Tuberculous Lymphadenitis: Skin Delayed-Type Hypersensitivity Reaction and Cellular Immune Responses
Tuberculous Lymphadenitis: Skin Delayed-Type Hypersensitivity Reaction and Cellular Immune Responses
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Date
2011-05
Authors
E. A. G. Khalil
A. A. Elnour
A. M. Musa
A. A. Elagib
S. H. Hassab Elgawi
W. M. A. Ismail
K. E. ELzaki
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Abstract
BACKGROUND: Tuberculous lymphadenitis (TL) is the
commonest form of extra-pulmonary tuberculosis in tropical
countries.
OBJECTIVE: This study aimed to characterize in vivo and in
vitro cellular immune responses to Mycobacterium PPD in
TL patients as markers of disease and healing.
METHODS: Following informed consent, 36 TL patients, 40
patients with pulmonary tuberculosis (TB) and 20 apparently
healthy individuals were enrolled when they met specific
selection criteria. The tuberculin skin test (TST) and
peripheral blood mono-nuclear cells (PBMCs) culture were
conducted using PPD. The cytokines were measured using
commercial kits.
RESULTS: The mean TST was 24.6 ±8.0 mm for TL patients.
The TST was variable in pulmonary TB patients and healthy
individuals. It was reactive in a third of pulmonary TB patients
with a mean of 20 ±3.0 mm and reactive in half of the healthy
individuals with a mean of 12.6 ±3.2 mm. Pre and posttreatment
interferon gamma (IFN-g) mean levels were 498.6
±905.8 pg/ml and 710.0 ±844.6 pg/ml respectively (p=0.0001)
for TL patients, while IL-10 mean levels were 93.0 ±136.0 pg/
ml and 32.4 ±31.7 pg/ml respectively (p= 0.0001). TST-reactive
Pulmonary TB patients had significantly higher IFN-g (851
±234.4 pg/ml) compared to TBLNT patients (p = 0.0001), while
pulmonary TB patients had significantly lower IL-10 compared
to TBLNT patients (p=0.0001). Apparently healthy individuals
had significantly lower IFN-g and IL-10 levels compared to
TBLNT and pulmonary TB patients (p=0.003).
CONCLUSION: Strong TST reactivity, high IFN-g and IL-10
levels are good surrogate markers of active TBLNT, while
increasing IFN-g levels and decreasing IL-10 levels mark
healing. Tuberculosis Skin Test reactivity although a good
diagnostic marker does not disappear with treatment.
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Citation
Khalil, E.A.G., Elnour, A.A., Musa, A.M., Elagib, A.A., Elgawi, S.H., Ismail, W.M.A. and Elzaki, K.E., 2011. Tuberculous Lymphadenitis: Skin Delayed-Type Hypersensitivity Reaction and Cellular Immune Responses. West African Journal of Medicine, 30(3), pp.193-196.