Cellular and cytokine changes in the alveolar environment among immunocompromised patients during Pneumocystis jirovecii infection

Med Mycol. 2010 Dec;48(8):1075-87. doi: 10.3109/13693786.2010.484027. Epub 2010 May 17.

Abstract

Limited data exist on the cytokine and cellular changes in the alveolar environment in immunocompromised patients during Pneumocystis jirovecii infection. A cellular and a cytokine analysis were performed on bronchoalveolar lavage (BAL) samples from three groups of patients, i.e., an initial study group of 64 immunocompromised P. jirovecii-positive individuals and two control groups of P. jirovecii-negative patients who had been or not immunosuppressed (65 patients). The results were related to alveolar dilution as determined by urea measurement. Compared with non-infected groups, P. jirovecii-infected patients had a lower level of alveolar macrophages (AM), particularly those with high burdens of P. jirovecii. Alveolar macrophages over-expressed the Dectin-1 receptor, which was largely implicated in P. jirovecii clearance. The alveolar CD8+T and CD4+T lymphocyte counts were increased and an inverse correlation was observed between the alveolar CD4+ cell count and the P. jirovecii burden. Although the alveolar IL-6 level was considerably increased, alveolar IL-17, IL-10, TNF-α, TGF-β concentrations of P. jirovecii patients were not different from the control groups. Changes in the pulmonary environment were also highlighted during P. jirovecii colonization. Our study suggests that there is a correlation between the P. jirovecii burden in the alveolus (from colonization to a high P. jirovecii burden), and the degree of impairment of the alveolar immune response.

MeSH terms

  • Bronchoalveolar Lavage Fluid / chemistry
  • Bronchoalveolar Lavage Fluid / cytology
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / immunology
  • Cytokines / metabolism*
  • Female
  • Humans
  • Immunity, Cellular*
  • Immunocompromised Host
  • Macrophages, Alveolar / immunology
  • Male
  • Middle Aged
  • Pneumocystis carinii / immunology
  • Pneumocystis carinii / pathogenicity*
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / pathology*
  • Pulmonary Alveoli / immunology
  • Pulmonary Alveoli / microbiology
  • Pulmonary Alveoli / pathology*

Substances

  • Cytokines