title: Enhanced anti-mycobacterial immunity in children with erythema nodosum and a positive tuberculin skin test.
abstract: Erythema nodosum (EN) may follow a variety of infections, but in regions with a high prevalence of tuberculosis, is frequently associated with a positive tuberculin skin test (TST) and tuberculosis infection. We aimed to investigate the immunological differences between patients with EN as a manifestation of primary tuberculosis, and those with progressive pulmonary tuberculosis (PTB) or asymptomatic infection. We studied the inflammatory response to both mycobacterial and non-mycobacterial antigens in 11 children with EN associated with a positive TST, 22 children with culture-confirmed tuberculosis, and 53 healthy skin test-positive children. In addition, we evaluated functional anti-mycobacterial immunity using an ex vivo assay of mycobacterial growth restriction in five children with EN and 15 with PTB. Patients with EN were distinguished by enhanced mycobacterial growth restriction on the functional assay, which was associated with a markedly increased production of IFNgamma in response to stimulation with purified protein derivative of Mycobacterium tuberculosis. Children presenting with EN and a positive TST show evidence of responses associated with enhanced anti-mycobacterial immunity.
authors: School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa. Mark.Nicol@uct.ac.za
authors: Mark P
authors: MP
authors: Nicol
authors: Beate
authors: B
authors: Kampmann
authors: Patricia
authors: P
authors: Lawrence
authors: Kathy
authors: K
authors: Wood
authors: Sandy
authors: S
authors: Pienaar
authors: David
authors: D
authors: Pienaar
authors: Brian
authors: B
authors: Eley
authors: Michael
authors: M
authors: Levin
authors: David
authors: D
authors: Beatty
authors: Suzanne T B
authors: ST
authors: Anderson
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000378:metabolism; D004893:Erythema Nodosum / Q000150:complications* / Q000276:immunology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation; D008297:Male; D009164:Mycobacterium Infections / Q000150:complications* / Q000276:immunology / Q000382:microbiology*; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000150:complications* / Q000276:immunology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines