IDIOPATHIC CD4+ T-LYMPHOCYTOPENIA - AN ANALYSIS OF 5 PATIENTS WITH UNEXPLAINED OPPORTUNISTIC INFECTIONS

被引:131
作者
SPIRA, TJ
JONES, BM
NICHOLSON, JKA
LAL, RB
ROWE, T
MAWLE, AC
LAUTER, CB
SHULMAN, JA
MONSON, RA
机构
[1] CTR DIS CONTROL & PREVENT,NATL CTR INFECT DIS,DIV VIRAL & RICKETTSIAL DIS,RETROVIRUS BRANCH,ATLANTA,GA 30333
[2] CTR DIS CONTROL & PREVENT,NATL CTR INFECT DIS,DIV VIRAL & RICKETTSIAL DIS,HERPESVIRUS BRANCH,ATLANTA,GA 30333
[3] WILLIAM BEAUMONT HOSP,DIV ALLERGY,ROYAL OAK,MI 48072
[4] WILLIAM BEAUMONT HOSP,DIV IMMUNOL,ROYAL OAK,MI 48072
[5] WILLIAM BEAUMONT HOSP,DIV INFECT DIS,ROYAL OAK,MI 48072
[6] EMORY UNIV,SCH MED,DEPT MED,DIV INFECT DIS,ATLANTA,GA 30322
[7] UNIV ARKANSAS MED SCI HOSP,LITTLE ROCK,AR 72205
关键词
D O I
10.1056/NEJM199302113280603
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Although patients with idiopathic CD4+ T-lymphocytopenia and serious opportunistic infections have been described previously, the clinical and immunologic features of this condition have not been well defined. Methods. We studied in detail five patients with idiopathic CD4+ T-lymphocytopenia. The studies included serologic testing, culture, and polymerase chain reaction for the human immunodeficiency virus (HIV) types 1 and 2, serologic testing for the human T-cell lymphotropic virus (HTLV) types I and II, lymphocyte phenotyping, immunoglobulin quantitation, and lymphocyte-transformation assays, as well as attempts to isolate a retroviral agent. The results were compared with those in HIV-infected persons matched for CD4+ T-cell counts and with those in normal controls. We also studied the spouses of patients and the blood donors for one patient. Results. In these five patients, there was no evidence of either HIV or HTLV infection. All the patients had both low percentages and low counts of CD4+ T cells, with relative increases in percentages, but not counts, of CD8+ cells. Numbers of B cells and natural killer cells were generally normal. As compared with HIV-infected persons, our patients had lower percentages and counts of CD8+ cells and more lymphopenia. CD4+ counts were relatively stable over time. Instead of the high immunoglobulin levels seen in HIV infection, these patients had normal or slightly low levels of immunoglobulins. The lymphocyte-transformation response to mitogens and antigens was depressed. Results in spouses and blood donors were normal. Conclusions. Idiopathic CD4+ T-lymphocytopenia differs from HIV infection in its immunologic characteristics and in its apparent lack of progression over time. Nothing about the immunologic or viral-culture studies performed in these patients or about their family members or blood donors suggests that a transmissible agent causes this condition.
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页码:386 / 392
页数:7
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