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Original Research: TUBERCULOSIS |

Neutrophils Are the Predominant Infected Phagocytic Cells in the Airways of Patients With Active Pulmonary TB

Seok-Yong Eum, PhD; Ji-Hye Kong, MS; Min-Sun Hong, MS; Ye-Jin Lee, MS; Jin-Hee Kim, MD; Soo-Hee Hwang, MD; Sang-Nae Cho, PhD; Laura E. Via, PhD; Clifton E. Barry, III, PhD
Author and Funding Information

From the Division of Immunopathology and Cellular Immunology (Dr Eum, and Mss Kong, Hong, and Lee), International Tuberculosis Research Center, Masan, Republic of Korea; National Masan Tuberculosis Hospital (Drs Kim and Hwang), Masan, Republic of Korea; Department of Microbiology (Dr Cho), Yonsei University College of Medicine, Seoul, Republic of Korea; and Tuberculosis Research Section, Laboratory of Clinical Infectious Disease (Drs Via and Barry), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.

Correspondence to: Seok-Yong Eum, PhD, International Tuberculosis Research Center, Division of Immunopathology and Cellular Immunology, 475-1, Gapo, Masan, Republic of Korea 631-320; e-mail: syeumkr@gmail.com


Funding/Support: This research was supported in part by the Intramural Research Program of the National Institutes of Health, National Institute of Allergy and Infectious Diseases (Z01 AI000783-11), and in part by a grant from the Bill and Melinda Gates Foundation and the Wellcome Trust through the Grand Challenges in Global Health Initiative (C.E.B. and S.-N.C.) Grant No. 37882 (Douglas Young, Imperial College, Principal Investigator).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):122-128. doi:10.1378/chest.09-0903
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Background:  The exact role of neutrophils in the pathogenesis of TB is poorly understood. Recent evidence suggests that neutrophils are not simply scavenging phagocytes in Mycobacterium tuberculosis (Mtb) infection.

Methods:  Three different types of clinical specimens from patients with active pulmonary TB who underwent lung surgery were examined: sputum, BAL fluid, and cavity contents. Differential cell separation and quantification were performed for intracellular and extracellular bacteria, and bacterial length was measured using microscopy.

Results:  Neutrophils were more abundant than macrophages in sputum (86.6% ± 2.2% vs 8.4% ± 1.3%) and in BAL fluid (78.8% ± 5.8% vs 11.8% ± 4.1%). Inside the cavity, lymphocytes (41.3% ± 11.2%) were the most abundant cell type, followed by neutrophils (38.8% ± 9.4%) and macrophages (19.5% ± 7.5%). More intracellular bacilli were found in neutrophils than macrophages in sputum (67.6% ± 5.6% vs 25.2% ± 6.5%), in BAL fluid (65.1% ± 14.4% vs 28.3% ± 11.6%), and in cavities (61.8% ± 13.3% vs 23.9% ± 9.3%). The lengths of Mtb were shortest in cavities (1.9± 0.1 μ m), followed by in sputum (2.9 ± 0.1 μm) and in BAL fluid (3.6 ± 0.2 μm).

Conclusions:  Our results show that neutrophils are the predominant cell types infected with Mtb in patients with TB and that these intracellular bacteria appear to replicate rapidly. These results are consistent with a role for neutrophils in providing a permissive site for a final burst of active replication of the bacilli prior to transmission.

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