Corynebacterium bovis Eye Infections, Washington, USA, 2013

of antimycobacterial drugs that are also effective against M. avium complex (4). In 2 studies that evaluated the effect of adjunctive IL-2 therapy in addition to ART for previously treatment-naive patients with HIV infection, baseline median numbers of circulating CD4+ cells increased significantly, but expansion of CD4+ T cells was not associated with the reduction in the risk for opportunistic diseases or death (8). In contrast to these results, in a study of HIV-positive patients who had low circulating CD4+ T cell counts, the participants experienced fewer AIDS-defining events and fewer deaths occurred when they were treated with adjunctive IL-2 immunotherapy (9). This case report provides lessons for the understanding of mycobacterial diseases. First, despite massive infiltration of duodenal mucosa, mesenterial lymph nodes, and bone marrow, the lack of inflammatory responses in this patient prevented tissue destruction. Second, in the absence of a sufficient immune response and an increase in the number of circulating CD4+ T cells, antimycobacterial therapy without adjunctive immunotherapy did not clear the systemic bacterial infection. Host responses to pathogens are not always beneficial. Intense immune reactions experienced during episodes of sepsis or HIV immune reconstitution inflammatory syndrome are frequently associated with patient death. Alternately , in the absence of inflammatory responses to pathogens , the patient is unprotected, and even microbiota that are harmless to an immunocompetent person can adversely invade. In an optimal immune response setting, a balance between proinflammatory and anti-inflammatory factors in response to pathogens is maintained (10). van Ingren J, et al. " Mycobacterium tilburgii " infection in two immunocompromised children: importance of molecular tools in culture-negative mycobacterial disease diagnosis. Vaneerchoutte M, et al. Disseminated infection with Mycobacterium tilburgii in a male immunocompromised patient. et al. IL-12Rβ1 deficiency and disseminated Mycobacterium tilburgii disease. et al. Interleukin-2 therapy in patients with HIV infection. Weiss L, et al. IL-2 therapy: potential impact of the CD4 cell count at initiation on clinical efficacy—results from the ANRS CO4 cohort. et al. Progress in tuberculosis vaccine development and host-directed therapies—a state of the art review. To the Editor: Corynebacterium bovis is well known as a normal bovine microbiota and is a common cause of bovine mastitis (1). C. bovis infections in humans are rare, and identification of the organism by biochemical methods is challenging (2). Although 9 cases of C. bovis infections in humans have been reported (3–6), only the most recent case, which involved prosthetic joint …