IGRA-positive patients and interferon-gamma/interleukin-2 signatures: can the Fluorospot assay provide further information?

A goal of testing for latent tuberculosis (TB) infection is to identify individuals who are at increased risk for the development of active TB. No laboratory tool is currently available to distinguish between individuals in the process of progressing from latent TB infection towards active disease and those who are not. Determination of the interferon-gamma and interleukin-2 T cell signature might provide an additional and rapid tool to evaluate treatment necessity and clinical management of a patient. Here, we present three cases of interferon-gamma release assay-positive patients with differing interferon-gamma and interleukin-2 signatures when analyzed by the Fluorospot assay.

[Chronic cough in children--what to consider and how to evaluate?]. / Chronischer Husten beim Kind--An was denken Sie? Was abklären?

There is a long list of differential diagnoses for chronic cough lasting longer than 4 weeks in children. Diagnostic work up starts with a detailed history taking and a clinical investigation followed by a chest X-ray (in one plane) and a spirometry. For the latter reliable results can be achieved by children older then 5 years. If the diagnostic work up is still inconclusive and if the child is in good clinical condition, a 4 weeks' course of inhalation therapy with steroids and betamimetics together with a 2 weeks' course of antibiotics with a macrolide is warranted. In case coughing persists a thorough diagnostic work up is indicated to rule out conditions like cystic fibrosis, relevant humoral immuno-deficiencies, primary ciliary dyskinesia, anatomic malformation or chronic pulmonary aspiration, preferably done by a pediatric pulmonologist. Chronic cough has to be considered abnormal in any child under the age of 1 year. For this age group a final diagnosis is of special importance.

Effect of 3 weeks' rehabilitation on neutrophil surface antigens and lung function in cystic fibrosis.

Neutrophil leukocytes have been shown to be the predominant cells in inflammatory airway infiltrates of cystic fibrosis (CF) patients. The aim of this study was to investigate the effect of rehabilitation on neutrophil surface antigen expression and lung function in healthy controls and stable CF patients with moderately severe disease. The absolute number of neutrophils and the level of surface marker expression on neutrophils were elevated in 12 CF patients compared with eight healthy controls. The level of neutrophil surface marker expression was similar in bronchoalveolar lavage fluid from CF patients who underwent bronchoscopy for diagnostic or therapeutic reasons. After 3 weeks' rehabilitation, there was a significant reduction in the expression of CD11b (complement receptor type 3), CD13 (aminopeptidase N), CD32 (low-affinity Fc gamma chain receptor II), and CD35 (complement receptor type 1) in only the CF patients. At the same time, lung function improved significantly. The increase in forced vital capacity correlated significantly with the decrease in CD32 level. These results demonstrate that rehabilitation in a specialized clinic can reduce the neutrophil-dominated inflammation and improve the lung function of stable CF patients with moderately severe disease even without changing any medications.