Immunocompetence in adults: more than HIV negative
I read a case report about Tuberculosis and fungal co-infection in a previously healthy patient published in Colomb Med (Cali) by Fontalvo et al., and I would like to address some related comments. Frequently clinicians report adult cases of patients with opportunistic infections as disseminated tuberculosis and/or fungal infections in patients consider as immunocompetent based mainly in the absence of human immunodeficiency virus infection (HIV negative). Immunocompetence is more complex than absence of HIV infection and involves a normal capacity to develop an immune response following the exposure to an antigen or broadly a normal immune response, but usually immunocompetent is define as the opposite of immunodeficiency. In the report authors said “Our aim is to report the case of an immunocompetent patient diagnosed with Mycobacterium tuberculosis and Candida albicans co-infections” but my deliberation is Do we make in the clinical practice all the efforts to consider a patient as immunocompetent?Mycobacterial, fungal and other opportunistic infections force the clinician to rule out a large list of conditions associated with secondary immunodeficiency as infectious agents (HIV, Herpesvirus, HTLV), drugs (steroids, immunosuppressants, biologics, chemotherapy) , metabolic diseases (diabetes, renal failure, cirrhosis), malignancies (leukemia, lymphomas and solid tumors) and environmental conditions (radiation, heavy metals) but even adult patients can have late onset primary genetic immunodeficiency
- Primary immunodeficiency
- Secondary Immunodeficiency
- Opportunistic infections
Fontalvo DM, Jiménez Borré G, Gómez Camargo D, Chalavé Jiménez N, Bellido Rodríguez J, Cuadrado Cano B, et al. Tuberculosis and pulmonary candidiasis co-infection present in a previously healthy patient2016.
Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. The Journal of allergy and clinical immunology. 2010;125(2 Suppl 2):S195-203.
Nelson KS, Lewis DB. Adult-onset presentations of genetic immunodeficiencies: genes can throw slow curves. Current opinion in infectious diseases. 2010;23(4):359-64.
Browne SK, Burbelo PD, Chetchotisakd P, Suputtamongkol Y, Kiertiburanakul S, Shaw PA, et al. Adult-onset immunodeficiency in Thailand and Taiwan. The New England journal of medicine. 2012;367(8):725-34.
Sarkadi AK, Tasko S, Csorba G, Toth B, Erdos M, Marodi L. Autoantibodies to IL-17A may be correlated with the severity of mucocutaneous candidiasis in APECED patients. Journal of clinical immunology. 2014;34(2):181-93.
Picard C, Al-Herz W, Bousfiha A, Casanova JL, Chatila T, Conley ME, et al. Primary Immunodeficiency Diseases: an Update on the Classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015. Journal of clinical immunology. 2015;35(8):696-726.
Browne SK, Holland SM. Anticytokine autoantibodies in infectious diseases: pathogenesis and mechanisms. The Lancet Infectious diseases. 2010;10(12):875-85.
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