Zaporožskij Medicinskij Žurnal (Dec 2018)
Immunological reactivity among young patients with community-acquired pneumonia and cytomegaloviral persistence
Abstract
Abstract The article discusses the main basic immunological changes among patients with community-acquired pneumonia (CAP) and cytomegaloviral infection (CMVI), the group is compared with control one and with CMVI-negative individuals. The research data are used for diagnostic approach optimization on the part of immunology among immunocompetent young patients and CAP-prognosis (by PORT scale) according to CMVI occurrence and persistence. The aim is to recognize the main cell and humor disturbances in immunological reactivity among CAP-patients with CMVI persistence and their influence on CAP course and prognosis. Materials and methods. One hundred and five CAP-patients (51 (48.6 %) males, 54 (51.4 %) females) and 61 healthy individuals (26 (42,6%) males, 35 (57.4 %) females) have been examined according to clinical, laboratory and instrumental standards regulated by the MH of Ukraine. All responders were additionally studied for CMVI persistence (CMV IgM, CMV IgG, CMV IgG-avidity) and immunological test of cellular (CD3, CD4, CD8, CD22) and humoral (IgA, IgM, IgG) immunity. Results. CMVI persistence was prevailed significantly higher (P = 0.003) among the CAP-patients (80 (48.2 %) patients) than in the control group (34 (20.5 %) responders) and was mostly characterized by high avidity level (51 (48.6 %) patients (P = 0.007)). The percentage of CD22 increased with age among the CAP-patients (χ2 = 8.479; P = 0.037) and made up (15.5 ± 7.19) % in the group of 18–20 years old compared to the group of 30–39 years old – (22.07 ± 6.06) %. The healthy individuals were characterized by CD4 decreasing with age (χ2 = 8.585; P = 0.037). The number of respondents with decreased levels of CD4 (P = 0.032), IgA (P = 0.005), IgM (P = 0.018), IgG (P = 0.009) was significantly higher among the CAP-patients than in the control group. Decrease in СD3, CD4, CD8 values was statistically significant with CAP severity increasing by PORT score (P < 0.0001). CD3 ((47.353 ± 1.503) %) and CD4 ((27.137 ± 0.992) %) levels were significantly higher in the CAP-group patients with high CMV IgG-avidity than in those ones with moderate ((46.174 ± 2.044) % and (25.696 ± 0.944) %, respectively) and low avidity ((39.429 ± 1.730) % and (22.429 ± 1.837) %, respectively) (P < 0.0001). The amount of lymphocytes, CD4, CD8 was significantly lower among the CMV-positive CAP-patients. Their deficiency progressed with the mortality risk score by PORT. Conclusions: The CMV-positive CAP-patients differ statistically significantly by immunological reactivity from CMV-negative respondents and healthy ones (P < 0.05). The progression of cellular (lymphocytes, CD3, CD4, CD8, CD22) and humoral (IgA, IgM, IgG) immunosuppression depends on the duration of CMV persistence (by avidity level) and CAP severity level (by PORT score).
Keywords
