AI Article Synopsis

  • Nocardia infections pose a significant threat to immunocompromised patients, particularly after allogeneic hematopoietic cell transplantation (AHCT), where the reconstitution of the immune system, especially CD4 T-cells, is crucial for recovery.
  • This study analyzed 15 cases of nocardiosis post-AHCT and assessed their immune status compared to a control group with similar transplantation characteristics, focusing on the counts of various lymphocyte populations.
  • The findings revealed that patients with nocardiosis had significantly lower counts of circulating lymphocytes, CD4 T-cells, and naïve CD4 T-cells, indicating impaired immune recovery in these patients compared to the control cohort.

Article Abstract

Purpose Of The Study: Nocardia affects immunocompromised human host exhibiting an altered cell-mediated immunity. Infectious risk after allogeneic hematopoietic cell transplantation (AHCT) is significantly correlated to the recovery status of donor-derived immune system, especially CD4 T-cells reconstitution and thymopoiesis. The purpose of this paper is to highlight a lack of cell-mediated immunity recovery for patients presenting a nocardiosis compared to a control cohort.

Patients And Methods: This is a case control retrospective monocentric study. We retrospectively analyzed a monocentric cohort of 15 cases of nocardiosis after AHCT and we explored the degree of patients' immunosuppression by phenotyping circulating lymphoid subpopulations, including NK cells, CD8 T-cells, CD4 T-cells and CD19 B-cells. We focused on CD4 T-cell subsets to appreciate thymic output, especially on naive CD4 T-cells (NTE, CD45RA/RO CD4 T-cells) and recent thymic emigrants (RTE, CD4CD45RA/RO/CD31). Infected patients were paired with a control cohort of patients with identical transplantation characteristics screened on hematological disease, AHCT conditioning, primary graft-versus-host disease (GHVD) prophylaxis, graft type, sex, age, and season at the AHCT and data concerning immunological reconstitution were compared.

Results: At onset of nocardiosis, circulating lymphocytes and CD4 T-cells means count were respectively 730/μL and 162/μL. CD8 T-cells, CD56 NK cells and CD19 B-cells means count were respectively 362/μL, 160/μL, 112/μL. CD4 T-cells subpopulations, naïve CD4 T-cells production was impaired with NTE and RTE means count at 26/μL and 11/μL respectively. Comparison between nocardiosis cohort and control cohort over time highlight significant lower cellular count for lymphocytes, CD4 T-cells, NTE and RTE with p = 0.001, p < 0.001, p < 0.001, p < 0.001 respectively.

Conclusion: Immune recovery monitoring follow-up after AHCT is of particular importance to identify patients susceptible to develop Nocardiosis. Efficient microbiological investigations toward Nocardia such PCR should be used in case of compatible clinical presentation.

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Source
http://dx.doi.org/10.1016/j.retram.2019.05.001DOI Listing

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