Frontiers in immunology · 2026
Distinct immune activation patterns in adult-onset Still's disease with fungal infections.
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Wu Tongxin, Yu Ye, Liu Xuesong, Chen Xiaoxiang, Gu Liyang, Lu Liangjing, Guo Ruru
Аннотация
OBJECTIVE: Fungal infections are uncommon but potentially life-threatening complications in adult-onset Still's disease (AOSD). The immunological features of AOSD patients with fungal infections remain poorly defined, and this study aimed to characterize immune activation profiles in this population.
METHODS: We retrospectively analyzed 277 patients diagnosed with AOSD, among whom 35 (12.6%) developed fungal infections. Clinical features and immunological parameters, including neutrophil CD64 (nCD64), myeloid-derived suppressor cells (MDSCs), activated T cells, and serum cytokine profiles, were compared between patients with and without fungal infections.
RESULTS: Compared to non-infected AOSD patients, those with fungal infections had a higher frequency of splenomegaly (60.0% vs. 33.5%, p = 0.0024), pulmonary infiltrates (57.1% vs. 20.2%, p < 0.001), and pericarditis (42.9% vs. 20.7%, p = 0.0038). Immunologically, the infection group showed significantly elevated levels of nCD64 (45.39 vs. 11.16, p < 0.05) and enhanced CD8+ T cell activation, particularly CD8+CD38+ T cells (81.54% vs. 66.89%, p < 0.05). Serum soluble IL-2R levels were also higher in infection patients (1884.18 vs. 1259.13 U/mL, p < 0.05). Cytokines such as IL-8, and IL-10 were markedly elevated during infection episodes. Additionally, ferritin elevation remained independently associated with fungal infection after adjusting for disease activity, MAS, and glucocorticoid exposure.
CONCLUSIONS: AOSD patients with fungal infections exhibit distinct immune activation patterns involving neutrophils and CD8+ T cells, reflecting dynamic immune changes during infection episodes. These immunological features may support integrated immune assessment and inform therapeutic considerations under immunosuppressive treatment.
METHODS: We retrospectively analyzed 277 patients diagnosed with AOSD, among whom 35 (12.6%) developed fungal infections. Clinical features and immunological parameters, including neutrophil CD64 (nCD64), myeloid-derived suppressor cells (MDSCs), activated T cells, and serum cytokine profiles, were compared between patients with and without fungal infections.
RESULTS: Compared to non-infected AOSD patients, those with fungal infections had a higher frequency of splenomegaly (60.0% vs. 33.5%, p = 0.0024), pulmonary infiltrates (57.1% vs. 20.2%, p < 0.001), and pericarditis (42.9% vs. 20.7%, p = 0.0038). Immunologically, the infection group showed significantly elevated levels of nCD64 (45.39 vs. 11.16, p < 0.05) and enhanced CD8+ T cell activation, particularly CD8+CD38+ T cells (81.54% vs. 66.89%, p < 0.05). Serum soluble IL-2R levels were also higher in infection patients (1884.18 vs. 1259.13 U/mL, p < 0.05). Cytokines such as IL-8, and IL-10 were markedly elevated during infection episodes. Additionally, ferritin elevation remained independently associated with fungal infection after adjusting for disease activity, MAS, and glucocorticoid exposure.
CONCLUSIONS: AOSD patients with fungal infections exhibit distinct immune activation patterns involving neutrophils and CD8+ T cells, reflecting dynamic immune changes during infection episodes. These immunological features may support integrated immune assessment and inform therapeutic considerations under immunosuppressive treatment.