Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis.
<h4>Background</h4>The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS)....
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2013
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oai:doaj.org-article:d4275c8a18034fd296ff0787b58b55272021-11-18T09:16:51ZCytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis.1935-27271935-273510.1371/journal.pntd.0002457https://doaj.org/article/d4275c8a18034fd296ff0787b58b55272013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24069500/pdf/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS).<h4>Methodology/principal findings</h4>We performed a case-control study design to compare cytokine profiles in patients with mild and severe forms of leptospirosis. Among patients hospitalized with severe disease, we compared those with fatal and nonfatal outcomes. During active outpatient and hospital-based surveillance we prospectively enrolled 172 patients, 23 with mild disease (outpatient) and 149 with severe leptospirosis (hospitalized). Circulating concentrations of pro- and anti-inflammatory cytokines at the time of patient presentation were measured using a multiplex bead array assay. Concentrations of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, and TNF-α were significantly higher (P<0.05) in severe disease compared to mild disease. Among severe patients, levels of IL-6 (P<0.001), IL-8 (P = 0.0049) and IL-10 (P<0.001), were higher in fatal compared to non-fatal cases. High levels of IL-6 and IL-10 were independently associated (P<0.05) with case fatality after adjustment for age and days of symptoms. IL-6 levels were higher (P = 0.0519) among fatal cases who developed SPHS than among who did not.<h4>Conclusion/significance</h4>This study shows that severe cases of leptospirosis are differentiated from mild disease by a "cytokine storm" process, and that IL-6 and IL-10 may play an immunopathogenic role in the development of life-threatening outcomes in human leptospirosis.Eliana A G ReisJosé E HaganGuilherme S RibeiroAndrea Teixeira-CarvalhoOlindo A Martins-FilhoRuth R MontgomeryAlbert C ShawAlbert I KoMitermayer G ReisPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 7, Iss 9, p e2457 (2013) |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
| spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Eliana A G Reis José E Hagan Guilherme S Ribeiro Andrea Teixeira-Carvalho Olindo A Martins-Filho Ruth R Montgomery Albert C Shaw Albert I Ko Mitermayer G Reis Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| description |
<h4>Background</h4>The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS).<h4>Methodology/principal findings</h4>We performed a case-control study design to compare cytokine profiles in patients with mild and severe forms of leptospirosis. Among patients hospitalized with severe disease, we compared those with fatal and nonfatal outcomes. During active outpatient and hospital-based surveillance we prospectively enrolled 172 patients, 23 with mild disease (outpatient) and 149 with severe leptospirosis (hospitalized). Circulating concentrations of pro- and anti-inflammatory cytokines at the time of patient presentation were measured using a multiplex bead array assay. Concentrations of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, and TNF-α were significantly higher (P<0.05) in severe disease compared to mild disease. Among severe patients, levels of IL-6 (P<0.001), IL-8 (P = 0.0049) and IL-10 (P<0.001), were higher in fatal compared to non-fatal cases. High levels of IL-6 and IL-10 were independently associated (P<0.05) with case fatality after adjustment for age and days of symptoms. IL-6 levels were higher (P = 0.0519) among fatal cases who developed SPHS than among who did not.<h4>Conclusion/significance</h4>This study shows that severe cases of leptospirosis are differentiated from mild disease by a "cytokine storm" process, and that IL-6 and IL-10 may play an immunopathogenic role in the development of life-threatening outcomes in human leptospirosis. |
| format |
article |
| author |
Eliana A G Reis José E Hagan Guilherme S Ribeiro Andrea Teixeira-Carvalho Olindo A Martins-Filho Ruth R Montgomery Albert C Shaw Albert I Ko Mitermayer G Reis |
| author_facet |
Eliana A G Reis José E Hagan Guilherme S Ribeiro Andrea Teixeira-Carvalho Olindo A Martins-Filho Ruth R Montgomery Albert C Shaw Albert I Ko Mitermayer G Reis |
| author_sort |
Eliana A G Reis |
| title |
Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| title_short |
Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| title_full |
Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| title_fullStr |
Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| title_full_unstemmed |
Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| title_sort |
cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2013 |
| url |
https://doaj.org/article/d4275c8a18034fd296ff0787b58b5527 |
| work_keys_str_mv |
AT elianaagreis cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT joseehagan cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT guilhermesribeiro cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT andreateixeiracarvalho cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT olindoamartinsfilho cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT ruthrmontgomery cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT albertcshaw cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT albertiko cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis AT mitermayergreis cytokineresponsesignaturesindiseaseprogressionanddevelopmentofsevereclinicaloutcomesforleptospirosis |
| _version_ |
1718420931297148928 |