Chronic Mucocutaneous Candidiasis and Transfer Factor

Abstract

Chronic mucocutaneous candidiasis (CMCC) is a syndrome characterized by persistent or recurrent Candida infection involving mucous membranes, contiguous and distant skin areas, and nails; it is often associated with an endocrinopathy (endocrine-candidiasis syndrome). There are several forms of this syndrome. Whether these clinical variants and the presence or absence of endocrinopathy represent different forms of a single disease or separate entities is not yet known. Several immunologic defects have been described, but no consistent abnormality has been noted. The author has proposed the hypothesis “immune deviation theory” in the pathogenesis of CMCC.The efficacy of restoration of cellular immunity in therapy of patients with certain chronic infectious or neoplastic diseases is under evaluation in several centers. Theoretically, a substance such as transfer factor (TF) is an ideal candidate for this therapy. TF, a dialyzable substance from blood leukocytes, selectively endows recipients with the cellular immune responses of the leukocyte donors. Moreover, it does not contain intact leukocytes and therefore does not sensitize the recipient to HL-A antigens and cannot induce graft-versus-host disease.Twelve patients with CMCC were treated with TF from randomly selected donors in conjugation with administration of certain antifungal agents such as clotrimazole or amphotericin-B. Mucocutaneous symptoms and signs were predominant at the time that the TF injections were started. Six patients showed remarkable improvement both immunologically and clinically. Patients with CMCC in association with endocrinopathy are unlikely to respond clinically to TF administration although in vitro and/or in vivo changes in cell-mediated immunity may be observed. These results indicate that TF therapy may be beneficial in some cases with CMCC.