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Delayed cutaneous hypersensitivity: epidemiologic factors affecting and usefulness in predicting diarrheal incidence
R E Black1, C F Lanata, F Lazo
1Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD.
Insights
Cell-mediated immunity, measured by skin tests, was lower in Peruvian children with more diarrhea. Malnutrition and weakened immunity are significant risk factors for infectious diseases in children.
Area of Science:
- Immunology
- Pediatrics
- Public Health
Background:
- Cell-mediated immunity, assessed via delayed cutaneous hypersensitivity, can be compromised by malnutrition and viral infections.
- Impaired immune function may increase susceptibility to and severity of infectious diseases.
Purpose of the Study:
- To evaluate cell-mediated immunity in young Peruvian children using a standardized antigen test.
- To investigate the relationship between immune responsiveness, nutritional status, and the incidence of diarrhea.
Main Methods:
- Delayed cutaneous hypersensitivity was assessed using the Multitest CMI in young Peruvian children.
- Immune responsiveness was measured by the number of positive antigen responses and the sum of induration sizes.
- Diarrhea incidence was monitored via household surveillance for six months post-testing.
- Nutritional status was determined by weight-for-age and length-for-age metrics.
Main Results:
- Tuberculin response was common, enhanced by Bacillus Calmette-Guérin vaccination.
- Responses to tetanus and diphtheria toxoids were good, particularly after diphtheria-tetanus toxoids-pertussis vaccination.
- Lower cell-mediated immunity correlated with a higher incidence of diarrhea.
- Undernutrition was linked to increased diarrhea incidence but not episode duration.
Conclusions:
- Depressed cell-mediated immunity and malnutrition are significant risk factors for diarrhea in children in developing countries.
- Assessing cell-mediated immunity can identify children at higher risk for infectious diseases.
Abstract:
Cell-mediated immunity, as assessed by delayed cutaneous hypersensitivity, can be diminished by malnutrition and viral infections. In turn, decreased immune functioning might lead to more frequent or more severe infectious diseases. Delayed cutaneous hypersensitivity was assessed in young Peruvian children by simultaneous application of seven standardized antigens and a negative control (Multitest CMI). Response to tuberculin was frequent and was higher in children vaccinated with Bacillus Calmette-Guérin, response to tetanus or diphtheria toxoids was also good, especially in children who had received at least two doses of diphtheria-tetanus toxoids-pertussis vaccine. Two summary assessments, the number of positive responses and the sum of indurations of all positive responses provided useful measures of delayed cutaneous hypersensitivity. Responsiveness, as assessed by these summary measures, was inversely related to the incidence of diarrhea, identified by household surveillance for the 6 months after the skin test. Undernutrition, as assessed by weight for age or length for age, was also a significant determinant of the incidence of diarrhea, but not the duration of episodes, in this group of study children. Depressed cell-mediated immunity and malnutrition may be important risk factors for diarrhea in developing country children.