Immunocompetence in adults: more than HIV negative

Abstract

I read a case report about Tuberculosis and fungal co-infection in a previously healthy patient published in Colomb Med (Cali) by Fontalvo et al., and I would like to address some related comments. Frequently clinicians report adult cases of patients with opportunistic infections as disseminated tuberculosis and/or fungal infections in patients consider as immunocompetent based mainly in the absence of human immunodeficiency virus infection (HIV negative). Immunocompetence is more complex than absence of HIV infection and involves a normal capacity to develop an immune response following the exposure to an antigen or broadly a normal immune response, but usually immunocompetent is define as the opposite of immunodeficiency. In the report authors said “Our aim is to report the case of an immunocompetent patient diagnosed with Mycobacterium tuberculosis and Candida albicans co-infections” but my deliberation is Do we make in the clinical practice all the efforts to consider a patient as immunocompetent? Mycobacterial, fungal and other opportunistic infections force the clinician to rule out a large list of conditions associated with secondary immunodeficiency as infectious agents (HIV, Herpesvirus, HTLV), drugs (steroids, immunosuppressants, biologics, chemotherapy) , metabolic diseases (diabetes, renal failure, cirrhosis), malignancies (leukemia, lymphomas and solid tumors) and environmental conditions (radiation, heavy metals) but even adult patients can have late onset primary genetic immunodeficiency

Authors Response: Tuberculosis and pulmonary candidiasis co-infection present in a previously healthy patient

“…In response to the note 1 about the case described 2 , we fully agree that immunodeficiency is not only the relationship with HIV infection, and that there are pathologies and different immunological and genetic conditions associated with it 3 - 5 ; the main ones were discarded in the patient.…”

Characteristics of nocardiosis patients with different immune status from a Chinese tertiary general hospital during 8-year period

“…Thus, a total of 23 cases of culture-proven, nonrepetitive nocardiosis patients from our hospital, a 1500-bed tertiary general hospital in Beijing China, during 8-year period were characterized in our study, and we performed the Nocardia species identification by DNA sequencing and antibiotic susceptibility testing by E test method with all the available strains at the same time, instead of collecting these data retrospectively. Then these patients were divided into ISPs and ICPs groups according to the previously defined criteria, [10,11] based on their clinical characteristics. Our study showed that the 39.1% of these nocardiosis patients were ICPs and most of them recovered.…”

“…[3] Co-infections, such as viral, bacterial, fungal pneumonia, were defined as previously described. [7] ICPs were defined following the criteria of Zea-Vera, [11] which involved not only the absence of HIV infection, but also the normal capacity to develop an immune response following the exposure to an antigen or broadly a normal immune response.…”

Tuberculous Meningitis: Immunocompetence, Secondary Immunodeficiency, or Adult Onset Primary Immunodeficiency?

“…Among the most relevant causes of SID are infectious diseases (HIV, hepatitis C virus, hepatitis B virus, herpesvirus, and human T lymphotropic virus), metabolic diseases, genetic and systemic diseases (diabetes and kidney and liver diseases), malignancies (hematological and solid organ cancer), autoimmunity (systemic lupus erythematosus or amyloidosis), drugs, radiation, and others. 2,3 From my point of view, a deeper evaluation is necessary before considering as immunocompetent the patients presented in this article.…”