Defective Neutrophil Chemotaxis and Cellular Immunity in a Child with Recurrent Infections

Studies of leukocyte function and cell-mediated immunity were done in an 11-year-old girl with a lifelong history of recurrent pyogenic and mucocutaneous candida infections. An intrinsic cellular defect in neutrophil chemotaxis was found with the Boyden chamber method. Family members had normal chemotaxis, and the patient's serum was capable of generating normal amounts of chemotactic factors. This in vitro defect correlated with a reduction in leukocyte migration in vivo by the skin window method, but all other aspects of neutrophil function, including phagocytosis, bactericidal activity, metabolic activity, and passive motility, were normal. Studies of cellular immunity disclosed negative delayed cutaneous reactions to antigens from Candida albicans and failure of in vitro production of migration inhibitory factor. The cellular defect in leukocyte chemotaxis and the abnormalities in cellular immunity in this child may be important factors in her marked susceptibility to infections.