CELL-MEDIATED-IMMUNITY IN ANERGIC PATIENTS WITH PULMONARY TUBERCULOSIS

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Abstract
Twelve adults with confirmed pulmonary tuberculosis who failed to respond to repeated skin tests with 250 TU [tuberculin units] of 2nd-strength purified protein derivative [PPD] of tuberculin were studied using in vivo and in vitro tests of cell-mediated immunity. All but 2 of the patients failed to respond to skin tests with candidin and histoplasmin, and only 1 could be sensitized with topical applications of dinitrochlorobenzene. The blastogenic response of peripheral blood lymphocytes from these anergic patients, when cultured in the presence of phytohemagglutinin, pokeweed mitogen and PPD was significantly less than that of lymphocytes from tuberculin-positive control patients. During the course of therapy with isoniazid and streptomycin, 6 anergic patients converted spontaneously and reacted positively to PPD. This skin-test conversion was accompanied by a significant increase in the blastogenic response of lymphocytes from the converted patients when cultured with PPD. Tuberculin anergy in these 12 patients was not associated with progressive, disseminated disease. All patients responded successfully to the primary chemotherapeutic regimen.