Tetsuya Kashiyama

Increased Synthesis of Anti-Tuberculous Glycolipid Immunoglobulin G (IgG) and IgA with Cavity Formation in Patients with Pulmonary Tuberculosis

ABSTRACT Tuberculous glycolipid (TBGL) antigen is a cell wall component of Mycobacterium tuberculosis and has been used for the serodiagnosis of tuberculosis. We investigated correlations between the levels of anti-TBGL antibodies and a variety of laboratory markers that are potentially influenced by tuberculous infection. Comparisons between patients with cavitary lesions and those without cavitary lesions were also made in order to determine the mechanism underlying the immune response to TBGL. Blood samples were obtained from 91 patients with both clinically and microbiologically confirmed active pulmonary tuberculosis (60 male and 31 female; mean age, 59 ± 22 years old). Fifty-nine patients had cavitary lesions on chest X-rays. Positive correlations were found between anti-TBGL immunoglobulin G (IgG) and C-reactive protein (CRP) (r = 0.361; P < 0.001), between anti-TBGL IgA and soluble CD40 ligand (sCD40L) (r = 0.404; P < 0.005), between anti-TBGL IgG and anti-TBGL IgA (r = 0.551; P < 0.0000005), and between anti-TBGL IgM and serum IgM (r = 0.603; P < 0.00000005). The patients with cavitary lesions showed significantly higher levels of anti-TBGL IgG (P < 0.005), anti-TBGL IgA (P < 0.05), white blood cells (P < 0.01), neutrophils (P < 0.005), basophils (P < 0.0005), natural killer cells (P < 0.05), CRP (P < 0.0005), KL-6 (sialylated carbohydrate antigen KL-6) (P < 0.0005), IgA (P < 0.05), and sCD40L (P < 0.01). The observed positive correlations between the anti-TBGL antibody levels and inflammatory markers indicate the involvement of inflammatory cytokines and NKT cells in the immunopathogenesis of pulmonary tuberculosis.

Endobronchial cryptococcosis in AIDS

Abstract:  Although cryptococcosis is a common thoracic complication among patients with AIDS, endobronchial abnormalities have rarely been reported. A 45‐year‐old man presented with a productive cough, fever, and headache. His CD4+ cell count was 7/mm3 and testing for antibodies to HIV‐1 was positive. Radiological examination revealed consolidation in the left lung, including cavitation. Bronchoscopic examination demonstrated white, slightly raised, plaque‐like lesions in the trachea and left bronchi. Histopathological examination of endobronchial biopsy specimens revealed granulation tissue with abundant encapsulated yeast in the tissue. Cryptococcus neoformans was cultured from the bronchial lavage specimen. Cryptococcal infection should be included in the differential diagnosis of endobronchial abnormalities in patients with AIDS.