RESUMO
Idiopathic CD4+ T-Lymphocytopenia is a rare immunodeficiency disorder characterised by significantly low absolute CD4 lymphocytes in absence of any viral infections. We present a case of Disseminated Cryptococcosis with Caverno- Oesophageal Fistula in a case of Idiopathic CD4+ T-Lymphocytopenia. 29 year old lady was referred to Institute in view of lung mass not responding to anti-TB treatment. Subsequently patient had developed headache. Radiological evaluation showed presence of ring enhancing lesion in the occipital region. On evaluation with Fibre-optic bronchoscopy, there was no evidence of malignancy or tuberculosis. Sputum showed presence and growth of Cryptococcus neoformans. Patient's investigations were negative for virus infection, with normal immunoglobulin levels. Her CD4 counts were 129 cells/mm3. Patient was treated with injectable antifungals. Patient developed a Caverno-oesophageal fistula which was confirmed on endoscopy and radiology. Patient was managed with percutaneous jejunal feeding (PEJ). Patient improved symptomatically with CD4 count of 475 cells/mm3.
Assuntos
Criptococose/complicações , Criptococose/epidemiologia , Cryptococcus neoformans , Fístula Esofágica/diagnóstico por imagem , Fístula do Sistema Respiratório/diagnóstico por imagem , T-Linfocitopenia Idiopática CD4-Positiva/epidemiologia , Adulto , Antifúngicos/administração & dosagem , Fístula Esofágica/etiologia , Feminino , Fluconazol/administração & dosagem , Humanos , Lobo Occipital/microbiologia , Radiografia , Fístula do Sistema Respiratório/etiologia , Escarro/microbiologia , T-Linfocitopenia Idiopática CD4-Positiva/diagnósticoRESUMO
We investigated children with CD4+ T lymphocytopenia to determine the magnitude and public health impact of this condition and to investigate possible causes. Children < 13 years old with CD4+ T lymphocyte counts below age-adjusted cutoffs (age < 24 months, 1000 cells/microliters; age > or = 24 months, 300 cells/microliters) or < 20% on 2 separate measurements were considered to have CD4+ T lymphocytopenia. We solicited information from clinicians and public health departments on these children and their families and collected blood for immunologic and retroviral testing. We identified 18 children (10 boys; 14 African-Americans) with a median age of 10 months at their first low CD4+ T lymphocyte measurement. Three children had had opportunistic infections and two still had low CD4+ T lymphocyte counts 5 and 7 years later. Of the 11 children born to human immunodeficiency virus (HIV)-infected mothers 7 were asymptomatic. Specimens from all children were negative for HIV and human T lymphotropic virus antibodies and negative for HIV by culture or polymerase chain reaction. Among 12 families interviewed no other HIV-seronegative family or household member had illnesses suggestive of immunosuppression. We conclude that negative retroviral tests and lack of illness among their family members do not support the hypothesis that a retrovirus causes CD4+ T lymphocytopenia among these children.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Soronegatividade para HIV/imunologia , Infecções Oportunistas , Infecções por Retroviridae , T-Linfocitopenia Idiopática CD4-Positiva , Anticorpos Antibacterianos/análise , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Feminino , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Humanos , Imunofenotipagem , Lactente , Transmissão Vertical de Doenças Infecciosas , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções por Retroviridae/diagnóstico , Infecções por Retroviridae/epidemiologia , Infecções por Retroviridae/imunologia , Infecções por Retroviridae/fisiopatologia , Testes Sorológicos , T-Linfocitopenia Idiopática CD4-Positiva/diagnóstico , T-Linfocitopenia Idiopática CD4-Positiva/epidemiologia , T-Linfocitopenia Idiopática CD4-Positiva/etiologia , T-Linfocitopenia Idiopática CD4-Positiva/imunologiaRESUMO
OBJECTIVE: Survey of the association of idiopathic CD4+ T cell lymphocytopenia in older persons with protein energy undernutrition and unusual infections/colonizations. METHOD: Retrospective chart analysis. RESULTS: Five subjects aged 61 to 87 years, with unusual organisms and/or either marasmus or kwashiorkor, were noted to have absolute CD4+ and CD8+ T cell lymphocytopenia. All were HIV negative. CONCLUSION: T cell lymphocytopenia may not be a uncommon finding in malnourished older persons, but additional studies to determine its prevalence need to be undertaken. Its role in disease and impact on therapeutic response needs to be further explored.
Assuntos
Linfócitos T CD8-Positivos , Linfopenia/complicações , Linfopenia/epidemiologia , Infecções Oportunistas/complicações , Desnutrição Proteico-Calórica/complicações , T-Linfocitopenia Idiopática CD4-Positiva/complicações , T-Linfocitopenia Idiopática CD4-Positiva/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Coleta de Dados , Feminino , Humanos , Linfopenia/sangue , Linfopenia/imunologia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Infecções Oportunistas/microbiologia , Prevalência , Desnutrição Proteico-Calórica/diagnóstico , Estudos Retrospectivos , T-Linfocitopenia Idiopática CD4-Positiva/sangue , T-Linfocitopenia Idiopática CD4-Positiva/imunologiaRESUMO
The syndrome of idiopathic CD4+ lymphocytopenia has recently been recognized and referred to as the persistent depletion of peripheral blood CD4+ T lymphocytes below 300 cells per cubic millimeter or less than 20% of total lymphocytes in the absence of either HIV infection or other known causes of immunodeficiency. The available literature indicates that neither human retroviruses (HIV-1, HIV-2, HTLV-I, HTLV-II) nor other transmissible agents play any clear-cut role in the pathogenesis. Furthermore, the epidemiologic, immunologic and clinical features of this syndrome differ substantially from those of HIV infection. The heterogeneity of both immunologic abnormalities, in addition to CD4+ depletion, and clinical course in patients with this disorder points out no common cause although in at least a subset of patients the pathogenetic pathways could be shared with common variable immunodeficiency.
Assuntos
T-Linfocitopenia Idiopática CD4-Positiva , T-Linfocitopenia Idiopática CD4-Positiva/terapia , Humanos , Síndrome , T-Linfocitopenia Idiopática CD4-Positiva/epidemiologia , T-Linfocitopenia Idiopática CD4-Positiva/etiologia , T-Linfocitopenia Idiopática CD4-Positiva/imunologiaRESUMO
Ten persons with idiopathic CD4+ lymphocytopenia (ICL) were reported in 1992. No common clinical or epidemiologic characteristics or evidence of HIV infection were found. It is unclear whether ICL is a syndrome of undetermined etiology or an immunologic manifestation of various diseases.