RESUMEN
BACKGROUND AND OBJECTIVE: Cellular immunity abnormalities are associated with sarcoidosis. Normal cellular immunity is required for adequate humoral immunity; therefore, a decreased humoral immune response is possible in patients with sarcoidosis. We evaluated humoral immunity by vaccinating patients with sarcoidosis against tetanus. PATIENTS AND METHOD: We screened 60 patients with sarcoidosis (42 females, average age 39 +/- 11 years) and 40 healthy subjects as a control (23 females, average age 38 +/- 9 years). Of the 51 sarcoidosis patients and 33 controls that did not have sufficient tetanus antibody titers, 48 patients and 31 controls agreed to be vaccinated and were included in the vaccination program. Blood serum samples were collected from the subjects before and after vaccination and evaluated for tetanus toxoid IgG antibodies with an enzyme-linked immunosorbent assay (ELISA). RESULTS: As a result of the vaccination, 24 of the sarcoidosis patients (50%) and 7 of the controls (23%) had insufficient antibody responses (p = 0.019). No relationship was found in sarcoidosis patients between the rate of having sufficient antibody levels and disease duration, activation state, and radiographic staging of the disease. Conversely, mean lymphocyte numbers were significantly lower in patients with insufficient tetanus antibody levels (p = 0.013). CONCLUSION: Tetanus vaccinations in sarcoidosis patients are less effective than in healthy controls, suggesting that patients with sarcoidosis have a hyporesponsive humoral immune system.
Asunto(s)
Inmunidad Celular , Inmunidad Humoral , Sarcoidosis/inmunología , Toxoide Tetánico/inmunología , Adulto , Anticuerpos Antivirales/sangre , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Recuento de Linfocitos , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Toxoide Tetánico/administración & dosificación , VacunaciónRESUMEN
BACKGROUND AND OBJECTIVES: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis (TB) infection (LTBI). LTBI screening of this population is recommended. The QuantiFERON-TB Gold assay (QFT-G) may be more accurate than the tuberculin skin test (TST) in the detection of LTBI. We prospectively compared the results of QFT-G to TST in HD patients. METHODS: We examined 100 patients and performed TST and QFT-G tests. Data obtained from patients and medical records included medical history (past history of TB, Bacillus Calmette-Guerin [BCG] vaccination, history of contact with previous TB cases), radiography reports (chest x-ray with changes consistent with old TB), and basic laboratory findings. RESULTS: Forty-three of 100 patients (43%) had a positive QFT-G test result and 34 (34%) had a positive TST test result. Overall agreement between the QFT-G and the TST was 65% (concordance [k]=0.26, P=0.01). Discordant test results were seen in 13 TST-positive/QFT-G-negative patients and in 22 TST-negative/QFT-G-positive patients. Before BCG vaccination and radiographic reports (of old TB changes) were associated with discordant test results. On multivariate analysis, a positive QFT-G test was associated with contact with previous TB cases (P=0.026) and radiographic report (P=0.034), whereas a positive TST test also was associated with a history of BCG vaccination (P=0.015). CONCLUSIONS: QFT-G test results were more closely associated with TB risk factors than were positive TST results. Additionally, the QFT-G test was not affected by BCG vaccination. We concluded that QFT-G test is a more useful diagnostic method than TST for detecting LTBI in HD patients.
Asunto(s)
Técnicas Bacteriológicas/métodos , Tuberculosis Latente/diagnóstico , Mycobacterium tuberculosis/inmunología , Diálisis Renal/efectos adversos , Prueba de Tuberculina , Proteínas Bacterianas/inmunología , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Interferón gamma/metabolismo , Tuberculosis Latente/sangre , Tuberculosis Latente/complicaciones , Masculino , Persona de Mediana Edad , Oligopéptidos , Estudios Prospectivos , Proteínas Recombinantes/inmunología , Insuficiencia Renal/complicaciones , Insuficiencia Renal/cirugía , Sensibilidad y Especificidad , TurquíaRESUMEN
Polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is considered to decrease predisposition to sarcoidosis. Our study aimed to investigate the roles of this polymorphism in the development and extent of sarcoidosis. We examined polymorphisms of the VEGF gene in 90 cases with histopathological diagnosis of sarcoidosis and in 110 healthy subjects. VEGF +813 gene polymorphisms were determined using a polymerase chain reaction-based method after DNA isolation. A significant increase in the frequency of the T allele was found in healthy subjects (odds ratio 0.55; 95% confidence interval 0.32-0.97, P<0.05). Our results suggest that increase in rarer T allele at + 813 locus of VEGF gene may diminish susceptibility to sarcoidosis in Turkish population.