LYMPHOCYTE DYSFUNCTION IN INJURED ADULTS WITH ELEVATED CANDIDA ANTIGEN TITERS

Background. Lymphocytes play an important role in the activation of po lymorphonuclear neutrophil (PMN) antimicrobial functions. This study w as undertaken to evaluate the ability of lymphocytes from severely inj ured adults with elevated Candida antigen liters to activate the antic andidal function of normal PMNs.Methods. Lymphocytes from 13 injured a dults with elevated Candida antigen titers (titer+) were isolated and incubated with or without heat-killed C. albicans. After a 48-hour inc ubation, cell culture supernatants were harvested and tested for the a bility to activate the anticandidal function of normal PMNs. Lymphocyt es from 13 volunteers and 13 injury-matched patients with negative Can dida antigen titers (titer-) were studied for comparison. Results. The patients with titer+ and titer- were well matched in terms of age, se x, Injury Severity Score, units of blood transfused, and length-breadt h of antibiotic therapy. Patients with titer+ had a higher incidence o f 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 P MN-activating factor(s) when exposed to C. albicans. Lymphocytes from the patients with titer+ were defective in their ability to release th is activating factor(s) after exposure to C. albicans. Conclusions. Al though culture evidence of Candida as uncommon, injured adults with el evated Candida antigen titers have lymphocyte dysfunction and often su ffer documented bacterial infections.