Logo of annsurgLink to Publisher's site
Ann Surg. 1977 Sep; 186(3): 241–249.
PMCID: PMC1396336

Delayed Hypersensitivity: Indicator of Acquired Failure of Host Defenses in Sepsis and Trauma

Abstract

Primary failure of host defense mechanisms has been associated with increased infection and mortality. Anergy, the failure of delayed hypersensitivity response, has been shown to identify surgical patients at increased risk for sepsis and related mortality. The anergic and relatively anergic patients whose skin tests failed to improve had a mortality rate of 74.4%, whereas those who improved their responses had a mortality rate of 5.1% (P < 0.001). This study documents abnormalities of neutrophil chemotaxis, T-lymphocyte rosetting in anergic patients and the effect of autologous serum. These abnormalities may account for the increased infection and mortality rates in anergic patients. Skin testing with five standard antigens has identified 110 anergic (A) or relatively anergic (RA) patients in whom neutrophil chemotaxis (CTX) and bactericidal function (NBF), T-lymphocyte rosettes, mixed lymphocyte culture (MLC), cell-mediated lympholysis (CML), and blastogenic factor (BF) were studied. The MLC, CML and BF were normal in the patients studied, and were not clinically helpful. Neutrophil CTX in 19 controls was 117.5 ± 1.6 u whereas in 40 A patients, neutrophils migrated 81.7 ± 2.3 u and in 15 RA patients 97.2 ± 3.8 u (P < 0.01). In 14 patients whose skin tests converted to normal, neutrophil migration improved from 78.2 ± 5.4 u to 107.2 ± 4.0 u (P < 0.01). Incubation of A or control neutrophils in A serum reduced migration in A patients from 93 ± 3.7 u to 86.2 ± 3.5 u (P < 0.01) and in normals from 121.2 ± 1.6 u to 103.6 ± 2.6 u (P < 0.001). The per cent rosette forming cells in 66 A patients was 42.5 ± 3.1 compared to 53.6 ± 2.8 in normal responders (P < 0.02). Incubation of normal lymphocytes in anergic serum further reduced rosetting by 30%. Restoration of delayed hypersensitivity responses and concurrent improvement in cellular and serum components of host defense were correlated with maintenance of adequate nutrition and aggressive surgical drainage.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Alexander JW. Emerging concepts in the control of surgical infections. Surgery. 1974 Jun;75(6):934–946. [PubMed]
  • Alexander JW, Meakins JL. A physiological basis for the development of opportunistic infections in man. Ann Surg. 1972 Sep;176(3):273–287. [PMC free article] [PubMed]
  • Alexander JW, Windhorst DB, Good RA. Improved tests for the evaluation of neutrophil function in human disease. J Lab Clin Med. 1968 Jul;72(1):136–148. [PubMed]
  • Berenberg JL, Ward PA. Chemotactic factor inactivator in normal human serum. J Clin Invest. 1973 May;52(5):1200–1206. [PMC free article] [PubMed]
  • BOYDEN S. The chemotactic effect of mixtures of antibody and antigen on polymorphonuclear leucocytes. J Exp Med. 1962 Mar 1;115:453–466. [PMC free article] [PubMed]
  • Clark RA, Kimball HR. Defective granulocyte chemotaxis in the Chediak-Higashi syndrome. J Clin Invest. 1971 Dec;50(12):2645–2652. [PMC free article] [PubMed]
  • Curreri PW, Heck EL, Browne L, Baxter CR. Stimulated nitroblue tetrazolium test to assess neutrophil antibacterial function: prediction of wound sepsis in burned patients. Surgery. 1973 Jul;74(1):6–13. [PubMed]
  • Dhillon KS, MacLean LD, Meakins JL. Neutrophil function in surgical patients: correlation of neutrophil bactericidal function, serum albumin, and sepsis. Surg Forum. 1975;26:27–28. [PubMed]
  • Eilber FR, Morton DL. Impaired immunologic reactivity and recurrence following cancer surgery. Cancer. 1970 Feb;25(2):362–367. [PubMed]
  • Hartzman RJ, Segall M, Bach ML, Bach FH. Histocompatibility matching. VI. Miniaturization of the mixed leukocyte culture test: a preliminary report. Transplantation. 1971 Mar;11(3):268–273. [PubMed]
  • Gordon J, MacLean LD. A lymphocyte-stimulating factor produced in vitro. Nature. 1965 Nov 20;208(5012):795–796. [PubMed]
  • Hill HR, Quie PG. Raised serum-IgE levels and defective neutrophil chemotaxis in three children with eczema and recurrent bacterial infections. Lancet. 1974 Feb 9;1(7850):183–187. [PubMed]
  • Jondal M, Holm G, Wigzell H. Surface markers on human T and B lymphocytes. I. A large population of lymphocytes forming nonimmune rosettes with sheep red blood cells. J Exp Med. 1972 Aug 1;136(2):207–215. [PMC free article] [PubMed]
  • MacLean LD, Meakins JL, Taguchi K, Duignan JP, Dhillon KS, Gordon J. Host resistance in sepsis and trauma. Ann Surg. 1975 Sep;182(3):207–217. [PMC free article] [PubMed]
  • Osoba D, Falk J. The mixed-leukocyte reaction in man: effect of pools of stimulating cells selected on the basis of crossreacting HL-A specificities. Cell Immunol. 1974 Jan;10(1):117–135. [PubMed]
  • Shizgal HM, Spanier AH, Kurtz RS. Effect of parenteral nutrition on body composition in the critically ill patient. Am J Surg. 1976 Feb;131(2):156–161. [PubMed]
  • Spanier AH, Pietsch JB, Meakins JL, MacLean LD, Shizgal HM. The relationship between immune competence and nutrition. Surg Forum. 1976;27(62):332–336. [PubMed]
  • Tan JS, Watanakunakorn C, Phair JP. A modified assay of neutrophil function: use of lysostaphin to differentiate defective phagocytosis from impaired intracellular killing. J Lab Clin Med. 1971 Aug;78(2):316–322. [PubMed]
  • Tan JS, Strauss RG, Akabutu J, Kauffman CA, Mauer AM, Phair JP. Persistent neutrophil dysfunction in an adult. Combined defect in chemotaxis, phagocytosis and intracellular killing. Am J Med. 1974 Aug;57(2):251–258. [PubMed]
  • Till G, Ward PA. Two distinct chemotactic factor inactivators in human serum. J Immunol. 1975 Feb;114(2 Pt 2):843–847. [PubMed]
  • Uhr JW. Delayed hypersensitivity. Physiol Rev. 1966 Jul;46(3):359–419. [PubMed]
  • Van Epps DE, Frierson JA, Williams RC. Immunological studies of anergic patients. Infect Immun. 1974 Nov;10(5):1003–1009. [PMC free article] [PubMed]
  • Van Epps DE, Palmer DL, Williams RC., Jr Characterization of serum inhibitors of neutrophil chemotaxis associated with anergy. J Immunol. 1974 Jul;113(1):189–200. [PubMed]
  • Ward PA. Leukotaxis and leukotactic disorders. A review. Am J Pathol. 1974 Dec;77(3):520–538. [PMC free article] [PubMed]
  • Ward PA, Schlegel RJ. Impaired leucotactic responsiveness in a child with recurrent infections. Lancet. 1969 Aug 16;2(7616):344–347. [PubMed]
  • Warden GD, Mason AD, Jr, Pruitt BA., Jr Suppression of leukocyte chemotaxis in vitro by chemotherapeutic agents used in the management of thermal injuries. Ann Surg. 1975 Mar;181(3):363–369. [PMC free article] [PubMed]
  • Zigmond SH, Hirsch JG. Leukocyte locomotion and chemotaxis. New methods for evaluation, and demonstration of a cell-derived chemotactic factor. J Exp Med. 1973 Feb 1;137(2):387–410. [PMC free article] [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...