The Role of Phagocytic Respiratory Burst in Host Defense Against Mycobacterium tuberculosis

Abstract

fluconazole dose was increased to 200 mg/d; thus, she was referred Candida Endocarditis Following Percutaneous to our hospital for further care. Transluminal Coronary Angioplasty Physical examination on admission revealed fever (temperature, 38.6ЊC) and tachycardia without any peripheral embolic signs in Although percutaneous transluminal coronary angioplasty the eyes and oral cavity. The heartbeat was regular, with a splitting (PTCA) is performed frequently, to our knowledge, it has not been of S 1 ; a grade 2/6 systolic murmur was heard over the right and associated with subsequent serious infection. We report a case of left upper sternal borders, with radiation to the neck. The chest candida endocarditis that occurred after PTCA was performed. was clear without basal rales. Splinter hemorrhagic spots were A 42-year-old female was admitted to the hospital with a found on the right 2nd and 4th fingers and the left 3rd finger, and 4-month history of fever. Five months before admission, she had Janeway lesions were seen over both palms. The right leg was cold undergone emergent PTCA twice at a local hospital because of and tender to palpation, and the right pedal pulse was diminished. acute myocardial infarction involving the right coronary artery. Findings of the remainder of the physical examination were unre-She was discharged after 1 week of hospitalization. Two weeks markable. later, she developed intermittent fever (temperature, £39ЊC) in Four sets of cultures of blood obtained at admission all yielded association with dizziness, black floaters, soreness over her right Candida parapsilosis. A transthoracic echocardiogram showed leg, and pain on pressure over her nails. vegetations on the aortic valves, which were associated with mild She was readmitted to the same hospital because of the persistent aortic regurgitation and mitral regurgitation. Left aortoiliac embolifever, soreness over her right leg, and painful nails. Blood cultures zation was disclosed by a Doppler study of the lower extremities. yielded Candida species, and nosocomial fungemia was diagnosed. Therapy with intravenous amphotericin B (0.5 mg/kg) was initiated Oral fluconazole was prescribed at a dose of 100 mg/d, and she immediately on admission, and therapy with oral fluconazole was was discharged 3 weeks later with instructions to continue taking discontinued. oral fluconazole. The fever and the symptoms of painful nails and Aortic valve replacement with a mechanical valve (Carbomedright leg soreness subsided during hospitalization but recurred 2 ics, Austin, TX) and left aortoiliac embolectomy were performed days after discharge. The fever persisted despite the fact that the on the 7th hospital day. Large vegetations were found over all three leaflets of the aortic valve, but there was no significant aortic valvular dilatation. Culture of the valve tissue yielded C. parapsilosis and Candida albicans.

Resistance of Macrophages toMycobacterium aviumIs Induced by α2-Adrenergic Stimulation

“…Also, individuals with chronic granulomatous disease are more susceptible to tuberculosis (42). Thus, these studies support a role for NADPH oxidase in resistance to mycobacteria.…”

Cu,Zn Superoxide Dismutase ofMycobacterium tuberculosisContributes to Survival in Activated Macrophages That Are Generating an Oxidative Burst

“…This is true for mycobacterial infections, including BCG and M. tuberculosis, which exhibit an increased incidence in chronic granulomatous disease patients (19,23,28). In addition, experiments performed with phagocyte oxidase knockout mice have established that the respiratory burst of the host contributes to the control of M. tuberculosis during experimental infections (2, 10).…”

Neutrophil-Mediated Mycobacteriocidal Immunity in the Lung duringMycobacterium bovisBCG Infection in C57BL/6 Mice

“…Likewise, a role for neutrophil-derived defensins has not been clearly established in humans, although growth of M. tuberculosis in mice and in vitro may be partially impaired by treatment with human neutrophil defensins (23,36). In addition, relapsing and intractable tuberculosis has been described in patients with a defective gp91 phox gene, a gene that is important for reactive oxygen radical production and oxidative killing of intracellular pathogens (19).…”