INVIVO AND INVITRO CELL-MEDIATED RESPONSES IN COCCIDIOIDOMYCOSIS .1. IMMUNOLOGICAL RESPONSES OF PERSONS WITH PRIMARY, ASYMPTOMATIC INFECTIONS

Abstract
Chest roentgenograms of 58 children who were skin test positive to [Coccidioides immitis] coccidioidin and resided in an area endemic for coccidioidomycosis revealed that 34% had roentgenographic evidence of an active inflammatory process, 14% showed calcific densities, and 52% showed no evidence of infection. The in vitro lymphocyte responses of children who had evidence of an inflammatory process (Group I) were compared with those of children who had calcific densities (Group II); those of children who were coccidioidin skin test negative and had normal chest roentgenograms (Group III); and those of patients who had active coccidioidomycosis (Group IV). The mean lymphocyte transformation responses (expressed as cpm [counts per minute] .times. 10-4) of Groups I, II, III and IV to a coccidioides antigen were 16.8, 19.5, 4.2 and 7.0, respectively. The mean migration inhibitory factor responses of these groups were 22.4, 20.0, 1.2 and 4.0%, respectively. Thus, the over-all responses of children in Groups I and II were comparable to each other; the responses of patients in Group IV were depressed to the extent that they were indistinguishable from those of coccidioidin skin test-negative donors in Group III. Follow-up chest roentgenograms, taken 3 mo. after the immunologic assays were performed, revealed that the 1 subject in Group I who was nonresponsive in the lymphocyte assays stabilized his infection, as evidenced by calcifications. In contrast, the 2 subjects in Group I who had yet to stabilize their infection exhibited strong in vitro lymphocyte responses. Primary, asymptomatic coccidioidomycosis is apparently not associated with an immunologically nonresponsive state. However, patients with active, progressive coccidioidomycosis do have a depressed immunologic response to coccidioides antigens.

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