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Clinical and Diagnostic Laboratory Immunology, January 1999, p. 73-78, Vol. 6, No. 1
Immunology Branch,1
and
Office of the Director,4
Division of AIDS, Sexually Transmitted Diseases, and
Tuberculosis Laboratory Research, and Investigation and Prevention
Branch, Hospital Infections Program,2 National
Center for Infectious Diseases Centers for Disease Control and
Prevention, Public Health Service, Atlanta, Georgia 30333 and
Bamrasnaradura Infectious Diseases Hospital, Nonthaburi,
Thailand3
Received 1 May 1998/Returned for modification 13 August
1998/Accepted 2 October 1998
Opportunistic infections (OI) and the human immunodeficiency virus
(HIV) cause significant morbidity and mortality in developing countries. Immune cell and cytokine profiles may be related to the type
and course of OI and to the OI-HIV interaction. Examining cell-specific
cytokine production ex vivo has only recently become feasible. In
Thailand, 53 febrile, hospitalized adults were enrolled in a study of
the immune correlates of bloodstream infections (BSI). On
site, blood cells were stimulated ex vivo. Cell-surface antigens and
eight intracellular cytokines were subsequently analyzed using flow
cytometry to determine associations with mortality and the organism
causing the BSI. By logistic regression analysis, the percentage of
CD3+ CD16/56+ cells making tumor necrosis
factor alpha (TNF-
1071-412X/99/$00.00+0
Immune Determinants of Organism and Outcome in
Febrile Hospitalized Thai Patients with Bloodstream
Infections

) (P = 0.033) and the percentage
of CD3
CD16/56+ cells (NK)
(P = 0.032) were related to HIV positivity. Lymph node
enlargement with HIV infection and the percentage of
CD3+ CD16/56+ making TNF-
were predictive of
death. A lower percentage of CD3+ CD8+
lymphocytes making interleukin-8 (IL-8)
(P = 0.005), fewer monocytes expressing CD14
(P = 0.009), and the percentage of CD3+
CD8+ cells producing gamma interferon (P = 0.011) were associated with blood culture positivity and the causative
organism. For every one point decrease in the percentage of
CD3+ CD8+ cells making IL-8, the likelihood of
a positive culture increased 23%; for every one point decrease in the
percentage of monocytes expressing CD14, the likelihood of a positive
culture increased by 5%. Only a few immune cell types and three of
their related cytokines were significantly associated with HIV disease
outcome or the BSI organism. These cell types did not include
CD3+ CD8
cells (a surrogate for
CD4+ cells), nor did they involve cytokines
associated with a type I to type II cytokine shift, which might
occur with advancing HIV infection. These associations
support the premise that CD8+ and CD16/56+
lymphocytes play significant roles in HIV and type I infections.
*
Corresponding author. Mailing address: Mailstop A-25,
Immunology Branch, DASTLR, NCID, CDC, 1600 Clifton Rd., N.E.; Atlanta, GA 30333. Phone: (404) 639-3919. Fax: (404) 639-2108. E-mail: JMJ1{at}CDC.gov.
Present address: Tufts University, Medford, MA.
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