Adult-Onset Immunodeficiency in Thailand and Taiwan

被引：393

作者：

Browne, Sarah K. ^{[1
,8
]}

Burbelo, Peter D. ^{[3
]}

Chetchotisakd, Ploenchan ^{[6
]}

Suputtamongkol, Yupin ^{[7
]}

Kiertiburanakul, Sasisopin

Shaw, Pamela A. ^{[2
]}

Kirk, Jennifer L. ^{[2
]}

Jutivorakool, Kamonwan ^{[1
,9
,10
]}

Zaman, Rifat ^{[1
]}

Ding, Li ^{[1
]}

Hsu, Amy P. ^{[1
]}

Patel, Smita Y. ^{[11
]}

Olivier, Kenneth N. ^{[1
]}

Lulitanond, Viraphong ^{[6
]}

Mootsikapun, Piroon ^{[6
]}

Anunnatsiri, Siriluck ^{[6
]}

Angkasekwinai, Nasikarn ^{[7
]}

Sathapatayavongs, Boonmee ^{[8
]}

Hsueh, Po-Ren ^{[12
]}

Shieh, Chi-Chang ^{[13
]}

Brown, Margaret R. ^{[1
]}

Thongnoppakhun, Wanna ^{[7
]}

Claypool, Reginald ^{[1
]}

Sampaio, Elizabeth P. ^{[1
,14
]}

Thepthai, Charin ^{[7
]}

Waywa, Duangdao ^{[7
]}

Dacombe, Camilla ^{[5
]}

Reizes, Yona ^{[5
]}

Zelazny, Adrian M. ^{[4
]}

Saleeb, Paul ^{[1
]}

Rosen, Lindsey B. ^{[1
]}

Mo, Allen ^{[1
,15
]}

Iadarola, Michael ^{[3
]}

Holland, Steven M. ^{[1
]}

机构：

[1] NIAID, Lab Clin Infect Dis, NIH, Bethesda, MD 20892 USA

[2] NIAID, Biostat Res Branch, NIH, Bethesda, MD 20892 USA

[3] Natl Inst Dent & Craniofacial Res, Lab Sensory Biol, NIH, Bethesda, MD USA

[4] NIH, Microbiol Serv, Dept Lab Med, Ctr Clin, Bethesda, MD 20892 USA

[5] Systex, Rockville, MD USA

[6] Khon Kaen Univ, Srinagarind Hosp, Khon Kaen, Thailand

[7] Mahidol Univ, Siriraj Hosp, Bangkok 10700, Thailand

[8] Mahidol Univ, Ramathibodi Hosp, Fac Med, Bangkok 10400, Thailand

[9] Chulalongkorn Univ, Fac Med, Dept Med, Bangkok 10330, Thailand

[10] Thai Red Cross Soc, King Chulalongkorn Mem Hosp, Bangkok, Thailand

[11] Univ Oxford, John Radcliffe Hosp, Oxford OX3 9DU, England

[12] Natl Taiwan Univ, Taipei 10764, Taiwan

[13] Natl Cheng Kung Univ, Tainan 70101, Taiwan

[14] Inst Oswaldo Cruz, Leprosy Lab, BR-20001 Rio De Janeiro, Brazil

[15] Colgate Univ, Hamilton, NY 13346 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2012年 / 367卷 / 08期

基金：

美国国家卫生研究院;

关键词：

NONTUBERCULOUS MYCOBACTERIAL INFECTION; INTERFERON-GAMMA AUTOANTIBODY; IFN-GAMMA; AVIUM COMPLEX; PATIENT; DISEASES; SUSCEPTIBILITY; RECURRENT; HIV;

D O I：

10.1056/NEJMoa1111160

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Autoantibodies against interferon-gamma are associated with severe disseminated opportunistic infection, but their importance and prevalence are unknown. METHODS We enrolled 203 persons from sites in Thailand and Taiwan in five groups: 52 patients with disseminated, rapidly or slowly growing, nontuberculous mycobacterial infection (group 1); 45 patients with another opportunistic infection, with or without nontuberculous mycobacterial infection (group 2); 9 patients with disseminated tuberculosis (group 3); 49 patients with pulmonary tuberculosis (group 4); and 48 healthy controls (group 5). Clinical histories were recorded, and blood specimens were obtained. RESULTS Patients in groups 1 and 2 had CD4+ T-lymphocyte counts that were similar to those in patients in groups 4 and 5, and they were not infected with the human immunodeficiency virus (HIV). Washed cells obtained from patients in groups 1 and 2 had intact cytokine production and a response to cytokine stimulation. In contrast, plasma obtained from these patients inhibited the activity of interferon-gamma in normal cells. High-titer anti-interferon-gamma autoantibodies were detected in 81% of patients in group 1, 96% of patients in group 2, 11% of patients in group 3, 2% of patients in group 4, and 2% of controls (group 5). Forty other anticytokine autoantibodies were assayed. One patient with cryptococcal meningitis had autoantibodies only against granulocyte-macrophage colony-stimulating factor. No other anticytokine autoantibodies or genetic defects correlated with infections. There was no familial clustering. CONCLUSIONS Neutralizing anti-interferon-gamma autoantibodies were detected in 88% of Asian adults with multiple opportunistic infections and were associated with an adult-onset immunodeficiency akin to that of advanced HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and the National Institute of Dental and Craniofacial Research; ClinicalTrials.gov number, NCT00814827.)

引用

页码：725 / 734

页数：10

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