Lymphocyte dysfunction in injured adults with elevated Candida antigen titers.

BACKGROUND

Lymphocytes play an important role in the activation of polymorphonuclear neutrophil (PMN) antimicrobial functions. This study was undertaken to evaluate the ability of lymphocytes from severely injured adults with elevated Candida antigen titers to activate the anticandidal function of normal PMNs.

METHODS

Lymphocytes from 13 injured adults with elevated Candida antigen titers (titer+) were isolated and incubated with or without heat-killed C. albicans. After a 48-hour incubation, cell culture supernatants were harvested and tested for the ability to activate the anticandidal function of normal PMNs. Lymphocytes from 13 volunteers and 13 injury-matched patients with negative Candida antigen titers (titer-) were studied for comparison.

RESULTS

The patients with titer+ and titer- were well matched in terms of age, sex, Injury Severity Score, units of blood transfused, and length-breadth of antibiotic therapy. Patients with titer+ had a higher incidence of bacterial infections than did patients with titer-. Only 2 of the 13 patients with titer+ had a positive Candida culture. Lymphocytes from the volunteers and patients with titer- released large amounts of a PMN-activating factor(s) when exposed to C. albicans. Lymphocytes from the patients with titer+ were defective in their ability to release this activating factor(s) after exposure to C. albicans.

CONCLUSIONS

Although culture evidence of Candida was uncommon, injured adults with elevated Candida antigen titers have lymphocyte dysfunction and often suffer documented bacterial infections.