The patient is a 60-year-old lady who has presented recurrent HSV type 2 lesions in the gluteal fold for more than 20 years. Antiviral therapy has been shown to be only partially effective, as she takes too long to respond to the medications (acyclovir, valacyclovir, etc). Blood tests demonstrated lymphopenia with relative and absolute reduction in CD8+ lineage (NK lymphocytes). Recently, she had a severe Candida infection with oropharyngeal and genital manifestations, and we needed 15 consecutive days of fluconazol to control the infection.
Her last blood tests, during candidiasis:
Leukocytes 2,900
Lymphocytes 1,066
CD4+ 70,3% - 749 cells
NK cells 15,5% - 165 cells
Neutrophils are always normal and she has no recurrent bacterial infections.
My question: is there any medication or oral supplement that increases or improves NK lymphocytes number and function? I looked at IL-2 and TNF but they are licensed only for specific types of cancer and carry a bad profile of adverse effects.
Looking forward to hearing from specialists about adequate therapeutic options to this patient.
Kind regards,
Ana.
Dear, Ana Cristina Diniz Silva,
I am not a clinician and not quite sure of the type of treatment you are looking for.
However, I wonder whether the patient is really solely diagnosed as NK-cell deficiency. Even if you write that her Neutrophil counts are normal, a total leukocyte count of 2,900 could be indicative of panleukocytopenia. If so , it might be meaningful to exclude pancytopenia. Besides, the above text looks like you mistake NK cells and CD8+ lymphocytes. A majority of CD8+ cells are usually CD8+ T cells.
I suppose it could be worth checking whether the patient has been accurately diagnosed before proceeding to an NK cell-based treatment.
Dear Tetsuo Tsukamoto
thanks for your very elucidative reply.
I've been conducting this case for about an year. Her leukocyte counts vary a lot, from normal (>5,000) to frank leukopenia, particularly when she is struggling against a viral or fungal infection.
FBC (12/02):
Hb 14,4
Ht 44,8%
Leukocytes 5,750
Neutrophils 3548
Lymphocytes 1,731
platelets 220,000
19/02:
Leukocytes 2,900
Lymphocytes 1,066
CD56+ CD16 165
She has never presented acute bacterial infections or neutropenia during this time.
Best regards,
Ana.
Dear, encourage the patient to maximise antioxidant containing fruits to build up the immune level.
Dear Ana Cristina Diniz Silva,
Thank you for your information. So there is no pancytopenia, but changing total WBC counts... I am not sure.
Regarding the Neutrophil count on 19/02, it is indirectly estimated as < 2900-1066=1834. So I would not think neutropenia (
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