Normal estrogen, but low dehydroepiandrosterone levels, in women with pulmonary Mycobacterium avium complex. A preliminary study.

RATIONALE: For unclear reasons, the phenotypical hosts for nontuberculous mycobacterial lung infection are often thin, elderly, white women without underlying lung disease. As these women are usually postmenopausal, we hypothesized that a state of relative hormone deficiency may predispose some women to pulmonary nontuberculous mycobacterial infection. OBJECTIVES: To conduct a prospective cross-sectional study to assess for alterations in systemic levels of sex hormones in patients with confirmed pulmonary Mycobacterium avium complex infection compared with healthy control subjects. METHODS: Female patients with pulmonary M. avium complex infection (n = 35) were recruited along with similar-aged control subjects (n = 27) without lung disease from the general population of our institution. Levels of dehydroepiandrosterone-sulfate (DHEA-S), estrone, and ultrasensitive estradiol were measured from sampled blood. MEASUREMENTS AND MAIN RESULTS: DHEA-S levels of patients with M. avium complex infection were significantly lower than control subjects (mean 33 µg/dl vs. 59 µg/dl, P = 0.001). No significant difference was found in the levels of estrone (mean, 27 pg/ml vs. 28 pg/ml, P = 0.665) or ultrasensitive estradiol (mean, 9 pg/ml vs. 9 pg/ml, P = 0.364). Patients with M. avium complex had a lower body mass index (BMI) than control subjects (mean, 22 vs. 26, P = 0.001). There was no association between levels of DHEA-S, estrone, or estradiol, and BMI or age. CONCLUSIONS: Women with M. avium complex infection had lower DHEA-S levels, but not lower estrogen levels, compared with control subjects. There was no relationship between BMI and hormone levels in the study population. Further study of these hormonal effects on immune function in nontuberculous mycobacterial infection is warranted.

Clinical presentations for influenza and influenza-like illness in young, immunized soldiers.

Concern about respiratory diseases in soldiers increased in the late 1990s as production of the successful adenovirus vaccines stopped and the possibilities of an emergent pandemic influenza strain and use of bioweapons by terrorists were seriously considered. Current information on the causes and severity of influenza-like illness (ILI) was lacking. Viral agents and clinical presentations were described in a population of soldiers highly immunized for influenza. Using standard virus isolation techniques, 10 agents were identified in 164 (48.2%) of 340 soldiers hospitalized for ILI. Influenza isolates (29) and adenoviruses (98) occurred most frequently. Most influenza cases were caused by influenza A and probably resulted from a mismatch between circulating and vaccine viruses. Most (58.5%) patients with an adenovirus had a chest radiograph; 31.3% of these had an infiltrate. Clinical findings did not differentiate ILI caused by the various agents. Only 29 cases of influenza occurred in approximately 7,200 person-years of observation, supporting the use of influenza vaccine.