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Title: | Application of Flow Cytometry in the Diagnostics Pipeline of Primary Immunodeficiencies Underlying Disseminated Talaromyces marneffei Infection in HIV-Negative Children |
Authors: | Pamela P. Lee Mongkol Lao-araya Jing Yang Koon Wing Chan Haiyan Ma Lim Cho Pei Lin Kui Huawei Mao Wanling Yang Xiaodong Zhao Muthita Trakultivakorn Yu Lung Lau |
Authors: | Pamela P. Lee Mongkol Lao-araya Jing Yang Koon Wing Chan Haiyan Ma Lim Cho Pei Lin Kui Huawei Mao Wanling Yang Xiaodong Zhao Muthita Trakultivakorn Yu Lung Lau |
Keywords: | Immunology and Microbiology;Medicine |
Issue Date: | 13-Sep-2019 |
Abstract: | © Copyright © 2019 Lee, Lao-araya, Yang, Chan, Ma, Pei, Kui, Mao, Yang, Zhao, Trakultivakorn and Lau. Talaromyces (Penicillium) marneffei is an AIDS-defining infection in Southeast Asia and is associated with high mortality. It is rare in non-immunosuppressed individuals, especially children. Little is known about host immune response and genetic susceptibility to this endemic fungus. Genetic defects in the interferon-gamma (IFN-γ)/STAT1 signaling pathway, CD40/CD40 ligand- and IL12/IL12-receptor-mediated crosstalk between phagocytes and T-cells, and STAT3-mediated Th17 differentiation have been reported in HIV-negative children with talaromycosis and other endemic mycoses such as histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis. There is a need to design a diagnostic algorithm to evaluate such patients. In this article, we review a cohort of pediatric patients with disseminated talaromycosis referred to the Asian Primary Immunodeficiency Network for genetic diagnosis of PID. Using these illustrative cases, we propose a diagnostics pipeline that begins with immunoglobulin pattern (IgG, IgA, IgM, and IgE) and enumeration of lymphocyte subpopulations (T-, B-, and NK-cells). The former could provide clues for hyper-IgM syndrome and hyper-IgE syndrome. Flow cytometric evaluation of CD40L expression should be performed for patients suspected to have X-linked hyper-IgM syndrome. Defects in interferon-mediated JAK-STAT signaling are evaluated by STAT1 phosphorylation studies by flow cytometry. STAT1 hyperphosphorylation in response to IFN-α or IFN-γ and delayed dephosphorylation is diagnostic for gain-of-function STAT1 disorder, while absent STAT1 phosphorylation in response to IFN-γ but normal response to IFN-α is suggestive of IFN-γ receptor deficiency. This simple and rapid diagnostic algorithm will be useful in guiding genetic studies for patients with disseminated talaromycosis requiring immunological investigations. |
URI: | https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85072767085&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/67872 |
ISSN: | 16643224 |
Appears in Collections: | CMUL: Journal Articles |
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