Recurrent vulvovaginal candidiasis: could it be related to cell-mediated immunity defect in response to candida antigen?

Background: Recurrent vulvovaginal candidiasis [RVVC] is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to Candida antigen in RVVC cases

Materials and Methods: Our cross-sectional study was performed in 3 groups of RVVC patients [cases], healthy individuals [control I] and known cases of chronic mucocuta-neous candidiasis [CMC] [control II]. Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mon-onuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to Candida antigen via flow cytometry

Results: T lymphocyte proliferation in response to Candida was significantly lower in RVVC cases [n=24] and CMC patients [n=7] compared to healthy individuals [n=20, P<0.001], but no statistically significant difference was seen between cases and control II group [P>0.05]. Family history of primary immunodeficiency diseases [PID] differed significantly among groups [P>0.0l], RVVC patients has family history of PID more than control I [29.2 vs. 0%, P=0.008] but not statistically different from CMC patients [29.2 vs. 42.9%, P>0.05]. Prevalence of atopy was greater in RVVC cases compared to healthy individuals [41.3 vs. 15%, P=0.054]. Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy [P=0.01, P=0.02]

Conclusion: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components

Innate lymphoid cells and cytokines of the novel subtypes of helper T cells in asthma

BACKGROUND: In this study, the expression of interleukin-9 (IL-9), IL-17, IL-22, and IL-25 genes that might be the potential predisposing factors for asthma as well as count of innate lymphoid cells (ILCs) as another source of inflammatory cytokines have been evaluated. OBJECTIVE: The aim of this study was to evaluate the expression of newly identified helper T cells signature cytokines and amount of ILCs. METHODS: Blood and sputum samples from 23 patients with moderate to severe asthma and 23 healthy volunteers were collected. The types of allergens to which our patients were sensitive were defined using immunoblotting method. Gene expression of studied cytokines was evaluated using quantitative transcription-polymerase chain reaction and ILCs were counted by the flow cytometry method. RESULTS: In this research, the gene expressions of IL-9, IL-17, IL-22, and IL-25 were significantly higher in asthmatics, especially in the severe form of the disease. This increase was even higher in serum samples compared with sputum samples. Counting ILCs revealed their increase in comparison with normal people. CONCLUSION: We showed the importance of IL-25, IL-22, IL-17, and IL-9 cytokines in patients with asthma as their expression levels are increased and these increase are correlated with the severity of the disease. We also showed that the increased amount of ILCs in asthmatics could confirm their potential role in the immunopathogenesis of asthma as another source of inflammatory cytokines.

CD107a expression and IFN-gamma production as markers for evaluation of cytotoxic CD3+ CD8+ T cell response to CMV antigen in women with recurrent spontaneous abortion

Some evidence has shown a relationship between primary human cytomegalovirus [CMV] infection and pregnancy loss. The impact of CMV infection reactivation during pregnancy on adverse pregnancy outcomes is not completely understood. It is proposed that altered immune response, and therefore, recurrence or reactivation of latent CMV infection may relate to recurrent spontaneous abortion [RSA]; however, few data are available in this regard. To find out about any cell mediated defect and reactivation of latent CMV infection in women with RPL, cellular immunity to the virus has been evaluated by specific cytotoxic T lymphocyte [CTL] response to CMV. In a case control study, CTL CD107a expression and intercellular IFN-gamma production in response to CMV pp65 antigen and staphylococcus enterotoxin B [SEB] in women with RSA were assessed by flow cytometric analysis. Forty-four cases with history of recurrent pregnancy and forty-four controls with history of successful pregnancies were included. The FACSCaliber flow cytometer were used for analysis. No significant difference was observed between CD107a expression and IFN-gamma production in response to CMV PP65 antigen in RPL patients and control group. However, the cytotoxic response to SEB antigen in patients with RPL was significantly lower than control group [p=0.042]. The results of this study show that impaired CD107a expression and IFN-gamma production as CTL response to CMV does not appear to be a major contributing and immune incompetence factor in patients with RPL, but cytotoxic T cell response defect to other antigens requires to be assessed further in these patients

Selective antibody deficiency and its relation to the IgG2 and IgG3 subclass titers in recurrent respiratory infections

Selective antibody deficiency with normal immunoglobulins [SADNI] may be identified as part of distinct primary or secondary immunodeficiency disorders. The clinical manifestations include recurrent, often severe or prolonged, upper or lower respiratory tract infections. To evaluate SADNI in patients with recurrent sinopulmonary infections and its relation to IgG subclass deficiencies. Methods: In a case-control study, anti-pneumococcal antibody titer and IgG2, IgG3 levels before injection of pneumococcal vaccine and anti-pneumococcal antibody titer at least 4 weeks the vaccination were measured in 46 patients and 54 controls. The results were compared using student's t-test. There was a significant correlation between age and anti-pneumococcal antibody titers before and after vaccination in patients. No significant relation was found between pre and post vaccination pneumococcal antibody titer and IgG2 and IgG3 in cases and controls [p>0.05]. The mean of anti-pneumococcal antibody before and after vaccination were significantly different in cases and controls and were higher in control group [p=0.01, p=0.001, respectively]. Anti-pneumococcal antibody titers in 97.8% of cases and 100% of controls group were normal [>3.4 micro g/ml]. 34.8% of cases and 9.1% of controls had low titers of anti-pneumococcal antibody [<20 micro g/ml] while 18.7% of cases and no controls failed to respond to vaccine. Evaluation of anti-pneumococcal antibody titer in patients with recurrent, chronic and severe respiratory infections with normal immunoglobulin levels seems to be necessary as early diagnosis. Treatment of such a cases could prevent later sequelae such as mastoiditis and bronchiecstasia

Antineutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis

Mycobacterium tuberculosis is a major cause of mortality and morbidity worldwide. Infection with this bacterium is known to induce the development of autoantibodies of which a few are also known to be diagnostic markers for some other diseases. antineutrophil cytoplasmic antibodies [ANCA's] are among those autoantibodies used in clinical setting for diagnosing systemic vasculitic syndromes. Multiple studies investigated ANCA positivity in diseases other than small vessel vasculitis. This study was performed to determine the prevalence of ANCA in pulmonary tuberculosis [TB] which may lead to the false diagnosis of Wegener's granulomatosis [WG] or vice versa. In a case-control study, 32 consecutive smear positive pulmonary TB patients and 32 normal individuals were studied. All cases and controls were screened for ANCA by indirect immunofluorescent assay [IIF], and MPO and PR3 were also tested by ELISA. A prenuclear pattern [P-ANCA] was detected in 25% of the cases and 6.25% of the controls and a cytoplasmic pattern [C-ANCA] was deserved in 3.1% of both the cases and the controls by IIF assay. ANCA specificities tested by ELISA in cases revealed that 75% of the cases had anti-MPO and 12.5% had anti-PR3, while in the in controls, 3.12% had anti-MPO and none had anti-PR3. The positive ANCA significantly correlated with TB [p<0.01]. ANCA's may be observed in both TB and systemic vasculitic syndromes such as WG. Tuberculosis and WG share some clinical features. Therefore, in countries with a high prevalence of TB, one has to distinguish between these two diseases especially when no sign of extrapulmonary involvement is observed

Association between chlamydia pneumoniae infection and carotid atherosclerotic plaques

Several studies have suggested an association between Chlamydia pneumonia infection and atherosclerosis. This study was designed to investigate the association between this organism and atherosclerotic plaque formation in right and left common carotid arteries [CCAs] and extracranial portions of internal carotid arteries [ICAs]. Antibodies to Chlamydia pneumoniae [IgA and IgG] were measured and compared in 42 patients who had plaque in at least one CCA or ICA [detected by duplex ultrasound] and 82 patients without any plaque in these arteries. Cp.IgG and Cp.IgA titers over 1.10 ISR were defined to be positive. We found that 6.1% of control subjects and 16.7% of cases were Cp.IgA seropositive. The difference between these two groups was prominent but was not statistically significant [P = 0.104]. 4.2% of females without atherosclerotic plaque and 31.6% of females with plaque were Cp.IgA seropositive. This difference is statistically significant [P = 0.005]. There was no significant difference in seropositivity of Cp.IgG between case and control subjects or in male and female groups with or without plaque. Cp.IgA is a predictor of atherosclerosis in women, but Cp.IgG has no predictive value for plaque formation in either gender

Anti-Cardiolipin antibodies and risk of coronary heart disease a hospital-based case-control study

Data concerning the relation between anticardiolipin [aCL] antibodies and coronary heart disease [CLID] in subjects without evidence of overt autoimmune disease are conflicting. The purpose of the present study was to determine whether the presence of aCL antibodies, carries a risk for CHD in a hospital-based case-control study. Using IgG aCL antibody as a risk factor of CHD, a hospital-based case-control study of CHD was conducted in Isfahan, Iran. We examined the sera of 50 CHD cases, aged 10-84 years [mean [Standard Deviation [SD]] 59.7 [12.8] and 100 hospital based controls aged 25-90 [mean [SD] 58.7 [13.7]]. The controls were non-CHD patients, selected from the same hospital as the cases and matched for gender, marital status and age [ +/- 5 years]. Samples were tested for IgG-class antibodies to cardiolipin by enzyme-linked immunosorbent assay [ELISA]. The prevalence of aCL antibody was 2% [95% confidence interval [CI: 0.05 to 10.7]] for cases and 5% [95% CI: 1,6 to 11.3] for controls and this differences was not statistically significant [odds ratio [95% CI]: 0.4 [0.04 to 3.4]]. The odds ratio for IgG aCL antibody did not suggest an increase risk. The mean [SD] of IgG aCL antibody level was higher in control subjects than in patients [2.7 [2.0] versus 4.7 [7.6]; P=0.07]. In a hospital-based. case-control study, the presence of a high IgG aCL antibody level is not an independent risk factor for CHD