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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 43-44

T-cell deficiency with recurrent mucocutaneous candidiasis




Correspondence Address:
A C Karnik


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A case had recurrent and chronic mucocutaneous candidiasis . The main immunological feature were gross T cell deficiency, anergy to common recall antigens but normal serum immunoglobulins, complement and phagocytosis. Ultimately, the multiple candida infections led to a fatal outcome.


Keywords: T-cell deficiency, Chronic mucocutaneous candidiasis.


How to cite this article:
Karnik A C, Vijayvargiya R. T-cell deficiency with recurrent mucocutaneous candidiasis. Indian J Dermatol Venereol Leprol 1990;56:43-4

How to cite this URL:
Karnik A C, Vijayvargiya R. T-cell deficiency with recurrent mucocutaneous candidiasis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Jun 24];56:43-4. Available from: http://www.ijdvl.com/text.asp?1990/56/1/43/3479


Mucocutaneous candidiasis with involve­ment of the skin, nails and mucous membranes is one of the common infections. Chronic candidial infections in T-cell deficient persons have been well documented.[1],[2],[3],[4],[5] However, there is very little data available in the Indian litera­ture on T-cell deficiency leading to chronic mucocutaneous candidiasis. A case of recurrent and chronic candidiasis with T-cell deficiency and a fatal outcome is being presented.


  Case Report Top


A 3-year-old child with multiple pyogenic abscesses all over the scalp since 3-4 months was seen in June, 1985. Besides the scalp infec­tions, there were recurrent episodes of respira­tory tract infection almost since birth. Candida albicans was grown from the abscesses and the patient was treated with cloxacillin, ampic liin, gentamicin and nystatin as a local applicant. The child came back again in December, 1985 with crusted lesions on the scalp and in the oral cavity. The pyoderma persisted on the scalp and Candida albicans was isolated from the scalp and oral cavity. After a few weeks, he developed small vesicles on the scalp, forehead, cheek, ear and nose with a serous discharge. The lesions then spread to the sternal area, groin and penis, along with cervical, axillary and inguinal lymphadenopathy.

Hemogram showed hemoglobin 8 gm, total WBC count 4,550/cmm, with lymphocytes 54%, neutrophils 36% and eosinophils 10%. immunoglobulins estimated by the radial immunodiffusion[6] (Using working kit from Behring, Germany), revealed IgG level 1400 mg%, IgM 85 mg%. IgA 124 mg%, which were within the normal limits. The patient's serum showed agglutination of Candida albicans with the slide method.

The child was admitted again in February, 1986 with no clinical improvement, furthermore he now had candidial otitis media also. The phagocytic function assessed by the nitroblue tetrazolium dye reduction test[7] was found to be normal. The T lymphocyte count performed by the sheep cell rossetting,[8] was found to be as low as 5% (Normal being 60-70%). Skin tests performed using the killed Candida albicans cells (isolated from the same patient), purified protein derivative (PPD) 10 IU, and streptolysin `O' (Prepared in the laboratory) were negative for all the three antigens. There was no improve­ment and the child developed severe pneumonia. This time, the sputum showed abundance of Candida albicans. Amphotericin B was tried but the child died of respiratory failure and toxemia.


  Comments Top


Frequent negativity of skin reaction to candidial antigens only in chronic candidiasis is well known implying the defect in response to a specific candidial antigens only. In the present case, the anergy was generalised since the skin tests were negative for candida antigen, tuberculin (PM and also to streptolysin O. Such findings have been observed earlier as well.[9] Depletion of T lymphocytes further confirms that the recurrent chronic candida infection was due to generalised T cell defect. Chronic candida infections are common in patients with lymphopenic forms of hypogam­maglobulinemia,[10] as well as in cases of hypergammaglobulinemia.[11],[12] Our case had normal immunoglobulin levels with an intact specific antibody response against candida; lie had developed agglutinating antibodies against the candidial antigen. Cell mediated immunity rather than the antibody mediated immunity is important in clearing the candida infection. Gross depletion of the T-cells in the form of inborn defects, leads to acquisition of opportunistic infections like candidiasis which ultimately may prove fatal. Antifungal drugs such as nystatin or ampho­tericin B did not erradicate the candidial infection in this case. Ketoconazole was not available at that time and hence could not be used.

 
  References Top

1.Rothman S : Some unusual forms of cutaneous moniliasis, Arch Dermatol, 1959; 79 : 598-600.   Back to cited text no. 1    
2.Valdimarsson H, Higgs JM, Wells RS et al Immune abnormalities associated with chronic mucocutaneous candidiasis, Cell Immune], 1973; 6 : 348.  Back to cited text no. 2    
3.Hayward AR : Immunodeficiency affecting pre­dominantly cell mediated immunity in : Current Topics in Immunology, First ed, Editor, Hayward AR : Arnold Publishers, London, 1976; n 42-43.  Back to cited text no. 3    
4.Sams WM Jr, Jorizzo JC, Snyderman et al Chronic mucocutaneous candidiasis, Immunolo­gical studies of three generations of a single family Amer, J Med, 1979; 67 :948-958.  Back to cited text no. 4    
5.Lehrer J, William SMA and Iranyil : Immunode­ficiencies in chronic mucocutaneous candidiasis, J Immunol, 1972; 22: 775-787.  Back to cited text no. 5    
6.Fahey JL and McKelvey EM : Quantitative determination of serum immunoglobulins in anti­body-agar plates, J Immunol, 1960; 94 :_84.  Back to cited text no. 6    
7.Segal AW : Nitroblue tetrazolium dye tests, Lancet, 1974; 2 : 1248-1252.  Back to cited text no. 7    
8.Brain P, Gordon J and Willets RA : Rossette formation by peripheral lymphocytes, Clin Exp Immunol, 1970: 6 : 681.  Back to cited text no. 8    
9.Chilgren RA, Meuwissen HJ, Quie PG et al Cellular immune defect in chronic mucocutaneous candidiasis, Lancet, 1969; 2 : 1286-1289.  Back to cited text no. 9    
10.Peterson RD, Balw M and Good RA : Ataxia telangiectasis, a possible clinical counter part of the animals rendered immunologically incompetent by thymectomy, J Paediat, 1963; 63 : 701-703.  Back to cited text no. 10    
11.Papazian LE and Koch R : New Eng J Med, 1960; 16-18 (Quoted in 9).  Back to cited text no. 11    
12.Engel MF : Arch Dermatol, 1961; 84 :60. (Quoted in 9)  Back to cited text no. 12    




 

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