Studies of patients with isolated immunodeficiencies give an insight into the relative importance of the different components of the immune response, lndi viduals with isolated defects of cell-mediated immunity develop severe, sometimes fatal viral infections such as measles and chickenpox. A single case of natural killer (NK) cell deficiency has been reported, with increased susceptibility to severe primary herpesvirus infections. Those subjects with isolated immunoglobulin deficiency recover normally from most viral infections, except enteroviruses (which may cause chronic central nervous system infection). Such 'experiments of nature' coupled with an extensive body of experimental work in animal models permit the following generalizations.
Antibodies appear to act principally by neutralizing virions (i.e. rendering virions noninfectious), whereas cell-mediated responses are directed against virus antigens present in the infected cell. Antibody is important in preventing primary infection and reinfection, by neutralizing viruses on mucosal surfaces and limiting their dissemination in body fluids, while cell-mediated immunity seems to be responsible for eliminating intracellular infection and limiting reactivation of persistent viruses.
The immune response may be divided into three phases (see Table 1) and into humoral and cell-mediated components, which include specific and nonspecific mechanisms.
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