Wegener's granulomatosis: immunological and microbiological factors involved in disease activation

Wegener's granulomatosisin its classic form is characterized by necrotizing granulomatous inflammation of especially nasal and paranasal structures and lungs in combination with pauci-immune necrotizing glomerulonephritis and small vessel vasculitis (1,2). Although a clinical presentationin its classical form is not uncommon, a patient with Wegener's granulomatosis may present with a wide variety of clinical problems, even without some or even all classic features (3). In patients with a less typical presentation the physician can easily be mislead and a long diagnosticd elay can occur (4,5). See: Introduction

Cell-mediated immune responses to influenza vaccination in Wegener's granulomatosis

Background: Both antibody and cell-mediated immune responses are involved in the defence against influenza. In Wegener's granulomatosis (WG), antibody responses to influenza vaccination appear to be similar to those in healthy controls, but cell-mediated responses have not been studied. Objective: To determine whether cell-mediated responses to influenza vaccination in WG vary from those in controls. Methods: Twenty-five patients with WG and healthy controls received subunit influenza vaccine. Peripheral blood mononuclear cells were obtained before and 1 month after vaccination. Cell-mediated responses to A/H1N1 and A/H3N2 were assessed using interferon γ (IFNγ) ELISpot and intracellular cytokine staining for IFNγ, tumour necrosis factor and interleukin 2. Results: Before vaccination, patients and controls showed similar recall responses to A/H1N1 and A/H3N2. After vaccination, patients and controls showed similar levels of increase in spot-forming cells against A/H1N1 and A/H3N2. By flow cytometry, upon vaccination, proportions of cytokine-producing CD4 T cells increased in patients and controls for A/H1N1 and A/H3N2. Conclusions: Cell-mediated responses to influenza vaccination in patients with WG are comparable to those in healthy controls