title: Disseminated penicilliosis, recurrent bacteremic nontyphoidal salmonellosis, and burkholderiosis associated with acquired immunodeficiency due to autoantibody against gamma interferon.
abstract: Acquired immunodeficiency due to autoantibody against gamma interferon has recently been associated with opportunistic nontuberculous mycobacteriosis, especially among Southeast Asians. We report another 8 cases, all except one apparently immunocompetent hosts who suffered from concomitant or sequential infections by other intracellular pathogens causing penicilliosis, extraintestinal nontyphoidal salmonellosis, and burkholderiosis. The only case with an underlying immunodeficiency syndrome had systemic lupus erythematosus that was quiescent throughout the multiple infective episodes. Eight out of 10 (80.0%) patients with serological evidence of penicilliosis, 5 out of 7 (71.4%) with culture-positive extraintestinal nontyphoidal salmonellosis, 5 out of 28 (17.9%) with serological evidence of melioidosis, and 7 out of 13 (53.8%) with culture-positive nontuberculous mycobacteriosis possessed autoantibody against gamma interferon, whereas only 1 out of 100 patients with systemic lupus erythematosus did. Our study represents the first and largest case series linking this emerging immunodeficiency syndrome with these atypical infections in apparently immunocompetent hosts. Thus, we advocate that any patient with unexplained recurrent or polymicrobial infections due to these intracellular pathogens should be screened for acquired immunodeficiency due to autoantibody against gamma interferon.
authors.affiliation: Carol Yu's Centre for Infection and Division of Infectious Diseases, Department of Microbiology, Queen Mary Hospital, the University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, PR China.
authors.forename: Bone Siu-Fai
authors.initials: BS
authors.lastname: Tang
authors.forename: Jasper Fuk-Woo
authors.initials: JF
authors.lastname: Chan
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Owen Tak-Yin
authors.initials: OT
authors.lastname: Tsang
authors.forename: M Y
authors.initials: MY
authors.lastname: Mok
authors.forename: Raymond Wai-Man
authors.initials: RW
authors.lastname: Lai
authors.forename: Rodney
authors.initials: R
authors.lastname: Lee
authors.forename: Tak-Lun
authors.initials: TL
authors.lastname: Que
authors.forename: Herman
authors.initials: H
authors.lastname: Tse
authors.forename: Iris Wai-Sum
authors.initials: IW
authors.lastname: Li
authors.forename: Kelvin Kai-Wang
authors.initials: KK
authors.lastname: To
authors.forename: Vincent Chi-Chung
authors.initials: VC
authors.lastname: Cheng
authors.forename: Eric Yuk-Tat
authors.initials: EY
authors.lastname: Chan
authors.forename: Bojian
authors.initials: B
authors.lastname: Zheng
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000209:etiology*; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D016470:Bacteremia; D019121:Burkholderia Infections / Q000209:etiology / Q000276:immunology*; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007371:Interferon-gamma / Q000276:immunology*; D008554:Melioidosis / Q000209:etiology; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000276:immunology*; D009894:Opportunistic Infections / Q000209:etiology; D010407:Penicillium / Q000472:pathogenicity; D012008:Recurrence; D012480:Salmonella Infections / Q000209:etiology / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007371:Interferon-gamma
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