640. Pulmonary Immunology of Human Coccidioidomycosis
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Coccidioidomycosis is a growing problem in the Southwest United States and diagnosing pulmonary disease may be difficult. In other granulomatous diseases, there are specific in vitro cellular immune responses that occurs in the lungs. We explored the pulmonary coccidioidal immune response in a group of individuals with undiagnosed pulmonary disease living in the coccidioidal endemic region.

Methods: Excess fluid was obtained from bronchoscopic alveolar lavage (BAL) in individuals with undiagnosed pulmonary disease. The cellular component of the fluid was isolated and incubated in AIM-V serum-free medium for 48 hr with the coccidioidal antigen T27K (a gift of D. Pappagianis), anti-CD28, and anti-CD49d. Brefeldin A was added for the last 12 hr. Surface and intracellular cytokine flow cytometric staining was then performed.

Results: BAL fluid from 13 subjects were studied. Based on intracellular expression of either IL-2, IFN-γ or TNF-α, 6 subjects had evidence of pulmonary coccidioidomycosis. All had negative BAL fungal cultures; two had positive serum anti-coccidioidal antibodies. In the BAL fluid, 4 samples had polyfunctional CD4 lymphocytes, simultaneously producing IL-2, IFN-γ, and TNF-α. In two donors, peripheral blood mononuclear cells (PBMC) were studied in parallel and both demonstrated polyfunctional CD4 lymphocytes after incubation with T27K. In one donor, IL-17 was measured in both BAL fluid cells and in PBMC and was only found in BAL fluid cells.

Conclusion: Six of 13 persons with undiagnosed pulmonary disease had coccidioidomycosis based on their BAL fluid cellular cytokine response in vitro. IL-17 was identified in the BAL fluid compartment of the one donor studied and may be an important local immune modulator.

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Neil Ampel, MD, FIDSA , Immunobiology, University of Arizona, Tucson, AZ
Lance A. Nesbit, B.S. , Department of Immunobiology, University of Arizona and SAVAHCS, Tucson, AZ
Kenneth S. Knox, M.D. , Department of Immunobiology, University of Arizona and SAVAHCS, Tucson, AZ


N. Ampel, None

L. A. Nesbit, None

K. S. Knox, None

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