|CD4+ counts||Alternative causes of depletion||Physical stress||Illness|
|Acute erythroderma as an exclusion criterion for idiopathic CD4+ T lymphocytopenia.|| ||Griffiths, T. W., S. R. Stevens, and K. D. Cooper.
| ||"We describe three patients with cutaneous T-cell lymphoma, atopic dermatitis, or psoriasis in whom acute erythroderma was concomitant with a peripheral CD4+ T lymphocytopenia that normalized after resolution of the erythroderma... We propose that CD4+ T lymphocytopenia can occur as a result of acute erythroderma of multiple causes and that acute erythroderma associated with transient CD4+ T lymphocytopenia be considered as an exclusion criterion for idiopathic peripheral blood CD4+ T lymphocytopenia."|
| ||Arch Dermatol, 1994, 130(12):1530-3.||1994|
|T-lymphocyte subsets in acute illness|| ||Feeney C, BryzmanS, Kong L, BraziH DeutscR, Frit LC
| ||"To determine the range of T-lymphocyte subsets (CD4, CD8, and CD4/CD8 ratios) in acutely ill, hospitalized patients and to determine whether these concentrations correlate with illness severity,survival rate,or immunodepression. : One hundred two consecutively admitted ICU patients (72 medical and 30 surgical). Acute illness alone, in the absence of HIV infection, can be associated with profound decreases of T-lymphocyte populations. This problem is unpredictable and does not correlate with severity of illness, predicted mortality rate, or actual mortality rate. No conclusions regarding HIV serostatus or survival can be made based on single measurements of T-cell concentrations in acutely ill hospitalized patients...This study was consistent with prior studies that have shown similar decreases in T-cell counts in specific subsets of acutely ill patients. These subsets included patients with bacterial infections, sepsis, septic shock, multiple organ system failure, tuberculosis, coccidioidomycosis, viral infections, burns, and trauma patients. Most of these studies reported decreases in lymphocyte populations, some of which were severe and included CD4/CD8 ratio inversions" Fully 30% of these patients had CD4 counts less than 300.|
| ||Crit Care Med 1995 Oct ; 23 (10) : 1680-5||1995|
|Non-HIV AIDS: nature and strategies for its management.|| ||Bird AG.
| ||"Since CD4 depletion in the blood (after an infection) can persist for long periods, the current CDC definition (of idiopathic CD4 T lymphopenia) is unsatisfactory. I propose that a period of at least 6 months is added to the requirement for consecutive low CD4 counts to rule out short-term secondary effects of infection."|
| ||Journal of Antimicrobial Chemotherapy. 1996;37(B):171-183.||1996|
|A biometrical view on normal values of CD4 and CD8 lymphocyte counts in peripheral blood.|| ||Zachar V, Mikulecky M, Mayer V, Mackay I, Frazer I
| ||Research has shown that CD4 cells become depleted in a wide variety of ways and that low CD4 counts is an incredibly non-specific finding which is common in many people suffering from all types of physical and psychological stress.|
| ||Pathology; 1988 Oct; 20(4):358-60||1988|
|Idiopathic CD4+ T-lymphocyte depletion in a west African population.|| ||Djomand, G., L. Diaby, J. M. N'Gbichi, D. Coulibaly, A. Kadio, A. Yapi, J. M. Kanga, E. Boateng, K. Diallo, L. Kestens, and et al.
| ||"In the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon ( 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection"|
| ||Aids. 8(6):843-7. 1994.||1994|
|Lymphocytopenia in a hospital population--what does it signify?|| ||Castelino DJ, McNair P, Kay TW.
| ||Lymphocytopenia is a common finding in hospital patients especially since the advent of automated differential leukocyte counters. The causes and significance of lymphocytopenia are generally poorly understood. There has been no large-scale study of its significance for 25 years. The HIV epidemic, and the recently described idiopathic CD4+ T-lymphocytopenia have raised interest in this finding. To describe the spectrum of lymphocytopenia in an adult teaching hospital and investigate its clinical significance. Using the available computer facilities, patients with significant lymphocytopenia (< 0.6 x 10(9)/L) were identified over a 102 day period and diagnoses, operations and medication lists obtained. Where necessary, patient histories were examined to supplement the above information. If feasible, previous and subsequent lymphocyte counts were checked to establish if the lymphocytopenia were temporary or longstanding. One thousand and forty-two patients were identified, with a mean age of 59.6 years, of whom 563 were male, and 757 were inpatients. Thirty-six patients were pancytopenic. We checked previous and subsequent counts for 698 patients and found 45 patients who were consistently lymphocytopenic, some for more than ten years. Thirty-four patients with previously normal counts remained lymphocytopenic throughout follow up, while 457 had at least one subsequent lymphocyte count > 1 x 10(9)/L. We found only one patient who was suspected of having idiopathic CD4+ T-lymphocytopenia. Patients fell into several categories (with some overlap): bacterial/fungal sepsis (250), post-operative (228), corticosteroid therapy (definite 159, suspected 53, inhaled steroids alone 14), malignancy (174 definite, six probable), cytotoxic therapy and/or radiotherapy (90), trauma or haemorrhage (86), transplants (73-38 renal and 35 bone marrow), 'viral infections' (26) and HIV infection (13). Thirty-four patients died within the study period. Lymphocytopenia in hospital patients is most frequently reversible, and due to acute illness, notably sepsis and trauma (including surgery). Malignancy, with or without chemotherapy, and steroid use are also common causes, but HIV infection is a relatively uncommon cause in our hospital.|
| ||Aust N Z J Med 1997 Apr;27(2):170-4||1997|
|Acquired immunodeficiency syndrome in the United States: a selective review.|| ||Layon J, Warzynski M, Idris A.
| ||“other diseases and some treatment regimens also can express a T-helper lymphopenia [deficiency]”|
| ||Critical Care Medicine. 1986;14(9):819-27.||1986|
|Concurrent infections and HIV pathogenesis.|| ||Bentwich et al.
| ||“Several of the features of Leishmania infection are reminiscent of HIV infection. In both, there is a decrease of CD4 lymphocytes, the immune activation profile is similar, and a dominant TH2 profile is present...All helminthic infections are associated with strong chronic immune responses...[including] dcreased CD4 and CD4:CD8 ratios.”|
| ||AIDS. 2000;14:2071-81.||2000|
|Idiopathic CD4+ T-lymphocyte depletion in a west African population.|| ||Djomand G, Diaby L, N'Gbichi JM, Coulibaly D, Kadio A, Yapi A, Kanga JM, Boateng E, Diallo K, Kestens L, et al.
| ||Retrospective review of databases and prospective case-control study. Project RETRO-CI, an AIDS research project in Abidjan, Cote d'Ivoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan. We conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever). In the retrospective data review, CD4+ T-lymphocyte counts < 300 x 10(6)/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients...|
| ||AIDS. 1994 Jun;8(6):843-7.||1994|
|T4 lymphopenia in patients with active pulmonary tuberculosis.|| ||Beck JS, Potts RC, Kardjito T, and Grange JM
| ||"We now report the relatively frequent occurence of moderate CD4 lymphopenia in patients with untreated but otherwise uncomplicated pulmonary TB." The authors also comment on some similar findings in leprosy, as well as in HIV-negative hemophiliacs : "Moderate reduction in the CD4/CD8 ratio has been reported in lepromatous leprosy, which reverts to normal under effective chemotherapy... It is tempting to speculate that these changes are analogous to those we now report in tuberculosis and that they are a consequence of ongoing immune response to the disease."|
| ||Clin Exp Immunol, Volume 60, 49-54.||1985|
|Analysis of T lymphocyte subsets in CMV mononucleosis|| ||Carney WP, Rubin RH, Hoffman RA, et al.
| ||In 1981 a group of researchers looked at CD4 and CD8 counts in ten consecutive patients with acute CMV mononucleosis, and compared their counts with those of ten healthy volunteers. The CD4 counts in people with mononucleosis were significantly reduced, with the healthy volunteers having 73% more CD4+ cells per ml than did people with mono, on average. The CD4 counts were measured in nine of the ten patients, and the three with the lowest CD4 counts had 194, 202 , and 255 cells/mm3. The authors also found that the T-lymphocytes of people with mononucleosis responded poorly to antigens, showing depressed function.|
| ||The Journal of Immunology 126(6); 2114-2116, 1981||1981|
|Transient immune deficiency in patients with acute Epstein-Barr virus (EBV) infection.|| ||Junker AK, Ochs HD, Clark EA et al.
| ||A set of researchers measured various lymphocyte subsets in acute EBV mononucleosis. They took 17 consecutive patients who had recently been diagnosed, gave them an immunization designed to activate their B lymphocytes, and then took samples of blood. The authors conclude that "these studies demonstrate that infection with EBV affects both B and T lymphocytes and causes a broad based transient immune deficiency in patients with uncomplicated infectious mononucleosis"|
| ||Clin Immunol Immunopathol 40(3); 436-446, 1986||1986|
|Serial changes in cellular immunity of septic patients with multiple organ-system failure.|| ||Nishijima MK, Takezawa J, Hosotsubo KK et al.
| ||Various lymphocyte subsets in 9 consecutive patients admitted to the ICU with sepsis. They examined their blood at weekly intervals for four weeks. The CD4 counts in these patients were markedly reduced, with averages beginning below 500 and staying there for the entire 4 week study period. The authors did not provide individual CD4 counts, nor do they present data showing how many patients have CD4 counts below 200, but having an average below 500 is still highly significant.|
| ||Critical Care Medicine, Volume 14(2); 87-91.||1986|