Defective mononuclear leukocyte chemotaxis: A previously unrecognized immune dysfunction. Studies in a patient with chronic mucocutaneous candidiasis

Immunologic defects in patients with chronic mucocutaneous candidiasis vary but generally include impaired cell-mediated immunity. Mononuclear leukocyte accumulation at cellular-immune inflammatory sites is important to host defense against microbial invasion. The mononuclear leukocytes of a patient with chronic mucocutaneous candidiasis and cutaneous anergy failed to migrate in vitro toward two chemotactic stimuli—lymphocyte-derived chemotactic factor and C5a. After treatment with transfer factor the patient's mononuclear leukocytes responded to both chemotactic factors. She also developed a delayed hypersensitivity reaction to Candida antigen, but even after treatment her lymphocytes failed to produce chemotactic factor in response to Candida antigen. These data suggest that defective mononuclear chemotactic function may result in hypersusceptibility to infection with Candida albicans and that transfer factor may enhance mononuclear leukocyte chemotactic responsiveness. T H E INFLAMMATORY RESPONSE is a primary mecha-nism of the immune system in localizing and destroy-ing a foreign challenge (1). An immunologically mediated inflammatory response may be divided into three stages, each of which is critical for normal hos