Clinical manifestations, course, and outcome of patients with neutralizing anti-interferon-γ autoantibodies and disseminated nontuberculous mycobacterial infections
Journal
Medicine (United States)
Journal Volume
95
Journal Issue
25
Pages
e3927
Date Issued
2016
Author(s)
Chi C.-Y.
Lin C.-H.
Ho M.-W.
Ding J.-Y.
Huang W.-C.
Shih H.-P.
Yeh C.-F.
Fung C.-P.
Huang C.-T.
Wu T.-S.
Chang C.-Y.
Liu Y.-M.
Feng J.-Y.
Wu W.-K.
Wang L.-S.
Tsai C.-H.
Ho C.-M.
Lin H.-S.
Chen H.-J.
Lin P.-C.
Liao W.-C.
Chen W.-T.
Lo C.-C.
Wang S.-Y.
Kuo C.-Y.
Lee C.-H.
Ku C.-L.
Abstract
Neutralizing anti-interferon-γ autoantibody (nAIGA)-associated immunodeficiency is an emerging medical issue worldwide. In the present study, we describe and discuss the clinical features and outcomes of patients with nAIGAs and disseminated infections by nontuberculous mycobacteria (dNTM). We thoroughly reviewed the medical records of all patients. Microorganisms and nAIGAs were identified using previously described methods with modifications. All data were calculated and analyzed using SPSS software. Among 46 adult patients with dNTM infections, we identified 45 cases (97.8%) with nAIGAs. The average patient age was 58.6 years, and there was no sex predominance. Cervical lymphadenitis (81.8%) was the most common clinical manifestation. Endocrine disorder was the leading comorbidity (7 cases). Malignancies were found in 4 patients, and all of the malignancies originated from the T-cell/macrophage lineage. More than half of the identifiable isolates were slow-growing NTMs. Twenty-eight (62.2%) and 18 (40.0%) patients had a history of zoster and salmonellosis, respectively. A high proportion of patients with recurrent episodes of NTM infection or a history of zoster and dNTM infection had initial nAIGA titers ?10 -5 dilution (P<0.05). Twenty-seven patients (60.0%) required long-term antimycobacterial therapy and had at least 1 episode of recurrent NTM disease. No mortality was related to dNTM infection. In Taiwan, nAIGAs are a recently recognized mechanism of dNTM infection. Long term of antibiotic treatment and adherence to medical advice are necessary to improve the clinical outcome of patients with nAIGAs. ? 2016 Wolters Kluwer Health, Inc.
SDGs
Other Subjects
amikacin; antimycobacterial agent; antineoplastic agent; azithromycin; C reactive protein; cefoxitin; ceftibuten; cephalosporin; ciprofloxacin; clarithromycin; cotrimoxazole; doxycycline; erythromycin; ethambutol; gamma interferon antibody; imipenem; isoniazid; levofloxacin; linezolid; minocycline; moxifloxacin; neutralizing antibody; pyrazinamide; quinolone derivative; rifabutin; rifampicin; steroid; tetracycline; tetracycline derivative; tigecycline; antiidiotypic antibody; antiinfective agent; autoantibody; gamma interferon; acute generalized exanthematous pustulosis; adult; aged; antibiotic therapy; antibody titer; Article; atypical mycobacteriosis; atypical Mycobacterium; autoimmune disease; autoimmune thyroiditis; bacterial arthritis; bacterial growth; bacterium isolate; Behcet disease; cancer chemotherapy; cell lineage; cervical lymphadenopathy; clinical article; clinical feature; comorbidity; diabetes mellitus; disease course; erythrocyte sedimentation rate; female; Hashimoto disease; herpes zoster; human; hypertension; hypothyroidism; Langerhans cell histiocytosis; leukocyte count; long term care; macrophage; male; measles like rash; medical history; medical record review; mortality; Mycobacterium abscessus; Mycobacterium avium complex; Mycobacterium chelonae; Mycobacterium fortuitum; Mycobacterium gordonae; Mycobacterium kansasii; Mycobacterium scrofulaceum; Mycobacterium szulgai; Mycobacterium terrae; nonhuman; osteomyelitis; outcome assessment; patient compliance; peripheral T cell lymphoma; priority journal; recurrent infection; salmonellosis; Sjoegren syndrome; T lymphocyte; thyroid disease; treatment duration; treatment refusal; atypical Mycobacterium; follow up; immunology; incidence; middle aged; Mycobacterium Infections, Nontuberculous; prognosis; retrospective study; Taiwan; time factor; very elderly; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Autoantibodies; Female; Follow-Up Studies; Humans; Incidence; Interferon-gamma; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Prognosis; Retrospective Studies; Taiwan; Time Factors
Publisher
Lippincott Williams and Wilkins
Type
journal article