[PAGID] Candidiasis and cellular dysfunction in a previously healthy adult

[Richard L. Wasserman]

I'd very much appreciate comments and suggestions for further work up of 
this patient.
Richard Wasserman
Dallas

The case:
I saw a 32 yo woman with candida esophagitis. She had been completely 
well until several months after the birth of her second child when she 
developed malaise, fatigue and non-specific GI symptoms of bloating, 
abdominal pain and intermittent diarrhea. She has lost more than 10% of 
her body weight and is significantly below her pre-pregnant weight. She 
has been on a high calorie diet and continues to loose weight. She has 
had an extensive GI evaluation including EGD, colonoscopy and capsule 
study; all normal. There have been no other infections (no significant 
infection history ever), no signs nor symptoms of collagen vascular 
disease. Her studies of cellular immunity are:


Abs.CD19+ Lymphs          245 /uL                    12-645
Absolute CD 3            1433 /uL                    622-2402
Absolute CD 4 Helper      1053 /uL                    359-1519
Abs. CD 8 Suppressor      326 /uL                    109-897
% CD19+ Lymphs            13.6 %                      3.3-25.4
% CD 3 Pos. Lymph.        79.6 %                      57.5-86.2  
% CD 4 Pos. Lymph.        58.5 %                      30.8-58.5
% CD 8 Pos. Lymph.        18.1 %                      12.0-35.5
CD4/CD8 Ratio            3.23                        0.92-3.72  
WBC                      5.4 x10E3/uL                4.0-10.5
 Hemoglobin                13.0 g/dL                  11.5-15.0
 Neutrophils              56 %                        40-74           
 Lymphs                    34 %                        14-46  
 Monocytes                8 %                        4-13  
 Eos                      1 %                        0-7  
 Basos                    1 %                        0-3            
Tests: (3) Lymphocyte Activation (826963)
Unstimulated CD4          12 ng/mL
PHA - CD4 Activation [L]  119 ng/mL           >225             Normal 
activation of CD4 cells is indicated if the
patient's responses reach the threshold or
reference value shown.  The cellular immune
response to PHA stimulation can be categorized as
follows:
ng/mL of ATP        Interpretation
<226                  Low Immune Cell Response
226-524            Moderate Immune Cell Response
 >524                 Strong or High Level of Immune Cell Response

Tests: (4) Tetanus toxoid-CD4 Activation (827140)
Tetanus toxoid-CD4 Act.*
                     [L]  10 ng/mL                    >23  
This test was developed and its performance

characteristics determined by IBT Reference Lab.
It has not been cleared or approved by the FDA.
**Effective October 29, 2008 this panel will be**
 non orderable. For replacement number, please
 contact your local LabCorp Representative.
 placement number, please contact
 your local LabCorp Representative.

Tests: (5) Concanavalin A(CON A)-CD4 Act. (827144)
Concanaval A (Con-A)-CD4 Act.*
                           189 ng/mL                  >136
This test was developed and its performance
characteristics determined by IBT Reference Lab.
It has not been cleared or approved by the FDA.

Tests: (6) Varicella-Zoster-CD4 Act. (827138)
Varicella-Zoster-CD4 Act.*
                     [L]  14 ng/mL                    >22
This test was developed and its performance
characteristics determined by IBT Reference Lab.
It has not been cleared or approved by the FDA.

Tests: (7) Candida albicans-CD4 Act. (827134)
Candida albicans-CD4 Act.*
                     [L]  13 ng/mL                    >25  
This test was developed and its performance
characteristics determined by IBT Reference Lab.
It has not been cleared or approved by the FDA.

Tests: (8) ANA w/Reflex if Positive (164863)
! Antinuclear Antibodies Direct
                           38 AU/mL                    0-99             
                               Negative        <100
                               Equivocal  100 - 120
                               Positive        >120



Tests: (9) Sedimentation Rate-Westergren (005215)
Sedimentation Rate-Westergren    5 mm/hr       0-20          
Tests: (10) C-Reactive Protein, Quant (006627)
C-Reactive Protein, Quant    2.7 mg/L           0.0-4.9      
-------------- next part --------------
A non-text attachment was scrubbed...
Name: rich_wasserman.vcf
Type: text/x-vcard
Size: 243 bytes
Desc: not available
Url : <http://seven.pairlist.net/mailman/private/pagid/attachments/20081202/7d6d9825/attachment-0001.vcf>