Association between some Tropical Pulmonary Infectious Diseases and known Human Leukocyte Antigens
1. Introduction
Human leukocyte antigen (HLA) is the most polymorphic genetic system in humans, with numerous alleles, and subsequently, various possible combinations [1]. These genes, the products of histocompatibility complex (MHC) [2] are located in the short arm of chromosome 6 at band p 21.3 [2] and are divided into three classes, I, II and III [1]. HLA class I is responsible for coding the molecules HLA-A, -B and -C, present in almost all somatic cells with killing of viral infected targets by class I antigens restrict cytotoxic T-cell (CD8+) function [2] while HLA class II genes code the molecules HLA-DR, -DQ and -DP [1] by presentation of exogenous antigens to T-helper cells (CD4+) or antigen presenting cells (APC) [2]. This polymorphism contributes to the differences in susceptibility to diseases among genetically distinct groups [1]. The molecules coded for by the HLA system are responsible for the antigen presentation [1]. The T lymphocytes that are linked to HLA molecules only recognize antigens by the antigen-specific cell surface receptor-antigens interaction [2], thus the HLA antigens [1] and MCH molecules [2] apparently participate in controlling susceptibility and resistance to various diseases. Some infectious diseases were considered as familial before the finding of the causative microorganism and early twin studies indicated that there was a substantial host genetic influence on susceptibility to diseases such as polio and tuberculosis (TB) [3]. At present, it has been confirmed that human genetic variation demonstrates a major influence on the course of diseases caused by several infectious microorganisms [3].
2. Severe Acute Respiratory Syndrome and HLA
Recently, Itoyama
3. Tuberculosis and HLA
HLA studies conducted in India revealed that there was association of
4. Human Immunodeficiency Virus Infection (HIV)/Acquired Immunodeficiency Syndrome (AIDS) — Related tropical pulmonary infectious diseases and HLA
The World Health Organization (WHO) estimates that 8-10 million new cases of TB globally occur each year [32]. Although AIDS is the same disease as HIV disease in all part of the world, this microorganism is mostly in many tropical countries [32]. In tropical countries, TB and bacterial pneumonia represent the major pulmonary infections among the patients with HIV-infection/AIDS [32]. Although the spectrum of HIV disease/AIDS is quite broad, the majority of the pulmonary infections in HIV-1 infected patients are similar to those observed in non-HIV infected persons [32]. The geographical differences are primarily due to varying frequencies rather than the kinds of infections [32]. Of all the pulmonary infections encountered in the tropics obviously
4.1. HIV-infection/AIDS-TB Co-infection and HLA
Studies from Haiti and sub-Saharan Africa have demonstrated that 17% to 66% of TB cases are HIV-1 seropositive while 50% of HIV-seropositive patients with pulmonary symptoms are sick with TB [32]. A previous study in Brazilians by Figueiredo
4.2. HIV-infection/AIDS-related community acquired pneumonia
A previous study in Kenya in 1976 demonstrated that 20% of patients presenting with pneumonia to Kenyatta National Hospital had pneumococcal bacteremia which was very common among HIV-infected patients (26% of the HIV-1 seropositive group versus 6% of the seronegative group) [40] whereas
4.3. HIV-infection/AIDS-related pulmonary Nocardia asteroides infection
4.4. HIV-infection/AIDS-related pulmonary melioidosis
Melioidosis is caused by the Gram-negative motile bacillus,
4.5. HIV-infection/AIDS-related fungal pneumonia
4.5.1. Pulmonary histoplasmosis
4.5.2. Pulmonary cryptococcosis
4.5.3. Pulmonary paracoccidioidomycosis
Paracoccidioidomycosis is caused by the dimorphic fungus
4.5.4. Pulmonary penicillosis
This disease caused by the usual dimorphic fungus,
4.5.5. Pneumocystis jeroveci (carinii) pneumonia (Pulmonary pneumocystosis)
Currently, the taxonomy of
4.6. HIV-infection/AIDS-related parasitic pneumonia
4.6.1. Pulmonary strongyloidiasis
Very few parasitic diseases have been reported to cause pneumonia in HIV- infected/AIDS patients [32]. A helminth,
4.6.2. Pulmonary ascariasis
4.6.3. Pulmonary ancylostomiasis
4.6.3.1. Ancylostoma duodenale
4.6.3.2. Necator americanus
4.6.4. Pulmonary paragonimiasis
In Asia, nearly 20 million people are infected with
4.6.5. Pulmonary schistosomiasis
4.6.6. Pulmonary hydatid disease
Human hydatid disease is caused by
4.6.7. Pulmonary trichinellosis
The most important species that infect humans is
5. Filarial parasites — Related tropical pulmonary eosinophilia and HLA
This syndrome results from immunological hyperresponsiveness to human filarial parasites,
6. Pulmonary malaria and HLA
Four types of malarial parasites (
7. Pulmonary amoebiasis and HLA
Pulmonary amoebiasis that caused by the protozoan parasite,
8. Pulmonary leishmaniasis and HLA
Pulmonary or visceral leishmaniasis, also called “ Kala azar ” is caused by
9. Pulmonary trypanosomiasis and HLA
Human African trypanosomiasis (HAT) or sleeping sickness is caused by an extracellularly protozoan parasite, called “
10. Pulmonary larval migrans
11. Pulmonary toxoplasmosis and HLA
A celled protozoan parasite, called “
12. Pulmonary dengue viral infection and HLA
This disease is caused by dengue virus (DENV) that belong to the family
13. Pulmonary leptospirosis and HLA
Leptospirosis is a zoonotic disease caused by genus
14. Conclusions
Most of several studies have inconclusively demonstrated statistical association between HLA class I and II molecules and susceptibility to a range of complex tropical pulmonary infectious diseases, particularly parasitic pulmonary diseases. The globalization of neglected tropical pulmonary infectious diseases can alert the healthcare providers in diagnosis in recent immigrants or travelers from endemic areas who present with respiratory manifestations and peripheral blood or tissue eosinophilia. A complete re-evaluation of the true impact of HLA/MHC genes on susceptibility to tropical pulmonary infectious diseases. Summary of association between known HLA alleles and susceptibility of some tropical pulmonary infectious diseases are shown in Table 1.
|
|
|
|
SARS |
|
More prevalent and more poorer outcome | 7, 8 |
|
Protective | 10 | |
|
Susceptible | 10 | |
Tuberculosis |
|
Susceptible | 26, 27, 28, 29 |
|
Decreased frequency | 28 | |
|
Relapse | 30 | |
HIV-Infection/AIDS |
|
Slow progression | 33 |
|
More rapid central nervous system impairment | 33 | |
|
Protective against disease progression | 33 | |
|
Protective against both disease progression and central nervous system impairment | 33 | |
|
Susceptible to TB disease | 39 | |
Filariasis |
|
Susceptible to chronically obstructive lymphatic form | 146 |
|
Susceptible | 148 | |
Malaria |
|
Susceptible | 160, 162 |
|
Protective | 161, 163 | |
Amoebiasis |
|
Protective | 178 |
Leishmaniasis |
|
Susceptible to visceral or pulmonary leishmaniasis | 196 |
|
Susceptible to cutaneous leishmaniasis | 205 | |
|
Susceptible to recurrent cutaneous leishmaniasis (American type) | 205 | |
|
Susceptible to re-infected cutaneous leishmaniasis American type) | 205 | |
|
Protecive against cutaneous leishmaniasis (American type) | 205 | |
Trypanosomiasis |
|
Susceptible to infection and development of Chagas’ disease | 1, 216, 217, 222, 223, 224, 225, 227, 228 |
|
Protective against development of chronic Chagas’ cardiomyopathy and cardiac damage | 216, 217, 220, 225, 226, 227, 228 | |
Toxoplasmosis |
|
Human hydrocephalus | 249 |
|
Protective in murine model | 249 | |
Dengue |
|
Susceptible to development of dengue hemorrhagic fever | 263, 280, 281 |
|
Susceptible to development of dengue fever | 281 | |
|
Susceptible to symptomatic dengue infection | 281 | |
Leptospirosis |
|
Increased risk of laboratory confirmation | 296 |
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