Different proinflammatory reactions in fatal and non-fatal enterovirus 71 infections: Implications for early recognition and therapy

T. Y. Lin, Luan Yin Chang, Y. C. Huang, K. H. Hsu, C. H. Chiu, K. D. Yang

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Aim: The mechanism of pulmonary oedema, a life-threatening manifestation of enterovirus 71 (EV71) encephalitis, is unclear. Our aim was to assess the relationship of proinflammatory cytokines to EV71-related pulmonary oedema. Methods: Proinflammatory responses in 33 EV71 patients with various complications and 21 normal healthy children were measured using an enzyme-linked immunosorbent assay. Results: EV71 patients with both encephalitis and pulmonary oedema were found to have much higher levels of blood interleukin-6 (IL-6) (947 ± 1239 vs 4.9 ± 3.1 pg/ml, p = 0.0003), tumour necrosis factor-α (TNF-α) (22.4 ± 29.5 vs 5.3 ± 1.0 pg/ml, p = 0.0035), interleukin 1β (IL-1β) (48.4 ± 85.2 vs 4.9 ± 10.1 pg/ml, p = 0.01), white blood cell count (28.3 ± 7.6 vs 15.5 ± 6.8 109/L, p ≤ 0.0001) and blood glucose (501 ± 186 vs 165 ± 117 mg/dL, p=0.0009) than patients with EV71 encephalitis alone. In fact, the cytokine levels in patients with encephalitis only or in those without complications were not significantly different from the levels found in normal children. The sensitivity, specificity, positive and negative predictive values of IL-6 > 70pg/ml for EV71 encephalitis with pulmonary oedema were all 100%. Conclusion: Patients with EV71-related encephalitis combined with pulmonary oedema were found to have significantly elevated levels of proinfiammatory cytokines and the best predictor for this complicated condition was found to be the level of serum IL-6.

Original languageEnglish
Pages (from-to)632-635
Number of pages4
JournalActa Paediatrica, International Journal of Paediatrics
Volume91
Issue number6
DOIs
Publication statusPublished - 2002
Externally publishedYes

Fingerprint

Enterovirus Infections
Enterovirus
Secondary Prevention
Encephalitis
Pulmonary Edema
Interleukin-6
Cytokines
Interleukin-1
Leukocyte Count
Blood Glucose
Tumor Necrosis Factor-alpha
Enzyme-Linked Immunosorbent Assay
Sensitivity and Specificity
Serum

Keywords

  • Brainstem encephalitis
  • Cytokine storm
  • Enterovirus 71
  • Interleukin 6
  • Pulmonary oedema

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Different proinflammatory reactions in fatal and non-fatal enterovirus 71 infections : Implications for early recognition and therapy. / Lin, T. Y.; Chang, Luan Yin; Huang, Y. C.; Hsu, K. H.; Chiu, C. H.; Yang, K. D.

In: Acta Paediatrica, International Journal of Paediatrics, Vol. 91, No. 6, 2002, p. 632-635.

Research output: Contribution to journalArticle

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AB - Aim: The mechanism of pulmonary oedema, a life-threatening manifestation of enterovirus 71 (EV71) encephalitis, is unclear. Our aim was to assess the relationship of proinflammatory cytokines to EV71-related pulmonary oedema. Methods: Proinflammatory responses in 33 EV71 patients with various complications and 21 normal healthy children were measured using an enzyme-linked immunosorbent assay. Results: EV71 patients with both encephalitis and pulmonary oedema were found to have much higher levels of blood interleukin-6 (IL-6) (947 ± 1239 vs 4.9 ± 3.1 pg/ml, p = 0.0003), tumour necrosis factor-α (TNF-α) (22.4 ± 29.5 vs 5.3 ± 1.0 pg/ml, p = 0.0035), interleukin 1β (IL-1β) (48.4 ± 85.2 vs 4.9 ± 10.1 pg/ml, p = 0.01), white blood cell count (28.3 ± 7.6 vs 15.5 ± 6.8 109/L, p ≤ 0.0001) and blood glucose (501 ± 186 vs 165 ± 117 mg/dL, p=0.0009) than patients with EV71 encephalitis alone. In fact, the cytokine levels in patients with encephalitis only or in those without complications were not significantly different from the levels found in normal children. The sensitivity, specificity, positive and negative predictive values of IL-6 > 70pg/ml for EV71 encephalitis with pulmonary oedema were all 100%. Conclusion: Patients with EV71-related encephalitis combined with pulmonary oedema were found to have significantly elevated levels of proinfiammatory cytokines and the best predictor for this complicated condition was found to be the level of serum IL-6.

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KW - Cytokine storm

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KW - Interleukin 6

KW - Pulmonary oedema

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