Anti-interferon-γ autoantibody and opportunistic infections: case series and review of the literature

Kampitak, Thatchai; Suwanpimolkul, Gompol; Browne, Sarah K.; Suankratay, Chusana

doi:10.1007/s15010-010-0067-3

Cited by 98 publications

(81 citation statements)

References 19 publications

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“…2,3,5,[18][19][20][21][22] Patient 2 had a slightly decreased CD4 lymphocyte count but not low enough to cause disseminated nontuberculous mycobacterial disease. All patients had been healthy into adulthood, whereas primary immunodeficiencies tend to present early in life.…”

Section: Discussionmentioning

confidence: 99%

Anti-CD20 (rituximab) therapy for anti–IFN-γ autoantibody–associated nontuberculous mycobacterial infection

Browne

Zaman

Sampaio

et al. 2012

Blood

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Section: Discussionmentioning

confidence: 99%

Anti-CD20 (rituximab) therapy for anti–IFN-γ autoantibody–associated nontuberculous mycobacterial infection

Browne

Zaman

Sampaio

et al. 2012

Blood

160

133

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“…Recently, high levels of certain anticytokine antibodies (e.g., anti-granulocyte-macrophage colony-stimulating factor [GM-CSF] antibodies) were associated with cryptococcosis in HIV-negative patients (276). These antibodies predispose individuals to opportunistic infections by impairing innate immunity and may be especially relevant among HIV-negative patients in Asia (277,278). Saijo et al most recently reported the presence of anti-GM-CSF autoantibodies in the plasma of seven apparently immunocompetent patients with C. gattii meningoencephalitis but, interestingly, not in the plasma of patients with C. neoformans disease (279).…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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SUMMARY Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans , although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

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“…Negative changes in a positive control are caused by individual background factors, such as an immunocompromised status, including acquired immunodeficiency syndrome or immunosuppressant intake. The level of anti-IFN-γ autoantibodies, as reported in severe infectious diseases, including sepsis caused by opportunistic pathogens (18) or disseminated nontuberculous mycobacterium infection (19,20), is also high in this situation.…”

Section: Discussionmentioning

confidence: 77%

Miliary Tuberculosis with Indeterminate Interferon Gamma Release Assay Results

et al. 2013

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Recently, interferon gamma release assays (IGRAs) have become an important clinical tool for detecting latent tuberculosis. However, IGRA results may impede making a diagnosis. We herein present an interesting case of miliary tuberculosis with a nonspecific IGRA reaction due to hemophagocytosis. Case ReportA 64-year-old man with advanced chronic kidney disease due to nephrosclerosis and ischemic heart disease was admitted to our hospital with an intermittent high-grade fever lasting for one week. The plan was to initiate hemodialysis therapy, and the patient underwent surgery for internal shunt ostomy in the left upper arm two months prior to admission. He was given neither steroids nor other immunosuppressants. On admission, he was free from respiratory symptoms, such as a productive cough. His laboratory data and radiological findings were evaluated. The clinical laboratory data obtained on admission confirmed a high alkaline phosphatase level (above 2,000 IU/mL) and a decreased hemoglobin (Hgb) level (below 10.0 g/dL). The serum C-reactive protein and procalcitonin levels were elevated, indicating an inflammatory reaction. The soluble interleukin-2 receptor (sIL-2R) level was elevated to 18,986 U/mL. Both anti-HIV and anti-human T-cell leukemia virus (HTLV) antibodies were negative. He had no history of hematological diseases. Chest roentogenography performed on admission showed no abnormalities, except cardiomegaly ( Figure A).We initially suspected a bloodstream infection, such as infectious endocarditis, and thus performed blood cultures and serological surveillance. However, these microbiological inspections yielded no useful data. On the other hand, chest computed tomography revealed slight density changes in both lung fields ( Figure B); however, the patient had no respiratory symptoms. Although we recognized a slight density elevation in the pulmonary alveolar field, radiologists in our hospital did not mention these findings, and miliary tuberculosis was not suspected. The detection of a column appearance depends on the type of monitor used. We attempted to obtain respiratory samples to detect pulmonary infections, including tuberculosis. However, due to the lack of sputum production, we were unable to obtain respiratory samples. The interferon gamma release assay (IGRA, QuantiFERON-TB TM Gold In-tube (QFT-3G)) results showed values for both negative and positive controls as well as the patient's samples exceeding 8.01 IU/mL. According to previous guidelines for using IGRAs (1), our patient's results were invalid due to the nonspecific reaction of the negative control (a positive reaction in the negative control).Despite conducting further studies, a final diagnosis was not reached, and the patient's condition deteriorated. Hemo-

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Anti-interferon-γ autoantibody and opportunistic infections: case series and review of the literature

Cited by 98 publications

References 19 publications

Anti-CD20 (rituximab) therapy for anti–IFN-γ autoantibody–associated nontuberculous mycobacterial infection

Anti-CD20 (rituximab) therapy for anti–IFN-γ autoantibody–associated nontuberculous mycobacterial infection

Cryptococcus gattii Infections

Miliary Tuberculosis with Indeterminate Interferon Gamma Release Assay Results

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