearly related to the inability of the patient to mount an inflammatory response (26). In the present study, there may be three explanations for the differences between in vitro and in vivo reactions: independence of lymphocyte response to mitogen and to antigen, functional defect in the chain of cellular immunity beyond the point of lymphocyte response, and defective inflammatory response not elicited under the conditions of testing.…”