PPD Skin Test Research Articles

アスベスト曝露労働者にみられたサルコイド反応の1例

Bilateral hilar and mediastinal lymphadenopathy was observed in a 32-year-old man who had been engaged in asbestos spraying for 16 years. Lymph nodes obtained from Daniel's biopsy revealed tissue reaction compatible with sarcoidosis. On the other hand, a large number of asbestos particles were detected in the lung tissue from transbronchial lung biopsy and in bronchoalveolar lavage fluid, but no epithelioid granuloma was observed in the lung tissue. Various immunoserological findings such as PPD skin test, serum angiotensin converting enzyme activity, serum beta-glucuronidase and lysozyme level, serum antinuclear antibody, lymphocyte subset of blood and bronchoalveolar lavage fluid were inconsistent with sarcoidosis. However, lymph node enlargement and immunological abnormalities in this patient may be related to asbestos exposure and may not have occurred merely by chance.

Difference of clinical features between bacilli positive tuberculosis patients diagnosed at the outpatients dept. (OPD) and diagnosed after admission

In order to determine the clinical features of patients whose tubercle bacilli were found after admission, the characteristics of 23 cases (17 males, 6 females) diagnosed after admission (Group I) were compared with 16 other cases (12 males, 4 females) diagnosed before admission (Group II). The patients in Group I were more elderly and had severer underlying diseases than those in Group II. In addition, the majority of the patients of Group I showed manifestations of respiratory infections similar to bacterial pneumonia. Therefore, 14 cases (61%) in Group I were diagnosed as bacterial pneumonia on admission. Radiological findings showed that less than half of Group I showed typical X-ray findings of tuberculosis such as location of lesions in the apex and upper lung field, cavity formation, and mixture of or new and old infiltrative lesions. Also on the PPD skin test, 7 cases (30%) of Group I were negative. Due to the above results, in many cases it took more than 10 days from admission to make a final diagnosis as tuberculosis. There were several differences in findings between two groups, but there was no definite signs to diagnose all patients at the OPD. It is therefore considered to be important to keep in mind the following to prevent admission of open tuberculosis patients into a general hospital: (1) Admission of patients suspected to have open tuberculosis at the OPD should be postponed until their smears are proven negative. (2) Sputum examinations for AFB always should be carried out in patients with respiratory symptoms.

Dietary protein deficiency and Mycobacterium bovis BCG affect interleukin-2 activity in experimental pulmonary tuberculosis

Inbred strain 2 guinea pigs were vaccinated with Mycobacterium bovis BCG or were left unvaccinated. They were maintained for 6 weeks on defined, isocaloric diets containing either 30% (control animals) or 10% (animals receiving low protein) ovalbumin as the sole protein source. Animals were challenged by the respiratory route with a low dose of virulent M. tuberculosis H37Rv and killed 4 weeks later. Protein-malnourished animals were not protected by previous vaccination with BCG. Lymphocytes isolated from various tissues were tested in vitro for proliferative responses to mitogen (concanavalin A) and antigen (purified protein derivative [PPD]), production of interleukin-2 (IL-2), and response to exogenous recombinant IL-2 (rIL-2). Protein-malnourished guinea pigs responded only weakly to PPD skin tests, and their blood and lymph node lymphocytes exhibited impaired proliferation when cultured with PPD in vitro. IL-2 levels were consistently low in cultures of stimulated blood and spleen lymphocytes from protein-deprived animals. BCG vaccination of nutritionally normal guinea pigs, on the other hand, induced significantly more IL-2 production by PPD- and concanavalin A-stimulated lymphocytes. The addition of exogenous mouse rIL-2 (40 and 80 U/ml) in vitro to PPD-stimulated blood and lymph node cells from nonvaccinated, protein-deprived guinea pigs resulted in no improvement of the proliferative response. Previous vaccination of malnourished guinea pigs did not consistently enhance the response of PPD-stimulated lymphocytes to added rIL-2. Dietary protein deficiency and BCG vaccination appear to modulate antigen-driven cellular immunity in animals with tuberculosis by altering the production of, and the response to, IL-2 by PPD-stimulated lymphocytes.

Differences in surface phenotype between cytolytic and non-cytolytic CD4+ T cells. MHC class II-specific cytotoxic T lymphocytes lack Leu 8 antigen and express CD2 in high density.

A number of cell surface molecules are differentially expressed on functionally distinct subsets of CD4+ T cells. However, to date CD4+ T cells capable of becoming CTL have not been shown to be phenotypically distinct from other CD4+ T cells, and in the current study we examined the ability of Leu 8+ and Leu 8- CD4+ subpopulations to become cytotoxic effectors after their stimulation with allogeneic lymphoblastoid cell lines. Although CD4+, Leu 8+ cells proliferated more vigorously than CD4+, Leu 8- cells in primary cultures stimulated with allogeneic LCL, the CD4+, Leu 8- population was the major source of cytotoxic effectors, killing targets with specificity for their class II MHC alloantigens. In most subjects, CD4+ precursors of CTL were distinguished not only by their lack of Leu 8 expression but also by their relatively high density of CD2, LFA-1, and LFA-3, molecules known to mediate non-specific cell-to-cell adhesion and postulated to be markers of immunologic memory. The absence of Leu 8 does not appear to be a reliable memory cell marker, however, because Leu 8+ as well as Leu 8-, CD4+ cells from PPD skin test positive subjects responded to the recall Ag, PPD. During 3 mo of continuous culture with allogeneic stimulators, Leu 8- cells retained their cytolytic activity and remained unreactive with anti-Leu 8 mAb, whereas Leu 8+ cells remained non-cytolytic and reactive with anti-Leu 8, suggesting that under the conditions used the Leu 8 phenotype is relatively stable. PHA or anti-CD3 mAb enhanced non-specific killing by alloantigen-stimulated CD4+,Leu 8- lines but failed to unmask any cytolytic potential in CD4+,Leu 8+ lines. We conclude that MHC class II-specific cytolytic CD4+ T cells can be distinguished from non-cytolytic CD4+ cells on the basis of their surface phenotype, and that most CD4+ CTL are contained within the Leu 8- subpopulation.

Immunological aspects of intravesical administration of Bacillus Calmette-Guérin (BCG) in the guinea pig.

The only form of effective immunotherapy for human cancer is the intravesical administration of BCG in the treatment of superficial bladder tumors. In this study BCG was administered intravesically (once a week for six consecutive weeks) in guinea pigs to investigate the immune response. Both specific immune responses against BCG itself and nonspecific immune responses such as leukocyte subset distribution, mitogenic (ConA, PHA, LPS) lymphocyte stimulation and spontaneous cytotoxic (NK and LAK cell) activity were determined in the regional draining (iliac) lymph node and in the spleen. The PPD skin test became positive after the fourth intravesical instillation of BCG when 1 X 10(5) culturable particles or higher dosages of BCG were administered. A low dose of 1 X 10(3) c.p. of BCG induced a positive PPD skin reaction in 2 of 4 animals after six BCG instillations. After six BCG instillation BCG immune lymphocytes were present both in the iliac lymph nodes and in the spleen. No differences in mitogenic responses to ConA, PHA and LPS were observed in iliac lymph nodes or the spleen between placebo or BCG treated animals. In the regional iliac lymph nodes a significantly increased number of leukocytes was present. These lymph node cells showed a significant increase in the expression of MHC class II (Ia) immune response antigen on their surface. In the spleen no differences were observed after BCG administration regarding the number of cells present and in terms of the Ia antigen expression of the leukocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody to PPD and tuberculin skin test in sar coidosis

Antibody to PPD and tuberculin skin test in sar coidosis

Antigen presentation in pulmonary tuberculosis

Antigen presenting capacity (APCC) by monocytes (Mono) and alveolar macrophages (AM), using PPD as the antigen, was determined in 15 patients with pulmonary tuberculosis and 9 healthy controls who all showed positive PPD skin tests. Results were as follows: 1) Mono from both healthy controls and tuberculosis showed APCC to autologous peripheral T lymphocytes, and no significant difference was observed between the two groups. 2) AM from tuberculosis showed APCC to autologous peripheral T lymphocytes, however AM from healthy controls did not. 3) APCC by autologous Mono or AM to lung T-lymphocytes was lower than that to peripheral T-lymphocytes, but the difference was not significant. 4) In tuberculosis, APCC, observed before chemotherapy, was remarkably weakened during the first two months of therapy, and almost recovered to the previous level thereafter. 5) The mechanism which enhances APCC by AM in tuberculosis is uncertain. But neither increased DR antigen expression on AM nor release of IL-1 from AM suggested to be be responsible for the enhanced APCC in tuberculosis.

Lymphadenopathy in an inner-city population consisting principally of intravenous drug abusers with suspected acquired immunodeficiency syndrome.

Generalized lymphadenopathy in intravenous drug abusers (IVDAs) at risk for AIDS has not been well studied. We have retrospectively analyzed the results of lymph node biopsies obtained from 27 patients referred to the Infectious Diseases Service for evaluation of generalized lymphadenopathy and suspected AIDS during a recent 18-month period. Fourteen of the patients were heterosexual IVDAs, 7 were male homosexual IVDAs, and 6 were male homosexual non-IVDAs. All of the patients were residents of the Bronx, New York. Mycobacterium tuberculosis (TB) was the most frequent diagnosis established on lymph node biopsies from IVDAs, in 12 out of 21 (57%). Tuberculous adenitis was not diagnosed in the 6 non-IVDAs. All TB patients were febrile, 11 (91%) had lost weight, and 10 (84%) had an abnormal chest roentgenogram. The 5TU PPD skin test, however, was reactive in only 2 (16%) of 12 patients. Tuberculosis is important to consider in patient populations with exposure histories to both AIDS and TB. The alarmingly high prevalence of TB in this drug addict population emphasizes the importance of lymph node biopsies with acid-fast smears and mycobacterial cultures in symptomatic IVDAs. Preventive antituberculosis therapy for HIV-positive persons, especially IVDAs, with a history of positive tuberculin reactions or of recent household contact should be seriously considered.

Vietnamese child health in a Hong Kong closed camp.

Vietnamese refugees arriving in Hong Kong since 1982 have been confined to restricted areas. In this study, 241 children in one of these areas were screened to identify their health status. Using NCHS standards, 48% were found to be below the fifth percentile for both weight-for-age and height-for-age. Anaemia was found in 8% and hepatitis B antigenaemia in 25%. Intestinal parasites were identified in 62% of faecal specimens and 26% of these contained more than one parasite. Although all children had received BCG, 41% had a negative PPD skin test. Chronic bacterial skin infections, lice and otitis media with perforation were identified as other common problems. Screening of this population revealed a high prevalence of health problems, some of which would respond to appropriate public health measures.

Immunotherapy of patients with terminal-stage malignant tumors with an immunopotentiator OK-432 — A comparison of SU-PS test-responding and -nonresponding patients

Terminal malignant tumor cases were treated with immunopotentiator OK-432. The absolute numbers of neutrophils and lymphocytes and different lymphocyte subsets were determined, and SU-PS and PPD skin tests were also performed to monitor the immunologic status of each patient. The SU-PS test changed to positive in one-third of the patients 2–6 weeks after the start of therapy. The SU-PS responding patients showed an increase in lymphocytes and Leu II+ cells, and an elevation of the OK T4/T8 ratio 2 weeks later. In all patients from the responding group, the (OKIal+ −Bl+) cells decreased in the peripheral blood immediately after the positive change in the SU-PS test. In the SU-PS nonresponding group, the OKT4+ cells tended to decline with time, while the OKT8+ cells increased. That is, the OKT4/T8 ratio remained low throughout the test period. In the SU-PS responding group, OK-432 therapy prolonged the survival time.

694 - BCG in the Management of Superficial Bladder Cancer: The Value of PPD Skin Testing

694 - BCG in the Management of Superficial Bladder Cancer: The Value of PPD Skin Testing

頭頚部悪性腫ように対するＯＫ‐４３２の長期生存効果について

In 82 patients with stage II or III malignant tumors of the head and neck, the cumulative survival rate was compared between 55 treated with and 27 not treated with OK-432. The annual survival rate was consistently higher in those treated than in those not treated with the agent; a significant difference was observed after 3 years and a slight different after 5 years.Intracutaneous administration of OK-432 had no effects on the cumulative survival rate, presumably because activation of pyrimidine fluoride compounds was unaffected.Of 57 parameters tested, we describe 9 immunological and biochemical parameters used in our hospital that indicate the onset and prognosis of malignant tumors of the head and neck. These parameters were:aspirin esterase, fibrinogen, a2-globulin, and cholinesterase levels; lymphocyte count, Su-Ps skin test, and PPD skin test; lymphocytes blastgenesis to PHA; and iron level.

多発性脳神経障害を呈したＨｕｎｔ症候群の一例 免疫・ウイルス学的検討

A patient with Hunt's syndrome had not only facial and vestibular nerve paralysis, but also glossopharyngeal, vagal and hypoglossal nerve paralysis. The patient was a 74-year-old fbmale who complained of right auricular pain, vertigo, hoarseness and right facial palsy. Physical examination revealed right auricular herpetic vesicles, peripheral facial palsy, paralysis of the soft palate, right laryngeal paralysis and deviation of the tongue. Hearing was also impaired. Vestibular examination showed right CP and left DP. A varicella-zoster virus(VZV)skin test reflecting cellmediated immunity was negative; a PPD skin test was positive. T and NK cells were decreased. VZV-antibody titers was remarkably high. These laboratory examination showed that humoral immunity was relatively normal but cellmediated immunity was depressed in Hunt's syndrome.

New micro-glass-tube leukocyte adherence inhibition assay assessing cell adherence of mononuclear cell subpopulations defined by monoclonal antibodies

A new micro-glass-tube leukocyte adherence inhibition (LAI) assay which is appropriate for detecting delayed type hypersensitivity in vitro has been developed for human leukocytes. Enumeration of adherent cells is replaced by a cellular radioimmunoassay determining antibody binding of the monoclonal reagents, OKT4, OKT8, and OKM1, to glass-adherent cells, fixed by glutaraldehyde or formaldehyde. An LAI reactivity to purified protein derivative of tuberculin (PPD) was detectable in donors giving a positive PPD skin test with OKT4 reagent, but not with the other two reagents.

Subretinal neovascularisation and snow banking in a case of sarcoidosis: case report.

A 49-year-old Japanese man presented with chronic granulomatous uveitis in his left eye. Later he developed macular subretinal neovascularisation. The chest x-ray showed bilateral hilar lymphadenopathy. Bronchoscopy and gallium-67 scanning were positive, PPD skin test negative, and serum angiotensin converting enzyme (ACE) levels increased. Ophthalmoscopy and fluorescein angiography of the left eye showed perivasculitis, retinochoroidal exudates, snow banking, and vitreous opacity. On these findings, the diagnosis of sarcoidosis was made. Treatment was based on topical corticosteroids, mydriatics, beta blockers, and oral carbonic anhydrase inhibitors. After 15 months the visual acuity decreased in the left eye, and a neovascular membrane was observed in the macula. Fluorescein angiography confirmed subretinal neovascularisation. Almost two years later the patient still has the neovascular membrane in his left eye.

Papulonecrotic tuberculid with inflammatory nodular lesions of the lower leg: a report of two cases.

ABSTRACTTwo cases of papulonecrotic tuberculid (PNT) with inflammatory nodules of the lower leg are reported. One is a 43‐year‐old woman with lymphadenitis tuberculosa, and the other is a 54‐year‐old man with penis tuberculid and epididymitis of possible tuberculous etiology. In both cases, PPD skin test was strongly positive, and antituberculous therapy was markedly effective. Although the theory of the etiology of PNT is changing due to the recent decrease in active tuberculosis, we think that one cause of so‐called PNT is still tuberculosis, at least in Japan.

Diagnostic Challenge: A Georgian with Pulmonary Cavitary Disease

Case History A 56-year-old white man was admitted to his local hospital in Georgia because of vague chest discomfort, cough productive of mucoid expectoration, a ten-pound weight toss, and malaise of two months duration. He denied night sweats, hemoptysis, or exposure to tuberculosis. He had recently taken a trip to Arizona. Physical examination was unremarkable. Hemoglobin was 9.7gm%; hematocrit 32%, total WBC count 6200/cu mm, with 52% neutrophils, 350/o lymphocytes, 50'/o monocytes, and 3% eosinophils. A PPD skin test was negative on two occasions. Chest roentgenograms showed a 3.6 by 2.5cm, thinwalled cavity in the right upper lobe. The patient underwent fiberoptic bronchoscopy. Bronchial brushings and transbronchial biopsies were obtained. Stains for acid-fast bacilli were negative. A KOH preparation of post bronchoscopic sputum revealed no fungi. Cytology was negative. Histological examination of lhe transbronchial biopsy specimens revealed granulomatous inflammation with caseation necrosis. flgure t : PA Chest roentgenogi-am showing right upper lobe caviry.

1077 NONTUBERCULOUS MYCOBACTERIAL (NTM) PULMONARY DISEASE IN CHILDHOOD EXPANDED SPECTRUM BASED UPON DIFFERENTIAL SKIN TEST REACTIVITY

Confirmed pulmonary infection by NTM is rare in childhood. Classically the diagnosis has been based upon cultures from children with findings of pulmonary disease. Differential skin testing using a panel of NTM antigens and PPD-T has been shown to be useful in the diagnosis of NTM lymphadenopathy and may be helpful in childhood pulmonary disease. We are reporting 13 patients in whom NTM pulmonary disease was likely. Three culture positive patients (5 mos,9 mos, 5 yrs) presented with brief febrile illnesses and chest x-rays revealing infiltrates and adenopathy. Ten patients were diagnosed by differential skin testing (2 1/2 yr-18 yr). Cultures were either negative or not done. These patients had a more indolent disease with hilar adenopathy (8/10) or infiltrates (4/10) on chest x-ray. Some were asymptomatic. Differential skin testing in all instances has shown a > 5 mm difference in induration between NTM antigens and PPD-T. Three culture (+)/skin test (+) patients and 4/10 culture [(-) or N.D.]/skin test (+) patients received antituberculous treatment of variable duration. All patients are alive and well 1-7 yrs from diagnosis and differential skin testing has continued to reveal greater induration to one or more NTM antigens than to PPD-T. There is an expanded spectrum of NTM pulmonary disease in childhood which encompasses asymptomatic pts, acutely ill pts, and patients with chronic symptoms. It would appear that differential PPD skin testing is a useful adjunct to diagnosis in patients with hilar adenopathy and/or pulmonary infiltrates.

A study of Wegener's granulomatosis

164 cases with Wegener's granulomatosis (WG) in Japan for 20years since 1958 up to 1977 based on the Annual of the pathological Autopsy Cases in Japan and six patients with WG which we have experienced in our institute were observed. The diagnosis of six patients with WG was made on clinical symptoms and the histological examination of the biopsied materials from the nasal membrane, bronchus and kidney.In our clinic, the male-tofemale ratio was 1 to 1 and the mean age at the onset of the initial manifestations of WG was 43.7years (range: 15.8 to 72.5years). Fever and upper respiratory symptoms were the first manifestations of WG in the majority of our cases. In the clinical features during the course of WG, upper respiratory and urinary manifes-tations were the most common (six cases). Pulmonary involvement was noted in five cases, eye in three cases, ear in one case, and central nervous system in one case. When the patients were given no drugs abnormal hematological manifestations were found: increase of erythrocyte sedimentation rate, C-reactive protein positive (5+_??_6+), neutrophilia and α2-globulinemia in all cases, γ-globulinemia and increase of ALP in five cases, leukocytosis in four cases, hypoalbuminemia in three cases. Positive rheumatoid factor were seen in 50%, increase of IgG and IgA in four patients, and hype rcomplementemia in four ones. The abnormalities in T cell function, such as the decrease of T cell counts, impaired skin delayed hypersensitivity (PPD skin test), and reduced lymphocyte blastogenesis by PHA, were noted in died cases.In autopsy cases of WG, the male-to-female ration was 84 to 80 and their ages ranged from 10 to 68years (the mean of 39.0years), The incidences of the organ system involvement in WG were given in Table 5. Upper respiratory tracts involvement was noted in 69.5% of 164 autopsy cases, pulmonary involvement in 47.0%, kidney in 43.9%, spleen in 23.8%, liver in 14.0% and so on.These observations were discussed with reference to the reports in the literature.

Various Immunological Parameters studied in Patients with Malignant Brain Tumor

The humoral and cellular immunity of fifty-two patients with malignant brain tumor was analysed by measurement of various immunological parameters with regard to their clinical condition, which was divided into three stages; initial, recurrent and terminal. Immunological parameters analysed in this study were the level of immunoglobulin, number of lymphocytes, percentage of IgG Fc receptor positive T cells, blastogenesis with PHA, PPD skin test and T cell subsets. T cell subsets were studied by flow cytometry using OKT monoclonal antibodies. The immunity of the patients with malignant brain tumor was almost normal in the initial stage and decreased in the recurrent and terminal stages. Especially, the percentage of OKT 4 positive cells in lymphocytes decreased and the percentage of OKT 8 positive cells in T cells increased with deterioration of the clinical stages. Consequently the ratio of OKT 4 to OKT 8 positive cells decreased markedly. The effect interferon (IFN) as a biological response modifier was also analysed by T cell subsets in nine patients with recurrent malignant brain tumor. After administration of IFN, the percentage of OKT 4 positive cells in T cells increased and consequently the ratio of OKT 4 to OKT 8 positive cells increased.